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RNAO is excited to announce that we will be hosting our Best Practice Spotlight Organization® Knowledge Exchange Symposium on November 20, 2024 in London, Ontario, Canada. Provincial, national and international BPSOs will come together to network, share, learn and continue to build on our global social movement.
The symposium spotlights clinical excellence and evidence-based practice in academia and in all sectors and areas of health care around the globe. We aim to celebrate our collective international commitment to enhancing evidence-based cultures and the impact on quality outcomes for persons, providers, organizations, systems, and global health outcomes.
There will be many opportunities to share strategies to shape practice and to discuss best practice programs and processes. Participants will celebrate the successes and share the challenges of providing excellent clinical care and implementing, evaluating, and sustaining evidence-based practice cultures.
Registration:
Trillium Health Partners’ (THP) Invitation to Leadership Program (ITL) is designed to support
highly motivated individuals build their leadership capabilities through targeted
professional development. The program offers a structured pathway for growth, combining
formal leadership training with dedicated mentorship to enhance participant learning.
The ITL program underwent a transformative shift following a 2022 Anti-Black Racism
Climate Review led by an external equity expert, which revealed pervasive impact of antiBlack racism, highlighting instances of disempowerment, exclusion and harm experienced
by many within the organization. The review prompted changes to practices in selecting,
recruiting, and developing new leaders at THP.
The ITL program, historically showed very little diversity in terms of race, role, gender and
sexual orientation. Representation from equity deserving groups was missing among the
ITL participants, mentors and selection committee. Generally, only 1-2 visible minorities
participated in the program for each cohort. Recommendations emphasizing equity,
diversity and inclusion were successfully implemented, resulting in a dramatic shift in the
application and selection processes along with the curriculum design and delivery.
To raise awareness, changes to the ITL program was promoted across several different
THP platforms with a particular focus amongst individuals from diverse roles, cultures, and
races. As a result, a 30% increase in ITL applications was realized. Further, an optional
self-report of demographic data was built into the application and selection process. It
was the first time data metrics included race, gender and sexual orientation evaluation. A
significant increase was noted in equity deserving groups participating in the 2023 ITL
cohorts including 24% Black, 44% Asian, 12% Mixed Race, 4% White and 16% Other, as
self-reported by participants.
These equity, diversity and inclusion initiatives aimed to dismantle barriers, enabling
formal leaders to mentor, coach and guide mentees while drawing from their own lived
experiences and overcoming challenges.
Objective: To explore the factors that affect the implementation of Best Practice Guideline (BPG) projects and provide a basis for developing evidence-based strategies to sustain the project.
Methods: A phenomenological approach in qualitative research was adopted to conduct semi-structured in-depth interviews with 15 stakeholders of the BPG projects, and data were analyzed using the Consolidated Framework for Implementation Research (CFIR).
Results: The research identified 23 influencing factors for BPG implementation, and 13 components of 5 fields in the CFIR framework are enablers. The intervention characteristics include relative advantages, high evidence strength and quality, adjustability, and trial availability. Internal factors include alignment of goals and feedback, incorporation of reward mechanism, strong leadership support and encouragement, and adequate knowledge of BPG; External factor includes establishing a rigorous implementation process; and individual characteristics include self-efficacy and exemplary attitude towards patients; Organizations need to reflect and evaluate the process and outcomes of the implementation. In the five domains of CFIR framework,10 components are in the category of barriers: Intervention characteristics include the complexity and high cost of BPG implementation. Internal factors include insufficient available resources, strengthen nurse-patient communication and organizational structure. External factors include inadequate policy support and negative peer pressure. Individual characteristics include lack of implementation confidence and motivational factors. As well, the lack of an execution plan is another barrier in the implementation process.
Conclusions: CFIR theoretical framework can be used to identify the factors affecting the BPG implementation projects and modify the key content of intervention programs to develop evidence based implementation strategies.
Purpose/Objectives-
Falls are one of the leading reported patient safety incidents for patients receiving care and identified as a key priority for keeping patients safe. The fall prevention strategy was enhanced through a focus on aligning to evidence-based practice through the RNAO Best Practice Guideline (BPG) for Fall Prevention, addressing gaps in meeting the standards outlined in the Required Organizational Practices and improving overall patient safety outcomes.
Methods/Components-
An interprofessional Fall Prevention Working Group, including patients, was established to execute on a comprehensive fall prevention strategy. Interventions implemented included: 1) an evidence-based falls risk screening tool derived from the RNAO BPG for Fall Prevention in the Electronic Medical Record, 2) visual identification of patients at risk for falls, 3) revised policy and procedure and 4) education for staff and patients.
The new fall prevention education program was delivered via iLearn, and included orientation for clinical and non-clinical staff. Additional educational resources for staff were made available, and teaching tools were provided to Clinical Educators.
Outcomes/Stages of Development-
Preliminary data from chart audits indicates that screening tools and interventions have positively influenced practice, leading to improved patient outcomes. Specifically, there has been a reduction in the rate of injurious falls from 1.8% in August 2022 to 0.8% in August 2023, and 2.6% in March 2023 to 1.5% in March 2024, demonstrating a consistent decrease since implementation. Nursing compliance with documentation assessments using RNAO BPG Fall Risk Assessment Tool has improved by 67%. Further, staff have provided positive feedback regarding the effectiveness of interventions, education and implementation strategies.
Conclusion/Implications-
Early data suggests widespread adoption of best practices and improved patient outcomes. The interventions implemented are essential elements of a a successful falls prevention strategy and would be important to share with other organizations at the symposium to spread advanced fall prevention practices.
A champion is a staff who facilitates and moves their organization through transformation. Change is often perceived as stressful and uncertain, but the most effective and successful process of change is when champions are involved, are part of the decision-making process, and have a say in how change should be conducted.
Within CAMH, the champions will bring awareness of best practices to clinicians and patients, influence groups and committees to consider best practices and mobilize, coordinate, and facilitate the development of education. Champions will also be part of a Community of Practice which will provide a means of sharing successes and challenges and continuous learning on dissemination and implementation of Best Practice Guidelines.
Change starts at the frontline, however clinical leaders’ support, buy-in, and acceptance are also relevant and a crucial step in bringing success, hence as part of our champion engagement strategy at CAMH, we focused on engaging the frontline staff and executive leader simultaneously. For frontline engagement to be supported and encouraged, clinical leadership needed to also understand the ‘why’ and ‘what’; they needed to also understand what the champions’ role would be and how best to support them in implementing change. We asked our BPSO leadership such as the Chief Nursing Executive and Director of Nursing Practice to not be present during unit huddles for champion engagement, to present at practice forums but also present to other clinical directors, managers as well as the Executive Leadership Team.
The other strategy we used was connecting with champions and unit leadership together to understand the current clinical/unit landscape for the assessments we are focusing on and to engage them in creating an implementation plan for each clinical area. This process allows the team to understand their roles better, and how clinical leadership can support champions’ roles and responsibilities.
This project explores the integration of inclusion principles specifically focusing on pressure injury prevention. The project highlights the collaborative efforts with Patient Care Advisors (PCAs) in co-designing an educational booklet, emphasizing the significant impact of inclusive and patient-centered approaches in healthcare.
Inclusion in healthcare transcends mere diversity; it encompasses creating environments where all individuals feel respected, heard, and valued in their care journey. By aligning inclusion principles we aim to enhance patient outcomes and experiences, particularly in pressure injury prevention.
The project methodology centers on partnering with PCAs, who contribute invaluable insights, lived experiences, and patient perspectives to the co-design process. Through collaborative workshops feedback sessions, storytelling, and iterative design cycles, we developed an education booklet that resonates with diverse patient populations, is culturally sensitive, and promotes active patient engagement.
Key project components include:
Engaging PCAs as co-designers to ensure the education booklet reflects patient needs, preferences, and perspectives.
Integrating inclusion principles to foster a culture of inclusivity and patient-centered care.
Incorporating diverse voices and experiences into the educational content to address disparities and improve patient outcomes.
Evaluating the effectiveness of the education booklet in increasing patient knowledge, engagement, and adherence to pressure injury prevention strategies.
The project will showcase the collaborative co-design process with PCAs, highlight the importance of inclusion in healthcare, and share insights and outcomes. By using the Leading Change Toolkit, this initiative promotes inclusive healthcare practices that prioritize patient empowerment, equity, and improved outcomes, demonstrating the value of a patient-centered approach in pressure injury prevention.
This alignment ensures that the project not only achieves its immediate goals but also contributes to a broader culture of inclusivity and continuous improvement in healthcare.
Objective
This study aims to develop and implement an evidence-based bleeding management protocol for renal biopsy patients tailored to clinical application scenarios and evaluate its effectiveness.
Methods
Using the "6S" evidence pyramid model, we systematically searched evidence synthesis databases, clinical practice guideline websites, evidence synthesis/systematic review databases and relevant original research databases for literature related to post-renal biopsy bleeding. The literature was subjected to quality evaluation, evidence extraction, and thematic summarization.
According to the Knowledge-to-Action (KTA) framework, stakeholder meetings were held to identify evidence items for inclusion. The research team discussed and developed review indicators, conducted a baseline review, analyzed the gap between clinical scenarios and evidence, and identified facilitators and barriers. An initial draft of the bleeding risk management plan for renal biopsy patients was developed, refined through two rounds of expert consultations, and finalized.
The bleeding management plan was implemented in pilot wards,A pre-post study design was adopted, selecting patients undergoing renal biopsy from October 2023 to March 2024,The incidence of bleeding and adverse events before and after the intervention were compared to validate the effectiveness of the plan. Data analysis was conducted using SPSS 27.0 software.
Results
A total of 11 articles were included, comprising 1 in Chinese and 10 in English, from which 34 pieces of evidence were extracted. The plan covered five aspects: bleeding risk assessment, prevention, postoperative monitoring, physical activity, and bleeding care. Post-implementation, nurse knowledge levels and adherence to review indicators significantly improved, with statistically significant differences (p < 0.001). The implementation of the bleeding risk management plan significantly reduced the incidence of post-renal biopsy bleeding, ensuring patient safety.
