rtso airwaves spring 2014

www.rtso.ca

Spring 2014

RTSO Airwaves

The Question of......

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Dear Colleagues,

I would like to take this opportunity to highlight the value and importance of association membership and the positive impact that it can have on our practice when our professional voice and interests are asserted in a unified and credible manner.

The Board of Directors of the Respiratory Therapy Society of Ontario (RTSO) would like to express our sincere thanks to all of our colleagues that have renewed or have newly registered for this membership year. We would also like to thank those of you that have provided feedback regarding our new membership program and alerting us to some confusion about our past and present membership registration. Your feedback has been instrumental in helping us understand how to better communicate our message and serve our membership. However, there are still a few outstanding issues that I hope to resolve with this letter.

We all appreciate that in this day and age of digital and electronic information sharing; we are all constantly bombarded with emails, e-blasts and updates from all sides. It can create confusion and electronic information fatigue. This creates a feeling of being overwhelmed with details, let alone actually finding the time to open and read all of the contents. The end result is a potential to miss important information that may impact you or your practice. Please take some time to read this letter carefully so that you can make an informed decision about what control and influence you would like to have over your practice. After

RTSOAirwaves

www.rtso.ca

President's Message froM rob bryan a-eMCa, rrt, aa

Spring 2014

RTSO Airwaves Spring 2014 1

all, it is the career that you have chosen and this decision relates to professional advocacy and your rights as a regulated health care professional in Ontario. Membership in the RTSO gives you a voice to advocate for your interests while also providing programs and services that can have a direct impact on your personal and professional life.

The RTSO is a non-profit organization that has been the voice advocate for all Registered Respiratory Therapists (RRTs) in Ontario, members and non-members, since 1972. The RTSO is governed and directed by a dedicated volunteer Board of Directors who is elected each year by our membership. The Board is mandated to ensure that our profession has a vehicle to provide its perspectives to key stakeholders throughout the Ontario healthcare system. These perspectives may relate to professional advocacy, interests or practice considerations but they may also delve into healthcare legislation or current healthcare events. We may also need to respond to any urgent issues, concerns or emergencies that could impact our professional and/or personal lives. This is done in an organized, collaborative and credible fashion and is, by far, the most important function of the RTSO. More importantly, I believe it is the fundamental right of every RRT in the province to be heard. Membership strength within the RTSO allows us to provide a province-wide professional perspective. This strength also enables us to be a valued and respected member of the Regulated Health Professions network in Ontario which is recognized throughout the Ministry of Health and Long Term Care (MoHLTC), various healthcare organizations and associations as well as other key stakeholders.

We are all well versed regarding the need of the College of Respiratory Therapists of Ontario (CRTO) as our regulatory body to serve the public of Ontario with the highest degree of professionalism, public accountability, standards and patient advocacy. The CRTO represents the public. However, the RTSO represents the profession. Unfortunately, many RRTs in Ontario fail to recognize the equal need of the RTSO to ensure our personal and professional interests are well represented and clearly advocated for with all public and government stakeholders. In fact, the RTSO is the only means that we have, as a profession, to engage with our regulatory body, other healthcare professional associations and the various MOHLTC agencies to ensure that our unique perspective is heard. The work that is done by the RTSO enables a healthy, vibrant and credible professional body that will continue to grow in all sectors of healthcare delivery in Ontario.

The RTSOs past and present achievements and contributions have helped shape the culture and landscape we practice in today and include amongst others:

Participation in the development of the MoHLTC Assistive Device Program- Home Oxygen Program.

Acted as the key stakeholder for the MoHLTC to develop the Respiratory Therapy Act and the Regulated Health Professions Act in 1991 which lead to the creation of the


2 RTSO Airwaves Spring 2014

CRTO and self-regulation for RRTs in Ontario.

In the early 2000s, we actively participated and successfully advocated for role expansion and advanced practice initiatives such as the Anaesthesia Assistant programs through the RTSO Anaesthesia Care Team special interest group

Supported the role of RRTs as certified lung health educators and promoted programs for chronic lung disease prevention and lung health promotion.

Collaborated with the CRTO in a unique Health Force Ontario study looking at how RRTs can help transition patients from the ICU to the home with complex chronic respiratory care needs such as tracheostomies and mechanical ventilator reliance. This project lead to the creation of the community-based complex respiratory care special interest group which focused on establishing out-of-hospital access to RRTs and RT services and programs funded by CCACs and Family Health Teams.

Today, the RTSO has several special interest groups and committees focusing on leadership, research and continuing education, community respiratory care and lung health promotion. Each of these groups ensures that we have our finger on the pulse of the ever evolving landscape of healthcare in Ontario in order to respond to our professions needs.

At this time, I would like to address some of the feedback that we have received from the profession since launching our new 2014 membership program. Despite all the effort and communication to bring everyone up to date regarding the joint membership trial with the Canadian Society of Respiratory Therapists (CSRT), there is still some confusion about this past initiative. The original goal was to encourage and increase membership for both associations through a single, joint membership fee program that would exist for a three year trial. This program was of great value to the RRTs in Ontario and saw our joint practicing membership grow to approximately 1300. After careful consideration by the CSRT Board, they decided to terminate the trial a year early and gave the RTSO notice in early 2013. This was not the fate that we had hoped for. As of March 2014, the program with the CSRT has been terminated and the RTSO has assumed all administrative and financial control of its membership registration once again. Since July 2013, more than fourteen electronic notices from the RTSO, the CSRT and the CRTO went out to all RTSO members and all practicing RRTs registered with the CRTO (over 3000) in the province about the end of this trial and the new RTSO membership process.

In the spring of 2013, the RTSO sent out an online survey to the entire RTSO membership. As well, we conducted another survey at the RTSO Inspire Education Forum in October 2013. Both were regarding the value of collaborative association membership strategies and a proposal to seek a similar joint membership trial with the Ontario Respiratory Care Society /Ontario Lung Association. Ninety percent of the survey respondents voted for a



President's Message froM rob bryan a-eMCa, rrt, aajoint membership plan with the ORCS. Further, many also valued a Professional Liability and Insurance (PL&I) program if it could be provided by the RTSO as an inclusion with membership. With this information, the RTSO Board worked with the ORCS and agreed to a three year trial that would see registrants receive an RTSO and ORCS membership. In addition, our front office was able to negotiate an incredible PL&I program that would also be inclusive with membership. This program protects the financial interest of all RTSO members and extends beyond what the Hospital Insurance Reciprocal of Canada (HIROC) program offered by most hospitals provides as the indemnity coverage that is mandated by the MoHLTC. What a lot of RRTs also fail to realize is that HIROC can opt out of covering you, if your actions are considered negligent or criminal. The RTSO insurance program will cover all claims, including legal fees for disciplinary hearings with the CRTO, criminal and court proceedings.

To summarize the value of RTSO membership, you now also receive ORCS membership and PL& I, as well as reduced membership fees for all of our education events and programs. This is less than the cost as our past three membership years. This is an exceptional value that you will not find anywhere else. Further, the RTSO has redeveloped and streamlined our membership registration processes to include on-line registration with a PayPal option as well as electronic insurance receipts and certificates.

Other initiatives of the RTSO include an advanced practice award in Anaesthesia Assistance for RRTs (with RTSO membership) enrolled in an accredited advanced AA program in Ontario. The RTSO is also pleased to launch a new initiative with an unrestricted grant focused on best practice and evidence-based care in Respiratory Therapy Anaesthesia

Professional Liability & Indemnity Insurance coverage:

$2M/incident / $4M aggregate; Nil Deductible

Disciplinary Defense: $175,000/claim / $175,000 Annual Aggregate

Criminal Defense Reimbursement: $200,000/incident / $200,000 Annual Aggregate;

Sexual Abuse Counselling & Rehabilitation: $10,000/insured / $250,000 Annual Aggregate

Legal Representation Expenses: Subpoenaed as witness $1,500 each claim

Complaint $5,000 / Max annual aggregate for both $50,000


President's Message froM rob bryan a-eMCa, rrt, aaAssistance for 2014-2015 and we hope to expand this program into other areas of respiratory therapy in the near future.

