Weekly outline

  • Nunavut Orientation Overview

    Welcome to CHCA's orientation to practice in Nunavut. 

    CHCA Nurses working in Nunavut will have already completed the Contract Nurse Training Program offered upon initial hire to our agency.  This comprehensive orientation program prepares nurses for practice in remote nursing stations in Canada's north. 

    This Agency Nurse Orientation Training Program (ANOTP) provides nurses with additional Nunavut and Inuit-specific information, in order to practice safely and effectively, and provide the highest possible quality of care for the Inuit people.  


  • Welcome to Canadian Health Care Agency!

    Required Pre-reading: 

    • Government of Nunavut - Community Health Nursing Manual
    • ISC Clinical Care Pathways (CPGs) (Adult and Paediatric) 
    • Pre-orientation administrative documents

    Text and media areas: 3 Folder: 1 URLs: 9 Files: 3

  • Inuit Cultural Safety

    Required Pre-Reading
    • ISC Clinical Care Pathways (CPGs): Adult Guidelines Introduction 
    • ANAC: Cultural Competence and Cultural Safety in Nursing Education - A Framework for First Nations, Inuit and Metis Nursing
    • SOGC: Indigenous Companion Piece
    • RNANTNU - Position Statement - Cultural Safety
    • Trauma Informed: The Trauma Toolkit

    Content in this module is derived from the Aboriginal Nurses' Association of Canada document: "Cultural Competence and Cultural Safety in Nursing Education - A Framework for First Nations, Inuit and Métis Nursing". 

    In this module, Agency Nurses will work toward reconciliation through delivery of health care. They will develop a better understanding of Cultural Safety, and how it relates to the Indigenous peoples of Canada, specifically Inuit People. This module will also review Inuit culture and history, and will explore ways in which Agency Nurses can deliver care, respecting traditions and culture. 

    Agency Nurses will develop the ability to establish a positive therapeutic relationship and open communication with Inuit clients and their families, characterized by understanding, trust, respect, honesty and empathy. 

    Socio-cultural and political factors that are health-protective will be explored, as well as those factors which undermine the health of Inuit peoples and place them at risk for increased morbidity and mortality. Discussion of how basic human rights (e.g. adequate housing, employment) are "out of reach" for many if not most Inuit people. 

    Agency Nurses will analyze and understand the limitations of their knowledge and perspective and incorporate new ways of seeing, valuing and understanding the health and health practices of Indigenous peoples. 

    Text and media areas: 4 URLs: 34 Files: 11

  • Team Communication, Patient Transport procedures and reporting

    Required Pre-Reading:

    • ISC Clinical Care Pathways (CPGs) - Adult Guidelines Introduction
    • CHCA Workplace Harassment Policy
    • Nunavut CHN Manual - Organization
    • Nunavut CHN Manual - Standards
    • Nunavut CHN Manual - Communications

    This module introduces Agency Nurses to the workplace environment, reviews procedures for medical consultation, coordinating schedevac/ medevac patient transfers, including forms and procedures required for consultation, transfer and evacuation of patient to other agencies and hospitals, or health professionals. 

    Agency Nurses will also review their role as referral agent, and discuss inter-agency collaboration through various methods of communication and consultation including telemedicine. 

    This module further discusses common types of reportable occurrences and how to effectively manage them, as well as recognition and management of workplace harassment and bullying. 

    Files: 7 Text and media areas: 2 URL: 1

  • Documentation, Confidentiality, Triage and Telemedicine

    Required Pre-Reading: 

    • ISC Clinical Practice Guidelines - Adult Guidelines Intro (p. 12-22)
    • NU - CHN Manual - 06 Communications
    • MEDITECH Tip Sheet 
    • RNANTNU - Documentation Guidelines
    • CNPS - InfoLAW - Documentation.pdf

    This module gives Agency Nurses the opportunity to apply theoretical concepts and practice skills to understand the expectations of Agency Nurses when documenting client care.  Clear, comprehensive and accurate documentation is an integral part of safe and effective nursing practice. 