Conclusion
By applying the KTA model to integrate evidence into clinical practice, The preliminary application of the plan demonstrated its feasibility, practicality, and effectiveness in significantly reducing the incidence of post-renal biopsy bleeding.
Objective: To identify barriers and facilitators to the implementation of prevention of central line associated bloodstream infections (CLABSI) in intensive care units (ICU) based on the Consolidated Framework for Implementation Research (CFIR).
Methods: We conducted a descriptive qualitative study. The semistructured face-to-face interviews were performed to collect data, guided by the Consolidated Framework for Implementation Research (CFIR). Doctors and nurses involved in CLABSI prevention in four types of ICUs were selected to participate in this study. The interview data was analyzed using a qualitative content analysis (QCA) method.
Results: Four domains of 'Innovation’, ‘Outer Setting’, ‘Inner Setting’, and ‘Individuals’ have an impact on implementation. The findings highlighted 21 implementation determinants of the prevention of CLABSI in ICUs, including 8 barriers and 13 facilitators. Barriers mainly included the uncertain feasibility of recommended measures, lack of consistency and updating in local policies, and lack of the recommended medical supplies, knowledge, and skills. Facilitators mainly included the atmosphere of positive innovation, the attention, and support from the leader, the professional multidisciplinary implementation team, and receptive patients.
Conclusion: Based on the CFIR theoretical framework, we identified barriers and facilitators to the successful implementation of CLABSI prevention through a system thinking approach. Tailored interventions should be developed to overcome barriers. Leaders should fully assess the feasibility of the items in the local context before implementation, develop the relevant local policies to improve rationality, and provide the necessary supplies, training, and supervision to improve adherence. Meanwhile, incentives should be developed to reinforce facilitators.
Mariann Home is a 62 bed long term care home, located in Richmond Hill Ontario. Our BPSO journey began fall 2021. By being part of the BPSO, we have been able to evaluate programs such as Person and Family Centred Care, Delirium, Fall Prevention and apply our gaps to making positive changes too optimize the excellent Quality of care we offer.
Our palliative care re-development has been a very important journey for our home. We are so excited of the changes we have made with the guidance of the BPSO program. Our program begins prior to admission to after the death of a resident. Grief support is provided throughout the journey for all residents, family and staff. We have revised our Palliative Care Committee, terms of reference, and increased number of committee members from all disciplines. 100% committee members are Palliative and BPSO trained. 56% of staff have completed palliative care training. We also offer palliative care education to resident and family members. We have included palliative care in our pre-admission questionnaire. Implemented a virtual monthly support group for family and friends called "Circle of Friends". Implemented PPS scoring on admission, yearly and if change. Revised spiritual care, implemented End of life Dr's orders, staff checklist, palliative screening, palliative risk assessment, and goals of care discussion. End of life such as comfort feeding, care cart and family care bag, and honor guard has been implemented. Residents created a poem that is in the care bag for family members. Palliative care pamphlets created for residents and family. We cannot help but be so proud of all we have accomplished in 2 1/2 years.
Overall, with the guidance of the BPSO and the team we will continue to improve to maintain excellent quality of care at Mariann Home.
The need for good oral care continues throughout the lifespan. Oral diseases can cause pain, discomfort, difficulties chewing and swallowing, and are also associated with heart and lung diseases, diabetes, and stroke. The need for good oral health is evident, as it leads to increase comfort for the resident, increased quality of life, self-confidence, and better overall health and well-being (Government of Canada, 2023).
In our eight municipally run LTCHs, oral care has not been at the forefront for prioritization of care among frontline staff. An average of only 51% of residents across all eight LTCHs receive oral care at least twice daily from quarter one of 2024.
A working group was formed to gain insight into different ways to combat this issue. Quality improvement advisors, clinical practice managers, clinical documentation and informatics leads and supervisors, nurse practitioners, BPG champions, and IPAC program managers were tasked to develop a plan to improve oral care in our LTCHs.
Infection control assessments were updated to include a task list when a final assessment was completed for respiratory and gastrointestinal infections, to remind registered staff, to replace toothbrushes following infection. Each quarter, toothbrushes are replaced by PSW staff during RAI-MDS roll-out. Contracted dental hygiene services were contacted to assist with education to frontline staff on the importance of oral hygiene and how to assess for oral health concerns.
As of now, we cannot definitively say there has been or has not been an improvement in oral care in our LTCHs. We aim to see an increase in overall compliance with providing oral care at least twice daily, and overall satisfaction with oral health from residents and their chosen families.
In 2020, suicide was the leading cause of unnatural death in Spain, with a rate of 8.3 deaths per 100,000 inhabitants and a high influence of mental health factors (1-4), highlighting the need to promote preventive measures.
For this reason, at the Torercárdenas University Hospital, Almería, Spain, we decided to begin the implementation of the Best Practice Guideline on Assessment and Care of Adults at Risk for Suicidal Ideation and Behaviour in an acute patient unit of the Mental Health area that had not previously received such interventions.
After the first semester of implementation, we aimed to evaluate the impact of the implementation on the detection of patients at risk and the deployment of preventive care in the mental health field.
To do this, an evaluation was conducted in December 2022, prior to the centre's designation as a candidate BPSO centre. Subsequently, variables were collected from all patients treated in the unit during the first months of guideline implementation, from September 2023 to March 2024.
A total of 325 patients were included, with a mean age of 43.75 years and a predominance of males (54.54%). In the baseline assessment (n=40), no records of suicide risk assessment or specific care for at-risk patients were found. During the intervention, all variables gradually increased, reaching 77% in risk assessment (n=41). In the March 2024 evaluation, 51.11% of the assessed patients presented a risk of suicidal ideation (n=23) and 82.61% (n=19) received safety care actions such as restricted access to medications or modifications in the physical environment.
CONCLUSIONS: The implementation of the recommendations increased the detection of patients at risk and the provision of safe care within the unit.
Background: The effects of the guideline implementation may not immediately be obvious; however, the role and significance of the practice change project will become apparent when the guidelines are continuously applied. Sustainability is the key to maintain the results of practice change and continuous development of evidence-based practice. The continuous application of the guidelines can not only improve patient outcomes, but improve nurses’ work efficiency, and their evidence-based practice ability. This paper discusses the factors that affect guideline sustainability and provides a basis to plan appropriate action strategies.
Methods: Using the National Health Service (NHS) questionnaire scoring system, these three hospitals in China conduct the survey among nurses who implemented Best Practice Guidelines. Data were analyzed by statistical analysis; and adhered to the STROBE reporting guidelines.
Results: Through the survey, it was found that 122 evaluators had great differences in the evaluation of project sustainability. The score ranged from 100 to 39.30, and the average score was 85.17. The average score is greater than 55 indicating that the project is more likely to continue. The average scores of process, staff and organization dimensions were 25.85,45.88 and 13.45 respectively. As well, the continuous implementation of the guidelines includes three factors: project characteristics, staff dimensions and organizational environment.
Conclusion: The results of the NHS sustainability questionnaire identified areas of strength in promoting sustainability and issues that needed to be improved. The clinical value of the project, the supportive environment provided by human resources and infrastructure for the project, and the degree of cooperation between interprofessional teams are important factors affecting the sustainability of the project.
Background: Clinical practice guidelines, derived from systematic reviews that weigh the benefits and risks of various interventions, offers evidence-based recommendations for optimal patient care. The effectiveness of clinical guidelines centers on their recommended implementation strategies. The impact and value of these published guidelines rely on how well they are applied. Yet, there is a scarcity of information on the factors influencing the implementation and sustainability of global nursing guidelines. This systematic review aims to consolidate current research by critically assessing and summarizing the factors influencing the implementation and sustainability of these guidelines in clinical settings.
Methods: This review complies with the PRISMA 2020 guidelines. Until August 2023, literature searches have been conducted on four English databases: PubMed, EMBASE, CINAHL, and WEB OF SCIENCE, as well as four Chinese databases: CBM, CNKI, Wanfang, and VIP. This initial study examined the factors influencing the use of nursing guidelines in clinical practice. It analyzed the facilitators and barriers impacting guideline adherence and longevity.
Results: We retrieved 3,629 records, and seven studies met our inclusion criteria for the review. These studies identified key factors influencing the sustainability of guideline application, predominantly the alignment between medical staff and patient and the congruence of project aims with organizational priorities. Financial constraints emerge as a significant barrier, while integration into routine care acts as a facilitator. Moreover, two studies highlighted ongoing leadership support and comprehensive staff training are effective strategies and key factors to sustain the guideline implementation.
Conclusion: This systematic review has outlined the facilitators and barriers to the sustained application of nursing guidelines. These elements should inform guideline development to ensure a sustainable implementation.
Trillium Health Partners’ Clinical Resource Team (CRT) comprises healthcare professionals
dedicated to advancing practice excellence. This team implements best practices organization wide, serving as a pivotal resource for early-career healthcare professionals to develop
foundational knowledge and skills.
In 2023, the CRT faced challenges including staff vacancies, inconsistent support for specialty
areas, and a lack of standardized processes for workforce development. Following a
comprehensive program evaluation, strategic recommendations were implemented to foster
growth and development within the CRT. Focused efforts successfully stabilized staffing
incorporating innovative recruitment strategies such as CRT-specific career fairs and a focus on
hiring Internationally Educated Nurses (IEN). Establishing a robust talent pipeline, we created
clinical pathways to support the transition of learners and clinical externs into nursing roles.
Further we supported CRT staff interested in specialty areas through facilitating education and
training in critical care, emergency and oncology.
To support career progression, a dedicated database was developed to map career paths for
CRT nursing staff. Regular stay interviews became standard practice to ensure ongoing
engagement and retention. Additionally, we fostered clinical practice excellence with targeted
skills sessions and the Transition to Independent Practice Support (TIPS) program, alongside
career development through charge nurse and preceptor training.
