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Ethics Nova Scotia Health: New structure for ethics support - Part 1
10/28/2024
Library Staff
Nursing, Physicians, Ethics, Nurse Practitioners

In September 2024, Ethics Nova Scotia Health launched its new model for delivery of ethics support. This was done to:

  • better align ethics support with the organization’s movement towards provincial approaches to program delivery and administration.
  • promote greater availability of ethics support across the province.

This post looks at the structure for ethics support and the changes we have made, and the types of ethics support available to health care providers, staff members, volunteers, and patients and families.

Changes to Ethics Nova Scotia Health’s structure

The main change to our structure is the formation of three Core Function Groups:

  • Clinical Ethics Support
  • Organizational Ethics and Policy Support
  • Ethics Education

These groups replace the previous Local Ethics Teams, Zone Ethics Committees, and the Ethics Leads group.

As of October 2024, Ethics Nova Scotia Health's updated structure and community includes about 55 members from all four zones. Each Core Function Group consists of health care providers and staff members from a wide range of programs and services, and community members. These Core Function Groups provide ethics support within Nova Scotia Health, with support from the Ethics Collaborations Team in the Department of Bioethics at Dalhousie University.

Types of ethics support available

While the delivery of ethics support has changed, the types of ethics support available remain the same and include:

  • Clinical Ethics Support offers ethics support pertaining to a specific patient’s care or to a particular clinical situation involving questions of professional ethics.
  • Ethics Education is available for education days or if there is an ethics topic that your team would like to explore. We can tailor the education session(s) to your needs. Some recent topics we have worked on include “ethics issues in health care documentation” and “moral distress.” We also develop ethics education resources, such as a guide for patients and families about Making Health Care Decisions for Someone Else: Acting as a Substitute Decision-Maker (SDM), and our Ethics Tool: Help with Ethical Issues.
  • Organizational Ethics and Policy Support addresses broader, systems-level issues that typically affect larger groups of patients and other stakeholders. Organizational ethics may involve overall direction for programs, zones, and Nova Scotia Health as a whole, where an ethics perspective can contribute to analysis and strategic choices. This can also include support with policy development and/or ethics review of policies. This Core Function Group is available to review draft policies through an ethics lens, as well as offer support in applying our feedback.
    For upcoming deadlines and details on how to submit policies for an ethics review, see our Ethics Review of Nova Scotia Health Policies – Submission Deadlines.

In part 2 of this post, we will take a closer look at ethics support available for policy developers and the process for requesting and obtaining stakeholder feedback on draft policies from Ethics Nova Scotia Health.

If you need ethics support, you can:

Lisbeth Witthoefft Nielsen

Ethics Program Manager, Ethics Nova Scotia Health

Celebrating Health Literacy Month - Part 2
10/15/2024
profile-icon Kallen Rutledge
No Subjects

In Celebrating Health Literacy Month – Part 1, we explored what it means to be a health literate organization. We highlighted the impact of low organizational health literacy on patients, care partners, and our entire health system. Research has shown that unless organizations make health literacy a priority, they will continue to see negative impacts on health outcomes (Santana et al., 2021).

How can we increase our organizational health literacy?

According to Brach & Harris (2021), all we need to do is “make health information and services easy to find, understand, and use” (Brach & Harris, 2021).

Within a health organization, all team members can play a role in making health literacy a priority. Such systemic changes can only happen when all employees recognize the significant impact of improvements in patients’ health literacy on patients’ health outcomes. As staff and clinicians develop policies and programs that shape the care provided within an organization, they are in a unique position to integrate health literacy strategies.

How can we make real change for our patients, care partners, and caregivers?

  1. Prioritize clear communication.
    a. Plain language
    All materials for patients (not just patient education materials) should be written in plain language. This includes appointment letters or notifications, emails, websites, posters, and office and hospital signs. If you have an item that doesn’t meet the criteria of a pamphlet, the Patient Education Pamphlets Team is happy to review it and offer suggestions for plain language and readability. Email: Pamphlets@nshealth.ca
    b. Translation
    Translation of oral communication and written materials should be a priority, to ensure medical terminology is accurately communicated and provider instructions are understood. We often rely on a patient’s family member or caregiver to translate complex and unfamiliar terminology – using a professional translator ensures nothing is left out or misinterpreted.
    c. Accessibility
    Design materials (handouts, websites, signs) to meet current accessibility standards. Everyone has the right to participate in and engage with their health care. Prioritizing accessibility can create a more equitable health system.
  2. Provide training and tools for employees
    Front-line staff and clinicians should have the resources they need to prioritize health literacy throughout their workday. Examples of training topics include cross-cultural communication, trust-building, motivational interviewing, the teach-back method, and the universal precautions approach (Center for Healthcare Strategies, 2024).
  3. Become a health literacy advocate!
    Change starts with you! Share what you have learned about health literacy and the impact of low health literacy on health outcomes with your colleagues and leadership teams. Use what you know to start a conversation or add perspective during a team meeting:
    Talking Points About Health Literacy
    https://www.cdc.gov/healthliteracy/shareinteract/TellOthers.html