This year we are very excited about new projects that we hope will continue to add value to our membership. This includes our affiliation with the ORCS and their lung health advocacy program, a joint education conference with the CRTO scheduled for this fall, and a new fundraiser The RTSO Zombie Run. We hope this event will raise money for Respiratory Therapists without Borders (RTWB) and the Kiwanis Clubs initiative to reduce mother and newborn mortality through immunization programs in underdeveloped countries. Through these programs, our goal is to support our fellow RRTs in their pursuit to reach out to our local and global communities and help raise our professions profile and public awareness of who we are and what we do.

As you can see there is tremendous value in RTSO membership. More importantly, we must have a strong and united professional association to ensure that the personal and professional interests of all RRTs in Ontario is well represented and clearly advocated for with all public and government stakeholders.

Thank you again for your continued membership with the RTSO and thank you to those that have newly registered. For those of you who question your need for membership, I hope that I have answered those questions. If you are interested in volunteering for a committee or event, in becoming a Board member or know someone that would like to join the RTSO, please contact the RTSO office. This can be done by phone at 647-729-2717 or toll-free via 1-855-297-3089 or through email at [email protected] or online through our website at www.rtso.ca at your convenience.

Sincerely.....

Rob Bryan A-EMCA, RRT, AA


The Regulated Health Professionals Act (RHPA), 1991 (Health Professions Procedural Code) dictates that all regulated healthcare professionals engaged in practice must carry liability insurance. Further, the College of Respiratory Therapists of Ontario (CRTO) also mandates that all members engaged in the practice of respiratory therapy must possess liability coverage. In fact, the CRTO has put together an excellent policy that details the facts about liability insurance and it is a recommended read. ( http://www.crto.on.ca/pdf/Policies/Insurance-eng.pdf )

For those who are employed by a hospital, most will have professional liability coverage through your employers plan. However, one should ensure that their employers coverage does not just pertain to the organization but also to the individual employees. It does not need to list every HCP individually; it just needs to state that the policy covers the employees. While, this type of insurance does meet the demands of the RHPA and the CRTO, but is it enough?

Employer policies offer blanket coverage to incidents that occur within the organization and most of these hospital policies offer the indemnity coverage that is mandated by the MoHLTC. Unfortunately, what a lot of RRTs fail to realize is that these insurance companies can also opt out of covering you, if your actions are considered negligent or criminal. As well, there are several other issues that exist in which that policy may not offer the coverage and protection that you may require. These include legal costs for CRTO disciplinary hearings, human rights tribunals, criminal acts and coroners inquests. Any one of these events could lead to emotional devastation as well as financial ruin. Even a false accusation can lead to horrendous legal costs with no ability to recoup those costs even when proved innocent.

The Respiratory Therapy Society of Ontario (RTSO) now offers Personal Liability Insurance (PLI) as part of its membership. This coverage expands beyond what employers offer because it protects you against allegations that may include: Malpractice Error, omission or negligence in providing a service Failure to provide a service Misrepresentation of Facts Improper Documentation

The RHPA states that PLI is required by all HCPs engaged in practice as a means to protect the public. Would it not then be feasible as a clinician to ensure that you are personally protected as well? Yes, hospital employers offer a coverage that satisfies the requirements of the RHPA but is that coverage enough to protect you and everything important to you?

The Question of Liability Insurance


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RTSO Committee UpdatesLeadership

The RTSO Leadership Committee continues to work on improving the methods by which we communicate with our members. Our Go to Meetings account is up and running and our monthly meetings are now held via this platform. RTSO members can attend the leadership meetings from any computer/laptop or a multitude of mobile devices. In addition to our Go to Meeting videoconferencing system, we are investigating the

possibilities of developing our own link on the RTSO webpage. This will enable RTs from across the province to post and share policies, procedures and best practice guidelines. As well, we hope to develop a message board for quick and easy discussions.

The Leadership Committee continues to keep open channels of communication with the Canadian Institute of Health Information (CIHI) as they pursue the RT workload measurement revamp. The RTSO has conducted a few surveys to provide continuous feedback and input from RTs across Ontario to CIHI and its working groups. The feedback provided has been well received by the CIHI development team and this information will be incorporated into the new model.

Currently, the RTSO and Covidien have partnered to host five events throughout Southern Ontario at the end of April until the beginning of May. These events are focusing on new initiatives that Covidien has undertaken pertaining to the safety of ventilator operation. These seminars will also enhance the understanding of the role of the RTSO, the need for profession advocacy and the importance of being a member of your provincial association.

If you would like to learn more concerning any RTSO initiatives or if you would like to become a member of the Leadership Committee or any of the other special interests groups of the RTSO, please contact me at [email protected] or the RTSO at [email protected].

Kyle Davies, RRTLeadership Chair


Ginny Myles, RRT, CRE, BHA (Hons).

Community RT Committee Co-Chair

Mika Nonoyama, RRT, PhD,

RTSO Director /Community RT Committee Co-Chair

We always look forward to new members and we value the input and views that they provide. The RTSO represents all RTs across the province, members and non-member since the work that we perform is vital to all of us. An increase in membership provides a greater input and a better representation of the needs of RTs throughout Ontario. This will, in turn, enable a greater influence for our profession at the provincial level.

Kyle Davies

Community RTThe Community RT group has been busy collecting feedback from interested RTs across the province regarding what they believed the priorities and objectives of this committee should be. These were compiled into a list of ten and sent out in a survey format to all members. These surveys are still being collected but a telephone meeting of the group was held on April 15. To date survey results were discussed and invitations to volunteer for a 7-8 member committee were presented. The next steps for this special interest group will be to receive formal approval from the RTSO Board of Directors to proceed with a committee, develop terms of reference for the committee and establish its priorities. Meetings are expected to be monthly for one hour by teleconference with a face to face meeting planned for the RTSO forum in November 2014. Other local duties will occur when necessary or when assigned.

There is still time for anyone who may be interested in participating in this special interest group. Please contact Ginny Myles at [email protected] or Mika Nonoyama at [email protected] , if you would like further information regarding membership.

Committee Reports - Leadership / Community RT

Focus on ResearchIntroduction


The members of the RTSO Research Committee would like to thank Dave McKay and Elisabeth Biers for the research focus of the 2014 Spring Edition of the RTSO Airwavessince all of us are excited and impressed with some of the research, evaluation and quality improvement initiatives that respiratory therapists are leading across the province! We are aware that evidence-

based medicine provides the underpinning for todays medical practice, and who best to provide the evidence for the practice of respiratory therapy than respiratory therapists! New opportunities are evolving through academic-centre research initiatives as well as academic, community and small hospital quality improvement opportunities!

Please take note that were in the process of updating the Research section of the RTSO web-site which will have lots of resources, courses (including on-line), examples of respiratory therapists peer-reviewed publications and more to help you on your research journey. Were also putting together the finishing touches for a Respiratory Therapy Research Network group to hopefully include social media opportunities to share information more readily.stay tuned.

We hope youll enjoy reading about your colleagues across the province. These are respiratory therapists, like you, who are readily engaging in qualitative and quantitative research, as well as quality improvement initiatives that offer a research component.

We all should be keeping up to date as new evidence becomes available. You can be involved by critically reviewing articles in peer-reviewed publications; supporting colleagues who are involved in research initiatives and/or become involved by assisting with a research project or even by completing the course work to become an investigator as part of

Nancy Garvey RRT, CAE, MAppSc.

Research Chair


a research teamall offer great opportunities to enhance your practice and contribute to improved patient care!

Thanks to the 2013-14 Research Committee members: Louise Chartrand RRT MA PhD(c) and Akhilesh Patel RRT BSc., both from Ottawa; Shelley Prevost RRT MAppSc., from Thunder Bay; Brooke Read RRT BSc. MHS(c), from London; Brittany Giacomino RRT BSc., from Toronto and Mika Nonoyama RRT PhD, who is the RTSO Clinical Scientist.

