Age Diversity and Cohesion: Strategies for Successful Teams


Teamwork is a fact of life in nursing. And it stands to reason that as healthcare becomes increasingly complex, so will the complexity and diversity of the teams that constitute it. If healthcare teams are to be mirrors of the societies and communities they serve, then it is imperative in a community nursing context to feature teams that possess many different languages, cultures, and – yes – ages. It is therefore incumbent upon leaders in community nursing to address issues of diversity in order to ensure a positive team culture and quality provision of services.

Claire Heath, the nurse educator at Evergreen Community Health Centre, asked me to conduct a literature review on the subject of age diversity in teams. It was a topic of particular interest to her, as the team at Evergreen was undergoing changes making it a more multi-generational unit. She wanted to know how these changes would affect team morale and unit culture. And she happened to have a UBC nursing preceptor student available to find out.

I conducted the review throughout the course of my preceptorship. What I found was that there was actually a fairly robust literature on the subject of multi-generational teams and the traits that make them successful. Little of this research, however, came from the field of nursing. Most of it, in fact, came somewhat unsurprisingly from the private sector. European (primarily German) researchers have been investigating the effects of age diversity on firm efficiency and productivity for some time. While these ends may be of slightly more importance in the private sphere, the literature also focused on the concept of group cohesion. Group cohesion, of course, is positively correlated with increased efficiency and productivity.

So how could we translate these findings into a community nursing context?

Well, the answer is a simple one. Although there are a variety of ways to foster group cohesion, as gleaned from the private sector, the most important goal is to create spaces that encourage innovation and creative freedom. But how nursing units can accomplish this – by promoting safety, learning together, and implementing diversity training – is ultimately unrelated to the notion of multi-generational teams. Successful age-diverse teams share traits of all successful teams, more generally. For nursing teams in the community, we should all learn to accept differences, communicate effectively, and value each other’s contributions. Sometimes, research simply affirms what we already intuitively know. With age-diverse nursing teams, it is much the same.


@UBC APSC #Design and Innovation Day


UBC Nursing Synthesis Project Feature: Kelsi Jessamine and the Vet Pop Up Clinic from Khristine Carino on Vimeo.

The UBC Nursing I-CAN Snowflake Diagram

The I-CAN project started as collaboration between two UBC School of Nursing faculty members, Maura and Ranjit, and the Director of the Union Gospel Mission (UGM), Melissa.

Maura and Ranjit posted a notice about the I-CAN project, and 10 students signed up for the project. The 10 students are those circles closest to the center of the snowflake.
In an initial project meeting between Maura, Ranjit and Melissa, Melissa identified the need for a sustainable foot care clinic. The School of Nursing currently does foot soak clinics every 6 weeks. This activity is very popular at UGM, but the staff and clients would like to expand available services, based on client requests for professional foot care.

Melissa suggested that we begin our project by talking with UGM staff and getting them on board. Four student volunteers interviewed these UGM staff. UGM staff members provided additional names of inner city clinics that might partner with us on this project. The students are setting up interviews with these clinics to determine whether or not they are supporters or competitors. These inner city services are in the next layer of the snowflake with ?s (competitor, supporter). We hope to win them over to our project!

Our asks are: 1) Are there professionals who can do foot assessments? 2) If so, would they be willing to volunteer their services every 6 weeks during the School of Nursing foot soak clinic? 3) Would they be willing to review the accuracy, utility of deliverables we create through this project? (We are creating a “Foot Care Tips” card and a referral form for UGM clients).
The bold lines between students indicate students who are working together on interviews or other aspects of the project. Melissa and UGM staff members have asked for a “Foot Care Tips” card to give to clients during foot soaks—a teachable moment for students doing client foot soaks. Two students are designing this card.

The UGM staff members have also asked us to create a standardized referral form to connect clients with foot disorders to inner city services. We need to identify inner city service providers who will receive UGM referrals, and we need to set up a standardized process for referrals to happen smoothly, efficiently. Two students are working on the referral form.

