Exercise Science as a First Line Therapy
Summary
Assessment, treatment, reassessment and documentation and management of Pain was recognized as a gap at the F.J. Davey Home, a 372 bed LTC home in Northern Ontario. These gaps have reduced quality of life for our senior population with chronic pain not successfully being evaluated or treated. The need for nonpharmaceutical treatments to be initiated by both registered and nonregistered staff was identified along with frequent need to assess, reassess and document outcomes. This AMS/RNAO fellowship provided this fellow the opportunity to complete a self-directed, intensive learning experience to increase her nursing knowledge, skills, values, compassionate and person-centered care and expertise to successfully treat CNCP in the aging population.
This fellow joined the Algoma Chapter Executive of the RNAO team and has become politically active to advance Pain Management and Assessments not only with the supporting organization, F. J. Davey Home but other Ontario LTC facilities and aging population. The progressive goal for the elderly in Ontario is improving patient outcomes, having quality of life and addressing aging issues in a timely manner throughout their medical journey.
Throughout this fellowship, the fellow developed knowledge, skills and an expert understanding of the Best Practice
Guideline for Assessment of Management of Pain, Person-and Family-Centred Care, and Addressing Abuse of Older Adults. The Fellow increased her knowledge and skills to confidently assess, prescribe and evaluate in both the cognitively well and impaired elderly population a humane, compassionate and individualized non-pharmaceutical treatment as a first line of treatment for chronic-non-cancer pain (CNCP).
This fellow will be focusing on avenues through the F. J. Davey Home, Sault Ste. Marie community and RNAO Algoma to educate and instil in health professional's a range of necessary knowledge, skills and values. Education will be targeted to provide quality outcomes, patient satisfaction, health system and professionals will have an evidence-based practice combined with humane, compassionate, and person-centred approach.
Objectives:
# 1: Develop both theory and practical knowledge of exercise science to design individual and or group programs tailored to improve client's quality of life through reducing/eliminating chronic non-cancer pain (CNCP).
# 2: Increase her knowledge through a systematic and comprehensive literature review including but not limited to Canadian guidelines for: Pain assessment and treatment for CNCP in a multicultural aging population Increase appreciation of the pharmacokinetic and pharmacodynamic changes of aging; and misconceptions about tolerance and addiction to opioids RNAO Third Edition "Assessment and Management of Pain" RNAO BPG.
"Preventing and Addressing Abuse and Neglect of Older Adults RNAO BPG "Person and Family-Centered Care Ontario Regulation Capacity Assessment, Substitute Decisions Act, 1992 Guidelines for Conducting Assessment of Capacity Complete RNAO. Understanding the role for a Capacity Assessor in Ontario and Guidelines for Conducting Assessments of Capacity under the Substitute Decisions Act, 1992 (SDA).
# 3: Observe and practice learned knowledge, confidently assessing, implementing and evaluating a sustainable treatment plan for managing CNCP in Sault Ste. Marie aging population. Becoming an effective speaker and voice for the aging population in creating change that will create quality of life for the elderly in our community. This fellow had the opportunity to work with the F. J. Davey Home BSO lead, Maria Church and Lyndsay Suurna, NP, assessing, implementing and evaluating CNCP in a LTC setting for both the cognitively impaired and cognitively intact multicultural elderly population.
This fellow worked with the Pain and Palliation Committee to evaluate the effectiveness of the new rolled out program at the F.J. Davey Home. She also had an opportunity to follow and collaborate alone side Kerry Gartshore-Hamilton, IPAC Coordinator/Staff Educator, learning effective communication and reviewing opportunities to improve the F. J. Davey Home LTC ministries mandated programs with a focus on best practice and the standards of care.
The fellow participated in the "Stand Up" ministry funded program for the elderly in the community setting, working with Amanda Lambert, Registered Health & Exercise Practitioner CEO/Owner of Strong Minds- a Fitness Based Therapy company.