To learn more about what you can do to help make Nova Scotia Health a health literate organization:

References

Brach, C., & Harris, L. M. (2021). Healthy People 2030 Health literacy definition tells organizations: Make information and services easy to find, understand, and use. Journal of General Internal Medicine, 36(4), 1084–1085. https://doi.org/10.1007/s11606-020-06384-y

Center for Health Care Strategies. (2024, March 21). How improving health literacy can advance health equity. Factsheet. https://www.chcs.org/resource/how-improving-health-literacy-can-advance-health-equity/

Santana, S., Brach, C., Harris, L., Ochiai, E., Blakey, C., Bevington, F., Kleinman, D., & Pronk, N. (2021). Updating Health Literacy for Healthy People 2030: Defining its importance for a new decade in public health. Journal of Public Health Management and Practice, 27(6), S258–S264. https://doi.org/10.1097/PHH.0000000000001324

Kallen Rutledge

Librarian Educator, Patient Education Pamphlets Lead
Nova Scotia Hospital, Central Zone

Celebrating Health Literacy Month – Part 1
10/08/2024
profile-icon Kallen Rutledge
Consumer Health, Patient Education

For many Nova Scotians, navigating the health care system can feel overwhelming. Health information is difficult for many people to understand and our health care systems are complex. 

October is Health Literacy month, when we take time to recognize the importance of both making the health care system easier to navigate, and ensuring that health information is easy to understand.

Health literacy is both personal and organizational:

Personal health literacy is the degree to which individuals have the ability to find, understand, and use information and services to inform their health-related decisions.1

Organizational health literacy is the degree to which organizations equitably (and fairly) connect with and enable individuals to find, understand, and use information and services to inform individual health-related decisions.1

This post takes a closer look at organizational health literacy and our role as Nova Scotia Health team members in helping to make our health system easier to navigate.

As Brach (2017) highlighted, “even the most skilled, well-intentioned clinician cannot single-handedly overcome the health literacy barriers people face”.2 Indeed, change needs to happen across our health systems and throughout the organization at all levels.

What makes an organization health literate?

Research from the past two decades2, 3 has outlined that health literate organizations:

  • Have leadership buy-in
  • Prioritize health literacy within planning, evaluation, patient safety, and quality improvement efforts
  • Provide health literacy supports and follow-up for employees
  • Integrate patients and care partners in the design, implementation, and evaluation of health information and services
  • Meet the needs of all individuals, including those with low literacy or other barriers
  • Utilize health literacy strategies in all communications, particularly in high-risk scenarios (like ensuring informed consent or medication adherence)
  • Provide easy access to health information, services, and navigation assistance
  • Design and distribute print and digital content that is easy to find, understand, and use

What are the impacts of low organizational health literacy?

Research has shown that low organizational health literacy (organizations that do not follow the principles listed above) can have a negative impact not only on health outcomes, but on the entire health system, including:

  • Increased patient frustration and stress4
  • Decreased patient engagement3, 5
  • Decreased patient safety3
  • Increased adverse outcomes6
  • Increased use of health care services6, 7
  • Increased health care costs6, 7

It is important that we work together to make real change for our patients and care partners. What can you do within your team to increase health literacy? To learn more about health literacy in health care, register for an upcoming Education and Training session or request a custom session for your colleagues or team.

Read Celebrating Health Literacy Month – Part 2 where we take a look at ways we can increase organizational health literacy within Nova Scotia Health. 

References

1. Office of Disease Prevention and Health Promotion. (2024, October). Healthy People 2030: Health Literacy in Healthy People. U.S. Department of Health and Human Services. https://health.gov/healthypeople/priority-areas/health-literacy-healthy-people-2030

2. Brach, C. (2017). The Journey to become a health literate organization: A snapshot of health system improvement. Studies in Health Technology and Informatics, 240, 203–237. https://doi.org/10.3233/978-1-61499-790-0-203

3. Agency for Healthcare Research and Quality. (2012). Ten attributes of health literate health care organizations. NAM Perspectives, 02(6). https://doi.org/10.31478/201206a

4. Yeh, J., & Ostini, R. (2020). The impact of health literacy environment on patient stress: A systematic review. BMC Public Health, 20(1), 749. https://doi.org/10.1186/s12889-020-08649-x

5. Koh, H. K., Brach, C., Harris, L. M., & Parchman, M. L. (2013). A Proposed ‘Health Literate Care Model’ Would Constitute A Systems Approach To Improving Patients’ Engagement In Care. Health Affairs (Project Hope), 32(2), 357–367. https://doi.org/10.1377/hlthaff.2012.1205

