Library News

Has your team ever been asked for permission to reproduce or adapt your content? Do you want to ensure proper credit is given when your work is shared?

Creative Commons (CC) licensing could be the solution.

Creative Commons is a global, nonprofit system that offers open licences for creative works. There are six types of CC licences, each allowing different levels of sharing, copying, and adaptation. All licences require attribution to the original creator.

Nova Scotia Health teams now have the option to assign Creative Commons licences to their work!

This change follows the example set by the Nova Scotia Health Policy Office, which publishes new policies under a CC licence, and is inspired by Alberta Health Services which has successfully used CC licensing for several years.

To retain control over how your content is used, we recommend choosing one of the two most restrictive CC licences:

• CC BY-NC-SA (Attribution-NonCommercial-ShareAlike)
  Allows others to reuse or adapt your work for noncommercial purposes providing they credit you and share any changes under the same license.
• CC BY-NC-ND (Attribution-NonCommercial-NoDerivatives)
  Allows others to share your work for noncommercial purposes with proper credit, but no changes or adaptations are allowed.

Want to learn more?

Visit the Creative Commons subject guide for information on:

• Why choose Creative Commons? Learn how it can increase collaboration and extend the impact of Nova Scotia Health’s work locally, nationally, and globally.
• Considerations before assigning CC licences, including the need for leadership approval.
• How to select the right CC licence for your content.
• Licensing Statements/Disclaimers, approved by Nova Scotia Health Legal Services.
• Support Tools, including a customizable licence tracking spreadsheet, infographics, templates for Word and PowerPoint, and a helpful FAQ section.

Ready to get started or have questions?

• Email us at copyright@nshealth.ca
• Book a one-on-one consultation
• Request a Custom Education Session for your team

Roxanne MacMillan

Librarian Educator
Halifax Infirmary, Central Zone

IPPL Clinical Practice and Policy digest posts summarize updates over the past month about:

• Clinical Policies, Care Directives, Guidelines and Learning Modules
  • Get the latest on clinically relevant, local guidance published through policies, care directives, guidelines and/or learning modules.
  • Identify competencies relevant to you/your team’s practice.
• Dynamic Health (DH)
  • Stay informed about implementation and use of Dynamic Health at Nova Scotia Health, including recent updates to Workplace Notes and Custom Workplace Skills.
• Clinical Practice Support (CPS) Subject Guides
  • Learn about recently published and updated CPS subject guides, where you/your team can find relevant resources across DH, policies, care directives, guidelines and learning modules. CPS subject guides also include Key Practice Points and additional educational and guidance resources to support implementation and competency maintenance.

Original posts on the above topics can be accessed by Nova Scotia Health Employees through The Compass > Clinical Resources News.

Policies, Care Directives, Guidelines and Learning Modules

• NEW CARE DIRECTIVE: Sepsis Recognition and Treatment in the Emergency Department Settings
  • CD-EC-095 is supported by and includes a Dynamic Health custom skill. Leadership and Clinical Educators can find this new care directive, DH link and more implementation support resources in the Sepsis Recognition and Treatment in the Emergency Department Settings Clinical Practice Support subject guide.
• NEW POLICY and PROCEDURES: Medication Administration
  • MM-MA-001 has been updated and includes several DH skills. Leadership and Clinical Educators can find this new policy, related procedures, DH links and more support resources in the Medication Administration Clinical Practice Support subject guide.

Dynamic Health Updates

• New Workplace Notes and Reviewed Skills
  • New notes have been created for a range of skills, including but not limited to: Arterial Catheter Site Care, Enteral Nutrition by Bolus, Gastrostomy Tube Care, Leg Ulcer Compression Systems, Liquid Nitrogen for Dermatologic Cryosurgery, Wasting Controlled Substances.
  • View the full list of New Workplace Notes and Reviewed Skills for September 2025.
• Revised Workplace Notes
  • Workplace Note about a range of skills have been revised, including but not limited to: Assessing and Managing Pain, Blood Product and Plasma Administration, CVADs, Feeding Tubes, IM Injections in Newborns, Oral Medication for Infants and Children, Urine Specimen Collection from Indwelling Catheters, Tracheostomies.
  • View the list of Revised Workplace Notes for September 2025.
• Custom Workplace Skills
  • NEW
    • Point-of-Use Cleaning of Flexible Endoscopes
    • Performing the Pediatric Respiratory Assessment Measure (PRAM) in Pediatric Patients with Asthma
    • Performing Burn Wound Debridement for Adults
    • Recognizing and Treating Sepsis in the Emergency Department (ED)

Clinical Practice Support Subject Guides

• NEW
  • Frailty and Elder Care Network
  • Perinatal, Newborn, and Pediatrics
  • Sepsis Recognition and Treatment in the Emergency Department (ED)
  • Tracheostomy Care

Obtaining CE With Dynamic Health for Nursing Practice and Leadership Premiums

It's that time of year again! It's time to start preparing to submit for your Nursing Practice and Leadership Premiums. There are three ways to earn CE using Dynamic Health:

1. Creating a DH Personal Account + Day-to-Day Use

Each time you use a skill in DH can count towards CE, but first you need to make a personal account. Once you’ve made a personal account, make sure you are logged in each time you use DH. Over time, you’ll notice the counter in the top right getting bigger. When you are ready, you can export your activity as CE credits. Regular use of DH will help you accumulate credits that can be converted to Practice Points as per Nursing Collective Agreements.

2. Skill Review and Creating a Workplace Note (WPN)

Priority skills needing review are identified by organizational leadership and clinical educators. You may put your name forward to our Team with the clinical areas you are competent to provide review for, and we’ll reach out when needs arise. This may be to update an existing skill with a workplace note, or to review a skill for potential workplace note or another customization.