    Topics include: the principles of SOAP documentation, the Agency Nurses accountability when documenting; and how to maintain security of confidential information.  Agency Nurses will then discuss triage and telemedicine, and discuss components of a high-quality telephone triage system.  They will summarize the essential aspects of good communication required for triage, and identify how language barrier, cultural norms, rules of thumb, cognitive biases and other distractors influence triage decision making. 

    Text and media areas: 3 Files: 9 URLs: 3

  • Pharmaceuticals in Nunavut

    Required Pre-Reading:

    • Government of Nunavut - 2021 Drug Formulary
    • NU - CHN Manual - 09 Pharmacy 
    • ISC Clinical Care Pathways - Adult Guidelines Intro (p. 9-11)
    • RESOURCE: Naloxone Injection Guideline
    • RESOURCE: Link - Canadian TB Standards

    Agency Nurses will examine pharmacological concepts and nursing practices required to safely care for clients in need of pharmacological treatments.  General principles of pharmacology, common drug classifications, principles of medication preparation and administration including drug calculations, and related regulatory competencies are studied.  Agency Nurses will learn to safely initiate prescription drugs and therapeutics based on assessment data.  

    Agency Nurses are provided with the opportunity to develop calculation skills necessary for the safe administration of medications. Emphasis is on caring for clients on drug therapy, interactions of drugs, psycho/social aspects of drug use, legal control over drugs and health teaching. 

    Agency Nurses will also become more familiar with the Drug Formulary for Nunavut, the Drug Classification System for prescribing and calculating drug doses for the paediatric population as well as renal dosing. 

    Agency Nurses will also review and understand the controlled substance policies, and become familiar with the Controlled Substance Register, counting, handling and wastage of controlled substances. 

    Agency Nurses will become familiar with Direct Observed Therapy (DOT) for the treatment of Active and Latent Tuberculosis, and gain and understanding of the role and responsibilities of the Community Health Nurse in directing this program. 

    Text and media areas: 3 Files: 11 URL: 1

  • Introduction to Laboratory Operations

    Required Pre-Reading: 

    • NU - CHN Manual - 08 Diagnostics 
    • NU - CHN Manual - 11 Clinical Procedures
    • COURSE - Transportation of Dangerous Good (PHAC) 

    Agency Nurses have sound working knowledge of all lab requisitions and how to complete them correctly. They will determine the need for the appropriate laboratory or diagnostic tests and how to processes each test. Agency Nurses will prioritizes specimen processing to ensure accuracy and avoid multiple collections and take steps to ensure that lab and diagnostic equipment are available and operational when needed;  by performing daily/ weekly/ monthly quality assurance testing. 

    Agency Nurses will understand how to perform venipuncture on clients across the lifespan and perform the correct specimen collection appropriate to treatment settings.  They will learn to interpret diagnostic laboratory or diagnostic results and respond appropriately.  Agency Nurses will identify all available point-of-care tests, understand how to provide and interpret the results, in order to guide treatment and management of the patient.  They will demonstrate sound decision-making skills related to lab testing and ongoing screening and lab or diagnostic testing.  Agency Nurses will come to understand scope of practice in relation to all laboratory and diagnostic testing and able to refer and consult as appropriate.  They will take steps to ensure that equipment is available and operational e.g., Glucometer, HemoCue

    Agency Nurses will demonstrate understanding of the following: use of the centrifuge, procedures for Point of Care testing (POCT): Erythrocyte Sedimentation Rate; Stat Haemoglobin; Urine HCG; Fecal Occult Blood Testing and Interpretation; Urinalysis, 24 hour urine collection, urine for microbiology; Haematology and Chemistry Specimen Processing.