Welcome to our new members for the 2014-15 year, Marianne Ng RRT BSc MHSM from Toronto who is replacing Brittany, and Ashley Waugh SRT, B.Sc. Hons., from London, who is a third year respiratory therapy student at Fanshawe College. And thanks again to Akhilesh who will be my Co-chair through 2014-15. Together we all aim to support colleagues in gaining and improving research skills in order to build a research capacity within our profession so that our practice will be based on solid evidence, and our patients will experience the best outcomes possible!

Focus on Research - Introduction

Editor - Dave McKay, RRTLayout/Design - Elisabeth BiersOpinions expressed in RTSO Airwaves do not necessarily represent the views of The RTSO. Any publication of advertisements does not constitute official endorsement of products and/or services.and may not be copied or duplicated in full or in part

without prior permission.

RTSO Airwaves is a publication of


Focus on ResearchWhy Should Respiratory

Therpaists Get Involved in

Research?

IntroductionWhy should RTs get involved in research? I find myself having to answer this question on numerous occasions. In fact, I have to answer this question every time I start teaching my course of research and ethics to second year students in the respiratory therapy program at La Cit collgiale. I also have to answer this question every time I state that I am a doctoral student at the University of Ottawa. It seems to me that every time the big R word is brought forth, there is a sense of incomprehension that can be pushed to the point of aversion towards research. In this article, I would like to build the argument that research

not only plays an important part in our role as clinicians, but I also intend to justify that it is the foundation of everything that we do and aspire to change. I am going to accomplish this by initially having a discussion about the way we gain knowledge. Said differently, in this portion, I would like to answer the following question: How do we get to know what we know? This will help us answer the question Why should we do research? Secondly, I am going to present the concept of the sociological imagination that was created by a famous sociologist, C. Wright Mills. This will be helpful to explain why, if we dont conduct our own research, we should at least get involved in helping other researchers do theirs. I also hope this article will help clarify or justify why we sometimes do things that we might find boring or insignificant in the name of research. But mostly, I wish to inspire other respiratory therapists to take a lead in research, as I am doing. This is necessary because it is the most effective way to improve who we are as clinicians and what we should be most passionate about, which is improving patient care.

Louise Chartrand RRT, PhD sociology.University of Ottawa

Why Should Respiratory Therapists Get Involved in Research


Epistemological reflection ways of gaining knowledge Before I lose a portion of my readers with the big term epistemology, I just want to reassure you that even though this word might sound very complex and out of reach, it is the portion of philosophy that studies the question of How do we know what we know? In order to answer this question, I am going to describe the four ways of gaining knowledge: the tradition, the authority, personal experience and finally science. At the end of this part, I hope to have convinced some of you why respiratory therapists should get directly involved in research.

The knowledge obtained by tradition is based on past belief (Fortin, 2010:17). Said differently, tradition is often based on irreplaceable forms of knowledge that permit generations to build on what has previously been done. This kind of knowledge, in numerous cases, is still true today as they were in the past (Fortin, 2010:17). For example, Newtons Laws are still as valuable today as they were in the 1600s when he first discovered them. Although tradition may represent a great advantage, some of the knowledge of the past can come into question, especially when it is based on ritual or is not critically analysed (Fortin, 2010:17). Therefore, a critical evaluation of tradition is necessary in order to advance and gain further knowledge.

Tradition is often passed on by the second form of gaining knowledge which is the authorities. The authorities are the people that are being recognized, often institutionally, for their competence in a particular domain. An example can be doctors (Fortin, 2010:17). The knowledge that comes from the authorities is extremely valuable and is necessary since we, as individuals, cant know everything and must rely on experts in order to guide us. However, there are times that the authorities maintain customs without tangible proof. In other words, the authorities are humans too. As a result, they can also make mistakes which mean that they are not necessarily right all of the time (Fortin, 2010: 17). Sometimes the authorities knowledge comes from personal experience, which is our third way of gaining knowledge.

A large portion of our knowledge comes from the experiences that we gain during the practice of our profession and the personal experiences that life often provides us. More specifically, during situations when an intervention is required. Personal experience allows us to recognize the tendencies or the various forms or modes of response which determine and suggest the ways that we should respond (Fortin, 2010:18). This permits us to master tasks and prevent negative events in our personal and professional lives. For example, the first time you did an intubation; there are things that you may have done that worked and others that



didnt work well. Therefore, the next time you did an intubation, you readjusted your behaviour and the way you preceded with it accordingly. This permits us to be more proficient in our professional practice. With time, our actions and beliefs become automatic and can contain errors or even false conclusions (Fortin, 2010:19).

This brings us to our last way of gaining knowledge which is science.The term science can have different meanings. Indeed, this term can represent a discipline, a particular knowledge or a particular field. The objectives of all science are to construct an organized body of knowledge on a particular subject and to give a valuable and reliable explanation of a phenomenon. Therefore, science is a collection of organized knowledge founded on evidenced-based research that confirms theories (Fortin, 2010:19). It is because of the development of knowledge through research that science is in constant progression. Furthermore, on the social ladder, evidenced-based research is the highest ranking form of gaining knowledge. This can be demonstrated by the fact that all professional medical fields, including respiratory therapy, advocate for evidenced-based practice. If we, as respiratory therapists, claim that we are an evidence-base practice, but the evidence is being produced by other professions, what does this say about our field? If research is being dismissed by some of our professional leaders, what does this say about our field? Is respiratory therapy still stuck in an era aligned with the Dark Ages where the authorities had the only word?

Our field has come a long way since it was first established fifty years ago. However, there is still a big road ahead of us if we want to gain the respect within our professional practice and amongst other disciplines. The only way to do so is to get more involved in knowledge production and in research because this is the fundamental base of our practice. Everything that we know and everything we aspire to change comes and will come from research. If, historically and socially, we were able to defeat religious authority through science (Martuccelli, 1999), I am sure our field can do the same. I do realize taking the road to partake in research is long and full of obstacles and I am also aware that it is not an aspiration for all of us. However, there is still a manner that you can help with research in an indirect way. This will be shown within the next portion of this article where I am going to explain the concept of the sociological imagination.

The Sociological Imagination you can be that final drop that makes the cup overflowThe Sociological Imagination is another concept that was developed by American



sociologist C.Wright Mills in 1959. He believed that Sociological Imagination was a tool that could help people to see the many connections that exist between what happens in an individual life and the rest of the social structures that make up society. Mills (2006) argues that the rise of modernity, with the focus on individualism, is making it more difficult for individuals to realize that they are part of a bigger whole. Therefore, this makes it difficult for individuals to see that their actions can make a bigger impact which can influence society as a whole.

I am now urging respiratory therapists to try to gain a bigger sociological imagination and start to participate or assist in research projects. Indeed, it sometimes only takes one participant to make the difference between statistical significance existing or it not existing. Just like it only takes one drop of water to make a glass of water overflow. I want you to reflect on your practice and be honest with yourself. Did you ever refuse to follow a research protocol because it created extra workload? Did you ever refuse to do a spirometry on someone because it was needed for research and not for a specific treatment? If you answered yes to one of those questions or others that may be similar, this may have been the one patient that was needed for that study to gain statistical significance.

ConclusionThis article aims to help respiratory therapists reflect on their own practice and attitude towards research. Since research is one of the highest ranked processes to gain knowledge, I strongly believe that we need to take ownership over our knowledge building and practice development. Furthermore, I believe that we have a very unique and particular kind of knowledge which can make a difference and be of significant value to the larger medical field. However, it also needs to go one step further where we can develop our own research protocols to address the gaps that exist in our own profession.

In closing, I must say that I am tremendously grateful to those of you who are taking the steps toward research because this is the most significant way that we are going to be able to develop the solid foundation necessary to move forward and improve our profession.