3. Creating a Custom Workplace Skill

The need to create a Custom Workplace Skill is determined through our review process, the CPP team, and leadership and clinical educators. For example, if you submit a review for a skill (after it was assigned to you) and our CPP team reviews and determines there are too many differences for a Workplace Note alone, the CPP team may reach out about collaborating on working with us to create a Custom Workplace Skill. Creating this type of skill takes more time and energy, therefore, this activity is worth the most Leadership Points offered.

Learn more and get additional tips by reading the original post at Clinical Resources News on The Compass.

Get in Touch!

Connect with Clinical Practice and Policy about this content update and opportunities to collaborate by emailing AskIPPL@nshealth.ca.

Find guidance about using Dynamic Health, setting up a personal account, exporting CE (Continuing Education) Credits, and more in the Dynamic Health Support guide.

IPPL Clinical Practice and Policy

AskIPPL@nshealth.ca

Both Zotero and Covidence can store, manage, and deduplicate citations. However, they differ significantly in their application and scope.

What is Zotero?

Zotero is a free citation management software that includes a desktop application and a browser extension.

What you can do with Zotero:

• Save bibliographic information from any page on the internet.
• Import citations through various file types (e.g. BibTeX, RIS, Zotero RDF).
• Sort your citations into folders and sub-folders.
• Create a single citation or an entire reference bibliography in any citation style.

Learn more about accessing and using Zotero:

• Visit our Citation Management subject guide for more information about accessing and using Zotero.
• Visit the Zotero website for tutorials and information on how to make the most out of Zotero.
• Visit the Zotero blog and forums to troubleshoot very specific issues that you may encounter.

TIP: You can use Google to search within the Zotero blog and forum by adding site: forums.zotero.org/discussions or site: zotero.org/blog/ after your Google search query. This limits your search to only those sites. For example, to learn how to add full-text PDFs to your saved citations, search full text pdf site:zotero.org/blog/.

What is Covidence?

Covidence is a web-based software that lets members of a research team collaborate through the various stages of a knowledge synthesis project (such as a systematic review). Nova Scotia Health has an institutional license to Covidence, which means Covidence is now free to use for Nova Scotia Health staff!

What you can do with Covidence:

• Upload citations
• Screen titles and abstracts
• Screen full-text articles and resources
• Complete data extraction

Learn more about accessing and using Covidence:

• To create an account or join your existing account to our license, follow the steps outlined on our Institutional Subscriber page or our Knowledge Synthesis and Covidence subject guide.
• For articles, books, and training webinars, visit Covidence Academy
• For troubleshooting and detailed walkthroughs, visit Covidence Knowledge Base
• For both shorter and longer video content (including recorded webinars) that are accessible to the public, visit Covidence’s YouTube Channel

What’s the difference?

Zotero is great for organizing literature sources, creating reference lists, and assisting with in-text citation. You will likely find Zotero more useful for everyday research needs.

Covidence is best for conducting knowledge synthesis projects with a team that will lead to a published review article. Outside of scholarly publications, Covidence could also be used by a team to screen through a large amount of potentially relevant literature to find those that are most relevant to your specific needs.

Both tools have distinct features that make them suitable for different purposes. The table below lists the different strengths of each tool, depending on your project needs:

Interested in learning more about knowledge synthesis? Check out our Knowledge Synthesis and Covidence subject guide!

Reach out to LitSearch@nshealth.ca with your questions.

Kendell Fitzgerald

Librarian Educator
Halifax Infirmary, Central Zone

Vinson Li

Librarian Educator
Yarmouth Regional Hospital, Western Zone

IPPL Clinical Practice and Policy digest posts summarize updates over the past month about:

• Clinical Policies, Care Directives, Guidelines and Learning Modules
  • Get the latest on clinically relevant, local guidance published through policies, care directives, guidelines and/or learning modules.
  • Identify competencies relevant to your/your team’s practice.
• Dynamic Health (DH)
  • Stay informed about implementation and use of Dynamic Health at Nova Scotia Health, including recent updates to Workplace Notes and Custom Workplace Skills.
• Clinical Practice Support (CPS) Subject Guides
  • Learn about recently published and updated CPS subject guides, where you/your team can find relevant resources across DH, policies, care directives, guidelines and learning modules. CPS subject guides also include Key Practice Points and additional educational and guidance resources to support implementation and competency maintenance.

Original posts on the above topics can be accessed by Nova Scotia Health Employees through The Compass > Clinical Resources News.

NOTE CPP Digest posts will take a break over the summer and resume in September.

Policies, Care Directives, Guidelines and Learning Modules

• NEW CARE DIRECTIVE: Management of Anaphylaxis (Outside Emergency Departments)
  • CD-CL-030 is supported by and includes several Dynamic Health (DH) skills. Leadership and Clinical Educators can find this new care directive, DH links and more support resources in the Management of Anaphylaxis Clinical Practice Support subject guide.
• NEW POLICY and PROCEDURES: Assess, Treat, and Release
  • CD-EC-090 has been updated and includes several DH skills. Leadership and Clinical Educators can find this new policy, related procedures, DH links and more support resources in the Assess, Treat, and Release Clinical Practice Support subject guide.