A third deliverable for this project will be a video of foot assessment: for all foot care clinic volunteers to watch. The UGM staff members (and UBC faculty) want to ensure that anyone volunteering for the clinic has basic information about foot assessments and specific issues for the UGM client population. Our intention is to ask service provider supporters to review and approve our three deliverables (i.e., foot care tips card for clients, referral form for inner city foot care services, and a video for foot care clinic volunteers).
The UBC faculty leads have been having conversations with the UBC chapter president of IHI Open School. They are discussing the possibility of making the foot care clinic an initiative of the UBC chapter. One student, a member of the UBC Social Medicine Network, is also talking with members of this student association to determine inter-professional student interest in our foot care clinic.
We realize that our snowflake will continue to grow as we establish more contacts and relationships with services (non-profits and for-profits) in our inner city area.
We have a question: We have not included the UGM clients as part of our team. We are, however, having regular discussions with them about the services they want, and we will ask for their input and feedback on our project deliverables. Should they be included in the snowflake?

Nursing students introduce Vancouver’s first Vet Pop Up Clinic


Photo Credit: Sandy Sharkey

                  Photo Credit: Sandy Sharkey

On December 4th, 2016   a team of UBC Nursing students collaboratively put on Vancouver’s first primary care clinic for clients and their pets. The idea for the clinic was proposed by Kelsi Jessamine, a 4th year UBC School of Nursing (SoN) student, who integrated development of the clinic into The SoN Synthesis Project course (N334). Kelsi worked on organizing, developing, and directing the clinic with devoted team of UBC Nursing students. The student team included: Jessica Ardley, Laura Gallagher, Livianna Cristea, Jennifer Hoffman, and Anna Dupas. The team of students partnered with the non-for profit agency, Community Veterinary Outreach (CVO), to provide free veterinary care to pets of under housed individuals, while offering health and social services to the owner(s).  CVO and the UBC Nursing students collaborated with groups including: Paws for Hope, Vancouver Coastal Health, Vancouver Family Services, to launch the highly success pilot at Directions Youth Services.

The Nursing Team from left to right: Elena Bernardi, Liviana Cristea, Laura Gallagher, Jess Ardley, Kelsi Jessamine and Jennifer Hoffman. Anna Dupas missing from photo.


The pilot was targeted to street youth with pets in the downtown region. Internal referrals for the clinic were made by Michlle Simms (NP, VCH); however, walk-in appointments were also accepted the day of the clinic. Paws for Hope provided veterinary care to 25 animals which included: immunizations, deworming, spay and neuter referral, nail trimming, and preventative education to owners. The UBC nursing students provided primary health care services to the pet owners. The services provided included the administration of 11 influenza vaccine youth and suppling 33 clients with naloxone kits and training. Additional care and education was provided on topics such as: dental care, STIs, and wound care.  The CBC story of the pilot can be found at the following link:

“We realize the potential of veterinarians and veterinary care to influence the health and welfare of marginalized people who are pet owners”, says Dr Michelle Lem (CVO founder). 

“The opening is the animal.”

UBC Animal Biology Student, Chloe Roberts assisting with the veterinary examination.

 CVO clinics are extremely influential in improving the public health of vulnerable populations, through harnessing the strength of the human-animal bond, especially in those who are marginalized. The same group of students and UBC Master of Public Health Candidate, Dr. Doris Lueng, are planning another clinic with CVO on May 1st at the Veteran’s Manor and Evelyn Sallor Center. This May 1st event will be promoted under the title, “Pet Fair and People care”. At this event primary care services will be offered to clients and grooming services to the pets. The event will be held from 12-4pm. This event will be offered as an UBC IPE event for both Nursing and Pharmacy students, with additional contribution from UBC Masters of Public Health Candidates. The will be opportunity for invaluable leadership and clinical experience for students. If you would like to find out more information about the upcoming event or future clinic, please contact Kelsi at: More information about CVO and how to get involved, please visit http://vetoutreach.

Special Thanks to:

Paws for Hope

Michelle Simmsm, NP (VCH)

Matt Smith (Assistant Manager, Directions Youth Services)

Dr Maura Mcphee, RN, PhD (UBC School of Nursing)

Joanne Ricci, MSN (UBC School of Nursing)

Warner Brothers (The Flash)

Whole Foods (4th Avenue)

Cobbs (4th Avenue)

Covenant House Women’s Drop-In Information Session about Pregnancy



Every Friday morning, Covenant House holds a Women’s Drop-In Center that offers numerous supports such as breakfast, clothing, and access to Youth Workers and Case Managers.

Youth (16-24 years) experiencing homelessness and facing barriers related to the social determinants of health are provided with a safe space. Numerous youth expressed their satisfaction over having a place where they could feel completely at ease and be surrounded by other women facing similar life experiences.