    Text and media areas: 3 URLs: 6 Files: 10 Folder: 1

  • Paediatric and Adult Immunizations

    Pre-Reading: 
    • Nunavut Immunization Manual 
      • Table of Contents
      • 1.0 Introduction 
      • 2.0 Principles of Immunology and Immunization
      • 3.0 Practice Guidelines
      • 4.0 Guidelines for Specific Populations
      • 5.0 Vaccine Reporting and Coverage Rates
      • 6.0 Nunavut Immunization Certification
      • 7.0 Nunavut Childhood and Adult Immunization Schedules and Catch-up Aids
      • 8.0 Setting up Clinics
      • 9.0 Active Immunization Protocols 
      • 10.0 Passive Immunization Protocols
      • 11.0 Specialized and Annual Immunization Protocols 

    Agency Nurses will review the key parts of a community immunization program and aspects of management, and can evaluate surveillance measures in the event of an outbreak and minimize risk of outbreak.  They will go over the application of current immunization schedules to ensure patient immunization status is up to date. 

    Agency Nurses will develop a working knowledge of all Biologicals and Vaccine Preventable diseases, and will understand the difference between expected reactions and unexpected reaction. They will learn to provide health teaching to clients and their caregivers. Agency Nurses will have a solid understanding of cold chain and how to operate required storage and monitoring equipment. 

    Text and media areas: 2 Folders: 3 Files: 12 URLs: 2

  • Public Health: Communicable Diseases, Sexually Transmitted Infections and Contact Tracing

    Required Pre-Reading: 
    • Nunavut Communicable Disease and Surveillance Manual
    • Nunavut Infection Prevention and Control Manual
    • ISC Clinical Practice Guidelines - Paediatric Guidelines - Chapter 18-1 to 18-25 - Communicable Diseases
    • ISC Clinical Practice Guidelines Adult Guidelines - Chapter 11 - Communicable Diseases 
    • Canadian Guidelines on Sexually Transmitted Infections

    Agency Nurses will discuss a variety of communicable diseases and infections that affect both the adult and paediatric populations, including tuberculosis.  They will learn to perform comprehensive assessments using an organized approach to assess chief complaint, history of present illness, sexual history as required and perform a relevant physical exam to screen for communicable diseases or sexually transmitted infections. 

    Agency Nurses will understand and determine the need for the appropriate diagnostic tests (blood work, or urine/ swab for culture) required to test for communicable diseases and sexually transmitted infections, and learn how to discuss assessment and laboratory findings with the client, recognizing the need and performing contact tracing if necessary. 

    Text and media areas: 3 Files: 5 Folders: 5 URLs: 8

  • Neonatal, Well Infant and Well Child Health Assessment and Paediatric Nutrition

    Pre-Reading: 

    • NUNAVUT - Guidelines for completing well child records
    • ISC Clinical Practice Guidelines - Paediatric Guidelines 
    • Chapter 1 – Paediatric Health Assessment 
    • Chapter 3 – Paediatric Prevention and Health Maintenance 
    • Chapter 5 – Child Maltreatment
    • Chapter 7 – Nutrition

    Agency Nurses will be able to complete focused assessments, recognize deviations from normal, analyze findings and develop differential diagnoses that can help identify urgent and emergency problems in the otherwise well neonate, infant and child.  they will perform screening assessments for well baby and well child visits, and understand and determine the need for further consultation, screening and diagnostic tests. 

    Agency Nurses will be able to discuss health assessment findings with clients and will be able to make appropriate prevention recommendations. They will also understand family structures, determine how to conduct a family assessment and assessment and assist families in accessing resources to meet health needs of their child. 

    Text and media areas: 3 Files: 7 URLs: 4 Folders: 3

  • Assessment of the Sick Child - Acute, Urgent and Emergent presentations and procedures

    Pre-Reading: 

    • ISC Clinical Practice Guidelines: Paediatric Guidelines
    • Chapter 2 - Paediatric Procedures
    • Chapter 4 - Fluid Management 
    • Chapter 6 - Dysfunctional Problems of Childhood
    • Chapter 9 - Ears Nose Throat and Mouth  (Otitis Media, Pharyngitis, Tonsillitis) 
    • Chapter 10 - Respiratory (Bronchiolitis) 
    • Chapter 11 - Cardiology (Rheumatic Fever) 
    • Chapter 16 - Skin (Impetigo)
    • Chapter 20 - General Emergencies and Major Trauma

    Agency Nurses will be able to complete focused assessments, recognize deviations from normal, analyze assessment and diagnostic findings and develop differential diagnoses that can identify urgent and emergent problems in the sick child.  They will understand and determine the need for the appropriate screening and diagnostic tests required treatment of common paediatric illnesses, e.g., blood sugar, Haemoglobin, urinalysis, hearing and vision acuity, ear and throat swab, blood tests.