Dynamic Health Updates

• New Workplace Notes and Reviewed Skills
  • New notes have been created for a range of skills, including but not limited to: Caring for tracheostomy, Educating about pregnancy hypertension, Performing closed bladder irrigation, and Treating head lice and nits.
  • View the list of New Workplace Notes and Reviewed Skills for June 2025.
• Revised Workplace Notes
  • Workplace Notes about a range of skills have been revised, including but not limited to: Administering medication to obstetric patients, Inserting indwelling urinary catheters, Performing postpartum fundal assessment, and Monitoring sepsis transfusion reaction.
  • View the list of Revised Workplace Notes for June 2025.
• Custom Workplace Skills
  • NEW
    • Corking or Capping a Tracheostomy
  • UPDATED
    • Dialysis: Blood Sample Collection from a Hemodialysis Central Venous Catheter
    • Dialysis: Changing a Peritoneal Dialysis (PD) Catheter Dressing
    • Dialysis: Infusion of Alteplase in a Hemodialysis Central Venous Catheter (CVC) during Hemodialysis
    • Dialysis: Performing Continuous Ambulatory Peritoneal Dialysis (CAPD) / Twin Bag Exchange in Adults
    • Dialysis: Performing the Modified Shower Technique for Peritoneal Dialysis Dressing Change
    • Dialysis: Post-Dialysis Lock and Dwell Using Alteplase in Hemodialysis Central Venous Catheter (CVC)
    • Dialysis: Short Dwell Method of Alteplase in a Hemodialysis Central Venous Catheter (CVC)

Clinical Practice Support Subject Guides

• NEW
  • Assess, Treat, and Release
  • Management of Anaphylaxis
  • Respiratory Therapy Skills and Procedures
• UPDATED
  • Blood Product Administration - Transfusion Medicine
  • Occupational Health and Safety: Continuing Care
  • Renal Dialysis - Clinical Practice Supports: Nursing Skills and Procedures

Site Visits and Dynamic Health Scavenger Hunt Winners

Thank you to all staff who spoke with Clinical Practice and Policy during our recent site visits in Eastern and Northern Zones and at each Zone’s Quality Summit! We received a lot of positive feedback, and suggestions or questions that will lead to positive improvements.

A special thank you to all the practice leads, clinical nurse educators and site managers who met with us in person to help navigate throughout specific locations and visit frontline staff on their units.

During our visits, we hosted a digital scavenger hunt for each site. Everyone who completed the scavenger hunt form entered a draw to win a $50 Amazon gift card provided by EBSCO. Remember to check your inbox (and spam/junk folder) or The Compass > Clinical Resources News to see if your name was picked!

Get in Touch!

Connect with Clinical Policy and Practice about this content update and opportunities to collaborate by emailing AskIPPL@nshealth.ca.

Find guidance about using Dynamic Health, setting up a personal account, exporting CE (Continuing Education) Credits, and more in the Dynamic Health Support guide.

IPPL Clinical Practice and Policy

AskIPPL@nshealth.ca

IPPL Clinical Practice and Policy digest posts summarize updates over the past month about:

• Clinical Policies, Care Directives, Guidelines and Learning Modules
  • Get the latest on clinically relevant, local guidance published through policies, care directives, guidelines and/or learning modules.
  • Identify competencies relevant to you/your team’s practice.
• Dynamic Health (DH)
  • Stay informed about implementation and use of Dynamic Health at Nova Scotia Health, including recent updates to Workplace Notes and Custom Workplace Skills.
• Clinical Practice Support (CPS) Subject Guides
  • Learn about recently published and updated CPS subject guides, where you/your team can find relevant resources across DH, policies, care directives, guidelines and learning modules. CPS subject guides also include Key Practice Points and additional educational and guidance resources to support implementation and competency maintenance.

Original posts on the above topics can be accessed by NS Health Employees through The Compass > Clinical Resources News.

Policies, Care Directives, Guidelines and Learning Modules

• NEW GUIDELINE: Management of Extravasation Events
  • CL-SR-060 is supported by and includes several Dynamic Health (DH) skills. Leadership and Clinical Educators can find this new guideline, DH links and an educational poster for front line staff in the Vascular Access Clinical Practice Support subject guide.
  • Please note: Extravasations of Systemic Therapy for Cancer medications are outside the scope of this guideline.
• LEARNING MODULES: Pathways for Electrocardiography (ECG), Archived and Revised Modules
  • Resulting from the addition of the new Electrocardiography (ECG) page on the Nursing Skills and Procedures Clinical Practice Support subject guide, please note the following changes:
    • Archiving of LMS modules around lead placement and adoption of Dynamic Health skills
    • Creation of two learning pathways: Introductory and Interpretation
  • As of May 20th, 2025, modules listed below have been developed, revised or archived, through the NS Health eLearning system (LMS – Medworxx).

    • New or Revised eLearning (LMS)

      Course Title	LMS Code	Status
      Diabetes 1: Diabetes 101	0137	Revised
      Diabetes 2: Starting Insulin in Hospital	0138	Revised
      Insertion and Care of i-Gel Supraglottic Advanced Airway Device	1065	Revised
      Medication Independent Double Check	0203	Revised
      National Early Warning Score Series: Acute Care	1079	Revised
      Protections for Persons in Care	1285	News
      Transfusion Therapy: Administration and Adverse Events	0543	Revised to align with policy changes
      Transfusion Therapy: Transfusion 1 Blood Basics	0542	Revised to align with policy changes

    • Archived eLearning and Replacement Resources  

      Archived Course Title	LMS Code	Replaced With
      Administration of Epinephrine in the Treatment of Anaphylaxis	0040	Coming soon: Policy: Management of Anaphylaxis Clinical Practice Supports Subject Guide: Management of Anaphylaxis
      Delirium in the Elderly - Acute Care	0136	Delirium: Assessing Adults for Delirium Using 4AT Assessing Neurological Status in Adults
      Enteral Feeds	0166	Enteral - Clinical Practice Supports: Nursing Skills and Procedures
      Infusion Pump Training - Kangaroo e-Pump	0206	Enteral - Clinical Practice Supports: Nursing Skills and Procedures

• NEW POLICY: Allergy Skin Testing
  • CL-AS-010 is supported by and includes several Dynamic Health (DH) skills. Leadership and Clinical Educators can find this new policy and DH links in the Allergy Testing Clinical Practice Support subject guide.

