Health Services Design, Support and Advisory Services

• In partnership with the Government of the Northwest Territories (GNWT), we responded to the concerns of two communities in the Northwest Territories about the rates of cancer in their surrounding areas. Both communities had felt significant losses due to cancer and reached out to the GNWT for answers and support.
• Community sharing sessions on cancer were held within each community to address fears and misconceptions through education and to support the building of meaningful solutions with and for communities. The strengths-based approach opened dialogue for the first time on cancer in the community.
• The model of community sharing sessions has been implemented by the GNWT in all communities across the Northwest Territories. The outcomes of these sessions have also contributed to the development of a territorial cancer strategy.
• To view the report visit https://www.hss.gov.nt.ca/sites/hss/files/fort-resolution-sharing-session-report.pdf

• This initiative aimed to improve First Nations, Inuit and Métis (FNIM) cancer patient transition experiences and to increase available knowledge and information for primary and oncology care providers of the care needs of FNIM cancer patients and their families, care providers and communities during these periods.
• With the support of local community champions in the Northwest Territories, British Columbia, Alberta and Manitoba we met with communities and invited them to share their experiences with cancer.
• Innovative use of methodology and collaboration to build trust and broker dialogue between First Nations cancer patients, their communities, and their primary and oncology care providers. To improve outcomes for Indigenous people during their cancer journey

Participants shared:

I'm a nurse and I think a lot of the time we see a lot of guidelines and policies and I think this provides something that is much more close to Traditional than we ever get to see a lot of the time, and it almost gives us permission for people as well to be able to express that story is so important and it’s one of the components that we can miss the most. So I am really thankful we have this and that it’s going to be available.” Aklavik, NT Community Nurse

“The Dialogue and Storywork project left an everlasting impact here in the Gitxsan Territory. Many were able to view loved ones on their cancer journey and left a valuable image embedded into our memories of loved ones passed on. The stories told helped others understand what it’s like to have cancer here in the north. One community member stated this instilled a sense of pride to see and hear from our own community members. Community members also said it was easier to relate to the stories…To see and hear the struggles and difficulties first hand and to be able to hear that from one of our own…living in the same communities, same environment… to show others they are not alone. To share the hurt, sadness but also the love and joy was healing to one another…. Our Gitxsan Nation is forever thankful for allowing us to share our people’s cancer journey. Thank you very much Doris for taking time to be with us. We are indebted to you!!” Robynn Muldoe - CH L.P.N.

• To see the videos and resources visit: https://research.sehc.com/resources/dialogue-storywork

• This initiative aimed to assist Ontario First Nations to honour the last wishes of those who wish to pass away (die) with dignity and respect, at the place of their choice. 
• Community-based health care workers that provide palliative and end-of-life services in Ontario First Nations were invited to complete a survey and interview as a method to capture solutions (wise practices) and the current state of palliative and end-of-life service delivery. Communities validated the Community Voices Report prior to finalization, honoring collective reflexivity, central to Indigenous evaluation methods.
• Evidence-based recommendations and wise community practices identified in the data collection stage provides a roadmap for key strategic investments to support Home and Community Care Programs in the delivery of quality, timely palliative and end-of-life services. 
• SE Health has acted upon the following recommendations identified in the Community Voices Report:
  • The creation of evidence-based, culturally safe policies and procedures to support the delivery of palliative and end-of-life care in Ontario First Nations.
  • The creation of an accessible palliative care toolkit that compiles screening tools to support and reinforce best practice in culturally safe palliative and end-of-life care.
• Review the final report: link

• A comprehensive wound care education program for nurses and PSWs.
• Phase 1:
  • Foundations of Wound Prevention and Management for PSWs Course
  • Foundations of Wound Prevention and Management for Nurses Course
  • Foundations of Wound Prevention and Management Webinar Series for Nurses and PSWs
    • Skin and Wound Care for Nurses
    • Interprofessional Approach to Wound Healing for Nurses and PSWs
    • Psychosocial Aspects of Wound Management for Nurses and PSWs
    • Diabetic Foot Ulcers for Nurses and PSWs
  • Virtual Hands-On Wound Prevention and Management Workshops for Nurses and PSWs – Live and interactive with ‘hands on demonstrations. The Instructors used GoPro cameras to demonstrate wound care skills and then participants returned-demoed the skills using tablets and webcams. Tablets and wound dressings supplies were provided to participants.
    • Session 1: Introduction
    • Session 2: Skin and Wound Care
    • Session 3: Care of the Lower Limb
    • Session 4: Pressure Injury Care
• Phase 2:
  • Intensive Wound Care Champion Training Program for Nurses
    • 5 days, in person
    • Introduction to the ‘Wound Champion’ Role
    • Review of Foundational Education
    • Complex Wound Etiologies and Treatments
    • Comprehensive Wound Consultation and Care
    • Skills Labs
    • Preceptorship Day
    • Knowledge Test