    Agency Nurses will learn to identify common, urgent, and emergent illnesses or conditions, and suitable treatment plans will be made, which best meet the patient’s and family's needs. They will understand how to discuss assessment findings with the patient/caregiver and make appropriate primary prevention, safety, environmental and lifestyle recommendations. Furthermore, Agency Nurses will better understand family structures, how to conduct a family assessment and assess potential for change to assist families in accessing resources to meet health needs of the child. 

    Text and media areas: 3 Files: 3 Folders: 7 URL: 1

  • Behavioural Health and Addictions - Adult and Paediatric chronic, acute and emergency presentations

    Required Pre-Reading: 
    • ISC Paediatric Guidelines - Chapter 19 - Adolescent Health
    • ISC Adult Guidelines - Chapter 15 – Mental Health

    Agency Nurses will demonstrate how to perform an organized, comprehensive behavioural health assessment. They will adapt assessment techniques to the client's condition, and recognize the deviations and/ or variations from normal findings, as they relate to the current Clinical Practice Guidelines (CPG) and screening.  

    They will consult with other healthcare providers regarding assessment in an appropriate and timely manner and perform screening assessments as required, including trauma assessment for patients with acute presentations and addictions. 

    Agency Nurses will also garner a better understanding to determine the need for appropriate laboratory and diagnostic testing to monitor patients with chronic mental illness on routine pharmacological treatment, as well as to assess and treat drug overdoses or other conditions related to excessive drug or alcohol misuse. 

    Agency Nurses will learn to utilize evidence-based tools such as the Generalized Anxiety Disorder (GAD-7) and Patient Health Questionnaire (PHQ-9), as well as the Clinical Opiate Withdrawal Score (COWS) and Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar). 

    Note: Suicide is covered entirely in Module 12.

    Text and media areas: 3 Files: 11 URLs: 12 Folders: 5

  • Suicide Prevention, Assessment and Treatment of the Suicidal Patient

    Required Pre-Reading: 

    • Centre for Addiction and Mental Health - "Suicide Prevention and Assessment Handbook"
    • Adult Guidelines Chapter 15 Mental health - (p. 15-72 to 15-84); 
    • Paediatric Guidelines Chapter 19 - Adolescent health (p. 19-22 to 19-29) 
    • Columbia Suicide Severity Rating Scale 

    Agency Nurses will discuss the Nurse’s role in suicide prevention including: Identifying risk and protective factors; identifying warning signs; understanding the importance of “no show” follow up; performing an organized, comprehensive behavioural health assessment, including history and mental status examination.

    Agency Nurses will adapt assessment techniques according to the client’s condition, and recognize the deviations and or variations from normal findings, conduct a Suicide Risk Assessment; Identify Non-Pharmacological Interventions; Identify Medevac Criteria; Recognize available community resources; Discuss: Coroner’s inquest findings (Selena Sakanee and Pikangikum First Nation inquests. They will become familiar with the use of the Columbia Suicide Severity Rating Scale, as well as gain familiarity with the use of Emergency Protection Order Form 1.  

    Agency Nurses will discuss assessment and follow-up of suicide attempt, as well as review Suicide Attempt – Initial Emergency Management for hanging and overdose. 