Dynamic Health Updates

• New Workplace Notes and Reviewed Skills
  • New notes have been created for a range of skills, including but not limited to: Implanted Ports, Bolus Injections, PICC lines, Central Venous Catheters, Procedural Sedation, Intraperitoneal Chemotherapy and Post-operative Care.
  • View the full list of New Workplace Notes and Reviewed Skills as of May 2025.
• Revised Workplace Notes
  • Workplace Notes about a range of skills have been revised, including but not limited to: Medication Administration, Changing and Flushing/Locking PICC or CVAD, Removing Sutures, PPE, Blood and Fluid Warmers.
  • View the list of Revised Workplace Notes as of May 2025.
• Custom Workplace Skills
  • Dialysis: Administering Intra-Peritoneal (IP) Medication
  • Dialysis: Blood Culture Collection from a Hemodialysis Central Venous Catheter
  • Dialysis: Performing the Modified Shower Technique for Peritoneal Dialysis Dressing Change
  • Dialysis: Sampling Peritoneal Effluent (Fluid) for Suspected Peritonitis
  • Dialysis: Termination of a Hemodialysis Session in the Event of an Evacuation Procedure
  • Dialysis: Warming Dialysate for Peritoneal Dialysis (Twin Bag or Cycler)
  • Performing In-Vehicle Specimen Collection

Clinical Practice Support Subject Guides

• NEW
  • Electrocardiography (ECG) - Clinical Practice Supports: Nursing Skills and Procedures
  • Medication Administration
• UPDATED
  • Renal Dialysis - Clinical Practice Supports: Nursing Skills and Procedures
  • Vascular Access (CVAD, Peripheral) - Clinical Practice Supports: Nursing Skills and Procedures

Connect with Clinical Policy and Practice about this content update and opportunities to collaborate by emailing AskIPPL@nshealth.ca.

Find guidance about using Dynamic Health, setting up a personal account, exporting CE (Continuing Education) Credits, and more in the Dynamic Health Support guide.

IPPL Clinical Practice and Policy

AskIPPL@nshealth.ca

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, as well as 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.

Dynamic Health Updates

We receive feedback submissions about Dynamic Health skills on an ongoing basis through the Suggest an Edit form and through partnerships with departments and teams. This month, the following customizations have been added:

New Workplace Note

• Administering an Intradermal Injection
• Administering Subcutaneous Insulin to Adults
• Assessing Adults Receiving Mechanical Ventilation
• Assessing and Caring for Patients With Delirium
• Assisting With Gown Changing in Patients With Peripheral IVs
• Managing and Dispensing Medications on the Sterile Field in the OR
• Preventing Medication Errors: General Principles
• Providing Emergency Care to Patients With Sepsis
• Providing Epidural Catheter Care
• Removing an Epidural Catheter

Revised Workplace Note

• Adding Medications to IV Solutions
• Administering a Subcutaneous Injection to Adults
• Administering a Subcutaneous Injection to Pediatric Patients
• Administering Aerosol Therapy
• Administering Alteplase for Acute Ischemic Stroke
• Administering an Enema
• Administering an IM Injection in Infants to Adolescents
• Administering an IM Injection to Adults
• Administering an IM Injection to Newborns
• Administering Buccal Medication
• Administering Eye Drops
• Administering Intranasal Medication to Pediatric Patients
• Administering IV Bolus or IV Push Medication to Adults
• Administering IV Heparin to Adults
• Administering IV Solution
• Administering Medication Through a Gastric Tube to Children and Adolescents
• Administering Medication Through a Nasogastric Tube
• Administering Medication Through a PICC
• Administering Medication Through an Enteral Tube
• Administering Medication Through Saline Lock
• Administering Medication to Adults Through an Endotracheal Tube
• Administering Medication to Older Adults
• Administering Medication to Pediatric Patients Through an Endotracheal Tube
• Administering Oral Medication to Adults
• Administering Parenteral Nutrition
• Administering Parenteral Nutrition Through Central Venous Access
• Administering Parenteral Nutrition Through Peripheral Venous Access
• Administering Parenteral Nutrition to Pediatric Patients
• Administering Syringe Pump for Medication
• Administering Topical Medication
• Applying Eye Ointment to Adults
• Applying Rectal Ointment
• Calculating Drip Rate for Gravity Flow IV Administration Sets
• Changing Peripheral IV Catheter Dressings in Adults
• Changing Peripheral IV Tubing in Adults
• Implementing Special Observation for Patients With Depression and Risk of Harmful Behaviors
• Inserting a Peripheral IV in Adults
• Inserting a Peripheral IV in Children and Adolescents
• Inserting a Rectal Suppository
• Instilling Medication in the Nose
• Instilling Medication Into the Vagina
• Managing Chemotherapy-Induced Peripheral Neuropathy
• Managing Extravasation in Adults
• Managing Extravasation in Pediatric Patients
• Performing Medication Reconciliation
• Preparing IV Solution
• Preventing IV Infiltration
• Preventing IV Therapy Complications
• Preventing IV-Associated Medication or Infusion Errors
• Removing a Peripheral IV Catheter in Adults
• Setting up IV Piggybacks
• Taking a Medication History
• Treating IV Infiltration
• Using a Metered-Dose Inhaler in Adults
• Using a Metered-Dose Inhaler in Pediatric Patients
• Using an Electronic Infusion Pump

No Workplace Note

• Administering Oral Medication to Infants and Children
• Administering Sublingual and Buccal Medications to Pediatric Patients
• Administering Sublingual Medication to Adults
• Using the Wong-Baker FACES Pain Rating Scale
• Withdrawing Medication From an Ampule

Custom Skills

• Administering Allergy Epicutaneous / Skin Prick Testing in Adults
• Collecting a Parotid Gland Duct/Buccal Specimen

Clinical Practice Supports – New and Updated

Clinical Practice Supports for Health Care Providers is a group of subject guides bringing together clinical skills and procedures in one place for health care provider-focused guidance across Dynamic Health, Policy Office, Learning Modules, established guidelines and current evidence. You can view available guides through our high-level tiled landing page or alphabetically.

