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Nurse practitioner Laura Istanboulian worked with patients, families and health-care professionals to co-design new tools that can better support patients

Already juggling a career as a nurse practitioner, marriage, two kids and aging parents, Laura Istanboulian wondered if she was too old – or if it was too late – to pursue her doctorate in nursing science.

Yet it had been her dream to complete her PhD – and as a nurse, she was motivated to situate her research around her patients. She was specifically interested in addressing a decades-old problem in hospital intensive care units (ICUs) that makes it difficult for individuals who require a ventilator to communicate with their health-care providers.

Istanboulian decided to pursue her doctorate, making it her objective to reframe communication as something essential to a quality patient experience.

While in the program, she co-designed and implemented a bundled communication toolkit for ICU patients as part of her PhD at the Lawrence S. Bloomberg Faculty of Nursing.

The bundle is a portable, multi-modal set of tools that Istanboulian co-designed with nurses, patients and their families. Each item in the bundle is evidence-based in supporting the communication needs of patients – including alphabet boards, blank boards for writing on, writing tools like markers and pencils, a pain scale, a basic needs scale and some pre-translated boards in multiple languages.

Istanboulian using tools from the bundle to communicate with a patient in the ICU (supplied photo)

The bundle also contains six short education modules for staff to gain a better understanding of how to use each tool option to best support a patient.

“I was not trying to invent something brand-new – these tools existed already, but it became necessary to have them contained in one convenient and accessible location, and to also make providers aware of the need to make an effort to communicate with ventilated patients,” Istanboulian explains.

When a patient is on a ventilator, no air can pass over their vocal cords – meaning that they cannot speak. They might make efforts to communicate – but that requires both interpretation and time from the health-care provider, which is not always available, Istanboulian says.

Some patients may also have cognitive impairments or brain dysfunction from their illness or medical condition, making communication that much harder – and their fear from not knowing what is going on even more palpable.

Istanboulian notes that limited communication with a patient can also affect care providers.

“It can be intimidating caring for someone when you cannot explain what it is happening to them or understand what they are trying to say,” she says.

Istanboulian recounts a moment when she used the new communication tools to try to understand one of her clients, who could not speak or hear.

“On the blank board, he wrote, ‘Thank you so much for taking the time.’ I took a photo of that and it hangs by my desk, because it is a reminder that this effort to communicate really mattered to this person – and it also tells me that this doesn’t happen as a rule,” she says.

“As nurses and physicians, we might be doing the best for them medically, but if patients don’t understand what is happening to them, they can feel very unsafe and alone.”

Developing the communication bundle was not without its challenges, especially as Istanboulian began her PhD just as the COVID-19 pandemic began to unfold.

The bundled toolkit in a central location on a hospital unit (supplied photo)

“Laura overcame significant obstacles posed by the global pandemic to complete her doctoral research,” says Istanboulian’s supervisor Craig Dale, an associate professor in the Lawrence S. Bloomberg Faculty of Nursing.

“She designed, implemented and evaluated this communication-support intervention for mechanically ventilated adult patients in the ICU and the outcome of her research has the potential to be implemented in ICUs worldwide – a positive impact that extends well beyond the pandemic.”

Despite the constantly shifting policies around visitors and isolation requirements for the ICU, Istanboulian found most families, patients and nurses were more than willing to help her design the new tools.

“They really wanted to engage in this process – which was so profound to me, because it showed how much everyone wanted to see this issue of communication addressed,” Istanboulian says.

Families and caregivers offered helpful tips for nurses on providing phone updates on loved ones, and nurses were able to speak to what they would find most helpful in using the bundle, including how to easily share some of the online tools using the internal hospital intranet.

Following the initial success of the tools, Istanboulian is keen to scale up the bundle so that it is accessible to larger units in the hospital – and eventually available across multiple hospital sites within the health-care system.

Istanboulian says one of the key lessons she learned from the project was that the toolkit does require tailoring to local environments in order to meet the needs of the end users. She is currently working with an international group of researchers who are developing core outcomes for communications research in critical care and recommendations that will assist in scaling up the bundle.

Her work with researcher Dr. Kelly Smith – a specialist in health-care quality and patient safety who is an associate professor and co-lead for outcomes and evaluation at U of T's Institute of Health Policy, Management & Evaluation – will also help to determine how patients and family members interpret communication as a safety issue and help reframe communication as something that many see as simply "nice to have," Istaboulian says, to something essential to a patient's experience.