    Text and media areas: 3 Files: 5 URLs: 8

  • Chronic Disease Case Management and Exacerbation Emergencies

    Required Pre-Reading: 

    • ISC Clinical Practice Guidelines - Adult Intro (p. I-7 to I-9)
    • ISC Clinical Practice Guidelines Chapter 10 - Haematology, Metabolism and Endocrinology 
    • RESOURCE: Canadian Thoracic Society - Clinical Practice Guideline for COPD
    • RESOURCE: Hypertension Canada 2017 Guidelines 
    • RESOURCE: Kidney Wise Clinical Toolkit 
    • RESOURCE: Canadian Journal of Diabetes - 2013 Clinical Practice Guidelines (p. S296)
    • RESOURCE: Eating Well with Canada's Food Guide - First Nations, Inuit and Métis 
    • RESOURCE: Dietary Guidelines for the Brazilian Population
    • VIDEO: 23 1/2 Hours: What is the single best thing we can do for our health? (9m18s)

    Agency Nurses will learn to recognize the deviations/ variations from normal findings, as they relate to the current clinical practice guidelines.  They will help identify potential chronic health problems, and better understand how to routinely manage them .  They will understand and determine the need for the appropriate diagnostic testing, including laboratory and imaging used for screening and prevention, and discuss health assessment findings with clients. 

    Agency Nurses will garner an understanding of common haematologic, endocrine and metabolic conditions such as; Diabetes (Type 1); Diabetes; Anemia (Microcytic, Normocytic, Macrocytic), Chronic Obstructive Pulmonary Disease, Chronic Kidney Disease and Hypertension. They will discuss and demonstrate the diabetic foot assessment (monofilament), as well as the use of screening and monitoring tools. 

    Text and media areas: 7 URLs: 8 Files: 9

  • Adult and Geriatric Periodic Health Examination and Preventative Screening

    Required Pre-Reading: 

    • ISC Clinical Practice guidelines - Adult Guidelines: Intro (p. I-7 to I-9)
    • ISC Clinical Practice guidelines - Adult Guidelines: Chapter 6 Genitourinary System (p. 6-1 to 6-4; 6-20 to 6-35)
    • ISC Clinical Practice guidelines - Adult Guidelines: Chapter 10 Haematology, Metabolism and Endocrinology (p. 10-31 to 10-34)
    • Comprehensive Geriatric Assessment 

    Agency Nurses will review how to perform a periodic health exam systematically using an Inspection, Palpation, Percussion and Auscultation (IPPA) format for both Well Woman and Well Man Exams.  They will also be introduced to regular and routine screening for Chronic Disease, as well as to Preventative Screening.  Agency Nurses will also learn to recognize the deviations/ variations from normal findings, as they relate to the current clinical practice guidelines.  

    Text and media areas: 6 Files: 18 URLs: 16

  • Routine and High-Risk Prenatal, Post-Partum and Gynaecological Health Assessment

    Required Pre-Reading: 
    • ISC Adult Guidelines Chapter 12 - Obstetrics
    • ISC Adult Guidelines Chapter 13 - Women's Health and Gynaecology 
    • RESOURCE: Nunavut Prenatal Record
    • RESOURCE: Preconception Tool 
    • RESOURCE: SOGC Policy - Health Professionals Working With First Nations, Inuit, and Metis Consensus Guideline 2013
    • RESOURCE: SOGC Policy Statement - Returning birth to indigenous communities

    Agency Nurses will discuss endocrine issues in obstetrical client including: Gestational Diabetes Mellitus, and review chronic conditions including: diabetes (type 1, type 2 and Gestational); depression; addictions; and domestic abuse. Agency Nurses will understand the management of obstetrical clients presenting with common, urgent and or emergent problems, initiate prescription of drugs and therapeutics as appropriate, based on the assessment data safely for prenatal clients and provide health teaching for clients and their caregivers. They will demonstrate knowledge of prenatal checklist, date a new pregnancy using the Maternity Care Calendar, understand key physical exam and laboratory tests for prenatal visit and know important "red flag" signs and symptoms to report. 

    Agency nurses will review various case studies, explain what maternal serum screening is for, as well as how and when to order this blood test, and explain why, when, and how to swab for Group B Strep. 

    Text and media areas: 3 Files: 7 Folders: 3 URLs: 8