• Performing complete health assessments including: Taking a full medical history including presenting complaint, past illnesses, social history, family history, and performing a complete physical examination.
• Screening patients at risk for hereditary conditions and potentially preventable disorders.
• Assessment, diagnosis, primary medical treatment and advice for management of acute medical conditions and injuries.
• Assessment of the exacerbations and complications of chronic medical problems.

Provision of continuous care to patients over their lifetime based on the delivery of the following services:

• Acute medical treatment for a range of medical problems from minor ambulatory care visits to severe life threatening illness presenting to emergency rooms, in hospitals, in the home and in long term care facilities.
• Provide primary reproductive care including maternal and newborn care.
• Provide screening for and treatment of sexually transmitted diseases (STDs).
• Provide primary mental health care.
• Provide palliative care.
• Provide hospital care where required.
• Provide early intervention and counseling to reduce risk or development of harm from disease.
• Provide appropriate immunizations.
• Provide care and monitoring of chronic illnesses, including patients with complex co-morbidities.
• Provide early access for assessment of episodic illness or injury with provision of diagnosis, primary medical treatment and advice on self-care and prevention.
• Maintain and keep safe the medical record of each patient.
• Perform surgeries where required.

• Provide counseling on many health and health care issues including but not limited to birth control, prevention of STDs, prevention of disease and issues related to the effects of disease on family members.
• Perform the role of advocate to assist patients to navigate through a complex health care system in order to obtain the best care in the most expeditious way in a cost effective manner.
• Identify and meet the needs of the individual patients, the practice population and the community in general by working with a variety of partners throughout the public health, community, and hospital sectors.

• Assist with discharge planning, rehabilitation services, out patient follow-up and home care services.
• Coordinate referrals to other health care providers and agencies, including specialists, rehabilitation and physiotherapy services, home care and palliative care services, and diagnostic services, as required.
• Collaborate with other mental health care providers when required.
• Coordinate referrals to secondary and tertiary facilities based on patients’ needs.
• Report births, deaths, and contagious and other diseases to governmental authorities.
• Collaborate with necessary public health initiatives.

Depending on the population health needs and the mix of other providers, the Family Health Team may choose to integrate an RN, RPN, or both into the interdisciplinary team.

• Assess holistically and provide services to patients in all developmental stages, and to families and communities.
• Complete health assessments, including a health history and physical examination.
• Formulate and communicate medical diagnoses.
• Synthesize information from patients to identify broader implications for health within the family.
• Use family assessment tools to evaluate family strengths and needs.
• Determine the need for, and order from, an approved list of screening and diagnostic laboratory tests and interpret the results.
• Determine the need for, and order and interpret reports of X-rays, ECGs and diagnostic ultrasounds for diagnosis.
• Assess patient preferences.
• Assessment of patient health care needs (physical, emotional, psychological, and spiritual).
• Analysis of the findings of a health assessment.
• Interpret patient health records.
• Observe and record outcomes.
• Collect data through a therapeutic relationship with a patient.

• Initiate and manage care of patients with diseases or disorders.
• Monitor the ongoing therapy of patients with chronic stable illness by providing effective pharmacological, complementary or counseling interventions.
• Prescribe drugs from an approved list.
• Use nursing strategies arising from the best available evidence and consistently incorporate patient’s perspectives in care.
• Determine the appropriate service or treatment, the appropriate care provider or the appropriate equipment.
• Provide nursing care and treatment (including complementary therapies and/or counseling) for health problems.

• Determine the need for, and implementation of, health promotion, and primary and secondary prevention strategies for individuals, families, and communities, or for specific age and cultural groups.
• Provide health education to individuals and groups.
• Identify community needs and resources and develop age and culturally sensitive community programs.
• Help patients to identify and use health resources.
• Involve patients in decisions about their own health.
• Encourage patients to take action for their own health.
• Initiate health education and other activities that assist, promote and support patients as they strive to achieve the highest possible level of health.
• Develop learning resources for nurses and other health care providers.
• Develop and deliver health education programs for patients, or communities.

• Consult with a physician in accordance with the standards for consultation with physicians, and/or refer the patient to another healthcare professional.
• Collaborate with other healthcare providers.
• Coordinate patient care.
• Refer to community programs and mental health services.