• Harm Reduction
  • Implementation supports and resources for authorized Harm Reduction Interventions.
• NEWS2 Early Warning Score
  • A systematic approach to measure six key physiological parameters in patients aged 16 and older. It provides a standardized method for identifying and responding to acute deterioration in a patient's clinical condition while they are hospitalized.
• Skin and Wound Care
  • NS Health Employees can check our latest memo outlining recently updated former DHA policy documents.

Claiming CE for Custom Workplace Skills in Dynamic Health

Custom Workplace Skills that are created by Nova Scotia Health (e.g., Administering Allergy Epicutaneous / Skin Prick Testing in Adults) do not get tracked automatically as CE credits in Dynamic Health. You can still use Custom Workplace Skills for CE credit (.1 per skill) by printing or saving the time stamped checklist and including it in your Practice Points submission each year you submit. For more info visit the Dynamic Health Support guide.

Health Promotion in March and Dynamic Health Topics

March 2025 marks promotion of:

• Colorectal Cancer Awareness Month
• National Poison Prevention Week March 16 to 22

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!

Colorectal Cancer Awareness Month

• Skills/Procedures
  • Assessing the Rectum in Adults
  • Assisting with Colonoscopy
  • Removing and Applying an Ileostomy or Colostomy Appliance
• Disease Overviews
  • Colorectal Cancer
  • Lynch Syndrome
  • Large Bowel Obstruction, Adult
• Care Interventions
  • Colonoscopy Interventions, Adult
  • Colostomy Interventions
  • Large Bowel Resection (Colectomy) Interventions, Adult
• Signs & Symptoms
  • Rectal Pain
  • Hematochezia, Adult
  • Excessive Weight Loss, Adult

National Poison Prevention Week

The Atlantic Canada Poison Centre provides our local guidance on poisoning information. Dynamic Health content may be used in combination with their recommendations.

• Skills/Procedures
  • Responding to Accidental Poisoning
  • Educating About Preventing Accidental Poisoning
  • Managing Patients After Chemical Exposure
• Disease Overviews
  • Acetaminophen Poisoning, Adult
  • Acetaminophen Poisoning, Pediatric
  • Lead Poisoning, Adult
  • Mushroom Poisoning
• Care Interventions
  • Drug Overdose Interventions, Adult
  • Drug Overdose Interventions, Pediatric
  • Chemical Inhalation Injury Interventions, Adult
• Signs & Symptoms
  • Cyanosis, Adult
  • Pruritus, Adult
  • Acute Blood Pressure Decrease, Pediatric

IPPL Clinical Practice and Policy

DynamicHealth@nshealth.ca

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, as well as 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.

Dynamic Health Updates

We receive feedback submissions about Dynamic Health skills on an ongoing basis through the Suggest an Edit form and through partnerships with departments and teams. This month, the following customizations have been added:

New Workplace Note

• Inserting a Peripheral IV in Adults
• Managing Extravasation in Adults
• Managing Extravasation in Pediatric Patients
• Obtaining a Nasopharyngeal Specimen From Pediatric Patients
• Obtaining a Nasopharyngeal Specimen in Adults
• Obtaining an Oropharyngeal Throat Specimen
• Performing a Head-to-Toe Physical Assessment With Adults
• Using Warming Blanket Therapy for Adults in the Hospital

Revised Workplace Note

• Administering IV Solution
• Assessing Neurological Status in Adults
• Obtaining a Blood Sample for Culture From a Central Venous Catheter in Adults
• Testing for COVID-19

Custom Skills

• Dialysis: Suture Replacement for Hemodialysis Catheter (Registered Nurse Delegated Medical Function)
• Dialysis: Instillation, Withdrawal, Dwell of Alteplase in Hemodialysis Central Venous Catheter (CVC)
• Dialysis: Infusion of Alteplase in a Hemodialysis Central Venous Catheter (CVC) during Hemodialysis
• Dialysis: Post-Dialysis Lock and Dwell Using Alteplase in Hemodialysis Central Venous Catheter (CVC)
• Dialysis: Sampling Peritoneal Effluent (Fluid) for Suspected Peritonitis
• Delirium: Assessing Adults for Delirium Using 4AT

2024 Highlights

February marks two years since we launched Dynamic Health with Nova Scotia Health customizations (Workplace Notes, Custom Skills, etc.). Thank you to all our collaborators, users and supporters. We include analytics below, including data from a system report run on January 29, 2025 that reflects our collective success this past year. The change from January 2024 is noted after the metric in brackets.

Dynamic Health

• 188,691 unique Topic Section views (+118,082)
• 1,797 Skills assigned and/or reviewed (+540)
• 638 Workplace Notes published (+151)
• 32 Custom Workplace Skills published (+24)
• 27 policy documents referencing Dynamic Health, Clinical Practice Support guides (New, +27)
• 2,974 Personal user accounts created (+1,709)
• 920.3 Continuing Education Hours Claimed (+762.8)

Clinical Practice Support Guides

In 2024 we established a group of subject guides to bring together skills and procedures in one place – Clinical Practice Supports for Health Care Providers. This group includes pre-existing subject guides from the Library Services collection and adds health care provider-focused guidance across Dynamic Health, Policy Office, Learning Modules, established guidelines and current evidence. We currently host 64 Clinical Practice Support subject guides. You can view available guides through our high-level tiled landing page or alphabetically.

Engagement

We also kicked off promoting our services with our first zone visit to locations in Western Zone. We visited 8 hospitals over 3 days to chat about our support services. Over 150 staff members engaged with us during our visits, participating in a Scavenger Hunt aimed at helping to search for best practice guidance and set up a Dynamic Health account to track and export continuing education credits. We are looking forward to visiting the rest of the organization in 2025!