  A participant shared: “I feel blessed to have been a part of this training session. The facilitators were absolutely fantastic! Humble. Happy. Extremely knowledgeable. Willing to share their knowledge. I have attended many workshops, knowledge sessions and trainings…This one was by far the best! Tons of info which was all beneficial!” Session participant

  • Wound Care Guidelines and Documentation Tools
    • Wound Care Champion Role Guideline
    • Wound Competency Self-Assessment Tool
    • Wound Consult Escalation Process Guideline
    • Initial and Follow-Up Wound Consultation Tool
    • Wound Consultation Guideline (with samples)
    • Lower Limb Assessment Tool
    • Wound Communication Tool
  • Wound Care Practice Supports (Community of Practice/Group Practice Meetings/NSWOC Consultation)
    • Virtual group touchpoint meeting one month after the workshop
    • Ongoing access to online courses and webinar recordings
    • Weekly educational emails with ‘bite-sized’ wound care knowledge, tips and tricks.
    • Weekly consultative access to a Nurse Specialized in Wound Ostomy and Continence (NSWOC) for those Wound Champions who do not have access to an existing Wound Care Consultant in an First Nations organization or LHIN.
  • Digital Wound Care Pilot - Swift Medical App
    • SE Health is collaborating with Swift Medical to provide a digital wound care solution that will enhance remote wound care in ON First Nations to support timely wound care supported by wound specialists; increasing accessibility, quality and continuity of care for clients with complex wounds.
    • The project has implemented a Digital Wound Care Pilot, utilizing the Swift Medical Platform and supported by Wound Care Consultants (SE Health and/or a First Nation Organization Wound Care Consultant).
    • The point-of-care mobile application allows clinicians to take accurate and consistent wound images and measurements, assess and document wounds efficiently and track healing progression over time. Supports remote consultation with wound care specialists.
    • The Digital Wound Care Pilot is a great success with early pilot outcomes of clinician engagement, early signs of reduction of readmission, and interdisciplinary support.

• Collaboration with the Assembly of Manitoba Chiefs, Manitoba First Nation Communities to establish and implement a wait times guarantee for the prevention, treatment and care of diabetic foot ulcers in Manitoba First Nation (MFN) communities. This collaboration was formalized through a partnership agreement that ensured full and meaningful involvement of First Nations (FNs) and respected FN rights to self-governance. This project included three phases:
  • Assessment of the current system, the development of a strategic plan and creation of a model framework grounded in best practices
  • Implementation and testing of the model
  • Reporting of key findings, model refinement, conclusion
• The project undertook a comprehensive analysis of the underlying issues impacting the disproportional amputation rates for MFNs living with diabetes. Manitoba First Nations are 18 times more likely to have an amputation as a result of a diabetic foot ulcer than all other Manitobans. With the belief that those affected by the issues have the solutions, eight MFNs were invited to participate as pilot communities in the project. To collect information to inform action, three community gatherings, and guidance from a FN advisory committee and traditional healers, were included. Communities provided information on the issues and the solutions and tested and evaluated specific solutions targeted at reducing lower limb amputations.
• Despite the breadth and depth of the issues underlying the high rates of amputations, we were able to achieve some significant gains through the project, including:
  • Bringing together multiple stakeholders such as Health Canada, the province and FN communities under new and creative partnership models and approaches
  • Supporting communities to share their wealth of knowledge and demonstrate their desire and ability to impact the current situation
  • Supporting community health care providers’ skill and knowledge development related to diabetes program delivery and evaluation
  • Identifying barriers in referrals to specialists, and establishing an effective and standardized referral pathway
  • Implementation of the Mustimuhw cEMR (Community Electronic Medical Record) to improve delivery of health care services through technology
  • Adapting methodologies, models and best practice guidelines to meet the specific local context
  • Developing a clinical framework for the prevention, care and treatment of diabetic foot ulcers
• Recommendations from this project included investments in foot care programs and accessible/effective diabetes education, policy level changes, expansion of the Mustimuhw cEMR to all MFNs, and support for formal and lasting connections between First Nations Traditional Healers and practitioners in the biomedical system. This project has resulted in significant outcomes to date including provincial and federal investments in diabetes education, Foot Care Training and cEMR expansion and interoperability testing.
• Review the final report link