As a result of these strategies, we reduced our overall staff vacancy by 48%, along with 90% of
IEN, clinical externs and learners successfully transitioned to regulated roles, and a 100%
retention rate among first-year nursing hires. Furthermore, CRT’s sick time rates are notably
lower than both the organizational and provincial averages. CRT has met team needs,
leveraging the CRT platform to build clinical knowledge and skills, thereby fostering a stronger
team that advances practice excellence across the organization.
Introduction: Falls and resulting injuries are a worldwide public health issue, constituting one of the leading causes of death from unintentional injuries (1). Preventive care is crucial in addressing this issue in the hospital setting (2,3). Our centre had no previous experience with implementing fall prevention measures, so we decided to start implementing the Best Practice Guideline on Preventing Falls and Reducing Injury from Falls (4th ed.).
Aim: After the initial months of implementation, we aim to evaluate the impact on care processes related to fall screening, assessment of at-risk patients, and preventive measures implemented in the 8 participating hospital units.
Methods: A pre-implementation evaluation was conducted in December 2022. The implementation activities began in September 2023, and data has been collected prospectively until March 2024.
Results: A sample of 804 patients was included, with 51.45% male. In the pre-intervention evaluation, fall risk screening was conducted for 49.18% of patients (n=30), with 63.33% identified as at risk. Of these, only 9 patients had a care plan in place. In subsequent evaluations, all variables improved progressively, with fall screening at 90.34%, assessment at 29.20% (n=69), and 55.7% of patients having a preventive care plan.
In conclusion, the implementation of interventions based on the guidelines led to increased adherence to key fall prevention care practices.
Despite the success of the Registered Nurses Association of Ontario (RNAO) Best Practice guidelines (BPGs) integration in Canada and globally, little has been published about its integration in nursing education (Ewers et al., 2022; Malik et al., 2016). In health care organizations, application of BPGs has shown improvement in patient and organizational level outcomes which can be assessed in the clinical setting by measuring indicators such as infection rates, patient satisfaction, self-reported quality of life, and other BPG specific indicators. Health care organizations use a database system of outcome indicators called NQuIRE (Nursing Quality Indicators for Reporting and Evaluation) to effectively monitor and evaluate the impact of BPG (RNAO, 2015). Academic Best Practice Spotlight Organizations (BPSOs), on the other hand, report using Key indicators such as influences of BPGs on curriculum, course objectives, content related to BPGs, and nursing students’ knowledge and practice skills around BPGs (Bajnok et al., 2018). There is a need to establish measurable indicators for academic BPSOs to monitor and evaluate the impact of BPG integration in curriculum.
This presentation will focus on the recommendations to include indicators to measure evidence-based practice in academic settings. The recommendations are from doctoral research on Evaluation of Best Practice Guidelines Implementation in an Undergraduate Nursing Curriculum conducted in an academic BPSO which has successfully integrated RNAO BPGs in the curriculum. The Knowledge-to-Action Framework described by RNAO is utilized to recommend changes to the implementation approach. This includes inclusion of an evidence-based practice (EBP) course and a scaffolded approach to integrate EBP teaching, learning and assessment strategies throughout the curriculum from beginner understanding of EBP to proficient level. The benefit of this approach is that instructors will have set objectives and evaluation strategies to work with, and the curriculum committee and the BPSO members will have defined indicators for reporting.
Attracting and retaining nurses has become a particularly acute need. New graduates (NG) and Internationally Educated Nurses (IENs) require a supportive strategy for integrating them into the highly specialized community nursing workforce while addressing their unique needs and diverse backgrounds. The need and benefit of a Transition to Practice Program (TPP) is well documented in the literature.
VON Canada undertook an 8-month long initiative on the development of a TPP which included an organizational gap analysis, literature reviews, partnerships with universities and consultation of subject matter experts. An evidence-based, four module program was created that supports increasing levels of autonomy and complexity of practice using a combination of didactic, independent, and experiential learning within variety of supports. The aim of the program is to guide NGs and IENs to integrate into the home care specialty while utilizing education, self-reflection and individualized supports to develop professional capacity, competence and independence. The TPP promotes new VON nurses to engage in professional relationships while building a supportive practice network within the context of community nursing. Furthermore, a Preceptorship Program was created to support TPP and equip VON mentors and preceptors with the right tools and skills in guiding NG and IENs in their integration into the home care setting.
A mix of NG and IENs have completed the program since the launch with positive feedback from participants and site leads. An evaluation matrix comprised of qualitative and quantitative data was completed analyzing participant’s completion and experience data. Furthermore, focus group discussion was held with nursing leads to discuss ease of implementation and further opportunities for improvement.
Symposium participants will learn about the TPP and Preceptorship Program development process, implementation strategies, and evaluation results with the aim to support nursing organizations in integrating New Graduate nurses and IENs into their community practice settings.
Background: A group of international nursing students will host the inaugural international student virtual conference to highlight the use of Registered Nurses Association of Ontario (RNAO) Best Practice Guidelines (BPGs) within a global context. The aim is to break barriers, enhance equity, diversity, and inclusion through the use of RNAO BPGs. The conference is created, developed, and hosted by international nursing students for students to augment the formal education received in their clinical programs.
Objective: The process undertaken to plan for the conference will be discussed from the perspective of the international student planning committee members. We will share our insights with regards to our strengths, challenges, and recommendations for future student led academic conferences/initiatives. In this presentation, we will share and discuss our experience as members of the planning committee on the preparations leading up to the conference. We will highlight how the conference assists students and health care professionals to integrate equity, diversity, and inclusion into practice through use of the RNAO Best Practice Guidelines in the clinical setting. We will also highlight the key points from various group and engagement sessions pertaining to equity, diversity and inclusion, which occurred during the international virtual conference.
Methods and future projects: We have used virtual platforms to create a global community that will be accessible to all participants. By creating a global working group that includes 10 RNAO BPSO countries we have shown a commitment to equity diversity, and inclusion amongst ourselves. Through this presentation we will encourage further development of international led projects among students. This event will set the stage for the future generation of nursing leaders to advance equity, diversity, and inclusion on a global scale.
Introduction.Clinical records are documents containing data, assessments and others informations about a patient's clinical status during the health care process. In most Spanish healthcare organizations, the Electronic Health Records(EHR) has been introduced as a way to facilitate transportability of pertinent information concerning patient’s illness across varied health providers. So, EHR are a patient's right and a professional's duty in order to guarantee adequate healthcare. These records can serve as a guide for professionals to unify and systematize diagnoses and interventions, promoting equality in care and equity in health outcomes. The implementation of RNAO Best Practice Guidelines(BPG) implies improvements in care processes that must be reflected in the EHR.
Objective:To integrate the registration of RNAO BPG recommendations in a standardized way into the EHR of the Castilla-La Mancha(CLM) Health Service (SESCAM).
Main points:Work groups led by nurses with expertise in implementation and evaluation were formed to propose modifications to the EHR, coordinated by the BPSO-CLM regional Host.
Outcomes and results: 23 forms and standardized care interventions have been modified in the hospital setting and 12 in primary care. Forms are related to assessment of pain, breastfeeding, pressure ulcers risk, neurological status in patients with stroke, dysphagia or wound healing. The standardized care interventions are applied to patients at risk of falls, pressure ulcers, stroke, breastfeeding, pain or ostomies. Client satisfaction with the process is 85.7%. The restructuring of the EHR, including a common base of standardized forms and interventions on the application of RNAO BPGs, contributes to avoiding unwanted variability in patient care and promotes equal care for patients in any SESCAM healthcare centers.
Benefits to symposium participants:This experience demonstrates the feasibility and effectiveness of standardizing nursing records based on RNAO BPGs to promote equality of care. These outcomes suggest that standardized nursing records can contribute to reduced healthcare disparities.
The Best Practice Spotlight Organization designation is a longstanding knowledge translation strategy .This program’s strategic approach has been proven to improve patient experience and health outcomes, lower cost of care by preventing complications, and enrich staff satisfaction.
Here are some methods to further utilize BPSO to promote fairness, diversity, and inclusivity:
Firstly, we should study and understand the achievements, current levels, and challenges faced by each member hospital in knowledge transfer. And based on these current situations, establish high, medium, and low or more specific baselines.
Then, in order to promote fairness, diversity, and inclusiveness, we should customize different training courses and corresponding assessment indicators for members at different baseline levels.
Also, we should create our own cultural concepts. Create a relaxed atmosphere while promoting best practices among members. Make each member feel fair, rich, and inclusive.
We should encourage members to participate in the decision-making process, provide feedback mechanisms, ensure that all voices are heard, thereby enhancing members' sense of belonging and participation.
We'd best incorporate indicators of fairness, diversity, and inclusivity into the management system, and encourage the organization's own performance in these areas through incentive mechanisms.
In order to enhance trust and fairness,we should ensure transparency in the decision-making process, as well as make all members understanding the reasons and considerations behind the decision.
Last but not the lest,we should evaluate and review organizational practices regularly, make necessary adjustments based on feedback and results, and use technical tools, such as data analysis software, to monitor and evaluate organizational diversity indicators, identify potential inequality and discrimination issues.
Through these methods, the Best Practice Spotlight Organization can make significant progress in promoting fairness, diversity, and inclusivity, while also enhancing the overall competitiveness and reputation of the organization.
Learning Objectives: Learn how to develop a simple and efficient social media plan to increase public visibility of the BPSO culture at your health care institution.
Background: Social media is everything. The average time spent on social media by individuals is 2.27 hours per day (Digital 2022: Global overview Report). If you want to engage your audience, you need an efficient social media strategy. Having a social media strategy will help you plan and implement effective social media campaigns to reach your desired audience with the right content.
Method: At CHEO we have engaged in a partnership with our communications team to develop a simple and specific plan to increase public visibility of our BPSO culture at CHEO. This included developing a content calendar, aligning our BPGs with key dates (world asthma day, national IV nurse day) and identifying key target groups.