6. Lloyd, J. E., Song, H. J., Dennis, S. M., Dunbar, N., Harris, E., & Harris, M. F. (2018). A paucity of strategies for developing health literate organisations: A systematic review. PloS One, 13(4), e0195018. https://doi.org/10.1371/journal.pone.0195018

7. Farmanova, E., Bonneville, L., & Bouchard, L. (2018). Organizational Health Literacy: Review of Theories, Frameworks, Guides, and Implementation Issues. Inquiry : a journal of medical care organization, provision and financing, 55, 46958018757848. https://doi.org/10.1177/0046958018757848

8. Santana, S., Brach, C., Harris, L., Ochiai, E., Blakey, C., Bevington, F., Kleinman, D., & Pronk, N. (2021). Updating Health Literacy for Healthy People 2030: Defining its importance for a new decade in public health. Journal of Public Health Management and Practice, 27(Supplement 6), S258. https://doi.org/10.1097/PHH.0000000000001324

Kallen Rutledge

Librarian Educator, Patient Education Pamphlets Lead
Nova Scotia Hospital, Central Zone

Patient Education Pamphlets created, updated, or archived in September 2024
10/07/2024
profile-icon Kendell Fitzgerald
Patient Education, Patient Pamphlets

Writing in plain language matters. In Canada, it’s reported that nine million people have limited literacy skills, with over half of Canadians reading below a high school level. This is just one of the reasons why it is important to offer additional support to patients and families with easy-to-read, straightforward patient pamphlets. For more information about creating or updating patient pamphlets, please visit the Content Creator Toolkit. Please contact Pamphlets@nshealth.ca with any questions. You can search for pamphlets by title or keyword in the pamphlets catalogue, or view the complete listing of active titles in our Print Code Index.

The following pamphlets were updated or created in September 2024. 

Cardiovascular System 
WG85-2073 24-hour Ambulatory Blood Pressure Monitoring (En français: FF85-2389, AR85-2401)

Chinese (Simplified) Translations
CH85-2429 NEW Endoscopic Ultrasound (English: WI85-1482, En français: FF85-1793)
CH85-2430 NEW Esophageal Motility Pressure Studies - VG Site [Simplified Chinese] (English: WI85-0273)
CH85-2431 NEW Colonoscopy - VG Site [Simplified Chinese] (English: WI85-0211, En français: FF85-1506, Arabic: AR85-1479)
CH85-2432 NEW PEG (Percutaneous Endoscopic Gastrostomy) Tube - VG Site [Simplified Chinese] (English: WI85-1188)

Endocrine System 
WK85-1982 Diabetes Centres - Digby Diabetes Centre, Shelburne Diabetes Centre, Yarmouth Regional Hospital Previous title: Diabetes Centre: Digby General Hospital, Roseway Hospital, Yarmouth Regional Hospital
                    Previous title: Diabetes Centre: Digby General Hospital, Roseway Hospital, Yarmouth Regional Hospital

French Translations (en français)
FF85-1952 Accoucher après la date prévue d’accouchement: Hôpital régional Valley (English: WP85-1925)
                   Previous title: Accoucher après la date prévue d’accouchement
FF85-1853 Dispositifs d’assistance ventriculaire (DAV) (English: WG85-0931)

Geriatrics 
WT85-2216 Preventing Falls and Injuries in Long-term Care
                    Previous title: Fall and Injury Prevention in Long-term Care

Intensive Care Unit
IC85-2433 NEW Delirium in the Intensive Care Unit - QE II
IC85-2434 NEW Is Your Loved One Confused?

Mental Health & Addictions
WM85-2275 East Coast Forensic Hospital: Rehabilitation Program
WM85-2277 East Coast Forensic Hospital: Family and Friends
WM85-1626 East Coast Forensic Hospital: Transition Bungalow Program
WM85-2437 Mental Health and Addictions Day Hospital - Northern Zone
WM85-2435 NEW Leaving Eating Disorder Treatment

Nephrology
WQ85-2217 Erythropoieis-stimulating Agents (ESAs) for People With Chronic Kidney Disease (CKD) and Active Cancer or a History of Cancer or Stroke
                    Previous title: Erythropoieis-stimulating Agents (ESAs) for Chronic Kidney Disease (CKD): With Active Cancer or a History of Cancer or Stroke

Otorhinolaryngology
WV85-0302 Nose Surgery

Physiotherapy & Rehabilitation
WB85-0935 Shoulder Exercises for Early Recovery
                    Previous title: Shoulder Exercises

Respiratory System
WF85-1892 Opioids for Shortness of Breath in Advanced Chronic Obstructive Pulmonary Disease (COPD)

The following pamphlets were archived in September 2024:
WP85-2215 Abortion Choices: Medical and Procedural
WB85-1826 Positions for Upper Limb Swelling
WB85-1827 Positions for Lower Limb Swelling

If a pamphlet that has been archived is still needed, please let us know as soon as possible and we will work with you to make it available again.

