St. Mary’s Combines Education, Opportunity and Care

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How do you meet patient care and student learning needs, and fulfill the hospital’s mission, all while working with limited resources? For the first time ever, St. Mary’s General Hospital, Kitchener, began offering a university-level course, developed by Dr. Erin Tjam, Director of Research, to 4th year Kinesiology/Phys. Ed. students. The Multidisciplinary Field Practicum in a Health Care Setting course is designed to have students learn on-site and work with the Alternate Level Care (ALC) patient population in our acute care hospital. This past winter, students from Wilfrid Laurier University (Waterloo) began attending classes at St. Mary’s, while concurrently providing help to the ALC patient population, a group that needs much attention and care.

“The concept of ALC was introduced throughout Canada less than 15 years ago. The term ALC refers to patients who no longer require acute care treatment, but remain in an acute care setting, unable to be discharged because they are awaiting placement in another facility, or they lack support in their pre-morbid living arrangement,” says Dr. Tjam. ALC patients are typically older (65+ years), and may have one, or more, of the following characteristics: on multiple prescription drugs, limited family support, impaired cognition, reduced self care ability, low functional status, and frailty. These older and frail people often take longer to recover from acute illness and accidents than young people. As they are often unable to be discharged because they are awaiting a placement in another facility, ALC patients have been given many alternative names, the most common being “bed-blockers”.

In the current health model ALC patients are not considered a priority and are allocated minimal health-care funds. However, these patients still require care, stimulation and activity. Currently, hospitals are operating beyond their capacity, and proper rehabilitation for these patients is lacking. Due to this inconsistent level of care older patients are at risk of nosocomial deterioration. In one study, patients were discharged in worse shape than before their acute illness, and approximately one third of these patients had a decreased ability to perform activities of daily living (ADL) than before their acute illness (Landefeld, 2003). Some of the major problems documented regarding long-term care for ALC patients include: malnutrition, pressure sores, and urinary incontinence (Brymer et al., 1995).

This unique group of patients will increasingly become more important as the current population ages at an alarming rate. The current health care system is not equipped to provide medical, functional and social care needs to patients who are advanced in age. Due to the future increase of the aging population and the need for better conditions of care for these patients, a different model must be utilized within health care.

In the past, our strategies for dealing with the ALC population were limited. As part of St. Mary’s desire and mission to provide excellent, compassionate care, we needed to find a way to stimulate the ALC patients, physically and psychologically, even though their acute care stage was complete. Members of the Medical Program Steering Committee explored avenues for providing care to ALC patients, and the idea of a university level course was born. Having qualified students work with ALC patients eases the workload for nurses, and allows the student to gain experience. This type of course – with the dual mission to meet patient needs and provide learning opportunities at the university level – is truly innovative.

“We are offering university students first-hand experience of how we care for a particular patient population. They, in turn, get to use their academic learning with the ALC patient,” says Dexter Jones, Director of Decision Support.

“The combination of workshops given by our experienced staff in many specialty areas such as living and working with disabilities; health, illness and geriatric care; spiritual and emotional well-being; and health-care support and decision issues; as well as the job-shadowing of mentors makes this course multidisciplinary and experiential,” says Sandra Rains, Assistant VP of Patient Care.

With this approach to providing additional support to the ALC population, they benefit by receiving various forms of stimulation while the students gain health-care knowledge and hands-on experience. In turn, the hospital continues to fulfill its mission in a new, innovative way, and is able to expose future health care workers to the inner-workings of the organization. This course also enables St. Mary’s to give back to the community and help students with the gift of experience and education. It is truly a win-win situation for all.