We coordinated communications through different forms of media, maximizing exposure and engagement with our target audience and keeping track of our progress to identify areas for improvement.
Results: The use of a social media strategy has allowed us to increase visibility of our BPSO culture at CHEO. It allows us to track what social media platforms are working and allow for a more consistent, cohesive social presence.
Leveraging social media has been a powerful strategy that has highlighted BPSO work at CHEO and increased awareness, engaged community and staff, and promoted health initiatives and improvements
OHTs are built on a strong foundation of engagement with patients, caregivers and community. It is important to extend that strength into our work as a BPSO OHT. East Toronto Health Partners (ETHP) has evolved its BPSO OHT structure to include a community co-lead for its steering committee and has established a community engagement plan as part of its annual work plan. Our initial approach to guideline implementation was organizationally focused, however, over time we have recognized that the BPSO OHT model enables a wider lens for understanding and addressing gaps in evidence-based care.
ETHP community engagement and community leadership has a role across all activities of guideline implementation. Community members help OHT teams to understand gaps in care from a patient and caregiver perspective and advocate for the needs of the community. They play a role in co-designing educational materials for both providers and patients in support of BPG recommendations. Community members can serve as champions for disseminating resources and tools that support evidence-based care and can ensure that materials are culturally relevant to communities we serve.
Our communities are key to the “social movement” to impact real, sustainable change as we work toward more integrated and effective care. Working with communities requires a strong infrastructure for engagement and a commitment to anti-racism, equity and inclusion. The ETHP journey has demonstrated the value of community leadership in BPSO OHT work.
Objective
To provide verbal and non-verbal communication tools to clinical teams in pediatric hospital areas, in order to impact on the satisfaction of the child and his/her family.
Background
Communication is crucial in the health care process, impacting positively on the person and the family, improving clinical outcomes and user satisfaction. The pediatric hospital areas of a high complexity center receive patients with diverse pathologies and levels of severity. Parents face high levels of stress and anguish. Strengthening communication in clinical teams is essential to welcome, accompany and actively involve parents in the hospitalization process. This follows the recommendations of the Registered Nurses Association of Ontario's Patient and Family Centered Care (PFCA) guidelines, the organization's own 2027 challenges and aligned with the strengthening of humanized care.
Methodology
A training program was implemented in the pediatric units, in a first stage with workshops based on the language ontology for nurses, technicians and administrative staff. In a second stage, champions trained in empathic communication will work with the teams, providing practical strategies for use in pediatric clinical contexts. A third stage includes the creation of good communication decalogues and a workshop on humanized care.
Results
Upon completion of the workshops, the impact on user satisfaction as measured by the recommendation index and participant satisfaction surveys will be evaluated.
Conclusions
Developing communication skills in healthcare teams should be a priority for all organizations focused on patient and family care. Communication is a trainable skill that requires continuous effort and has a direct impact on clinical teams, patients and families.
BREASTFEEDING AND INTENTIONS FOR BREASTFEEDING SUPPORT
OF FIRST-TIME FATHERS IN DUMAGUETE CITY
Camille Marie A. Allena, Theresa A. Guino-o, et al.
College of Nursing, Silliman University ( sucn@su.edu.ph)
Abstract
The WHO affirms that breastmilk is the best, safe food for infants. This study sought to describe the attitudes and intentions of first-time fathers and their possible influence on the infant feeding practice. Respondents (n-101) were selected through a multistage, proportionate random sampling from 15 Barangays in Dumaguete City, Philippines. After ethics approval, self-administered questionnaires comprising the Iowa Infant Feeding Attitude Scale (IIFAS), Level of Intention to Breastfeeding Exclusivity Scale (LOITBES), and a demographics questionnaire were used to collect data. The results showed that most respondents were aged 23-28, single but cohabiting, had a college or high school education, were Roman Catholic, were employed full-time, and had a monthly income below Php 11,000. There was a neutral overall attitude score (3.56) toward breastfeeding among first-time fathers, with a high intention score (2.58) to support breastfeeding exclusively. The Chi-Square test and Point Bi-serial test (0.05) revealed no significant relationship between the paternal attitude towards infant breastfeeding, level of intention for breastfeeding exclusivity, and sociodemographic profile variables: civil status, highest educational attainment, religious affiliation, occupation, and monthly income. However, a significant relationship was seen between the positive paternal attitude and age. Therefore, a considerable number of first-time fathers are supportive of breastfeeding. Despite a high intention for breastfeeding exclusivity, they may have insufficient knowledge about its importance and benefits, thereby not necessarily promoting or discouraging the infant feeding practice. It is recommended that the factors influencing breastfeeding knowledge, attitudes, and practices of fathers be addressed and studied to increase breastfeeding support towards improved maternal and infant health outcomes.
Objective: To standardize pediatric neurogenic bowel dysfunction management in a pediatric inpatient rehabilitation program.
Methods: An interdisciplinary taskforce including stakeholders from the clinical team, evidence review, and a family leader were used to develop the Standard of Care (SOC). A targeted search of knowledge tools from clinical practice guidelines, best practice statements, hospital policies, and pre-existing reviews were considered. Seven tools were identified and assessed for trustworthiness, comprehensiveness, utility, and pediatric relevance.
Results: The taskforce successfully developed an evidence-based SOC, providing clinicians with guidelines on assessing, curating, and evaluating a bowel routine program, aiming to achieve social continence. It also addresses how to problem-solve when a bowel care program is not effective. Preliminary evaluation results demonstrate satisfaction and perceived utility from the perspective of nurses. This SOC relates to the Best Practice Guideline (BPG), Support Self-Management in Chronic Conditions: Collaboration with Clients and Developing and Sustaining Interprofessional Health Care: Optimizing patient, organizational and system outcomes.
Outcomes: Involving key stakeholders in the development of this standard led to the formation of a pediatric neurogenic bowel care evaluation and decision-making algorithm to problem-solve when a bowel routine is not effective. Following the rollout of the SOC, this information was disseminated to external partners and is available to families. Family-facing educational materials were adapted to empower families to help support with self-management and highlight public visibility and outcomes.
Introduction. The hospitalization of a premature newborn in a neonatal intensive care unit is generally an unexpected and stressful event for a family; the expectation of having a healthy child is interrupted by separation and loss of bond. Although modern units declare within their humanization policy to offer open-door services 24 hours a day, the real experience of a stay away from home in a clinical setting generates uncertainty, fear and ignorance in families. Taking into account the above, the on-site clinical simulation strategy called “School for parents of premature neonates” hospitalized in the intensive care unit of the Cardiovascular Institute of the International Hospital of Colombia was designed, whose scope is to strengthen parents' attitudes, knowledge, and skills; initially exploring the prior knowledge, needs and preferences of parents during the hospitalization of their sons or daughters, followed by guidance with the best evidence-based care, integrating the good practice guides of the Registered Nurses Association of Ontario (RNAO). ) for its acronym in English. Aim. Reflect on the experience of the “Parent School for Premature Neonates” and the implementation of the RNAO good clinical practice guidelines, related to the contents and strategies provided to parents who attend the neonatal intensive care unit. Topic for Reflection: Parent education in hospital environments offers an inclusion opportunity to learn to reduce fears of the unknown, to promote families to participate in the care of hospitalized newborns. Conclusions. Parent education in an on-site clinical simulation environment favors the comprehensive care of premature neonates, through the construction of empowering relationships of parents, initially knowing their concerns and preferences, to promote active and meaningful participation in care in home. As well as creating an institutional culture that declares the commitment to neonate- and family-centered care through the adoption of RNAO Good Practice Guides.
Skin-to-skin contact in the immediate postpartum period is associated with numerous benefits for the newborn and mother (1), including greater success in establishing breastfeeding, increased milk production, and improved emotional bonding (2, 3).
Within the framework of implementing the best practice guide: Breastfeeding - Promoting and Supporting the Initiation, Exclusivity, and Continuation of Breastfeeding for Newborns, Infants, and Young Children. 3rd ed. at the Torrecárdenas University Hospital, Almería, Spain, improvement measures were initiated, including institutional support for breastfeeding and skin-to-skin contact, improved record-keeping in the delivery room and postpartum units hosting dyads, professional training, and standardization of care protocols.
In this context, we aimed to evaluate the impact of these actions on improving skin-to-skin care provided in the delivery room.
For this purpose, an evaluation was carried out in December 2022, prior to the centre's designation as a candidate BPSO centre. Subsequently, variables were collected from the first months of the guide's implementation, from September 2023 to March 2024.
A total of 291 dyads were included, with 50.17% of the newborns being girls, and an average birth weight of 3332.23 ± 7.25 g. The pre-implementation evaluation included 37 cases, of which 29 (80.26%) received skin-to-skin contact, although only 5 cases (17.24%) were immediate. In 8 cases (27.59%), the duration of contact was more than 1 hour, achieving early breastfeeding in 77.22% (n=26). In the intervention period, we observed an increase in skin-to-skin contact up to 89.66% (n=26), being immediate in 68.18% (n=15) and lasting more than 1 hour in 86.96% (n=20). The rate of immediate breastfeeding was 96.55%.
CONCLUSIONS: The implementation of recommendations derived from the Guide resulted in an increase in immediate skin-to-skin contact and early initiation of breastfeeding.
Scarborough, where 73% of residents identify as visible minorities and 60% are foreign born, is one of Canada’s most diverse communities. This is reflected in SHN’s patient and staff populations. Our 2023 employee engagement survey showed 77% of employees self-identified as racialized and 40% were born outside of Canada. We celebrate the diversity of our workplace with the recruitment tagline, “Where the World Comes to Work”.
In 2022, Scarborough Health Network approved a multi-year, corporate Equity, Diversity and Inclusion strategy with four key pillars: Creating a Sense of Belonging, Education and Awareness, Data Collection and Monitoring and Service Delivery. The pillars are centered around our foundational principles of Anti-Oppression, Anti-Racism, Indigenous Cultural Safety and Intersectionality. The initiatives stemming from our strategy include an annual ‘inclusion calendar’, regular EDI education offerings that help build cultural competence; a 9-month Health Equity Certificate Program, ‘Communities of Inclusion’ that create safe spaces for staff with shared identities for skill sharing, networking and mentorship a full-time Indigenous Patient Navigator and more.