BibliographyFortin, Marie-Fabienne. Fondemments et tapes du processus de recherche: Mthodes quantitatives et qualitatives. Montral: Chenelire ducation, 2010.Martuccelli, Danilo. Sociologies de la modernit. France: ditions Gallimard, 1999.Mills, Charles Wright. L'imagination sociologique. 4. Paris: ditions La dcouverte, 2006.

The author is being funded by the ORCS


Not every Respiratory Therapist is excited about the prospect of being involved in research, but every Respiratory Therapist uses evidence derived from research in their clinical practice. Effective research continually influences the practice of respiratory therapy and patient outcomes.

As a third-year clinical student in Respiratory Therapy, I often see confusion on the faces of my classmates when I show excitement about research. More frequently, when a research

paper, article critique or literature review is mentioned, students dread the thought of sifting through journal databases, reading abstracts and compiling references. A handful of us, however, feel quite differently!

My undergraduate degree in Biological Science and Psychology exposed me extensively to research, both applied and theoretical. Countless volunteer hours were dedicated to pipetting at lab benches and recording data. I wrote many research papers, created scientific posters and presented at seminars. Despite the fantastic exposure and practical experience derived during university, I made the decision to pursue my growing interest in healthcare as post-graduate work prior to obtaining a masters degree.

Throughout the two didactic years of the Respiratory Therapy program, my continued interest in research has been incorporated into my studies whenever possible. Some of my attempts at making research accessible to students were more successful than others. My attempt at founding a Journal Club to discuss relevant papers in our profession was met with general disinterest. Undeterred, I continued

Focus on ResearchA Personal Look at Research in

Respiratory Therapy

Ashley R. Waugh, B.Sc. Hons, SRTFanshawe College

to involve myself in organizations and events that would support my interests. I am fortunate enough to be on the executive board of the Respiratory Therapy Student Federation (RTSF) and was extensively involved in planning the 4th Annual RTSF Conference in 2013. As my responsibilities included reaching out to prospective speakers, an assembly of respected healthcare professionals who value evidence-based practice relayed the importance of understanding research in an interesting, understandable way. Students appreciated the value of applying research findings to clinical work and realized the knowledge derived from academic studies can be (and should be) translated into bedside practice.

In my final clinical year, I have had the opportunity to mentor students with their own research projects and have been regarded as a peer resource. Currently, I am presenting a scientific poster at the Student Research and Innovation Day at Fanshawe College. Thirty-one applied and social innovation research projects have been selected to compete, based on abstract submissions. It is encouraging to see that four of the selected abstracts are authored by Respiratory Therapy students! I am hoping that my involvement with the RTSO Research Committee will inspire students, recent graduates and all of our colleagues to pursue research interests and enjoy applying research findings in their practice. There are many ways to become involved I know there are more than just a handful of us!

A Personal Look at Research in Respiratory Therapy



At UHN, through the Collaborative Academic Practice (CAP) Professional Practice portfolio as well as through the Organization & Employees Development (OED) office, there are many learning opportunities available to staff Respiratory Therapists (RTs) who want to expand their interest in quality improvement initiatives, point of care leadership and research skills and project development. We hope to use this article as an opportunity to share with you, our experience as novices venturing into the world of research and leadership.

"When the window of opportunity appears, don't pull down the shades" - Tom Peters Firstly, CAP offers exciting fellowship and research learning opportunities to health professionals including Respiratory Therapists across our organization. RTs can apply to CAP for interprofessional fellowships and point of care research grants. The CAP Fellowship Program aims to provide an annual opportunity to lead an innovative quality improvement or research project. It is intended for healthcare professionals who are not ordinarily able to leave their point-of-care work environment without coverage by other staff, and who do not already have leadership development or research time built into their roles. The CAP Research Grant Program - Phase One Facilitating Participatory Learning in Research is a newly formed program based on very successful legacy programs in allied health and nursing, that aims to support and coach a team of novice researchers to formulate a full research plan for an internal funding competition. Staff members participate in a mandatory curriculum provided by CAP Research Leaders and UHN clinician scientists which covers the academic steps necessary to formulate and research a question, consider methodology and develop a proposal. Accepted teams are paired with expert mentors to help develop the full research plan to be

Focus on ResearchRespiratory Therapists Research

and Leadership Journey at University Health Network

(UHN) Submitted by Marianne Ng, Nancy Chan, Madeeha Chatoo, and Jules Malone

submitted for the research grants competition and ultimately research ethics board approval. This year there were eight health profession teams selected for the awarded opportunity, two of which are led by RTs at UHN. Last year there was one fellowship which included an RT.

Secondly, OED offers a program called Emergent Leaders, which provides an opportunity for self-identified, high-performing employees to strengthen their leadership skills through a combination of formal development, relationship building and on-the-job activities. Ultimately, this program is focused on and fosters an environment of interprofessional collaboration for advancement and innovation in patient care. This year, an RT staff member was awarded the opportunity to participate in this program with stiff competition from other applicants.

The following are the three RT led opportunities: Collaborative Academic Practice (CAP) Research Program: Participatory Learning in Research:

Research Topic: BNP (B-type natriuretic peptide) as a cardiac biomarker for diagnosis and prognosis

The TGH RT Team - Lucy Song RRT MHSc, Michelle Hudson RRT, Jingli Yang RRT MHSc , Madeeha Chatoo RRT, BHSc

Madeehas Journey:

Having the opportunity to participate in the CAP Research Internal Grant Competition has been a rewarding learning experience. The purpose of our study is to determine whether or not adding BNP will have an effect on clinical decisions about readiness for weaning from mechanical ventilation. By going through the Participatory Learning in Research option, we were able to engage in four sessions which were meant to guide and teach us how to put together a research proposal. It is amazing how much we learned and grew during this time. With the help from our mentors, we were able to transform our basic idea into a final research proposal. RTs work in a high demanding environment where resources are limited; hence, participation in research does require a lot of time, effort and

Respiratory Therapists' Research and Leadership Journey at UHN


If we knew what we were doing, it would not be called research, would it? - Albert Einstien


dedication. However, it was definitely worth it. Being part of this research study has allowed me to discover another passion of mine, and I am glad that I have had the opportunity to work in the critical care field as well as be involved in a research study at the same time.

Research Topic: The effect of education and skills training on self-reported clinical knowledge and self-efficacy of tracheostomy care and deep suctioning among nurses and physiotherapists

The TWH Team: Nancy Chan RRT, BSc(Hons), Bo Siu PT, MScPT, BScKIN, Paula Cripps-McMartin RRT, MAHSc ,Grace Ojo RN, BScN, CMSN(C)

Nancys Journey:

Our interprofessional research team consists of two respiratory therapists, a physiotherapist, and clinical nursing educator from Toronto Western Hospital. This participatory program was a phenomenal experience that seamlessly allowed our team to collaborate with one another. We did this by attending exciting educational seminars while receiving mentorship from research experts. During the education sessions of the program, CAP leaders and mentors shared their knowledge of their research skills, resources, materials and methods, as well as data analysis strategies. During our last session in mid-January, both Bo Siu PT and I presented the blueprint of our research to a dynamic panel of peer reviewers, and we received positive, insightful feedback to strengthen our research project. Finally, we submitted a formal grant proposal to the CAP research committee for funding. Throughout the entire process, our interprofessional team received the guidance and support of the members of the CAP research committee, our designated mentor, statisticians and information specialists. The CAP Participatory Learning in Research experience has empowered our team to pursue research with confidence. This is a big leap forward to cultivate new knowledge and skills to explore and contribute to clinical research at Toronto Western Hospital.

You can do what I cannot do. Together we can do great things.- Mother Teresa



Collaborative Leadership in Research: The best of both worlds - When the Emerging Leader meets the Fellowship The Interprofessional Team: Jules Malone, RRT, BSc & Jenny Barker, SLP, MHSc

Jules Journey: This leadership training empowered me to exercise my collaborative leadership skills by engaging in a project with a Speech Language pathologist, who is participating in a research fellowship program. This research project is to investigate the quality of communication using a talking trach as part of an action learning project. I took on a research leadership role within the RT department and in the Intensive Care Unit to champion an innovative patient-centred practice change and look for evidence that improves the quality of care.