Collaborator Feedback

If you’ve collaborated with IPPL's Clinical Practice and Policy Team (adoption of Dynamic Health content, publication of a custom skill, package of skills in a Clinical Practice Support guide, etc.), then we want your input on our supports! Please use this form to provide feedback on your experience working with us.

Health Promotion in February and Dynamic Health Topics

February 2025 marks the promotion of:

• World Cancer Day, February 4
• Wear Red Day, February 13
• Mental Health Nurses Day, February 21

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!

World Cancer Day

• Disease & Condition Overviews
  • Cutaneous Squamous Cell Carcinoma
  • Non-Hodgkin Lymphoma, Adult
  • Colorectal Cancer
• Signs & Symptoms
  • Excessive Weight Loss, Adult
  • Fever of Unknown Origin, Adult
  • Fatigue, Adult
• Skills
  • Managing Cancer Anorexia-Cachexia Syndrome
  • Providing Emotional Support for Newly-Diagnosed Patients With Cancer
  • Assessing for Depression in Patients With Cancer
  • Providing Support to Patients and Families in Grief
  • Managing Constipation in Patients With Cancer
• Patient Handouts
  • Palliative Care for Cancer
  • Cancer Fatigue
  • Skin Cancer - Overview
  • Cancer Pain Syndromes

Wear Red Day

• Disease & Condition Overviews
  • Acute Myocardial Infarction, Female
  • ST-Elevation Myocardial Infarction (STEMI)
  • Heart Failure, Adult
• Signs & Symptoms
  • Cardiac Palpitations
  • Arm Pain
  • Chest Pain, Adult
  • Nausea, Adult
  • Fatigue, Adult
  • Shortness of Breath, Adult
  • Anxiety, Adult
• Skills
  • Emergency Department - Interpreting a Cardiac Rhythm Strip in Adults
  • Auscultating Heart Sounds in Adults
  • Performing a 12-Lead Electrocardiogram in Adults
  • Analyzing and Interpreting a 12-Lead Electrocardiogram in Adults
  • Performing 15-Lead Electrocardiogram in Adults
  • Performing Telemetry Monitoring
• Patient Handouts
  • Getting to the Heart of a Healthful Diet
  • Cardiac Arrest
  • Heart Healthy Physical Activity
  • Tips to Help You Stop Smoking

Mental Health Nurses Day

• Disease & Condition Overviews
  • Major Depressive Disorder, Adult
  • Obsessive-Compulsive Disorder, Adult
  • Posttraumatic Stress Disorder, Adult
• Signs & Symptoms
  • Anxiety, Adult
  • Depression, Adult
  • Insomnia, Adult
• Skills
  • Assessing Mental Health Status in Adults
  • Collecting a Mental Health History in Adults
  • Mental Health and Addictions: Self Care Education in the Emergency Department
• Patient Handouts
  • Anxiety Disorders
  • Depression and Chronic Illness
• Leadership
  • Self-Awareness in Nursing Practice

IPPL Clinical Practice and Policy

DynamicHealth@nshealth.ca

For many Nova Scotia Health team members, sharing documents is an essential part of the workday. But as you may have noticed, there are many ways to link to documents or share URLs. In this post, we’ll share best practices to help make sure the links you share are inclusive, accessible, and most importantly, usable!

Before we dive in, let’s make sure we understand some key words:

• As a noun, 'a hyperlink' (often shortened to 'link'), refers to a digital link from a file to another file or location. The hyperlink is activated when the user selects the hyperlinked word(s) or image on the screen.
• As a verb, 'to hyperlink' refers to creating a digital link between different documents or locations.
• 'URL', or uniform resource locator, refers to the web address of a specific internet web page (such as, www.nshealth.ca). 

Best practices

1. When adding a hyperlink, be sure the linked text appropriately describes what you are linking to.

Don’t hyperlink non-informative phrases like, “click here”, “read more”, or “view here”, etc.
Example:
Want to learn more about accessibility? Click here!

Do hyperlink the title or description of the link.
Example:
Want to learn more about accessibility? Check out: Best practices for accessible links

Why does it matter?

When we hyperlink instructions, like adding a link to the words “click here” or “read more,” we are not giving the user enough information about where the link goes. When these types of links appear one after one another, it’s difficult to differentiate between them, which can create a frustrating user experience.

This practice makes it more difficult for those using screen readers to identify the link’s purpose. When a screen reader comes across a URL, it reads the associated text aloud, as well as the written URL. Often, these URLs are lengthy and an unpredictable combination of characters and numbers. Appropriately labeling your URLs can help screen reader users know exactly what to expect when selecting your link (Microsoft, n.d.).

Descriptively naming your hyperlinks also allows search engines (like Google) to use your descriptive text as metadata to appropriately rank search results. This means you will get more intentional visitors to your content because the information stored about your URL is accurate.

You may have noticed that Microsoft Office 365 products have already started doing this for you. For instance, when you copy and paste a hyperlink into the body of an email, Outlook now automatically changes the visible text associated with the hyperlink to the title of the document (A) instead of the URL (B). The same is true when adding URLs within other Microsoft Office 365 products like Word or PowerPoint. These links look something like this:

2. For printed resources, include the written URL as well as your descriptive hyperlinked text.

If you are creating content that will be used both in print and online, including the descriptive link and the written URL ensures equal access for all users to the resource you are linking to. Those using the print copy may need to enter the URL manually into a computer, tablet, or smartphone, but having the written URL provides them with enough information to access the resource.

Don’t assume everyone is reading your content online. Be mindful of the digital divide and add written URLs for those using print resources.

Do add the written URL beside or below the hyperlinked descriptive text.

Why does it matter?

In this day and age, it’s easy to assume everyone has access to reliable internet. Unfortunately, a ‘digital divide’ still exists in many communities in Canada (Currie, Ronquillo. & Dick, 2014; Latulippe, Hamel, & Giroux, 2017). Researchers note that this divide “persists along lines of social inequalities (i.e., education, urban versus rural, income, age, and immigration status)” (Ismond et al., 2021).