Our RNAO session will provide a high-level overview of our EDI strategy and initiatives with a spotlight on a recent program aimed at improving the retention and engagement of our internationally educated nurses (IENs). SHN’s three-pronged IEN retention initiative includes:
• training for leaders of teams that include IENs
• 24 hours of specialized training delivered in partnership with a private college and designed to facilitate workplace integration and enhance professional competencies in the Canadian healthcare context; topics were validated in advance in a focus group of 10 IENs
• creation of a Community of Inclusion for IENs for peer support and mentorship.
We will share our experience implementing this 3-part program including achievements, lessons learned and the evaluation findings from the first cohort of 24 IENs to complete the specialized workplace integration training.
In 2021, William Osler Health System (Osler) received Accreditation Canada exemplary status, being recognized for achievements in people-centred care, including implementation of the RNAO Patient and Family Centred Care (PFCC) Best Practice Guideline (BPG).
A PFCC BPG initiative resulted in adding a question to the inpatient nursing admission assessment (NAA) “We want to involve you in your care. What is most important to you today?” This resulted in patients feeling more involved in their care, evidenced by a 2.5 % improvement with a FYE 23/24 result of 80% “Yes, Definitely.” These positive outcomes prompted further discussions to embed cultural safety within the NAA process.
The NAA is informed by social determinants of health (SDoH) data gathered at Osler’s patient registration, validated by the nurse and patient, albeit limited to age, sex at birth, preferred language and religion. In this context, Osler’s transgender and non-binary patients shared several complaints, where they felt dismissed regarding their gender expression. In addition, staff felt a lack of confidence in asking about gender identity and partnering with patients to include this awareness in care and discharge planning.
An action plan included building foundational capacity, addressing immediate patient needs and planning for the future. Creating a culture of safety was initiated, ensuring Osler staff were supported through their own experiences of gender transition, education in the use of pronouns, change in public washroom signage, and consultation with persons with ‘lived experience’ and community experts. Immediate patient needs were addressed by revising Osler’s NAA to include gender expression and pronouns, with ongoing coaching at iHuddles. Future directions include adopting the RNAO ‘Promoting 2SLGBTQI+ Health Equity BGP, planning for advanced SDoH registration requirements and refreshing Osler’s commitment to AIDET (Acknowledge, Introduce, Duration, Explanation and Thank you) communication framework to include offering staff name, role, and pronouns in introductions.
Workplace violence is a growing concern across all sectors. In response, and aligned with the BPG: Preventing Violence, Harassment, and Bullying Against Health Workers, SickKids developed the Comfort and Safety Bundle (CSB). The CSB is a screening tool to identify and mitigate risks of patient-related agitation and aggression.
The CSB takes a trauma-informed, systematic approach to safety, focusing on both the healthcare provider and patients. It uses a comprehensive framework to manage and prevent escalating events, advancing EDI by ensuring compassionate and culturally safe patient care. Objectives include increasing patient satisfaction, reducing behavioural risk events, and improving patient and staff safety.
The CSB includes the Comfort and Safety Screening Questions (CASQ) and a Comfort and Safety Plan (CASP) for all patients). Development involved extensive staff, patient, and family engagement, pilot projects, simulation exercises, and a phased implementation. Consultations with diverse groups ensured cultural safety and inclusivity.
The CSB has streamlined identifying patients at higher risk of behavioural events and developing personalized safety plans. Preliminary evaluation results indicate improved safety planning and increased leader awareness of risk, integrated into the EMR to facilitate accessibility and consistency in risk assessment and management.
The CSB demonstrates significant implications for safety in pediatric healthcare and the promotion of equity when performing sensitive assessments. Our work highlights the importance of a trauma-informed approach, key actor engagement, and continuous improvement in addressing workplace violence. This initiative sets a precedent for other facilities to adopt similar measures and showcases SickKids' commitment to creating inclusive and safe healthcare environments for all.
Participants will learn about the development, implementation, and outcomes of the CSB, gaining insights into how to leverage BPSO initiatives to advance EDI in their own organizations. This presentation will provide practical examples and tools adaptable to various healthcare settings to improve safety and inclusivity.
In the context of rising STBBI rates, 2SLGBTQIA+ patients are disproportionately affected by STBBIs due in part to obstacles impeding connection to comprehensive STBBI prevention, treatment and care. In York Region, patients have reported leaving the area to access more inclusive health care.
Using the RNAO 2SLGBTQI+ Health Equity BPG as a guide, learn how York Region Public Health (YRPH) highlights sexual health clinics as inclusive health care spaces while also encouraging other health care providers to improve inclusive care options across York Region.
The YRPH sexual health clinics offer inclusive sexual health care, but feedback suggested that increased promotion of the clinics in this context was needed. As such, YRPH embarked upon a comprehensive campaign to promote the clinics as supportive and inclusive health care spaces. Campaign development included engagement with internal and external groups representing and supporting the 2SLGBTQIA+ community and garnered successful social media engagement results.
Subsequently, YRPH is partnering with experts to develop and deliver a learning event for health care providers that will aim to:
• Share strategies to discuss sexuality and STBBIs comfortably and respectfully with diverse patient populations
• Communicate up-to-date data evidence on screening, testing and both pre- and post-exposure prophylaxis for HIV and other STIs
• Foster enhanced understanding of the barriers 2SLGBTQIA+ individuals face when accessing health and social services
• Create more visible 2SLGBTQIA+ inclusive healthcare spaces in York Region
This event will take place October 10, 2024 and results will be presented at the 2024 Global
BPSO Symposium. Guest speakers will include Dr. Kevin Woodward (Executive and Medical Director, HQ) and Dr. Alex Abramovich (Canada Research Chair 2SLGBTQ+ Youth Homelessness and Mental Health t, CAMH), with our host Dr. Kathryn Cleverley (Associate Medical Officer of Health, YRPH) and moderator Dr. Lana Kiehn (Family Physician, Sexual Health Clinic Physician).
The purpose of the rapid oral presentation is to share the steps taken within Niagara Region Public Health’s Family Health Division to support nurses in assessing and supporting clients who may be at risk for suicide. As part of the journey to implement and integrate the Assessment and Care of Adults at Risk for Suicidal Ideation and Behaviour best practice guideline new approaches to practice and staff education have emerged.
The outcomes to be covered in the presentation would be the development of policy, procedures, and referral pathways to support staff in completing assessments and clinical decision-making. Training needs will also be discussed, including training on the use of the Columbia Suicide Severity Rating Scale and in navigating complex client scenarios. Finally, the presentation would cover future planning to further support nurses and consolidate learning. This includes a brief overview of a high-fidelity simulation training pilot project being developed, with data collection to take place in the fall of 2024.
This presentation will benefit symposium participants in several ways. Participants who have, or are considering, implementing the Suicide Assessment best practice guideline may consider adapting Niagara’s approach to meet their own needs. Additionally, any participants who have an interest in the development of research and furthering nursing science may be interested in the pilot project in development.
Learning objectives:
Participants at this session will learn about:
a. resources developed to support nurses in critical thinking about ethical principles
b. learnings from the evaluation results
c. successes and challenges encountered in implementation of the module; and
d. recommendations that apply to other health care organizations.
Professionalism is the knowledge, attributes, behaviors, and values that characterize a profession. The nursing profession is rooted in ethics and ethical values (RNAO, 2007). A significant challenge for nursing professionals is the lack of critical reflection on the ethical principles that guide nursing practice. The RNAO Professionalism in Nursing Best Practice Guideline (Professionalism BPG) recommends engaging nurses in critical thinking about ethical principles in clinical and professional practice.
This urban health unit, a Best Practice Spotlight Organization, is implementing and evaluating the RNAO Professionalism BPG by developing and launching a tailor-made interactive online module on professionalism and ethics for their nurses. The content for this module was adapted from the College of Nurses of Ontario’s Code of Conduct Practice Standard; and includes specific Public Health scenarios related to diverse equity-deserving populations. All frontline nurses in this health unit are expected to complete the module, while all other public health staff are encouraged to complete the module.
The intention for this initiative is to build nurses’ capacity to recognize, reflect on, and apply ethical principles within a public health context.
This presentation will provide insight into the development, implementation, and evaluation of this module in a urban health unit. Successes, challenges, and recommendations for implementation in other health care organizations will also be shared.
Reference
Registered Nurses’ Association of Ontario (2007). Professionalism in Nursing. Toronto, Canada: Registered Nurses’ Association of Ontario.
Women’s College Hospital (WCH) is a world leader in health for women, health equity and health system solutions – a hospital designed to keep people out of hospital. We are developing ground-breaking innovations that address issues related to population health, patient and staff experience, equity and accessibility, and system costs using the quintuple aim framework.
In Summer 2023, WCH received one-time funding from Ontario Health to implement the Clinical Scholar Program (CSP) with an end date of March 31, 2024. The CSP is a formal nursing mentorship program to support skill building, knowledge acquisition and integration into their clinical areas, aiming to improve nursing retention. New graduate nurses and nurses wishing to upskill are paired with an experienced nurse. WCH has experienced a 2023 nursing turnover rate of 35%, compared to a stable 3% pre-pandemic rate.
We leveraged our BPSO designation and the RNAO’s systematic implementation of best practice guidelines using evidence-based implementation science by focusing on the best practice guideline of Professionalism in Nursing, concentrating on Autonomy to support mentee nurses’ self-identified learning goals. These goals included Communication, Scope of Practice, Clinical Skills, Self-Reflection, and Leadership.