As Istanboulian embarks on life after her PhD, which includes ongoing research and a new position as an assistant professor at Toronto Metropolitan University, she's grateful for the many people that helped her on her path to graduating with her doctorate.

“My wife was my No. 1 – she was always making space for me to be able to write or research. My supervisor and clinical supervisor were so supportive of me not only conducting the research, but maintaining my clinical practice; and my parents were so proud of me,” Istanboulian says.

“I’m not sure everyone is as fortunate to have that level of support – and I think that was really the recipe for this dream becoming a reality.”

Nursing Week: Women's health advocate Sheila Tlou on breaking barriers in the fight for global health equity

siddiq22 — Mon, 08 May 2023 14:15:02 +0000

Nursing Week: Women's health advocate Sheila Tlou on breaking barriers in the fight for global health equity

siddiq22 Mon, 05/08/2023 - 10:15

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Sheila Tlou, Botswana's former minister of health, will give a keynote address on May 9 as part of National Nursing Week at the Lawrence S. Bloomberg Faculty of Nursing (supplied image)

Topic

World Health Organization

United Nations

Women's Health

The ��Ƶ's Lawrence S. Bloomberg Faculty of Nursing will mark National Nursing Week with a keynote address by Sheila Tlou, Botswana's former minister of health.

Over the past few decades, Tlou – a professor, nurse, HIV prevention advocate and artist – has merged her talents as a leader in health policy and community theatre to bring about lasting change in health outcomes in eastern and southern Africa.

“Nurses are a formidable and passionate force, and I say to all the young nurses out there, 'We can make an impact anywhere and everywhere we go,'” Tlou says.

Tlou will speak on May 9 at Innis College, sharing stories of her own experience as a changemaker in global health through her work with the World Health Organization (WHO), UNAIDS and the International Council of Nurses (ICN), where she has tackled issues around HIV transmission and prevention – particularly in women and children.

Of her many accomplishments, which have included being a member of parliament for the Republic of Botswana and director of a WHO nursing and midwifery initiative for anglophone Africa, Tlou says that she is most proud of her work saving the lives of children and their mothers by significantly lowering rates of HIV transmission in communities in Botswana.

When Tlou first became Botwana's minister of health in 2004, the rate of mother-to-child HIV transmission was very high. To address this urgent issue, Tlou created a comprehensive HIV/AIDS prevention strategy that included engaging with community members and leaders prior to rolling out an education and awareness campaign focused on HIV testing for pregnant women, as well as treatment with antiretrovirals.

By speaking with women and those supporting them in child-rearing – including partners and mothers-in-law – Tlou and her team of nurses, nurse practitioners and midwives were able to change the stigma around HIV and encourage early testing, shifting the community’s perspective and focus onto efforts that helped women birth healthy babies.

This community-engaged approach successfully reduced the rate of mother-to-child transmission of the disease from 30 per cent in 2003 to 8 per cent in 2008.

“This success was really saying to the world, 'Look at what can be achieved in a resource-limited area through the intervention of nurses,'” Tlou says. “Now the rate of transmission is less than 1 per cent, and the stigma is so low that many women continue to get tested. However the rates of infection of HIV among women remain very high, and that is still something that needs to be addressed.”

Tlou's advocacy has always been centered around issues of gender and empowering women to improve their health through education. Before she became a nurse, Tlou was passionate about theatre, originally planning to become an actor or interpreter for the United Nations because of her love of languages.

However, with only health sciences scholarships available to her as a young university student, Tlou entered the nursing program at Dillard University in New Orleans, opting to take public health and theatre as electives to foster her knack for engaging with people.

After completing her master’s degree in nursing education and instruction from Columbia University in New York City, Tlou returned to Botswana to teach community-health nursing and also co-directed a travelling theatre group that performed plays – some which imparted health-focused messages about family planning and spacing out pregnancies.

“Being able to take this practical public-health message out into the communities and villages was uplifting for the nursing students involved, because they could see the impact of community engagement from a nursing perspective,” Tlou says.

Though now retired, Tlou – who taught at the University of Botswana for decades – continues to work as a consultant on health promotion strategy for organizations such as the African Union, the United Nations and the WHO on efforts to reduce deaths from malaria, in addition to her work on HIV/AIDS.

During Nursing Week and beyond, Tlou wants nurses around the world to remember the importance not just of bedside care, but of community impact – and the ability of nurses to break down barriers that contribute to inequity in health care.

“My advice to current and future nurses is to look at the UN Sustainable Development Goals in your region, meet with nursing associations and find your niche,” Tlou says.