When creating print resources for the public (like patients, families, and support persons), including a descriptive hyperlink and a written URL allows all readers to access the same information. The written URL (C) gives them sufficient information to find the resource at a later time, when they have access to the internet (like at a public library, community center, or loved one’s home, for example).

Remember, if you are creating print resources and the software you are using automatically changes the URL to match the title of the document (like Outlook, Word, or PowerPoint), be sure to add the written URL beside or below it so that your hard-copy readers can use your links, too.

3. Use ScreenTips

When hyperlinking within a Microsoft product, you can also change what text appears when the cursor hovers over a link (D). In the ‘Insert Hyperlink’ pop-up window, select, ‘ScreenTip…’ in the top right. Use this window to edit the URL addess, the descriptive text that will be hyperlinked, as well as what will appear when the user hovers over the link.

As technology evolves, there are bound to be new ways to share links and URLs. Keeping up to date on how to make your links usable and accessible helps ensure your intended audience can access whatever resource you’re sharing, reducing user frustration and broken links.

Happy sharing!

References

1. Currie, L. M., Ronquillo, C., & Dick, T. (2014). Access to internet in rural and remote Canada. Studies in Health Technology and Informatics, 201, 407–412.https://pubmed.ncbi.nlm.nih.gov/24943574/

2. Latulippe, K., Hamel, C., & Giroux, D. (2017). Social Health Inequalities and eHealth: A Literature Review With Qualitative Synthesis of Theoretical and Empirical Studies. Journal of Medical Internet Research, 19(4), e136. https://doi.org/10.2196/jmir.6731

3. Ismond, K. P., Eslamparast, T., Farhat, K., Stickland, M., Spence, J. C., Bailey, R. J., Abraldes, J. G., Spiers, J. A., & Tandon, P. (2021). Assessing Patient Proficiency with Internet-Connected Technology and Their Preferences for E-Health in Cirrhosis. Journal of Medical Systems, 45(7), 72. https://doi.org/10.1007/s10916-021-01746-3

4. Microsoft. (2024, July 25). Make your Word documents accessible to people with disabilities. https://support.microsoft.com/en-us/office/make-your-word-documents-accessible-to-people-with-disabilities-d9bf3683-87ac-47ea-b91a-78dcacb3c66d?ui=en-us&rs=en-us&ad=us

Kallen Rutledge

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

National AccessAbility Week (NAAW) starts every year on the last Sunday in May. It promotes ways we can make Canada more accessible and inclusive and celebrates people with disabilities in our communities.

"Nova Scotia was the first province in Canada to champion Access Awareness Week as an extension of Rick Hansen’s 1987 Man in Motion World Tour." (NSLEO, n.d.)

In 2017, the government of Nova Scotia passed the Accessibility Act. To support this legislation, as well as of Nova Scotia Health’s Accessibility Plan, our Library Services team is promoting accessibility in our physical and online spaces by:

• Educating our team about accessibility features and considerations for:
  • patient education pamphlets,
  • subject guides,
  • Microsoft Teams,
  • and PowerPoint.
• Evaluating the accessibility of our physical library spaces.
• Maintaining plain-language standards for patient education materials.
• Making digital patient education pamphlets compatible with assistive technology, such as screen readers.

Want to take part in National Accessibility Week? Accessibility webinars, events and further educational resources can be found through the Rick Hansen Foundation and the Nova Scotia League for Equal Opportunities (NSLEO).

Interested in learning more about the importance of access within health care? Attend the online session, ‘Health Literacy in Health Care.’ This session outlines the impact of low literacy in health care settings, and the ways staff can help patients and their support persons overcome literacy barriers. You can find more information about this session at our Learning Opportunities calendar.

You can also learn more about accessibility through our Library News Blog. Check out the posts below for helpful information, tips, and resources:

• Part 1: Create accessible and readable text documents with these tips
• Part 2: Create accessible and readable text documents with these tips
• Easy ways to build health literacy into your daily routines

References

1. Bill 59: Accessibility Act. (2017). 3rd Session, 62nd General Assembly. Retrieved from Nova Scotia Legislature website: https://nslegislature.ca/legc/bills/62nd_3rd/3rd_read/b059.htm

2. Nova Scotia Health Authority. (2023). 2023-2026 Accessibility Plan: Working together for barrier-free care. Retrieved from: https://www.nshealth.ca/sites/default/files/documents/Universal%20Access%20NSH%20IWK%20Accessibility%20Plan.pdf

3. Nova Scotia League for Equal Opportunities. (n.d.). About Access Awareness Week Nova Scotia. https://nsleo.com/access-awareness-week-nova-scotia/

Kendell Fitzgerald

Librarian Educator
Central Zone

Generative Artificial Intelligence (AI) tools have been a hot topic of both news and conversation since OpenAI launched ChatGPT in March 2023. In addition to the possibilities these tools present, there has been much discussion about their limitations and risks. Let’s take a look at some things you should be aware of from a copyright and citation perspective.

Copyright

The big question is who owns the copyright for AI-generated materials?

As yet, there are no clear answers.

OpenAI, for example, claims to own the copyright for content produced by ChatGPT and its image generator, Dall-E. OpenAI assigns its users the right to use the content for any purpose, including commercial use (OpenAI, 2023a), but do they really have the authority to do so?

ChatGPT and other generative AI tools are ‘trained’ on huge amounts of data “scraped from the internet” (CBA National, 2022). Although this content is freely accessible, much of it is likely copyright protected, and that’s where things get murky. According to the Canadian Bar Association, clarity will likely have to be provided by court decisions—in Canada and worldwide—to address questions such as:

• Do AI tools use enough of an original work to infringe on copyright?
• Does the use fall under Fair Dealing?
• Is AI output a purely “mechanical exercise” (CCH Canadian Ltd. v. Law Society of Upper Canada, 2004) and not copyright protected at all?