To ensure that our deep commitment to equity was embedded in this program and recognizing the influence that the nurse mentors would have on shaping the nursing staff receiving mentoring, we worked with the Office of Equity and Ganawishkadawe Centre for Wise Practices in Indigenous Health to provide enriched education to our Clinical Scholar Nurses on culturally safe care. We measured the self-efficacy and confidence in equity of nurse mentees and mentors, noting a significant increase. While the tool is not validated, we will monitor these outcomes with our next cohort of mentees, as we have received funding to continue the program.
Objective: Explore the benefits of implementing an Indigenous Patient Navigator to enhance healthcare services by 1) offering additional support to patients and families within hospital 2) reducing gaps in service and removing barriers to accessing equitable healthcare 3) identifying health trends and common needs among the indigenous population.
Background: In 2021, 5,885 individuals residing in York Region and the Chippewas of Georgina Island First Nation identified to have an indigenous background (York Region, 2021). Among them, 3,230 indigenous residents of York Region identified as First Nations (York Region, 2021). Indigenous peoples represent Canada's first nation people. Due to historical trauma, many indigenous individuals feel unsafe accessing medical care.
Results: Since its introduction in 2023, Southlake's Indigenous Patient Navigator is working to enhance the well-being of our indigenous patient community. By bridging the Western health model with Indigenous health practices, the Navigator collaborates closely with indigenous individuals to facilitate healthcare access and support services in their homes. Additionally, they coordinate community resources and healing supports, offer counseling throughout clinical appointments, advocate for patients and families, aid in care planning, and advocate for end-of-life care aligned with individual goals and wishes.
Conclusion: Participants in this session will gain valuable insights into Southlake's Indigenous Patient Navigator role and its positive impact on our indigenous population Participants will discover how this initiative raises awareness within our organization, success factors, as well as sustainability moving forward. In addition, participants will also learn how implementing this role within their organization will positively impact their indigenous population.
Background: Recruitment of internationally educated nurses (IENs) is a longstanding health human resource strategy. The current state of our nursing crisis has led to increased recruitment of IENs (Nji-Mokonya, 2018). Though the recruitment of IENs is gaining popularity, there remains a lack of a clear pathway for these nurses to transition back to practice (Kurup et al., 2023). Instead, IENs are met with various obstacles and challenges that threaten the successful integration of IENs into the Canadian nursing workforce (Lee & Wojtiuk, 2021).
The TBRHSC is currently experiencing a major gap in effective orientation and onboarding of IENs. During the initial application and hiring phase, IENs can be seen as getting lost within the system. The current orientation process impedes a smooth transition back to practice and integration into the workplace. Additionally, the IEN receives insufficient resources, educational materials and follow-up. This has been detrimental to IEN success and TBRHSC retention rates.
Methods: Pre-screening interview questions and a communication and collaboration simulation were designed, implemented, and evaluated.
Results: The pre-screening interview questions provided a greater understanding of IEN skills variation and transfer, IEN’s perception of the nurses’ role, and the reality of nursing in Canada. The communication and collaboration simulation allowed the IENs to practice various communication skills and use of communication tools to facilitate communication and collaboration.
Conclusion: Effective transition of IENs back into practice and integration into the workplace requires one foot in acknowledgement and the other in possibility. Organizations must then not only be open to change but also committed to the successful transition and integration of IENs. The pre-screening interview questions along with the communication and collaboration simulation are steps in the right direction. These efforts foster a more supportive practice environment that will not only attract but also retain IENs at the TBRHSC.
Disparities among residents living in long term care may exist when an organization’s culture lacks respect, dignity, and acceptance. To improve cultural competence, Peel Region is utilizing best practice to create safe and inclusive environments that enhance the quality of care and the quality of life for residents, families/caregivers, volunteers. and staff.
Across its five centres, Peel Region implemented recommendations from the RNAO best practice guidelines (BPG) Promoting 2SLGBTQI+ Health Equity and Embracing Cultural Diversity. Key strategies include recruitment of champions, establishing 2SLGBTQI+ committee meetings, integrating DEI training into staff orientation and training, using inclusive signage and updating policies. Additionally, residents were provided the opportunity to participate in a survey aimed to understand the experiences of older adults within the 2SLGBTQI+ community.
Efforts to enhance awareness, change practice and mold culture include the use of inclusive language in tour packages and history-taking assessments to promote equality and sensitivity. The electronic health record system now includes sections for preferred names/pronouns and gender identities, ensuring respectful and individualized care. Regular review and updates to policies ensure they align with DEI goals.
These efforts are paving the way towards an environment where every resident can feel respected and valued, leading to higher social engagement. Staff education and awareness is enhancing confidence and competence in providing inclusive care. Peel region is committed to implementing and sustaining these best practice guidelines to ensure equitable care where no one is left out or left behind.
Peel Region’s proactive measures in adopting these BPGs are yielding positive outcomes by promoting inclusive language, creating safer spaces, and ensuring cultural competence that will enhance the quality of life for residents and the work environment for staff. Peel Region’s innovative strategies exemplify practical approaches that other organizations could adopt to elevate equity, diversity, and inclusion in their care environments.
The objective of the presentation is to share engagement strategies undertook with multiple members of the community to achieve public visibility of BPSO within a LTC home that began as a BPSO pre-designate in April 2024. In preparation for LTC BPSO pre-designate launch, the steering committee implemented several strategies to improve visibility internally among staff, residents and families. This included utilizing multiple forms of communication: social media, presentations to Resident’s Council, emailed communication to family members and advertising the launch on television screens throughout the home and on the announcement sign outside of the home. Furthermore, with the support of the home’s Communications Officer; members of the County Council and the MPP participated and demonstrated support of the BPSO pre-designation. BPSO liaisons were interviewed, and media releases were made in print and televised on CKWS news.
To illustrate the commitment to evidence based practice in the pursuit of becoming a BPSO, residents and staff participating at the BPSO launch wore T-shirts in the BPSO colours of orange and teal imprinted with Fairmount Home’s brand, “Together”. Acknowledging the importance of visibility, Fairmount Home is providing T-shirts with the BPSO logo as well as belt bags to all staff members who have completed the Best Practice Champions’ training.
With this strategy, Kingston and the southern Frontenac community has received education on the purpose of becoming a BPSO pre-designate. Residents and their families are now aware of the impact of implementing best practice guidelines and where Fairmount Home wants to improve. Fairmount Home staff will be able to identify who is a Best Practice Champion so they know who to contact to seek support.
Our presentation will benefit symposium participants by providing insights into how utilizing multiple strategies increases the BPSO public visibility to multiple groups: residents, families, staff and the community.
Background: Recent data from a Transitional Care Unit (TCU) identified that 43% of older adult patients transferred to acute care facilities had risk factors for delirium. None of these patients had been assessed for delirium using a validated assessment tool. After surveying nurses, gaps were identified in knowledge of risk factors and recognition of delirium, management, prevention, and the use of the Confusion Assessment Method (CAM-S) tool.
Purpose: This project aims to evaluate the effectiveness of education on delirium in improving nurses’ knowledge, competency level when assessing with the CAM-S tool, and the early identification of delirium.
Framework: This project applied Kolb’s experiential and constructivist learning theories to delirium education and the Knowledge-to-Action framework to implement the tool and evaluate its effectiveness in identifying delirium.
Process: 38 nurses attended delirium education. The participants completed pre- and post-self-reported knowledge questionnaires on delirium signs and symptoms, risk factors, interventions, prevention strategies, the CAM-S tool, and their confidence in using the tool. The tool was integrated into routine patient assessments. Health records audits are conducted to determine the percentage of patients screened and identified as positive for delirium, and the percentage of patients transferred to acute care with risk factors for delirium.
Findings: After the education, nurses’ understanding of delirium significantly increased in several areas: knowledge of signs and symptoms, risk factors, interventions, prevention strategies, and increased confidence when utilizing the CAM-S tool for assessment of delirium. This resulted in improved screening rates, decreased delirium rates, and reduced acute care transfers.
Conclusion: Multimodal and interactive education improved nurses’ knowledge of delirium and confidence in using the tool. The KTA framework improved delirium screening rates, facilitating timely interventions and enhancing patient outcomes for those exhibiting risk factors for delirium.
Sharing our BPSO implementation journey from where we started in September 2020 to where we are now. How we created and changed the culture in our home and remarkable improvements we achieved along our BPSO implementation journey. The positive impact on the lives of our residents, staff, connection with families and our quality indicators as we implemented: Promoting Safe Alternatives to Restraints, Assessment & Management of Pain, Delirium (Dementia & Depression) in Older Adults: Assessment and Care, Person & Family Centred Care, A Palliative Approach to Care in the Last 12 months of Life & End-of-Life Care in the Last Days & Hours. We are currently working on implementing: Preventing Falls & Reducing Injuries from Falls.
Key changes and the improved quality outcomes we have achieved along our implementation process. Pain indicator for residents who “has pain” decreased from 9.0% prior to implementation to 0.5%. Pain indicator for residents with “worsened pain” decreased from 8.1% to 3.6%; both numbers are now well below provincial and national averages. We have also gained the enhanced staff knowledge and consistency in completing assessments with the introduction of Nursing Advantage Canada RNAO Clinical Pathways.
The overall impact of BPSO implementation changes in our home include: increased resident safety, transformed care, empowerment and fostering of knowledge sharing culture amongst staff, including increased time management allowing for more engagement with residents. The implementation of Best Practice Guideline Assessment and Management of Pain provided positive changes which includes: early recognition and monitoring of residents who may be experiencing pain, prompt identification and treatment of acute and chronic pain, improved quality of life for residents, resident comfort, enhanced knowledge of a variety of assessment tools which include O, P, Q, R, S, T, U and V, PASSERO, PAINAD & Nursing Advantage Canada- RNAO Pain: Clinical Pathways.
Background:
Successful implementation of the BPSO Framework into Long Term Care requires two important elements: Commitment and Champions. At Heritage Green Nursing Home we had a vision to change the culture into an “evidence based decision making” culture – a culture that required team members to think, talk and act aligned with evidence based practice principles. The BPSO framework was new to the Heritage Green team, but we had committed leaders and enthused champions to ignite the new EBP culture, which began in 2023.
