Two former intensive care unit nurses enhance patient care through inclusive language

Former intensive care unit (ICU) nurses Yolanda Baker and Robin Fraser worked together at the Aberdeen Hospital in New Glasgow. 

Independently, they identified a need for more inclusive language in forms used on their unit to assess the health of patients, which has led to significant improvements in patient care.

“I noticed that our forms did not reflect the diverse populations that we serve, and it was not sitting right with me," said Baker, now a clinical team lead. “I thought it's time that we push for a change since we have seen an increase in diversity within our patient population."

Similarly, Fraser flagged the inaccurate language surrounding skin color assessment forms on her unit. 

“At the time, I thought it was a little thing, but now that I look back, it has made a major, positive change in the language used in forms across the province,” said Fraser.

The feedback from Baker and Fraser initiated the update of critical care records across Nova Scotia Health, ensuring that skin color documentation accurately reflects the diverse patient population, including ethnicity and race. These changes are crucial for providing accurate and personalized patient care.

Their concerns were presented to Nova Scotia Health’s Diversity and Inclusion Committee, inspiring the formation of the Critical Care Skin Assessment Working Group which reviewed suggestions and sources to implement these changes. 

This group included Kimberly Lacey, program manager for the Interprofessional Practice and Learning (IPPL) wound prevention and management program at Nova Scotia Health, and Seneca Classen-Pottie, an African Canadian community member and representative of the Health Association of African Canadians. 

Classen-Pottie is also a nurse practitioner with Mental Health and Addictions Program at Nova Scotia Health. 

"In part of the skin assessment, we are looking for changes to patient skin color because that can indicate different clinical conditions," said Lacey. The original forms used the term ‘pink,’ which was not applicable to many patients. 

"We didn't have an objective way to assess what is someone's skin color on admission and be able to address potential changes, which could indicate a health concern," added Classen-Pottie.

Beyond updating the forms, the initiative has also improved the education provided around skin assessments for all patients, ensuring that assessments are accurate and inclusive. 

“As an African Canadian in Nova Scotia, representation matters," emphasized Classen-Pottie. “However, it's not just Black Nova Scotians we’re talking about, but also our indigenous folks, immigrants, and other diverse populations."

The initial learnings and improvements from the critical care skin assessment working group have expanded Nova Scotia Health's cultural competency and impacted overall cultural humility. 

This initiative has also inspired further work within IPPL on wound care and the inclusion of special characteristics for all skin assessments, promoting the use of inclusive language in future projects.

“This is a significant step forward in removing barriers to access for health services as we work towards improving access to inclusive, diverse and equitable care in Nova Scotia,” said Karen Oldfield, interim president and CEO of Nova Scotia Health.

Nova Scotia Health recognized this initiative with the 2024 Quality Improvement award for Excellence in Inclusion, Diversity, Equity & Accessibility (IDEA).

This improvement initiative ensures that the care provided by Nova Scotia Health reflects patient, family and health community values through an equity lens to support the diverse population base and enhance patient care across the province.

Photo of Yolanda Baker, former clinical lead, intensive care unit and Robin Fraser, former critical care nurse, Aberdeen Hospital. Baker is now an infection control practitioner and Fraser a clinical resource nurse, both at Aberdeen Hospital.