(Note: Midwifery is often a separate specialization, but foundational nursing includes aspects of maternal and child health.)

• Assess and monitor women during pregnancy.
• Provide pre-natal education.
• Order tests if necessary.

• Deliver babies.
• Administer some medications during delivery if necessary.
• Manage labour and conduct spontaneous normal vaginal deliveries.
• Perform episiotomies and amniotomies and repairing episiotomies and lacerations, not involving the anus, anal sphincter, rectum, urethra and periurethral area.
• Administer, by injection or inhalation, a substance designated in the regulations (Midwifery Act, 1991, c. 31, s. 4).
• Take blood samples from newborns by skin pricking or from women from veins or by skin pricking.
• Insert urinary catheters into women.
• Prescribe drugs designated in the regulations (Midwifery Act, 1991, c. 31, s. 4).
• Monitor women in post partum period.
• Assess/monitor new babies.

• Assist women in making informed decisions about their care and choice of birthplace.

• Arrange consultation or transfer to physician if necessary.
• Assist in complicated deliveries.
• Report births to governmental authorities.

The Registered Dietitian (R.D.) is a healthcare professional trained in the single specialty of nutrition science. Their goal is to promote health and fight illness by fostering the practice of proper nutrition to individuals and groups.

• Work with individual patients to determine nutritional needs.
• Conduct nutritional and weight assessments.

• Develop nutritional plans based on comprehensive needs assessments.
• Provide nutritional counseling.
• Provide weight management counseling.

• Promote behaviour change related to food choices, eating behaviour and preparation methods to optimize health.
• Promote patient independence and autonomy in decision making for patient to achieve health.
• Conduct patient workshops and seminars.
• Identify community capacities and facilitate community skill building, health advocacy, and social action.

• Work with physicians on medication monitoring plans as they relate to nutrition.
• Communicate relevant nutritional information to other health care providers.

Pharmacists dispense drugs and medications prescribed by physicians, physician assistants, nurse practitioners, and dentists. They also advise healthcare professionals and patients on the use and proper dosage of medications, as well as expected side effects and interactions with other prescription and nonprescription medicines. These professionals also order and maintain supplies of medications and various medical supplies required for use in the clinical setting.

• Ensure appropriate patient information is gathered and recorded.
• Review patient profile including known patient risk factors for adverse drug reactions, drug allergies, known contraindications to prescription drugs, nonprescription drugs, natural health products, and complementary or alternative medicines.
• Evaluate patient drug therapy and identify potential and actual drug-related problems and determine appropriate therapeutic options to resolve or prevent them.
• Conduct patient assessments for medication problems.

• Manage medication.
• Monitor patient compliance.
• Home follow-up.

• Patient education to facilitate patient’s understanding of her/his drug therapy and ability to comply with the therapy regimen.

• Refer the patient to appropriate health care providers within the Family Health Team if necessary.
• Communicate with physicians to help the patient achieve maximum benefit from drug therapy and to prevent medication errors or potential significant adverse reactions.

• Complete health assessment through information gathering, lower extremity physical examination, patient health history and relevant clinical findings.
• Evaluation of overall lower extremity foot and ankle function relating to activities of daily living.
• Examination and review of lab tests, diagnostic tests and consulting medical and surgical notes.
• Assessment of the impact of an injury, disability or disease (rheumatoid arthritis/diabetes/sprains/strains) on foot function.

• Perform surgery by cutting into subcutaneous tissues of the foot.
• Administer, by injection into feet, a substance designated in the regulations.
• Prescribe drugs designated in the regulations.
• Perform surgery by cutting into bony tissues of the forefoot if the required training has been completed.
• Communicate a diagnosis identifying a disease or disorder of the foot as the cause of a person’s symptoms.
• Take x-rays under the Healing Arts Radiation Protection Act.

• Educate and advise patients about the prevention and care of morbid conditions relating to chronic diseases (e.g., diabetes and peripheral vascular disease).

• Chiropodists and podiatrists work as key interdisciplinary practitioners in hospitals, community health care centres, and nursing and retirement homes. In private practice, they receive referrals from medical and other health care practitioners and consult with these referring practitioners to provide timely and optimal care for their patients.

The role of social workers in an interdisciplinary team is to provide the psychosocial perspective to complement the biomedical perspective.