Lessons Learned:

Lesson 1: Research is not always a smooth journey! Planning strategically and working step by step are key components to the success of the focussing, shaping and investigation process.

Lesson 2: Building relationships and engaging key stakeholders fuels the energy, perspectives, skills and expertise needed to drive the project forward.

Lesson 3: There will always be more questions along the way and the best solution is to seek out expertise or mentors for assistance to ensure and maintain the necessary focus.

Respiratory Therapists can benefit professionally by developing leadership skills and research understanding and abilities. Together, these can build academic knowledge as well as change professional and interprofessional point of care practice for patients and families. Workplace-based programs in healthcare institutions can act as a catalyst for this development. RTs on this journey, as our stories illustrate, can act as mentors and leaders for colleagues, students and other professions. By acting in this capacity, RTs can also help create new knowledge pathways between academic faculties and practice.



The Ontario Respiratory Care Society:Improving lung health through excellence in interdisciplinary

respiratory care

Beginning with the 2014-2015 membership year, the Respiratory Therapy Society of Ontario (RTSO) is including membership in the Ontario

Respiratory Care Society (ORCS) as a benefit of its membership. I was asked to write a history of the ORCS to introduce the Society to RTSO members

who will become ORCS members for the first time.

The Lung AssociationThe Lung Association was founded in 1900 as The Canadian Association for the Prevention of Consumption and Other Forms of Tuberculosis. The Christmas Seal Campaign, a tradition begun in Denmark in 1903, was brought to Canada in 1908 to assist in raising money to build hospitals for individuals with tuberculosis. Since 1927 the Campaign has been The Lung Associations primary national direct mail fundraiser. Following the introduction of antibiotics to cure TB, The Lung Association expanded its mandate to address other lung diseases, including asthma, COPD, lung cancer and other less common diseases. In addition, the organizations programs have included funding of multi-disciplinary respiratory research, health education and the development of resources for respiratory health-care providers, people with lung disease and the public. The Lung Association also acts as an advocate with various governmental

agencies. The Ontario Tuberculosis Association, which later became the Ontario Lung Association (OLA), was founded in 1945. In 2010, Kelly Munoz became the first Registered Respiratory Therapist to chair the OLA.

Submitted by:

Sheila Gordon-Dillane, Director, ORCS

100th Anniversary Christmas Seal


Ontario Respiratory Care SocietyHealth professional societies are a unique feature of Lung Associations. The Ontario Thoracic Society (OTS) was formed in 1960. The ORCS began in the early 1970s as the Nurses section of the OLA and became multi-disciplinary in 1977, encouraging nurses, physiotherapists, occupational therapists, social workers and respiratory therapists to join. Its goal, according to a 1986 report to the OLA Governing Council was: To encourage the provision of quality respiratory care to individuals by providing educational opportunities for health professionals. The annual membership fee was $5.00. The first respiratory therapist to join the Provincial Executive was Robin Warren from London in 1987. She was also the first RRT to chair the Society in 1990-1991. Chairs over the years have included nurses, physiotherapists, a social worker, a pharmacist and two other respiratory therapists, Mike Keim and Libby Groff. The Chair-Elect, Shelley Prevost, is an RRT. Leadership is provided to the ORCS by the Provincial Committee, which includes the Chair, a Chair-Elect or Past Chair in alternate years, the chairs of four standing committees, regional and interest group representatives and a representative of the OLA Board of Directors. It meets three times a year. The ORCS has two staff, a Director and an Administrative Assistant. For many years these positions were part-time, becoming full-time in 2001.

Respiratory Health Educators Interest GroupThe Ontario Asthma Educators Association (OAEA) was formed in 1997 when the Canadian Network for Asthma Care (CNAC) and certification of asthma educators began. Membership was multi-disciplinary. They charged a $35 membership fee and offered occasional education programs and a publication called Connections. After several years of operating as a volunteer organization, the Executive decided that administrative support was needed and they approached the OLA to propose a merger. The OAEA became an Interest Group of the ORCS in 2001, with a $15 supplementary membership fee. When COPD Educator programs began, the membership broadened and the name was changed to Respiratory Health Educators Interest Group (RHEIG). Their two main programs have been Connections and a half day education program at the Better Breathing conference. Interest group membership has been consistent at about 100 people a year.

When Asthma Educator certification began, The Michener Institute introduced asthma and later COPD educator training to prepare people for the national exam. When that program ended in 2006, the OLA introduced RespTrec, developed by the Saskatchewan and Manitoba Lung Associations, to Ontario. Most of the trainers for the program, now managed at the Ontario Lung

Improving Lung Health Through Interdisiplanary Respiratory Care


Association by Diane Feldman, RRT, CRE, are respiratory therapists. Several hundred people are trained each year across the country and

most become certified as CREs.

Professional Education ProgramsDuring the 1980s, multi-disciplinary ORCS Regional Groups were formed

in several centres, initially Toronto, Hamilton, London and Kingston and later in Sudbury and Thunder Bay. Some were assisted by The Lung

Associations local offices and part-time staff support was provided by the OLA Provincial Office. The Regional Groups organized full day seminars,

with volunteer ORCS members handling most of the arrangements.

The Regional Group structure has worked well and professional education continues to be a key program area for the ORCS. Currently, we have seven

Regional Groups: Eastern Ontario, Greater Toronto, South Central Ontario, Southwestern Ontario, Essex/Kent, Northeastern Ontario and Northwestern

Ontario. Each Region offers a full day seminar or an educational evening session each year and some offer more than one. Normally, five or six full day seminars

and about five educational evenings are held each year, attended in total by several hundred people. Extensive volunteer involvement and strong exhibitor support have resulted in a highly regarded and affordable seminar program. The dedication of the members of our regional group committees, some of whom have participated for more than 20 years, is extraordinary. Speakers generously volunteer their time and expertise.

Better Breathing Conferences The Better Breathing Conference, a province-wide education program, initially involved only the OLA staff and volunteers and the OTS. In 1986, under the leadership of the Toronto Region (the strongest regional group at the time), the ORCS held a one-day seminar at Better Breathing on Mechanical Ventilation from ICU to the Home with a registration of 135 people. The following year, the theme was A Paediatric Focus on Respiratory Care. In 1988, the ORCS Annual General Meeting was held at the

Better Breathing conference for the first time. It was not until 1991 that the ORCS members began attending the Plenary Session with the OTS and OLA staff and volunteers.

20 Year Members at Better Breathing Conference 2008


Although ORCS attendance at Better Breathing has remained fairly constant at about 150 people per year, the conference content has grown and evolved. The program is now planned by the ORCS Education Committee, currently chaired by Mike Keim. Saturday morning workshops were added in 1992 the first two on how to write a research grant proposal and how to write for publication attracted 12 people. Gradually the Saturday program grew into its present format of two sets of three concurrent workshops addressing a range of topics and care settings. Approximately 120 ORCS delegates now attend the Saturday workshops.

A Thursday pre-conference workshop was offered in conjunction with the OAEA in 2001. This evolved into the RHEIG sessions when the OAEA became part of the ORCS. Today, the RHEIG sessions are an integral part of the conference, attended by more than 100 people.

The poster session was added to the conference in 1999 which was an initiative of the Research and Fellowship Committee. Ten posters were submitted the first year. This session provides an opportunity for people who have never presented a poster before to gain experience with this skill. We have averaged about 14 posters per year. As well, various formats have been used for the moderated poster session including Saturday morning workshops and the current format of a reception at the end of the Friday sessions. Awards were added in 2003 for the best poster and the best student poster. Judy King (PT), who currently chairs the Research and Fellowship Committee, has moderated the poster session throughout its history.