“As nurses, we need to make ourselves visible – and that includes in how we mentor the next generation."

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'I'm ready to get started': Two incoming students share why they decided to pursue careers in nursing

Christopher.Sorensen — Thu, 15 Sep 2022 21:06:02 +0000

'I'm ready to get started': Two incoming students share why they decided to pursue careers in nursing

Christopher.Sorensen Thu, 09/15/2022 - 17:06

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Jinal Patel, left, and Conor Chiasson, right, are beginning an accelerated two-year bachelor of science in nursing program at U of T this fall (supplied images)

Rebecca Biason

Topic

Jinal Patel never imagined she would become a nurse.

While she knew she wanted a career in the health sciences after studying biomedical science at Toronto Metropolitan University, Patel says she was unsure of what that might entail – that is, until she volunteered at the Hospital for Sick Children.

There, Patel says her interactions with patients and nurses soon set her on a path that led her to the ��Ƶ’s Lawrence S. Bloomberg Faculty of Nursing.

“That environment in the hospital and seeing how the nurses worked caring for their young patients made me want to apply to the nursing program at U of T right away,” she says. “So many of those nurses are graduates of this program – and I felt it was absolutely the right choice for me.

“I want to be a nurse. I’m ready to get started.”

Patel is one of several first-year U of T nursing students who are beginning their accelerated two-year bachelor of science in nursing (BScN) program this fall – a time when the nursing workforce is facing considerable challenges ranging from staff shortages to the pressures of the ongoing COVID-19 pandemic.

In Patel’s case, she says her decision to pursue nursing also stemmed from another part of her life: a keen interest in serving others, inspired by her role model His Holiness Pramukh Swami Maharaj, the fifth spiritual successor and guru of the BAPS Swaminarayan Sanstha.

“Growing up my parents wanted me to experience my religion and culture, and when I went to the BAPS Swaminarayan Mandir in Toronto, I grew inspired by the relief work that H.H. Pramukh Swami Maharaj had done and his selflessness and humility in those acts of service,” says Patel. “That is something I want to bring to the forefront of my work as a nurse.”

The BScN program at Bloomberg Nursing stood out to Patel for many reasons, including the varied types of learning opportunities offered within the program – from working closely with top-tier research faculty to taking part in hands-on learning in the simulation lab and highly sought-after clinical placements.

While she says she is most excited about working with pediatric patients in acute care settings, Patel is open to the many possibilities available through the program and its placement partners. She is most looking forward to pursuing her studies amid the diversity of downtown Toronto and working, as well as networking, with people from all backgrounds.

Incoming nursing student Conor Chiasson is similarly eager to make a difference in in the lives of patients – particularly people who are HIV-positive, unhoused or who identify as queer or racialized youth.

He says his decision to pursue nursing stems from a series of life experiences, including studying in U of T’s bioethics program. That’s where he met his mentor Professor Elizabeth Peter, an ethicist and scholar at the Lawrence S. Bloomberg Faculty of Nursing.

“Professor Peter really encouraged me to bridge my interest in ethics and women and gender studies with nursing and community care,” says Chiasson. “I thought that as a humanities student, nursing was not for me – but she saw my initiative and work ethic, and said, ‘I think you would be a great nurse.’”

Chiasson’s interest in ethics complements his desire to make an impact and to be a leader in community health. He says he has witnessed first-hand the impact of the opioid crisis in Toronto and in rural Ontario. He adds that harm reduction has long been an interest, and that he hopes to continue to provide harm reduction care throughout his career as a community health nurse.

“I want to ensure that any patient I give care to has informed consent, which is of particular importance in harm reduction,” says Chiasson. “I want them to understand what the treatment is, where it is going and how it will affect their life goals.

“It is really about encouraging autonomy for these patients in addition to providing care.”

Looking forward to his community health placement, Chiasson says he wants to help provide both face-to-face healing and upstream health-care solutions, including in the realm of policy. Upon graduation, he says he plans to work at a safe injection site or community health outpatient clinic, and is also considering travel to Nunavut and the Northwest Territories to learn how he can support care in these communities.

U of T nursing prof draws on video games to design learning simulations

geoff.vendeville — Fri, 28 Jan 2022 17:38:15 +0000

U of T nursing prof draws on video games to design learning simulations

geoff.vendeville Fri, 01/28/2022 - 12:38

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(Illustration by Han-Han Li)

Rebecca Biason

Topic

Academics

Rebecca Biason and Sinai Health Staff

Teaching

Simulation learning can be like a choose-your-own-adventure story: there are multiple decision points for a student to consider when they are in the simulation learning environment. This allows them to make clinical decisions while learning, providing them opportunities to see the outcomes of their actions, without fear of harming a real patient.