We attended these drop-in sessions for four weeks building relationships, getting used to the space, and engaging with the attendees. During our last week, we held an information session about safe pregnancy because it was a health topic that had not been done previously. The three main components of the information board were early signs of pregnancy, health centers and resources in the area, and a game with fact or fiction myths regarding pregnancy.

We used tea tree oil balm giveaways as a “hook” to incentivize them to partake in the game. Tackling pregnancy myths was a good way to gauge the different levels of knowledge and engage in health teaching. One interesting thing that was prominent was the lack of knowledge about safe influenza vaccinations for individuals who are pregnant.

We took this as an opportunity to emphasize the importance of flu shots for this demographic and the different resources available. It was great to engage the young women with knowledge that they were interested in! Not everyone has regular opportunities to seek out medical and health-related information. The information board and interactive game seemed to be very well received amongst the women!

Overall, we had a very positive experience at Covenant House, as it was a great learning opportunity to experience public health nursing in a community setting.

A student’s insights on the 2017 BC Quality Forum- Maryam Koochek


Left to right: Dr. Maura MacPhee, Ranjit Dhari, Maryam Koochek and Rebecca Anthony. (Photo by Khristine Carino.)

The BC Patient Safety and Quality Council holds a Quality Forum once a year to showcase quality projects that are benefiting our patients and to raise awareness of initiatives that are being implemented to meet the demand for quality improvement. At this year’s event, the objectives were to:

Ignite action to improve quality of care for patients and providers;

Create and strengthen connections and collaborations across all areas of care; and

Share effective strategies and leading practices to stimulate and sustain improvement

These objectives were met through inspirational plenary presentations, from important figures in the healthcare community including the current provincial minister of health, Mr. Terry Lake; various interactive workshops, rapid fire presentations and field trips to organizations that are known for having complex operations such as the Port of Vancouver.  The diversity in the mode of delivery and the topics discussed ensured that every attendee had plenty of opportunity to attend and learn about their area of interest.

Given my interest in community nursing and working with marginalized populations, I attended workshops on team-based care in the community, trauma informed practice, cultural safety and responding to a public health emergency: the opioid crisis in BC just to name a few. This last session struck me as especially inclusive of all the players in this crisis. There were three speakers, each with their own unique place within the crisis response management. The session began with Laura Shaver, the president of Vancouver Area Network of Drug Users (VANDU). Laura is a recovering heroin user who is currently on the methadone program and has been witness to the devastating loss of life that has resulted from illicit fentanyl on the streets. She is a powerful advocate for her community and having her at the session gave us a glimpse of the lived experience of those who are closest to the crisis. Dr. Christy Sutherland is the medical director of PHS community services society and she gave the audience an account of the daily challenges and the on the ground response from her team including setting up Naloxone tents in alleyways and working around the clock to meet the demands of this crisis. The third speaker was Dr. Bonnie Henry, the Deputy Provincial Health Officer for BC. She gave the audience an overview of what is being done at the provincial and federal levels to manage the crisis including working with Health Canada to open more safe injection sites; working with the the Border Agency to curb the entry of these substances from abroad and working with local agencies to put more resources in place.

I concluded the Quality Forum by presenting the student IHI I-CAN Quality Improvement Project with my colleague Rebecca Anthony. The presentation was very well received and showcased the amazing work of UBC students and our ever supportive faculty.

Attending the forum was inspiring and motivational and I would recommend every nurse to attend it. One of the lessons I took away from attending the forum is how well our program has prepared us for practice. I sat with nurse managers who had never heard of trauma informed practice or cultural competence. I feel that as soon to be graduating nurses, those fundamentally important concepts are forever embedded in our cells and that is partially due to the education and awareness we have received over the course of our training.

UBC Nursing students provide Diabetes education to UGM staff


The Union Gospel Mission (UGM) provides meals, shelter, and substance recovery services to people living in the Downtown Eastside (DTES) every day.

To better serve their guests, UGM requested training from the UBC School of Nursing on how to manage hypoglycemia in guests who have diabetes. For our N344 Synthesis Project, a team of students (Rebecca Burns, Brittany Kliment, Katelyn Newell, and Shelby Slater) developed a training module, hypoglycemia kits, and a foot care poster, the latter to be used during foot soak clinics. The module provides an overview of diabetes, common diabetic complications, signs and symptoms of hyper- and hypoglycemia, and a protocol for managing hypoglycemic episodes. Our team also prepared hypoglycemia kits for UGM that each include a copy of the four-step hypoglycemia protocol, as well as a bottle of Dex4 glucose tablets. Finally, we created a foot care poster that includes tips that are applicable to all UGM guests, particularly those with diabetes.