Prior to the introduction of industry-sponsored breakfasts at Better Breathing conferences, the ORCS hosted a Saturday morning breakfast session each year. This provided an opportunity for some memorable presentations patient perspectives on living with home oxygen, a therapeutic clown from the Hospital for Sick Children, a Street Health nurse, therapeutic drumming and many more. Various social events, most sponsored and hosted by ProResp, were also offered after the traditional Friday evening banquet was discontinued in 2006.

ORCS Research ProgramsAt the national level, the Canadian Lung Association had two societies for non-physician health care professionals: the Canadian Nurses Respiratory Society and the Canadian Physiotherapy Cardio-Respiratory


Mika NanoyanaPoster Award Winner 2008



Society. In the 1980s, they each had a research program, through which they funded research grants and fellowships for members taking

Masters and PhD programs. After encouraging members to apply to the national programs, the ORCS developed its own research program. Led

by Margaret Fitch, the first ORCS Research Committee Chair and Dale Stedman, the ORCS President in 1989-1990, the ORCS convinced the

OLA Governing Council to assign 10% of the OLAs dedicated research budget to the ORCS, with 90% going to the OTS. The first year of ORCS

funding was 1991. This 90/10% division of funds has not changed over the years; however, the overall budget for the research program has increased

annually for the last five years.

Despite its limited funding, the ORCS Research and Fellowship Program has made a substantial contribution to increasing the research capacity and

enhancing research skills of respiratory health professionals in Ontario. Many people funded for Fellowships to complete post-graduate degrees have gone

on to be funded provincially and nationally as investigators on research grants. Initially, because most were diploma-trained, few respiratory therapists qualified

for these funds. This has changed as many RRTs obtained Masters level degrees, mostly through Charles Sturt University. A few have also gone on to complete doctoral degrees in Education or Rehabilitation Science. Many ORCS members

who are university professors have served as mentors to their students, encouraging them to apply for funding and to volunteer for the ORCS. One of the expectations for funding recipients is the presentation of results at a Better Breathing conference. The Committee often offers skill-building workshops at the conference as well. Several RRTs have served on the Research and Fellowship Committee: Renata Vaughan, Nancy Garvey, Mika Nonoyama, Marilyn Hyndman and Paula Burns, who chaired the Committee for several years. ORCS PublicationsThe first issue of Update was published in March of 1985 and featured a story about the St. Josephs Hospital in Londons COLD Program excursion to the CNIB camp at Lake Joseph in Muskoka. Other articles addressed Long-term Oxygen Therapy, Physiotherapy Approach to Rehabilitation and Smoking and Health Policy. A previous newsletter had been published sporadically in the late 1970s

Update First Issue - 1985


and early 1980s but Update became the official publication of the ORCS. One issue was published in 1986 and in 1987, the three issue per year format, published in January, May and September, began. A volunteer Editorial Board was created in 1988. Corporate sponsorship was provided by pharmaceutical companies to cover printing costs. In recent years, home oxygen and medical equipment companies have provided support. Jocelyn Carr, a physiotherapist who joined the Editorial Board in 2011, is now the Editor.

The dedication of members of the ORCS Editorial Board, resulting in a high quality publication with articles on a wide range of respiratory topics, cannot be over-stated. Of particular note is Dina Brooks (PT), who sat on or co-chaired the Editorial Board from 1995 until 2013, providing exceptional leadership and introducing the Respiratory Articles of Interest and In the Spotlight (recognizing exceptional members) columns that are now regular features. Several RRTs are long-serving Editorial Board members: Renata Vaughan, Yvonne Drasovean, Mika Nonoyama and Libby Groff.

Research Review is published jointly by the ORCS and the OTS to highlight the results of research projects funded by The Lung Association. The joint publication was preceded by the ORCS publication Research Update, which began in 1997 as a joint initiative of the Editorial Board and the Research and Fellowship Committee. Research recipients are asked to provide a summary of their project or thesis study, focusing on its results and clinical implications, and a personal profile responding to questions such as why they chose to study or work in respiratory care. The same format was kept when the OTS agreed to participate in a joint publication in 2003. Due to a lack of sponsorship support for printing and distribution, Research Review has been issued only electronically since 2010.

The third ORCS publication is the RHEIG Connections. As noted earlier, it began as the OAEA newsletter. Regular columns have been maintained over the years Eye On a respiratory education program, Lung Association News, a Tool Box of teaching tips or resources and an Executive Team Message. Connections is published three times


Cover of Spring 2013 Update



a year and is distributed with Update to RHEIG members and Lung Association offices.

Support of Lung Association Programs

Since its inception, ORCS members throughout the province have contributed their time and expertise in support of Lung Association

in a variety of ways. These include patient education programs, the development of educational resources and clinical practice guidelines,

assisting patient support groups and participating in OLA advocacy and fundraising efforts. When the OLA had Community Office Boards

of Directors and program committees, many ORCS members served on them. As more services were centralized and some local offices were

closed, Society members have continued to be representatives of The Lung Association in their communities, serving as media spokespersons and

assisting at local events.

Impact of Health Policy and Program ChangesOver the years, changes in health policy and restructuring of health care delivery have affected ORCS members and programs. Some of the key events were hospital restructuring and contracting out of homecare by the CCACs in the mid-1990s during which many ORCS members lost or changed jobs. The Ontario Asthma Program and

the Smoke-Free Ontario Act expanded the role of the OLA and also shaped Lung Association program priorities. The transformation in primary care, including the establishment of Family Health Teams, shifted care from hospitals to community settings. As a result, more ORCS members, including RRTs, work in community agencies than occurred in the past.

ORCS Volunteers Extraordinary Commitment Each year, more than 100 ORCS members volunteer for The Lung Association in some capacity. With a current membership of about 500, this is a very high degree of participation. Also exceptional is that there are at least 30 members who have volunteered for more than 20 years and a few who have now been involved for 30

ORCS members at advocacy event 2011


years. We appreciate this dedication and commitment very much. Registered Respiratory Therapists now comprise about half of the ORCS membership and this will grow with our partnership with the RTSO. The ORCS Membership and Program Promotion Committee which is chaired by Miriam Turnbull RRT, has introduced recognition programs for long-term members and volunteers.

Conclusion - A Personal NoteIt has been a privilege for me to have been the Director of the ORCS for the past 24 years. I have been very impressed with the willingness of members to participate on planning and program committees, write articles for our publications, speak at seminars, review articles or research proposals and support advocacy efforts despite the pressures of work and family commitments. I was very honoured last fall to be selected by Rob Bryan for the RTSO Presidents Award.

On behalf of the ORCS, I welcome those of you who are new members. We look forward to working with you to improve lung health and respiratory care in Ontario. For further information, visit www.on.lung.ca/orcs or call 416-864-9911 or 1-888-344-5864, ext. 236 or 256.

Rob Bryan and Sheila Gordon-Dillaneat RTSO Education Forum 2013



The Respiratory Therapy Student Federation (RTSF) started from the idea of two students in the Respiratory Therapy (RT) program at Fanshawe College in 2006. Their idea was to develop an organization in which students from the RT program could work together and help promote what it meant to be a respiratory therapist. The organization also strived to assist various associations and activities throughout the community of London to promote lung health.

Today, the RTSF has over 200 members annually and is composed of first and second year students at Fanshawe College as well those in their third year doing clinical placements at various hospitals in and outside of London. There is a full executive committee that provides guidance to the membership and the RTSF continues to use a wide variety of platforms (i.e. website and social media: Facebook & Twitter) to endorse the organization. Throughout all of the years, the RTSF has continued to maintain its original message; awareness of the profession of respiratory therapy throughout the college and education to the public on the importance of lung health.

The year begins for the RTSF during Respiratory Therapy Week. The federation puts on a very large two-day display of various exhibits celebrating the wide variety of employment opportunities for the profession; some of the roles and responsibilities of an RT associated with acute, critical and chronic care and a brief look at some of the major lung pathologies which are impacting the health of the general public. This event involves close to 75% of our membership and has a direct impact on the faculty and student-body at Fanshawe College. It is estimated that close to two thousand students have interacted and/or discussed some aspect of the exhibits on display during the two-day event. The RTSF also uses this platform to begin fundraising for the annual student education conference.