Kendell Fitzgerald

Librarian Educator
Central Zone

IPPL Clinical Practice and Policy October Round-up: Dynamic Health Updates + Auto-generated Checklists + CPS Guides: Transfusion Medicine – Blood Product Administration + Breast Cancer Awareness Month + Occupational Therapy Month + World Psoriasis Day
10/01/2024
Library Staff
Nursing, Physicians, Teaching & Learning, Clinical Practice & Policy , Point-of-Care Tools, Paramedicine, Nurse Practitioners, Occupational Therapy, Dynamic Health, Physiotherapy

IPPL Clinical Practice and Policy round-up posts keep you informed about implementation and use of Dynamic Health at Nova Scotia Health, highlight any new priority projects and events, and updates to our Workplace Notes and Custom Workplace Skills. We’ll also highlight new publications we’re supporting and maintaining including policies, clinical practice support guides, clinical resources on the intranet and clinical learning modules.

Updates: Workplace Notes and Custom Workplace Skills, Transfusion Medicine – Blood Product Administration Clinical Practice Support (CPS) Guides

We receive feedback submissions on an ongoing basis through the Suggestions for Skills form and through partnerships with departments and teams. This month, the customizations below have been published.

New Workplace Note

Revised Workplace Note

Reviewed: No Workplace Note

Custom Workplace Skill

Auto-generate Checklists with Dynamic Health

Did you know that skills within Dynamic Health have an associated Checklist function that you can use in practice and for instructing new staff and learners? If you’re updating procedures and need associated competency checklists for documentation, save yourself some time and adopt this function. The Checklist function is available for all skills in Dynamic Health, including any Custom Workplace Skills we create.

Let's say you are interested in precepting a fellow health care provider using the Dynamic Health Custom Workplace Skill PACU: Assisting with Endotracheal Extubation in Adults:

  1. Navigate to the skill through Dynamic Health by searching “PACU Extubation” (1), navigating to Skills > Your Workplace, or through the direct Skill link (above).
  2. From the Skill menu, select Checklist (2).
  3. Select the printer icon to the upper right of the Checklist (3).
  4. Select the sections to include in the Checklist (Pre-procedure Steps, Procedure Steps, Post-procedure Steps), or Select All (4).
  5. Select Print (5). Note that the printable version of this checklist contains a form to allow you to record evaluator and examinee names and signatures, date and pass/fail status as appropriate.
  6. Choose to print a physical copy or to export a PDF to your computer, depending on your settings and needs.

CPS Guides: Transfusion Medicine – Blood Product Administration

The Blood Product Administration Policy and Procedure NSHA: CL-BP-030; IWK-625 has been revised, effective as of October 1, 2024. We supported our Transfusion Practice Coordinator and Pathology & Laboratory Medicine colleagues with building a resource guide that helps make accessing blood product administration resources easier and is embedded within the updated policy. All blood product guidelines, product monographs, the Competencies for Safe Transfusion Tool, Adverse Events Algorithm have also been updated to align with the revised policy and procedure.

This project is a great example of collaborating across the organization to build and update a knowledge support resource that is easily accessible to all health care providers that work for or interact with Nova Scotia Health. It’s also a great example of clinical practice guidance and competency being created outside of the content we adopt from Dynamic Health. We’re ready to help you customize solutions where practice or organizational gaps exist versus the content we can access through our Dynamic Health subscription.

Health Promotion in October and Dynamic Health Topics

October 2024 marks the promotion of:

In recognition of these health promotion events, we encourage you to engage with the curated list of Dynamic Health content below.

If you spot any Skills below that you feel need a Workplace Note, consider being a reviewer! Fill out our Suggestions for Skills form with your notes and we will get in touch!

Breast Cancer Awareness Month
Occupational Therapy Month
World Psoriasis Day

IPPL Clinical Practice and Policy

Gloria Connolly, RN, BScN, NCA, WOCC(c), GNC(c)
Clinical Nurse Educator
Interprofessional Practice and Learning

Leah MacDonald, RN, BSc, BScN
Professional Practice Leader
Interprofessional Practice and Learning, ERIN Network

Katie McLean
Librarian Educator
Interprofessional Practice and Learning, ERIN Network Hub, Library Services

Margaret Poitras
Policy Lead
Policy Office

Valorie Shaddick, BNRN, CCNP, CVAA (c)
Clinical Nurse Educator
Interprofessional Practice and Learning

Ann Slaunwhite
Library Technician
Interprofessional Practice and Learning, Library Services

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