Erica Cambly

“Simulation allows students to make mistakes and get messy, try things as they learn, and make big decisions,” says Erica Cambly, an associate professor, teaching stream, at the Lawrence S. Bloomberg Faculty of Nursing. “Many of my students will comment on how much better prepared they were for a situation in clinical practice because they had already been exposed to something similar in a simulation and received feedback.”

Cambly, who is also the lead of the simulation team in the bachelor of science in nursing program, has received a grant from the Colleges and Institutes of Canada (CICan) Virtu-WIL program funded by the Government of Canada, to create enhanced games for simulation learning for health sciences students, including nurses.

Virtual simulation, much like video games, requires users to be involved in optimal decision-making within a strategic setting. Cambly is using game theory in her development of three new “games” or virtual scenarios, as part of a Canada-wide simulation project involving a partnership between Simulation Canada and CICan.

She and her colleagues have developed their simulation games using best practices in pedagogy and simulation and have been proactive in ensuring these scenarios include marginalized populations, such as LGBTQ2S and racialized patients.

Designing the scenarios to be inclusive and diverse is a huge part of the project, Cambly says, as nurse educators have historically found it challenging to find resources that are representative of all people.

“We need to make sure we are providing students with the right tools to care for all patients,” Cambly says. “Simulation learning, whether it happens in-person in a lab or remotely, is an integral piece of nursing education. It gives students the opportunity to think critically and learn from the decisions they make. And it gives them an opportunity to practice or experience clinical situations that we cannot guarantee they will be exposed to while in their placements.”

One of the simulation scenarios that Cambly and colleagues are currently developing involves the care of a non-binary patient, who speaks a language other than English. The patient is dying, with their condition deteriorating over the course of a shift in hospice. Students work through the simulated scenario making a series of decisions about this patient’s care along the way.

“For the learner, this type of scenario involves making decisions around how to communicate with the patient, types of pain medications they will be providing and other nursing interventions like how and when to touch the patient to promote comfort,” Cambly says.

To develop just one scenario like this for simulation involves an array of components, starting with the development of learning outcomes. The work requires creating a storyline, writing questions and dialogue, designing decision points and working with artists to develop graphics.

“With these types of scenarios, our goal is to capture the learner’s interest so that they want to learn more and engage with the decision points,” Cambly says. “That is where the game theory, or narrative arc, becomes important in our development. We also need to embed a rationale behind each decision point so that the learner understands why something is happening to their patient based on their decision and the simulation path they chose to follow.”

In addition to providing complex patient scenarios for learners to practice their skills, Cambly’s work with CICan will aim to provide learning access to students across Canada, including those in remote communities. Each of the scenarios is designed to be used on a computer, tablet or phone, and doesn’t necessarily require an in-person lab component. The design allows students to go back and try again if they want to get better at dealing with a specific scenario, or if they needed to make better decisions for the patient.

This hands-on approach is one of the key reason’s Cambly became a simulation instructor, and it is one of the core principles of her teaching practice in nursing.

Next steps for Cambly and her team will be to see these simulation scenarios piloted to over 6,000 students in multiple health disciplines across Canada.

“Simulation learning is gaining popularity, and while it doesn’t replace in-person, on-the-job learning,” says Cambly, “it is a unique opportunity for health science students to build their confidence and learn to provide the best care for patients in need.”

Sinai Health, U of T's Lawrence S. Bloomberg Faculty of Nursing collaborate on Centre for Nursing Excellence

Christopher.Sorensen — Mon, 10 Jan 2022 16:35:01 +0000

Sinai Health, U of T's Lawrence S. Bloomberg Faculty of Nursing collaborate on Centre for Nursing Excellence

Christopher.Sorensen Mon, 01/10/2022 - 11:35

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Nurses at Mount Sinai Health (Photo courtesy of Colin Dewar/Sinai Health staff)

Topic

COVID-19

Sinai Health

The ��Ƶ’s Lawrence S. Bloomberg Faculty of Nursing is working with the hospital system, Sinai Health, on the design of a new, hospital-based Centre for Nursing Excellence that will empower nurses to lead in research initiatives that advance the science of care, and improve patient experiences and outcomes.