Student CornerFocus on Fanshawe CollegeThe Respiratory Therapy Student Federation -

Fanshawe College: Then and Now.....Submitted by Ryan JohnsonPresident of the

Respiratory Therapy

Student Federation

Fanshawe College

As the year progresses, the RTSF is actively involved with a number of events endorsed by non-profit organizations. From the Lung Associations Amazing Pace and their annual Festival of Trees events; to the Cystic Fibrosis Chapter in Londons Sugar Bush event and the Canadian Cancer Societys Relay for Life. Each activity in the London community has a specific goal and the RTSF works relentlessly to help them achieve their objective.

The year is culminated with one of the largest student-coordinated and facilitated conferences in Ontario. For the last five years, the RTSF has taken on the task of providing a one-day education conference to respiratory therapy and other allied-health students. Students from colleges and universities across Southwestern Ontario have participated in this conference and have had the opportunity to listen to some exceptional subject matter experts in the fields of various lung pathologies, medical/surgical techniques, patient care interventions and patient perspectives. The conference provides the students with the opportunity to actively be involved in their own current education and all funds generated by the conference are donated to a local charitable organization.

This years 5th Annual RTSF Student Conference looked at the expanding roles of RTs in the community as well as the challenges faced by patients living with Pulmonary Hypertension. The conference took place at Fanshawe College on March 15th, 2014. All proceeds of this event were offered to the London Chapter of the Pulmonary Hypertension Association of Canada (PHA). For more information of this and future events, please go to www.rtsf.ca

As the President of the RTSF, it gives me great pride looking back at all of the accomplishments that have taken place over the last eight years. We, as members of the RTSF, cannot thank those past members enough for all of the hard work that they have done. To our current membership, your dedication to continue to grow and expand the RTSF is unwavering. I cannot thank you enough for all of your help over this last year and all of the achievements that you have successfully completed. I look forward to seeing what the future holds for the RTSF.

Ryan JohnsonPresident of the Respiratory Therapy Student Federation Fanshawe College


Student Corner - The Respiratory Therapy Student Federation - Fanshawe College: Then and Now.....


Student CornerFocus on Fanshawe CollegeAn Outlook into the Life of a

First-Year RT Student at Fanshawe College

Before we started as students in the Respiratory Therapy Program at Fanshawe College, we didnt know what to expect. We knew little regarding the amount of content we would cover and the hard work and dedication that would be needed. As we near the end of this first year, it has proved to be very challenging but also extremely rewarding.

On the first day of classes, we had the pleasure of meeting a handful of second-year students. They came to our class to give us some advice and encouragement. The primary message conveyed to us was to jump in head-first because the course load would build up quickly and there would be no stopping. They encouraged us to stay on top of our readings, notes and labs. At that time, most of us took that

advice for granted. Little did we know that within the first month of classes, coursework would be piled high and we would enter into our first set of mid-terms. Even though it has been challenging, we have learned why Respiratory Therapists are very passionate about their roles as healthcare professionals. Not everyone can stick with the gruelling exam schedules or nerve wracking practical exams. The road isnt easy, but it sure has been rewarding thus far.

In the first year of the Respiratory Therapy program, we are introduced to a variety of classes such as Disease Transmission in Healthcare, Mechanical Ventilation and Assessments in Respiratory Care. All of these courses follow the National Competency Profile that will help

graduated RT students prepare for the written licensing exam. In the lab, we learn all of the essential clinical applications to prepare us for third year such as patient interview and assessment, intubating and extubating, as well as hands-on work with current respiratory therapy equipment. We are given the opportunity to practice on mannequins, lab partners and standardized

Submitted by Stephanie Morin & Victoria Tesolin

Samantha DaCosta, first year student trying out the Horns of Plenty in the lab.


An Outlook into the Life of a First-Year RT Student at Fanshawe College

patients. Having lab time allows us to gain confidence in our practice before going into our hospital placement. Together, these classes prepare us for our clinical year when our didactic studies will come together with our practical learning during real-life experiences.

Our timetables and coursework are quite heavy but, as students in the program, we would not be able to survive without our supportive faculty. They give us all the necessary information to prepare us for our future placements as well as careers. Not only do they care about our success, they also make their greatest effort to provide all of the resources necessary for us to succeed in the program. Most of the faculty are RTs themselves and they all have unique qualities to add to our program. Their experiences include the emergency room, NICU, critical care, operating room as well as homecare which allow us to learn how RTs function in different environments and how unique our skillset is.

At Fanshawe College, we also have the benefit of being a part of a student-run organization called the Respiratory Therapy Student Federation (RTSF). It is made up of students from all three years of the program, professors and an official RTSO Board of Directors representative. As members, we provide awareness of our profession throughout the college by hosting events during Respiratory Therapy Week and an annual RTSF Educational Conference.

Victoria Tesolin and Stephanie Morin, experience what it is like to wear a nasal

cannula and feel the flow of oxygen.

Celine Dubeau practicing airway managment.


An Outlook into the Life of a First-Year RT Student at Fanshawe College

Banner on display at Fanshawe College during RT week.

Respiratory Therapy Week is our chance to provide other students at Fanshawe with information about Respiratory Therapy and show our excitement and pride. There are interactive demonstrations such as an intubation station and pig lungs attached to a ventilator, information

posters, banners and of course, plenty of RT students to answer questions and promote our profession.

The annual RTSF Conference is held at Fanshawe College each year and organized by upper year students. This year the topics included the Expanding Roles of RTs and Pulmonary Hypertension. The conference ran all day with different guest speakers and it allowed for students to network with different companies and organizations.

Members of the RTSF also help raise money for charitable lung and heart organizations by hosting bake sales or participating in events such as Relay for Life and Tulip Day to name a few.

Overall, being a Respiratory Therapy student at Fanshawe College has been a positive experience which has allowed many of us to get involved with every aspect of the Respiratory Therapy world. We look forward to future years filled with much

more learning and together with opportunities for growth, we hope will result in each of us having successful and rewarding careers as Respiratory Therapists.

Cyrus Tse and Stephen Lussier, first year students learing to intubate at RT Week at Fansawe College

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A revolutionary new tool for critical care respiratory support has recently been approved for use in Canadian hospitals, as well as in Europe and Australia. The device is called the Hemolung Respiratory Assist System (RAS). The Hemolung RAS provides partial support to the lungs by removing carbon dioxide directly from the blood using a simple, minimally-invasive, extracorporeal circuit. Unlike a mechanical ventilator, which provides support directly to the lungs, the Hemolung RAS provides ventilatory support independently of the lungs. This enables a patient experiencing acute respiratory failure to be ventilated with lower tidal volumes and peak airway pressures, preventing further damage to already compromised lungs. In some cases, the Hemolung RAS can be used to avoid intubation and mechanical ventilation in patients failing support with noninvasive ventilation due to refractory hypercapnia and respiratory acidosis.

The Technology behind the Hemolung RASThe Hemolung RAS is a simple extracorporeal circuit with only a single component that functions as both a pump and blood gas exchanger. Although the Hemolung RAS is technologically similar to cardiopulmonary bypass (CPB) and extracorporeal membrane oxygenation (ECMO) systems, it is substantially simpler to operate and is much less invasive. CPB and ECMO systems are used to provide full cardiopulmonary support and, therefore, require more invasive circulatory access and operational characteristics veno-arterial cannulation, two large bore catheters ( > 21 French), large surface area gas exchangers ( > 2.5 m2), pumping of blood at high flows (3 7 L/min), and heat loss compensation. Not surprisingly, these multi-component systems are highly complex and difficult to setup and operate. In contrast, the Hemolung RAS is intended to provide partial ventilatory support and operates at blood flows of only 350 550 mL/min, similar to dialysis, without the need for heat loss compensation. Circulatory access is achieved with a single, dual-lumen, 15.5 French catheter which can be inserted percutaneously in either the femoral or

Innovative Technology for Hypercapnic Respiratory Support


jugular vein. The gas exchange membrane surface area is only 0.6 m2 and the membranes are coated to increase hemocompatibility and eliminate plasma leakage. The Hemolung RAS is operated with a user-friendly, fully integrated controller which monitors for and signals alarm conditions.