Outcomes
Objective #1 was directed at increasing the fellow's knowledge of prescribing exercise in the healthy and medically compromised older adult under supervision of a NP/MD. FIT 153 courses through Sault College stated in the Canadian Physical Activity Guidelines for the older adult-65 years & older. "To achieve health benefits, and improve functional abilities, adults aged 65 years and older should accumulate at least 150 minutes of moderate to vigorous-intensity aerobic physical activity per week, in bouts of 10 minutes or more." "It is also beneficial to add muscle and bone strengthening activities using major muscle groups, at least 2 days per week." "Those with poor mobility should perform physical activities to enhance balance and prevent falls." "More physical activity provides greater health benefits." It was noted that only 12 % of the Canadian population 65 + meet the minimum standards. During the course the fellow was able to prescribe, assess, monitor and evaluate/re-evaluate an exercise program for a senior client. The fellow completed the Revelation Wellness Instructor Certification program and upon completion developed two programs with a body, mind, spirit approach. One program at the Garden River Recreational and Educational Center and the second at the F. J. Davey Home open to all the staff, recognizing our aging staff population.
The fellow is presently in discussion with our Aboriginal population to develop and meet a need in this community to improve the Canadian Physical Activity Guideline met percentages especially in the 65 years & older group but not limited to. The gap analysis conducted at the F. J. Davey identified a lack of pain assessment and management among our registered staff. Working along side the BPSO team at the home, the outcomes for Pain assessing and managing substantially improved in the past year. Assisting with train the Trainor/Registered Staff while performing other duties as a charge nurse. This fellow is presently in discussion and on a list to become a Stand-Up educator in our community that intentionally focuses on movement, activity and prevention to reduce falls in the aging population.
The F. J. Davey Home has provided this fellow with an amazing opportunity to increase her nursing skills, knowledge and practice. Senior management and the leadership team for the BPG Assessment and Management of Pain identified a gap in pain assessment, treatment, documentation and evaluating at the F.J. Davey Home, this has reduced quality of life for our senior population with chronic pain not successfully being assessed, treated and evaluated. In 2019 it was identified that the BPG Pain Assessment and Management Program had improved residents' quality of life, their pain outcomes, through, patient satisfaction survey's and CIHI scores.
The staff had available and participated in a Revelation Wellness, mind, body and spirit focused work-out class once weekly. The fellow educated, engaged and empowered both registered and nonregistered staff to improve their outlook, attitudes and quality of life/work. The attendee's feedback were comments like, "I needed those stretches today", "I am going to work on moving and stretching throughout the week", and "I like your positive outlook at things to create attitude/appreciation change". AMS Healthcare is a Canadian Charitable Organization advocating for change in Canadian healthcare. The AMS fellowship focused on education for this fellow with delivery of humanistic and compassionate care, with a focus on addressing critical issues in our healthcare system. AMS Healthcare is one of the co-sponsoring Change Day Ontario because. October 29, 2018 the FJ Davey Home enlisted the help of Change Day Ontario, in order to provide better outcomes for people living in long-term care nursing home. The healthcare providers at the F. J. Davey Home are recognized as the backbone of the facility providing compassionate quality care.
Overall experience
Working with an aging population is very rewarding and engaging, giving me an opportunity to improve my practice, knowledge and quality of life as I age. The fellow learned how differently our western culture ages. With further research on exercise science it is clear that as our bodies are a three-part entity, we were designed to be strong when aligned properly. Dysfunction can be created physically, spiritually and mentally. The fellow observed her 90-year-old mother who cared for her body, mind and spirit, attend and complete the exercises designed for her, while other, younger seniors who were not aligned physically, mentally and spiritually, clearly their bodies had dysfunction both physically and cognitively. The effects of pharmaceuticals may have relieved one immediate issue but with further research it appeared to add further dysfunction in other area's debilitating at times to the point of reducing the senior's quality of life.
The question was presented in FIT 153, What is Active Canada? "Active Canada 20/20 – A Physical Activity Strategy and Change Agenda for Canada…. Eighty-five percent of Canadian adults and 93%of Canadian children and youth do not achieve the minimum level of physical activity necessary to ensure long-term good health and well-being." CSEP/SCPE; The Gold Standard in Exercise Science and Personal Training. Physical activity prescription for reducing sedentary behaviour includes a minimum of 150 minutes of Moderate-Vigorous Physical Activity (MVPA) per week. Sedentary behaviors have been associated with adverse health outcomes according to WHO, World Health Organization. This fellow's sustainability strategies are for further education, research and funding for development of activity programs recommended by WHO, CSEP, and Active Canada 2020, that will meet the minimum standards for prevention of chronic diseases and improving our senior's quality of life. Garden River Indian Reserve has become one of the fellow's partners in developing programs that will focus on improved quality of life and reducing or preventing chronic diseases for the native aging population. This fellow obtained her Revelation Wellness Instructor Certificate that personally improved her quality of life and reduced the pain from a previous workplace injury during my nursing career.