A first in Canada, the creation of the centre – jointly housed at Mount Sinai and Hennick Bridgepoint hospitals – is possible thanks to a gift of more than $10 million from a group of female philanthropists led by Maxine Granovsky-Gluskin, co-chair of the board of directors at Sinai Health Foundation and president of Maxine Gran investments.

“For our students and researchers, working collaboratively with our partners at Sinai Health will provide greater opportunities to be involved in shaping the health-care system through education, research and leadership,” says Linda Johnston, dean of the Lawrence S. Bloomberg Faculty of Nursing. “We are excited about this future partnership and its potential impact on patient care.”

Jane Merkley, executive vice-president, chief nurse executive and chief operating officer at Sinai Health as well as adjunct professor in U of T's Faculty of Nursing, says the centre has the potential to spur innovation in health care at a crucial time.

“This gift serves as a powerful tribute to the nurses and all health disciplines who have been working tirelessly throughout the pandemic,” says Merkley. “With this centre, we are taking research to the places and spaces where care happens with patients and their care partners. Our nurses are advancing care to better meet fundamental health needs such as nutrition, sleep and comfort that are essential to improving health outcomes for all patients.”

In addition to research opportunities, the centre will provide a launchpad for nurses to generate ideas and innovation by finding new ways of providing care.

“Nurses are uniquely positioned to see where the health system falls short and they have ideas we desperately need to improve care,” says Granovsky-Gluskin. “This gift … will allow our nursing leaders to look towards the future and reach for new heights in patient care through research and innovation.”

U of T ranked top 10 internationally in six subjects: QS ranking

ullahnor — Wed, 08 Mar 2017 21:03:13 +0000

U of T ranked top 10 internationally in six subjects: QS ranking

ullahnor Wed, 03/08/2017 - 16:03

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U of T ranked in the top 10 globally in nursing, sports-related subjects, anatomy & physiology, geography, computer science and education (photo by Ken Jones)

Jennifer Robinson

Author legacy

Jennifer Robinson

Topic

The ��Ƶ has top 10 international ranking in six subjects, says the independent QS World University Rankings by Subject.

In the report released today, U of T ranked in the top 10 globally in nursing (6th), sports-related subjects (6th), anatomy & physiology (8th), geography (9th), computer science (10th) and education (10th). Medicine, anthropology and religious studies just missed the top 10 list, landing in 11th place.

Among Canadian universities, U of T was first in all five of the broad subject areas and first in 32 of the 43 subjects in which the university was ranked by Quacquarelli Symonds.

Globally, the results place the ��Ƶ among the world’s elite institutions in all five subject areas and in 43 of the 46 subjects surveyed. The university scored even higher when public higher education institutions alone were counted in the subject areas ranked.

The news comes one day after Times Higher Education (THE) placed U of T in a group of 53 institutions that “have the greatest chance of catching up with and surpassing the likes of Oxbridge and the Ivy League.” THE editors cited U of T’s clinical ranking as a primary reason for adding it to a list of “international powerhouse institutions.”

“We’re pleased to see the breadth and depth of the research programs offered at the ��Ƶ once again globally recognized for their excellence across the board,” said Vivek Goel, U of T’s vice-president of research and innovation.

To compile the rankings, QS evaluated 4,438 global universities, qualified 3,098 and ranked 1,117 institutions in total. More than 127 million citations attributions were analyzed and the company verified the provision of more than 18,900 programs.

The QS subject ranking includes five broad subject areas and 46 narrow subject-level rankings in a hierarchical structure. This is a new format for 2017 and the inclusion of the broad subject areas is a replacement for the QS Faculty Area Rankings that haven’t been published since 2015.

The QS subject ranking results are based on four measures: academic survey results, employer review survey results, citations per faculty and the H –Index, which attempts to measure both the productivity and impact of the published work of a scientist of scholar.

Read ranking results from U.S. News & World Report

Read U of T in fourth spot in 2016 National Taiwan University Ranking

Read U of T scored 22nd in THE's world university rankings

Read about the overall QS ranking

Read about U of T having one of the world's best graduate employability outcomes

Why this U of T Varsity Blues flag is flying over a Florida high school

Romi Levine — Tue, 07 Mar 2017 17:59:25 +0000

Why this U of T Varsity Blues flag is flying over a Florida high school

Romi Levine Tue, 03/07/2017 - 12:59

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U of T alumna Kelly Johnson and her father, alumnus John Ruttle McLeod posing with a Varsity Blues flag (photo courtesy of Kelly Johnson)

Romi Levine

Author legacy

Romi Levine

Topic

City & Culture

Alumni