• Assessment and social work diagnosis of psychosocial problems.

They provide counseling, and enable individuals, families, and communities to obtain social services. They work with clients on issues of unemployment, illness, disability, housing, abuse, and financial problems. Social workers specializing in providing mental health services and counseling are called Clinical Social Workers. In the community, they may be active in organizing communities to improve health and social services. Social workers often assist families in crisis situations and during periods of transitions.

• Individual, couple, family and group counseling and psychotherapy.
• Case Management, including linkages to community resources.

• Health Promotion.
• Psycho-education related to the prevention of mental health problems.
• Assistance in navigating service delivery networks to find required resources.
• Advocacy to establish and access needed resources.

• Development, management and delivery of programs alone or in collaboration with other professionals.
• Consultation with other professionals related to patient needs.

• Evaluation, diagnosis, and assessment of the functioning of individuals and groups related to mental disorders as well as wellness and mental health.

• Interventions with individuals and groups and organizations.
• Treatment of serious mental health disorders.
• Treatment of individual, marital and family relationships problems.
• Maintenance of wellness and disease prevention.
• Management of psychological factors and problems associated with physical conditions and disease (e.g., diabetes, heart disease, stroke).
• Management of psychological factors in terminal and chronic illnesses such as cancer, brain injury, and degenerative brain diseases.
• Treatment of addictions and substance use and abuse.
• Pain management.
• Assist with stress, anger and other aspects of lifestyle management.
• Management of the impact and role of psychological and cognitive factors in accidents and injury, capacity, and competence one’s to manage personal affairs.
• Treatment of problems associated with cognitive functioning such as learning, memory, problem solving, intellectual ability and performance.
• Management of psychological factors related to work such as motivation, leadership, productivity, and healthy workplaces.
• Administration of psychological services.

• Public education regarding wellness and the promotion of mental health.
• Implementation of primary and secondary prevention strategies.
• Program development and evaluation.

• Consultation relating to the assessment of or interventions with individuals and groups to facilitate the prevention or treatment of difficulties.
• Referral to community agencies/services.

• Intake and assessment.
• Develop treatment plan.

• Counsel individuals, couples and families.
• Facilitate/run counseling groups (e.g., relapse prevention, guided self-change, anger management, stress management).
• Assess and adjust and adjust of treatment plans on an ongoing basis.
• Develop discharge plan.

• Provide information about community resources.
• Assist patients accessing other services.

• Advise physicians and other health care workers regarding indicators of substance abuse, relapse prevention and appropriate referral techniques.
• Collaborate with physicians, psychologists, and other professionals regarding after care plan and follow-up activities.
• Refer to community programs and mental health services.
• Refer to psychologists, psychiatrists, and other professionals as appropriate.

Health educators teach clients, both individually and in groups, about various health topics. Although all members of the healthcare team are charged with client education, health educators are focused on providing adequate information to the client to assure understanding of the medical problem and treatment plan. These individuals may focus their educational efforts in health promotion and disease prevention activities that reduce the burden of disease in the community. Some health educators are utilized to provide in-depth instruction to clients about specific illnesses after being diagnosed.

Community Health Workers (CHW) can be broadly defined as individuals who connect healthcare consumers and providers, promoting health particularly among groups who have traditionally lacked access to care. The CHW is a member of the community and play an important role in identifying a community’s problems and in developing solutions. Examples of successful uses of the CHW include: using ex-addicts to educate intravenous drug users about AIDS risks and increasing breast, cervical, and colon cancer screening in minority communities. CHWs may play critical roles in improving community health status by providing cultural and technical linkages between community members, primary care providers, and the health care delivery system.

• Intake Assessment.

• Facilitate coordinated access to services in areas such as assistance with daily living, housing, crisis intervention, treatment, health promotion and prevention.
• Facilitate linkages with appropriate services, supports, and resources.
• Provide crisis intervention and intensive/short-term support.
• Evaluate achievement of patient goals.
• Financial management: budgeting, banking.
• Nutrition: menu planning, grocery shopping, food preparation.
• Personal effectiveness: problem-solving, decision making, communication and interpersonal skills, goal-setting, time structuring and management.
• Community integration: use of transit, social/recreational, peer support and other services.
• Health and wellness: support clinical plan including medication, appointments, healthy choices and lifestyle.
• Employment/service: support maximum involvement in volunteer, community service or paid employment.
• Personal care: hygiene grooming, self-care skills, clothing maintenance.
• Household management: such as laundry and house cleaning.
• Housing support: finding and maintaining adequate housing, liaison/support to landlord, utilities.