The Hemolung RAS was developed and manufactured by ALung Technologies (Pittsburgh, Pennsylvania, USA). ALung Technologies was established in 1997 by Dr. William Federspiel, a bioengineering professor at the University of Pittsburgh, and the late Dr. Brack Hattler, a cardio-thoracic surgeon at the University of Pittsburgh Medical Center, to market artificial lung technology patented by Drs. Federspiel and Hattler and developed in Dr. Federspiels bioengineering lab. The

Hemolung RAS is the only device of its kind which employs a unique and safe means for actively mixing the blood as it passes over the gas exchange membranes, which significantly enhances the rate of gas exchange. In addition to its increased gas exchange efficiency, the Hemolung RAS was designed with the focus of therapeutic carbon dioxide removal as opposed to oxygenation. In membrane gas exchangers, the rate of carbon dioxide removal is much greater than oxygenation because of the greater solubility of carbon dioxide in blood and because the carbon dioxide carrying capacity of blood is not limited as it is for oxygen by the binding capacity of hemoglobin. Because of the increased efficiency of the Hemolung RAS and its focus on carbon dioxide




removal, clinically meaningful ventilatory support in the form of extracorporeal carbon dioxide removal (ECCO2R) can be achieved at much lower blood flows, exposing the blood to less membrane surface are, and with a smaller, single catheter as compared to other extracorporeal systems.

Who is a candidate for the Hemolung RAS?ECCO2R with the Hemolung RAS can be used as either an alternative or an adjunct to mechanical ventilation in cases where hypercapnia and respiratory acidosis persist despite adequate oxygenation. Severe exacerbations of chronic obstructive pulmonary disorder (COPD) are a prime example. The Hemolung RAS can be a valuable alternative to mechanical ventilation for patients admitted to intensive care due to a severe exacerbation where hypercapnia and respiratory acidosis persist or worsen despite support with

noninvasive ventilation. For COPD patients in particular, intubation and mechanical ventilation are associated with difficulty or failure to wean, and higher mortality.1-3 In such cases, use of the Hemolung RAS to provide supplemental carbon dioxide removal has been shown in a feasibility study to enable avoidance of intubation.4 In one of the cases from this study, a COPD patient

who was on the lung transplant list was able to avoid intubation because the Hemolung RAS was used during an acute exacerbation of his COPD. He was subsequently able to maintain his candidacy for transplant.5

The Hemolung RAS can also be used as an adjunct to mechanical ventilation in patients with acute respiratory distress syndrome (ARDS) for whom lung-protective ventilatory strategies have been shown to improve survival.6 The strategies for implementation of lung-protective ventilation involve reduction of tidal volume and peak airway pressures. Despite the known benefits of these strategies, their implementation can be limited by inadequate ventilation of carbon dioxide, leading to hypercapnia and respiratory acidosis. Partial support with the Hemolung RAS can be used to facilitate successful implementation of these strategies. In addition, recent observational studies have suggested that even further reductions in tidal volumes and peak airway pressures applied in



conjunction with supplemental ECCO2R may further benefit patients with severe ARDS.7,8

More on the Hemolung RASFurther information and resource material on the Hemolung RAS and partial ECCO2R support can be found on the ALung Technologies website at www.alung.com. For Hemolung sales and support in Canada, visit the website of Novus Medical at www.novusmedical.ca, or contact Novus Medical at [email protected].

References

1. Anon JM, Garcia de Lorenzo A, Zarazaga A, Gomez-Tello V, Garrido G. Mechanical

ventilation of patients on long-term oxygen therapy with acute exacerbations of chronic

obstructive pulmonary disease: prognosis and cost-utility analysis. Intensive Care

Medicine. May 1999;25(5):452-457.

2. Schonhofer B, Euteneuer S, Nava S, Suchi S, Kohler D. Survival of mechanically

ventilated patients admitted to a specialised weaning centre. Intensive Care Med. Jul

2002;28(7):908-916.

3. Chandra D, Stamm JA, Taylor B, et al. Outcomes of Non-invasive Ventilation for Acute

Exacerbations of COPD in the United States, 1998-2008. Am J Respir Crit Care Med. Oct

20 2011;185(12):152-159.

4. Burki NK, Mani RK, Herth FJF, et al. A Novel Extracorporeal CO2 Removal System:

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Graphics courtesy of the Media Kit on www.alung.com

RRT Perspective Does Apathy Exist in Respiratory Therapy


I remember a tradition of sorts that existed throughout my time in high school whereby the editor of the yearbook would always set aside some space for a picture of a very unique club. Each year, this photograph would be mixed with those of the Badminton Club, the Judo Club and the Drama Club amongst others. When I was the editor in Grade 12, I continued the tradition and succinctly positioned a similar picture of an empty classroom and placed the proper heading overtop. It was called the Apathy Club.

Apathy, as we all know, is well defined as a lack of emotional involvement, interest or concern in the activities or life that surrounds us. It is a state of indifference that leads often to an inability to be expressive, to be passionate or take pleasure in

something. According to rightdiagnosis.com (http://www.rightdiagnosis.com/symptoms/apathy/causes.htm), there are seventy-six medical conditions that can be attributing causes for apathy.

Recently, the discussion of apathy seems to be constantly at the tip of our tongues. As such, it leads us to our first question. Does apathy exist in the respiratory therapy profession? Ive had discussions and emails with friends and colleagues regarding this question on many levels; Ive done searches on-line to find the answer; Ive read blogs and listened to others have a similar debate. In fact, there are even those days that Ive asked myself if Ive become apathetic.

The answer regarding the existence of apathy is, of course, a resounding yes and we are all aware of its presence because we are all reasonably intelligent people who can make simple observations

Submitted by Dave McKay, RRT

RTSO Airwaves Editor

Dave McKay with Lily and Luger


to see that it does exist. However, there are two more pertinent questions that still remain in relation to apathy within our realm. The first is what is causing it and the second is, are there any solutions to it?

To try to find an answer to these two questions, I sent an email out to survey twenty-five respiratory therapists that I respect from across the province. These RTs represented all facets of our profession and included individuals who are clinical or work in diagnostics, management, education, sales or primary care. In response to the second question, everyone who replied provided several different answers but sadly in the real sense, it seemed that they all said the exact same thing. It would appear that the causes are widespread. At this time, Id like to share a few synopses with you to provide you with some of the insights and beliefs of your peers that I surveyed.

Many believed that the cause lay rooted in the fact that most hospitals have still not adopted the true sense of a multidisciplinary team particularly at the management level where nursing still holds much of the power in the healthcare industry. Apathy then develops as a result of not being included in the hierarchical planning and program development in such a nurse-centered environment. This is also reflected in the fact that a few RT managers have lost their jobs which then forces RT departments to be placed under nursing or other non-RT management structures. This can lead to a sense of being voiceless or lost within the system which complicates the ability for growth or advancement of our profession within these environments.

Many also felt that the continued drive to cut staffing as well as the increase in patient volumes with higher acuities have had a direct burn out effect; by always being asked to do more with less. The stressors of using a workload measurement tool that offers no reward also complicated things. If statistics say that youre operating at 90%, then you are either working inefficiently or are overstaffed. However, if the statistical analysis says that you are working at 120%, then the auditors state that the staff must be fudge-factoring. These uncontrollable outcomes, even in the face of a known workload growth across the province, lead to a feeling of if my employer wont invest in me, why should I invest in my employer? To expand upon this last quote, I also believe that part of the problem lies in th

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