On February 9th we presented our final products to UGM staff and discussed how they could be implemented. UGM plans to include the diabetes module on their internal website and as part of staff training. They also plan to share the module and hypoglycemia protocol with the UGM location in New Westminster, as well as with select other organizations working in the DTES. This project helped to fill a knowledge gap at UGM and gave staff the information they need to better serve guests experiencing hypoglycemia.

Stop spreading germs through hand washing!

Kindergarten teaching as a part of clinical practice with community and population


Fluorescent Germ Experiment

On February 9th 2017, one of the student nurses in my clinical rotation group and I got to meet 22 little health promoters at David Livingstone Kindergarten. We provided them with a fun learning experience regarding to how best to stop spreading germs, “hand washing”.

In the beginning of the clinical practice, the school of nursing had offered us a variety of teaching opportunities with various health topics such as sexually transmitted infections, nutrition and healthy food choices, baby massage, and hand washing. As I have learnt that health teaching is one of major public health interventions, I considered this teaching practice as a highlight of this clinical rotation.

Generally, health teaching in community and public setting aims to build the community and public capacity to put health in their agendas and perform health promotion and protection strategies; to provide up-to-date accurate health information; and to empower individuals and families’ self efficacy so that they can elicit the best personal health practices and coping skills in their lives. Making sure to keep these points in my mind, my partner student nurse and I chose to teach kindergarteners hand washing to help them build the healthy habit. While developing a teaching and learning plan, we referred to the program called ‘Do Bugs Need Drugs?’, an educational program of Alberta Health Services and the British Columbia Centre for Disease Control (2014) and adapted a glo-germ activity.

Teaching Characteristics of Germs and Proper Handwashing Skill Before the Actual Hand Washing Activity

To meet the students’ learning objectives, we utilized multiple teaching strategies; power point slides to deliver knowledge with visual effects; role playing to show how germs can easily spread and make others sick; singing a handwashing song to help them acquire a proper hand washing skill; putting yellow sticky notes on which students believe germs are to help them understand that germs are everywhere; coloring sheets to reinforce their memory; and actual handwashing activity using glo-germ powder and black light to show the spread of germs and the difference before and after hand washing using a soap. Consequently, students seemed to be content with the learning experience and aware of the day’s lessons as evidenced by their best performance to get the glo-germs off through proper hand washing! I hope that they remember the importance of frequent and thorough hand washing and keep playing a role as little health promoters in their families, schools, and community.

References: Retrieved from

G.O. Day – Girls Only Lifestyle Expo 2016


While on my UBC nursing preceptorship at Richmond Public Health I was able to participate in health teaching at G.O. Day. In collaboration with various community partners, I was able to speak to Grade 9 girls about healthy eating habits and the importance of leading an active life. This day opened up the opportunity for Grade 9 girls to see what community health activities are available to them, highlighting activities that are actually fun and exciting. Alongside, some UBC nursing students, I participated in Belly Dancing, Barre, Pilates and Life coaching. It was inspirational to engage with young girls and yet take moment to think about my own self-care goals as a busy student and future health professional.

Facilitating difficult conversations and deepening perspectives of discriminated populations: A personal account from Elder Don


“I had the pleasure of meeting Elder Don while UBC Nursing students were engaged in health promotion teaching at the Turing Point in Richmond. Elder Don and I quickly established a trusting friendship as he shared life stories. I invited Elder Don to the N336 classroom to share his lived experiences of being in residential school, foster homes and  living in marginalized conditions in the Down Town East Side (DTES) Vancouver. Through his stories Elder Don encouraged students to  become kind compassionate non judgmental health care  practitioners. On behalf of the N336 class ( Rotation A 2017) and UBC SON we thank Elder Don for so willingly to share his life story to enhance student learning”. –Ranjit Dhari, N336 Course Leader 2017


“Bevel up,” a street nurse says to a young man in an alley of Vancouver’s Downtown East Side (DTES) in a documentary by Nettie Wild. The nurse is pointing to the side of the needle he should insert in his arm when injecting drugs. The outreach nurses interact with residents of the DTES in an attempt to increase health care services and build trust with a population where many have been failed by our health care system. The documentary revealed there exists a population of people unjustly profiled, mislabeled, and mistreated by health care professionals here in British Columbia.