• Advocacy: support appropriate use of available community public services and programs.
• Advocate for patient’s civil and legal rights.

• Collaborate with other professionals regarding after care plan and follow-up activities.
• Refer to community programs and mental health services.

• Assess movement, strength, endurance and other physical abilities.
• Assess the impact of an injury or disability on physical functioning.
• Assess physical preparation for work and sports.
• Evaluate pain and movement patterns, muscle balance, joint function, cardio-respiratory status, reflexes and sensation.
• Examine relevant x-rays, lab tests, medical records and surgical notes.
• Evaluate overall functional ability both in the workplace and in other activities of daily living.

• Plan treatment programs, which include education, to restore movement and reduce pain.
• Provide individualized treatment of an injury or disability based on scientific knowledge, a thorough assessment of the condition, environmental factors and lifestyle.
• Provide treatment which can include an individualized exercise program, manual therapy, modalities, as well as patient and family education and home exercise prescription.

• Educate to restore movement and reduce pain.
• Encourage patients/patient to take charge of their health by teaching techniques for recovery, pain relief, injury prevention and improved physical movement, with emphasis on what the patient can do for her/himself.
• Promote independence and facilitate patients assuming responsibility for their rehabilitation and self-care.

• Based on assessment the physiotherapist either plans an appropriate treatment program and carries it out or refers the patient to another professional.
• Coordinates treatment with other providers.

• Assessment of physical, emotional, and cognitive functioning with environmental considerations.
• Evaluation of the home, work or school environment to assess the need for specialized equipment modifications and/or supports.

• Individualized treatment plans to develop, maintain, or augment function using evidence based treatment modalities.
• Teaching daily living and community life skills.
• Prescribing specialized adaptive equipment and teaching proper usage.
• Modification of the physical and social home, work or school environments.

• Educating and counseling family members and caregivers regarding the impact of disability, injury or disease on the individual and their potential role within the recovery process.
• Educating and counseling to promote function and independence including health promotion and injury prevention.

• Based on assessment the occupational therapist refers the individual to additional health care and community services as needed.
• Collaborates with other health care professionals and community service providers to promote comprehensive and coordinated care.

• Diagnosis, including differential diagnosis, of musculoskeletal disorders or referral for non-musculoskeletal complaints.
• Ongoing evaluation of treatment/management outcomes using standard measurement tools.
• Request/utilize X-Rays as authorized by the Healing Arts Radiation Protection Act.
• Assessment or evaluation of workplace or home environments to inform treatment decisions and to provide ergonomic, activity, or other advice.

• Treatment of acute conditions and management of chronic or recurrent complaints with a focus on self-care.
• Manual care including joint manipulation and mobilization and a wide variety of soft tissue techniques.
• Electrotherapies such as ultrasound, electrical stimulation, laser, etc.
• Planning, instruction, and supervision of therapeutic exercise programs.

• Education for self-management of musculoskeletal conditions, including injury prevention, lifestyle and ergonomic advice.
• Encouraging fundamental health promotion activities are integral to chiropractic practice.

• Refer to physicians, physiotherapists, occupational therapists, psychologists, and others where appropriate.
• Share care where the expertise of others is appropriate.
• Communicate with other health professionals to facilitate patient care.

Volunteers are individuals that that provide services in the clinical setting with no monetary payment. They may be retired healthcare practitioners or citizens with a strong desire to provide public service to the community. Many clinics utilize these volunteers to perform a variety of jobs, such as interpreters, filing, answering telephones, or more patient oriented services, such as taking vital signs, assisting patients in completing forms, and assisting other health care team members.

Other members of the interdisciplinary health care team may include: surgeons, ophthalmologists, ENT specialists, radiotherapists, laboratory technicians, speech and language therapists, and art or music therapists. The availability of these additional members of the health care team depends on the community served and the health care services offered.

Below are the core and other references listed in the curriculum for Module CN-1111. Refer to the original document for full details.

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