(CBA National, 2022)

There are already several high profile court cases involving generative AI. For example, Getty Images is suing Stability AI for allegedly using its content without permission to ‘train’ the image generator, Stable Diffusion (Brittain, 2023).

Citations

OpenAI (2023b) acknowledges that ChatGPT “sometimes writes plausible-sounding but incorrect or nonsensical answers.” This is sometimes referred to as hallucination and fake citations are one example.

University of Waterloo Library and Memorial Sloan Kettering Cancer Center Library, among others, have tested the reliability of citations produced by ChatGPT. I thought I’d try it myself.

I asked ChatGPT to write a paragraph on the use of carbamazepine in benzodiazepine withdrawal and to include a reference list.

This was the response:

Carbamazepine is a medication commonly used in the management of benzodiazepine withdrawal, particularly in cases of long-term benzodiazepine dependence. It belongs to the class of anticonvulsant drugs and acts by stabilizing neuronal membranes and reducing excessive neuronal firing. Carbamazepine helps alleviate withdrawal symptoms such as anxiety, insomnia, restlessness, and irritability, making it a valuable adjunct in the detoxification process. The drug's mechanism of action involves modulating the gamma-aminobutyric acid (GABA) neurotransmission system, which is disrupted during benzodiazepine withdrawal. While carbamazepine has demonstrated efficacy in managing benzodiazepine withdrawal symptoms, it should be used under close medical supervision due to its potential for side effects and interactions with other medications. Further research is needed to optimize dosing and duration of carbamazepine therapy in benzodiazepine withdrawal.

Reference List:

1. Sood A, Armon C. Carbamazepine for benzodiazepine withdrawal. Cochrane Database Syst Rev. 2005;(3):CD001905. doi: 10.1002/14651858.CD001905.pub2
2. Nardi AE, Lopes FL, Valença AM, Freire RC, Veras AB, de-Melo-Neto VL. Withdrawal from long-term benzodiazepine use: randomised trial in family practice. Br J Gen Pract. 2006;56(533):958-963. doi: 10.3399/096016406775101759
3. LoVecchio F, Pizon A, Riley B, et al. Use of phenobarbital and carbamazepine in patients with alcohol withdrawal. Am J Emerg Med. 2007;25(3):299-302. doi: 10.1016/j.ajem.2006.08.004
4. Koster ES, Maes J, Janssen HE, et al. Use of benzodiazepines and benzodiazepine-related drugs in older adults with intellectual disability: A register-based study. J Appl Res Intellect Disabil. 2020;33(2):312-321. doi: 10.1111/jar.12658

I am not a subject matter expert, so I won’t speak to the accuracy of the paragraph (though I would welcome input from readers). As for the citations, at first glance they looked promising—formatted correctly, reputable journal titles—but looks, as the saying goes, can be deceiving.

Of the four citations, only one is even partially correct. The others are complete fabrication!

A search of PubMed® and Google Scholar indicates that references 1, 3, and 4 do not exist. The DOIs provided by ChatGPT are for different and unrelated articles. Reference 2 IS a real article from the British Journal of General Practice, but the authors and the DOI are incorrect.

What does this mean for you?

If you use generative AI tools for any purpose:

• Always confirm that the content is accurate. Check everything (including citations) against reputable sources, such as those provided by Nova Scotia Health Library Services. Consider using a plagiarism detector or Google’s reverse image search to determine if text or images have been copied from a copyrighted resource.
• Pay attention to developing legislation and policy. The federal government has proposed an Artificial Intelligence and Data Act and the Office of the Privacy Commissioner of Canada recently announced an investigation into ChatGPT for possible misuse of personal information.
• Exercise caution. Open AI CEO, Sam Altman, described ChatGPT as “incredibly limited” and warned that it should not be relied on for anything important (O’Brien, 2023). Generative AI tools are rapidly improving, but it will always be up to the user to ensure that the content they produce is accurate and copyright compliant.

If you have questions about copyright:

• visit our Copyright subject guide
• book an appointment with a library staff member, or
• reach out to us at Copyright@nshealth.ca.

Further Reading:

Alkaissi H, McFarlane S I (February 19, 2023) Artificial Hallucinations in ChatGPT: Implications in Scientific Writing. Cureus 15(2): e35179. doi:10.7759/cureus.35179

Flanagin, S., Bibbins-Domingo, K, Berkwits, M. & Christiansen, M.A.. (2023, Jan. 31). Nonhuman “authors” and implications for the integrity of scientific publication and medical knowledge. JAMA 329(8), 637-639. doi:10.1001/jama.2023.1344

References (not AI generated)

1. Brittain, B. (2023, Feb. 6). Getty Images lawsuit says Stability AI misused phots to train AI. Reuters. https://www.reuters.com/legal/getty-images-lawsuit-says-stability-ai-misused-photos-train-ai-2023-02-06/

2. CBA National/ABC National. (2022, Dec 7). The legal status of generative AI. The Canadian Bar Association. https://nationalmagazine.ca/en-ca/articles/law/hot-topics-in-law/2022/the-legal-status-of-generative-ai

3. CCH Canadian Ltd. v. Law Society of Upper Canada. [2004] 1 S.C.R. 339, 2004 SCC 13. https://scc-csc.lexum.com/scc-csc/scc-csc/en/item/2125/index.do

4. O’Brien, M. (2023, Jan. 6). What is ChatGPT and why are schools blocking it? The Globe and Mail. https://www.theglobeandmail.com/world/article-explainer-what-is-chatgpt-and-why-are-schools-blocking-it-2/

5. OpenAI. (2023a). Terms of use. https://openai.com/policies/terms-of-use

6. OpenAI. (2023b). IntroducingChatGPT. https://openai.com/blog/chatgpt

Roxanne MacMillan

Librarian Educator
Central Zone