Without an understanding of the pathways to homelessness and addictions, the factors that contribute to the intergenerational trauma of First Nations communities and ongoing structural systems in place that keep the oppressed, oppressed; student nurses run the risk of perpetuating the mistreatment of marginalized populations. Elder Don, a Dene First Nations Elder, brought his amazing story of hardship and perseverance to illuminate the challenges he faced while experiencing addiction and living on the streets of the DTES.

“People don’t necessarily want to confront these issues…it forced students to hear something that is hard to hear,” said one student. “People talk about truth and reconciliation and they want the reconciliation but not the truth. It’s too hard.” they continued, baring a sensitive dichotomy that exists concerning First Nations issues in Canada.

Across Canada, depending on their upbringing and school curriculum, students may not even learn about residential schools. Kait Kilyk from Fonthill Ontario found the presentation illuminating and inspiring. “My knowledge of residential school prior to the presentation was quite limited. I was aware of some scenarios from previous documentaries but never had the opportunity to discuss with someone their experiences in the school.”
Elder Don was taken from his family and community, forced into residential school, and then placed into foster care. First Nations children in residential schools had their hair cut, were punished when they spoke their language, segregated from their siblings and too often were sexually, emotionally and physically abused. Today, First Nations children still suffer. A report in 2011 by Statistics Canada revealed that First Nations children make up 48% of children in foster care in Canada, grossly over representing any other group in care. In 2016, the Canadian Human Rights Tribunal ruled that the Canadian government is discriminating against First Nations children by providing flawed, discriminatory and inequitable health care services which is a violation of the Canadian Human Rights Act. To date, Prime Minister Trudeau announced a 5-step plan to implement the Tribunal and the Truth and Reconciliation Committee’s call to action, however progress is slow and in the meantime First Nations children bear the brunt of the inaction, many ending up homeless. Creating a safe space to answer our questions, Elder Don challenged our preconceptions about homelessness and offered insight to First Nations culture.

“Why did you sleep outside?” a student asked Elder Don during the presentation.

“Shelters are crowded, a big room full of beds, with bed bugs and scabies and you have no personal space. I preferred living outside under the stars, I didn’t mind it.” Elder Don replied, sharing some downfalls of the systems in place meant to be salvation for homeless individuals.

Seohee Lee, a global citizen from South Korea related to Elder Don in her desire to work coming from a place of love. “He is doing the same thing by making [medecine bags] and giving them to people who need strength. I guess this is how he appreciates his life, being spiritual and recovering himself. He powerfully inspired me to be a nurse with heart.”

The Cultural Competence and Cultural Safety in Nursing Education framework manual published by the Aboriginal Nurses Association of Canada offers 6 core competencies to incorporate into nursing education curricula. At the top of the list is walking through the nursing journey with an understanding of the legacy of residential school and recognizing barriers to health equity that continue to impact First Nations, Metis and Inuit communities. One of those barriers is the absence of Indigenous perspective in health care.

“Elder Don showed people there is a different way to think about things. Like how he only uses traditional medicine. How he gets his strength and mental health through traditional practices… the medicine wheel encompasses well being- something that I think nursing is trying to do but hasn’t [accomplished] yet,” one student thoughtfully contributed.
Moving forward with nursing education necessitates sharing the truth of residential schools in order to develop a culturally safe practice. Do not wait for a challenging situation to learn this truth. We know that students retain the most information by hearing, seeing and doing. Incorporating opportunities outside of readings is integral to equipping nursing students with a holistic, critical and relational practice.  Using traditional practices embedded with First Nations teachings, Elder Don reaches out to struggling individuals on the DTES and the greater Vancouver Area. Nurses are also in the position to help this population. For student nurses it can feel overwhelming to know where to begin. Here are some strategies student nurses can use, beginning now.

Learn about the territory you are in and acknowledge the community that existed pre-colonization. Normalize acknowledging territories during formal meetings and presentations to reduce feelings of discomfort that can arise. Be curious and ask questions with an open heart and genuine compassion, only after you have listened and observed. Seek out resources, partnerships and get involved! Lastly and perhaps most importantly, it is about treating each patient contextually to this particular place and time. In the clinical setting weighted by systemic structures, long hours, and staffing shortages, it can be easy and reactionary to hastily profile a patient or client.  Kait pointedly summarizes how to address this reaction:
“Something that Elder Don said during his presentation has stuck with me. He said that he will never judge someone who is on the street because you never know what got them there, and what they may have overcome being there. That is something that I will carry with me.”