Methods: Heritage Green Nursing Home partnered with RNAO in 2023 to start the BPSO journey. The journey started with Step One: creating the committed leaders at Heritage Green, who were needed to ignite the culture and build trust among the front line team members. Step Two: involved implementing Champion training workshops for the front line team members. These training workshops were vital elements in the uptake and embedding of BPSO across the organizational culture. During the workshops, leaders were able to gain the trust of the front line staff through their positive attitudes and beliefs of BPSO. The leaders gained the trust by showing the relevance of BSPO to the services/care planning for residents & families and how improvements can be made (for example: reducing falls). Step Three: The Leaders and Champions ignited enthusiasm together, by celebrating successes and sharing stories (fall prevention/reducing pressure injuries/resident & family centred care) through celebratory meetings. Thus, the creation of the BPSO momentum, into the Heritage Green culture was launched. The enthused Champions continue to ignite the BPSO movement through their positive stories and comments focusing on our 3 BPSO focus areas.
Trillium Health Partners’ (THP) relies on a highly trained, experienced nursing workforce to meet the complex care needs of our patients across specialized programs. Currently, half of THP’s nursing workforce are under the age of 29 and have less than 5 years of experience. With the demanding nature of their role and novice skill set, this group of nurses are reporting high rates of burnout and are at risk of leaving the profession.
In September 2023, THP introduced the Transition to Independent Practice Support (TIPS) program in response to evidence-based practice literature and feedback from new nurses. TIPS aims to support new nurses through mentorship and clinical guidance, fostering a positive learning environment and facilitating a smooth transition to autonomous practice. The program also targets retention of skilled nurses, particularly those in highly specialized areas.
The TIPS Program introduces an integrated learning environment, with both virtual & in-person learning components to build clinical competence and confidence. Professional Practice Clinical Educators lead webinars and simulation sessions utilizing competency checklists to evaluate knowledge and skills. This approach caters to individual learning needs while providing valuable insights for managers and educators.
Since the launch, the TIPS program has engaged over 370 nurses, garnering enthusiastic feedback. Participants consistency rate sessions highly for relevance and engagement with a notable 62% increase in staff confidence levels observed post-program, and some individuals experiencing up to a 102% boost in confidence levels. These results underscore the program's effectiveness in enhancing clinical competence and reinforcing commitment to patient care excellence. By systematically evaluating outcomes, we aim to continually refine and strengthen the TIPS Program, ensuring it remains a cornerstone in nurturing our nursing workforce and advancing patient care excellence at THP.
Advancing Equity, Diversity and Inclusion at Chatham-Kent Health Alliance
Abstract
In Canada, healthcare is regarded as a fundamental right, with the provision of equitable and culturally competent care being essential for the well-being of its diverse population. However, despite efforts to promote inclusivity, disparities continue among communities, including Indigenous peoples, under-represented groups, 2SLGBTQIA+ individuals, and persons living with disabilities. We will investigate the ongoing efforts by Chatham-Kent Health Alliance (CKHA) to address disparities by utilizing the Best Practice Guideline (BPG) Embracing Cultural Diversity in Health Care: Developing Cultural Competence. CKHA has implemented strategies for improvement by developing an Equity, Diversity, Inclusion & Anti-Racism (EDIAR) Framework to guide decision making. Select strategies include external allyship, free Rainbow Health Ontario 2SLGBTQ Foundation Course, implementation of an Indigenous Transition Navigator, Indigenous art display, and implementation of a Chosen/Preferred Name Policy. However, despite these efforts, challenges persist, including the need for increased funding and resources, policy enhancement, and greater representation of diverse voices in healthcare decision-making processes. Overall, the importance of prioritizing and embedding equity, diversity, inclusion, and anti-racism at CKHA will ensure that individuals receive equitable access to quality healthcare services, regardless of their background or identity.
Key words: equity, diversity, inclusion, anti-racism, hospitals, challenges, initiatives, improvement, recommendations, Chatham-Kent Health Alliance
Abstract
Background
Scarborough Health Network (SHN) is committed to building our culture by empowering and inspiring our staff. In February 2022, SHN partnered with the College of Nurses of Ontario (CNO) and Ontario Health (OH) to introduce the Supervised Practice Experience Program (SPEP) within the organization. This initiative aims to assist Internationally Educated Nurses (IENs) who require clinical hours to obtain CNO registration under the supervision of an experienced nurse. A focused group was arranged which included past and current SPE candidates to determine the ongoing challenges they experienced as they transitioned into independent clinical practice.
Purpose
The purpose of the focus group was to assess current gaps in the SPE program, determine the
needs of internationally educated nurses and how SHN can help improve the SPE program to
ensure IENs have a smooth transition into their nursing careers.
Method
10 IENs participated in the focus group study. Using a survey, the IENs were asked 10
questions about the supports they continued to need and the challenges they faced as they
transitioned into their nursing careers.
Results
IEN needs were identified through the focus group study. Based on those needs, SHN had the
opportunity to collaborate with an external partner- 369 Global. 369 Global (in collaboration with
Computek College) facilitated an 8-week virtual course that aimed to help transition IEN’s into the
Canadian health care system. Key topics included: Financial literacy, Leadership, Diversity and Inclusion,
Civic Engagement and Communication. The preliminary overall feedback from participants was very
positive- 25/25 candidates stated they would recommend this program to other IENs. In June 2024, SHN
had their first cohort of 25 participants graduate the program. The next steps will include a thorough
evaluation of the program and planning for a second cohort at SHN to enroll in Global 369.
The Empathetic Hands: Wound Care Outreach course is designed for healthcare providers working with individuals struggling with addictions and homelessness and integrates the principles of the Registered Nurses' Association of Ontario (RNAO) Best Practice Guideline (BPG) on Engaging Clients Who Use Substances which promotes Equity, Inclusion, and Diversity. This course addresses challenges faced by vulnerable populations, recognizing that their wounds are often exacerbated by socio-economic factors, stigma, and limited access to healthcare.
The course is designed for healthcare professionals in hospital and also in community settings where resources may be limited, or persons may not wish to seek care in a formal medical setting. The course provides knowledge and skills to provide compassionate, inclusive, and effective wound care. It covers the physiological aspects of wound healing and the social determinants of health that impact this process. Modules include overcoming barriers to care, building trust, effective communication, and understanding the impact of trauma and substance use on wound healing.
By aligning with the RNAO guidelines, the course promotes an inclusive approach that respects the dignity and diverse needs of individuals experiencing homelessness and addiction. This course also promotes collaboration across disciplines and organizations within our Ontario Health Team partners. This approach aims to reduce health inequities and improve outcomes by ensuring that care is accessible, non-judgmental, and tailored to the specific needs of these populations. A pre and post course knowledge evaluation was completed, showing an improved confidence level from 53% to 84%.
Overall, the course fosters a healthcare environment that values equity and diversity, enhancing the ability of practitioners to deliver high-quality wound care to marginalized groups. Through this alignment with RNAO BPG's, the course contributes to a more inclusive healthcare system that addresses both the clinical and social aspects of wound management for those most in need.
Johs-Artisensi (2017) highlighted the importance of involving residents actively in their care planning process, emphasizing their informed participation. This aligns with Van de Ven's view that patients value relationships with providers based on mutual respect and engagement in decision-making. These insights underscore the critical role of robust care planning in soliciting resident preferences, integrating them into care plans, and ensuring clear communication among caregivers.
At Shepherd Lodge, the "CARESync Forum" introduces an innovative protocol during resident move-in. This protocol involves a comprehensive, multidisciplinary meeting including the resident, family members, and the entire care team. The primary objective is to create an inclusive environment where all stakeholders collaboratively understand the resident's individual needs, preferences, and care goals, resulting in a personalized 24-hour care plan. This initiative facilitates direct communication between all departments and the resident's family, enhancing person-centered care and aligning with palliative care principles.
The CARESync Forum offers advantages; Promotes a cohesive approach by providing the entire care team with a unified narrative about the resident, ensuring consistency and clarity in care delivery. It also ensures early integration of the resident's and family's wishes, particularly regarding end-of-life care, into the care plan. This proactive inclusion of goals-of-care discussions respects the resident's values and preferences, contributing to ongoing personalized care.
Moreover, the session enhances person-centered care by tailoring the care plan to reflect the resident’s specific preferences, routines, and daily preferences, thereby enhancing their overall well-being and satisfaction. Family involvement fosters supportive and transparent environment, strengthening trust and collaboration with the care team.
In conclusion, the CARESync Forum significantly enhances care quality by ensuring comprehensive, consistent, and personalized care planning from the outset. This protocol addresses the medical and emotional needs of residents while upholding their dignity and autonomy, aligning care delivery with their individual goals and preferences throughout their stay.
Osler started working towards achieving Best Practice Spotlight Organization (BPSO) Designation in April 2021. As part of this approach, the Preventing Falls and Reducing Injury from Falls Best Practice Guideline (BPG) was selected for implementation. To support and sustain the multiple practice changes, the Fall Prevention BPG working group developed a strategy to utilize Osler staff who had completed the Registered Nurses Association of Ontario (RNAO) Best Practice Champion (BPC) certification specifically for fall prevention work.
Once staff were recruited for the Fall Prevention Champion role, they were provided with an orientation and a Fall Prevention Guidance Document for BPCs. The tool connected staff with relevant resources, such as policy content, educational materials, audit and documentation tools. Initially the team of Fall Prevention Champions was quite small and dedicated to target units, however after evaluation of the program there are now 17 champions organization wide.
Osler has collected and submitted data to the RNAO NQUIRE system since 2021 for two indicators. The falls rate per 1000 patient care days was 5.33 in 2021 and reduced to 4.56 in 2023 (14.5% reduction). Osler also collected data for percentage of adult's screened for falls risk. In 2021 it occurred 87.2% of the time, and by 2023 it was occurring 92.5% of the time (5.4% increase). Fall Prevention Champions were primarily introduced in the 23/24 fiscal year, and the biggest improvement within Osler’s data is observed to be during the time that the Champions were visible within the acute care units. Because this role has been so successful, Fall Prevention champion recruitment is now a change idea on Osler’s 24/25 QIP in relation to reducing Falls per 1000 patient days.
This topic will benefit symposium participants as fall prevention BPC strategies and resources will be shared.
Early detection of personal expressions has been fundamental to the home’s behavioral support program. Markhaven Home for Seniors has an internal dementia rate of 65% in which personal expressions are often observed. With many post-pandemic changes, the program required a significant overhaul. Using RNAO’s Delirium, Dementia and Depression (3Ds) Best Practice Guideline and the Person and Family Centered Care (PFCC) Best Practice Guideline, the home was able to re-establish and restructure the behavioral support program. Upon completion of the 3D’s gap analysis the home focused on:
• Creating an organizational culture that exemplifies its commitment to dementia care and PFCC
• Educating frontline staff on delirium, dementia and depression.
Recommendations from the 3D and PFCC guidelines strengthened the care approach and provided residents with more opportunities to be involved in their care.
Some initiatives include:
• Improving the collaboration between inter-professional team members and external partners
• The implementation of a clinically validated tool for delirium screening
• Recognizing the impact pharmacological management has on behavioral management (specifically identifying factors that contribute to the need for pharmacological management and monitoring for any adverse effects of pharmacological interventions).
The anticipated results of this initiative include:
• An increased use of non-pharmacological approaches in supporting residents with personal expressions
• Improved use of resident’s identified preferences, values, and culture in developing care plans.
The revitalized approach using RNAO’s BPGs addressed and supported the development of staff’s BSO approach. The integration of RNAO’s clinical pathway assessment for delirium has served as an opportunity for sustainability. Interdisciplinary relationships have improved as each discipline is able to contribute based on their specialty and support those around them. The BPSO program has been a key success factor to the BSO program and has increased the program’s impact and awareness.
Research indicates that patients with darker skin tones are often diagnosed with higher-stage pressure injuries due to inaccurate assessments and delayed identification (Black, et al., 2023). Trillium Health Partners (THP), a 1500-bed community hospital, has prioritized pressure injury prevention since 2019, achieving a sustained reduction in overall hospital-acquired pressure injuries (HAPI) well below the national benchmark.
In 2023, THP began to focus on early identification of pressure injuries in patients with darker skin tones aligned with RNAO Best Practice Guidelines. This initiative included updating standards and policies for prevention, assessment, and management of stage 1 and 2 injuries to incorporate staging across diverse skin tones. Education was enhanced for new staff during orientation, wound care education offerings for all staff and for our leadership teams. Further, recognizing patient diversity, THP implemented the Monk scale in pressure injury audits to capture critical data on varying skin tones, addressing a notable gap in the literature and healthcare resources.
With these interventions in mind, a significant decrease in HAPI was observed from March 2023 (4.8%) to September 2023 (2.8%) and sustained to the March 2024 audit (3.9%). Notably, there was also a decrease in both the frequency and severity of pressure injuries amongst patients with Monk scale ratings of 6-9 in the March 2024 audit (four stage 2) compared to previous audits in September 2023 (six stage 4, three unstageable) and March 2023 (one stage 1, eight stage 2, six stage 3, one deep tissue injury). These outcomes indicate improved HAPI prevention efforts in darker skin tones, and suggest promising results aligned to the quintuple aim.
Tailored education and policies focusing on pressure injury staging across skin tones can decrease the incidence and severity of pressure injuries. Broader education on nursing assessment is essential for delivering holistic care to our diverse community.
The Middlesex Hospital Alliance (MHA) is a 54 bed acute care community hospital caring for an often older person patient population on the medicine floor. Older adults are at risk for accelerated hospital decline during and after hospitalization (Mathews 2014). Providing cognitive stimulation has been shown to decrease falls, particularly in older persons with cognitive impairment. Therapies that enhance cognitive function can improve gait and reduce falls risk. Our Cognition Wall (aka “Cog Wall”) was built to enhance patient cognitive stimulation with the aims of decreasing falls and responsive behaviours, improving the patient experience and building community engagement.
The Cognition Wall was developed by building upon the “Brain Train” work done by the Best Practice Guideline teams for Preventing Falls and Reducing Injury from Falls (RNAO, 2017) and the 3Ds Delirium, dementia, and depression: Assessment and care (RNAO, 2016). The Cog Wall consists of 4 panels: garden, workshop, driving and kitchen. Each panel has visual and hands-on activities to engage patients. For example, a video screen on the garden panel can display weather or animal videos. The driving panel has a functioning steering wheel with videos simulating driving on city or countryside roads. Every element on the cognition wall was designed to be patient focused with consideration of cultural influences, work and education background, and patient physical abilities to interact with the Cog Wall.
This presentation will: 1. Highlight the development of our Cognition Wall with evidence-based principles guided by RNAO BPGs, 2. Share success and challenges with implementation, and 3. Share early feedback from staff, patients, and families on their “Cog Wall” interactions. Participants will benefit from hearing the development and implementation experiences of the “Cog Wall” team, be able to enhance their understanding of older person care,and consider similar strategies that could be used in their organizations.
Hampton Terrace Care Centre is committed to excellence in resident care through evidence-based practice. The home has implemented Best Practice Guidelines, supported by Clinical Pathways documentation, which has improved the quality of care that our residents receive.
By adopting The Assessment and Management of Pressure Injuries for the Interprofessional Team and Clinical Pathways Admissions, Delerium, Dementia and Depression in Older Adults and Person-Family Centred Care our staff have been empowered with knowledge-based decision making.
The positive impact on resident outcomes has been demonstrated by more thorough screening, a resident focused approach to care, more effective management of Pressure injuries and by increasing confidence in the skills of our staff.
Solid outcomes influenced by the utilization of evidenced based practice has included: 100% screening for delirium on admission, more thorough history taking, a more resident centered approach such as recognizing indigenous people and their beliefs on admission, preferred names, gender identity, sexual orientation, admission information sheet to communicate to front line staff a more holistic picture of who our residents are and improved identification and assessments of pressure injuries.
Through the implementation of best practice guidelines in our home, the culture of care has been significantly improved. As a result, we have cultivated an environment of evidence informed care including a more open dialogue with staff on how best we can improve resident outcomes using this evidence-based knowledge. At Hampton Terrace, our mission is to promote and enhance resident-focused c and quality of life through excellence, teamwork, integrity and innovation and our work as a Best Practice Spotlight Organization helps us do that.
Objectives: Health Human Resource challenges in critical care are a long-standing concern. The COVID-19 pandemic has exacerbated the gaps, requiring innovative approaches to support newly hired nurses while retaining experienced critical care nurses. Niagara Health successfully obtained funding in a competitive process to pilot an innovative Team Coach role in our Critical Care Program. The objectives of this pilot are to improve teamwork and provide professional development opportunities for experienced nurses.
Three experienced critical care nurses have been hired starting in February. The first of five PDSA cycles was completed in early February 2024. Pre-implementation data collection has been achieved using a quantitative survey with five validated scales. Additional mixed methods data collection will occur in May and September.
Results: ICU staff who participated in data collection (n = 40) reported a significantly higher collaborative practice environment (M = 39.9, SD = 6.5) compared to the provincial average (38.5). 12% of staff reported high levels of burnout, 41% moderate, and 47% low levels of burnout. Intent to stay and job satisfaction were measured pre-implementation and will be compared to the mid-point and final data collection periods. The initial quantitative and qualitative data demonstrate the positive impact of normative behaviours and shared experiences among small scheduling teams within each unit that work together frequently. This finding has been used to inform how the Team Coaches scale their team-building interventions across each unit to improve the impact of the team-building interventions.
Conclusions: The innovative Team Coach role has shown promising results in improving the work environment and staff experience. These early learnings from the first months of the pilot will continue to shape and enhance the Team Coach role development over the next several months.
Background: Persistent tobacco use results in adverse effects during treatment, increased risk of recurrence and reduced survival. In Q1 to Q4 2021/2022, 172 patients declined a smoking cessation intervention at the KHSC SE Regional Cancer Centre. The project aimed to 1) understand why some oncology patients continue to use tobacco and what biopsychosocial factors influence their decision-making and 2) to improve the smoking cessation program's access, engagement, and acceptability by gaining a deeper understanding of oncology patients' views.
Methods: This project aligns with the Model for Improvement outlined by Health Quality Ontario (HQO, 2023) and is specifically located at the 'understanding your system' phase in planning to improve the existing smoking cessation referral process. As a result, a literature review, telephone interview questionnaire, consent, REB approval, and qualitative data collection processes were designed to complete the project.
Results: 12 patients consented to participate. One-quarter (25%) of participants (n=3) expect the smoking cessation program to provide information on smoking/cigarette/ tobacco to take home. A quarter (25%) of participants (n=3) expect the smoking cessation program to respect and uphold individual choices in engaging with smoking cessation programs. Two-thirds (67%) of participants (n=8) remember coming to the Cancer Centre for the first time but did not recall the events of the day, including being screened for tobacco use.
Conclusions: This project is a critical Quality Improvement opportunity to change and offer smoking intervention at a different time to avoid cognitive overload on the first clinic visit.
This project also highlights that the best evidence-based interventions at the wrong time can sometimes have a poor uptake.
In Canada, older adults represent the second highest rate of suicide among all population groups, resulting in the 12th leading cause of death in this age group. Despite this information, suicide prevention and awareness are often overlooked in this specific population (WHO, 2014).
Working with fourth year Brock BScN nursing students, a survey was conducted to understand whether frontline staff were aware of Niagara Region policies and procedures, staff roles in suicide risk assessment, interventions, and confidence in completing suicide risk assessments. From here, it became evident that developing and implementing a risk-based assessment for suicide would be important to improve overall practice across the eight long-term care homes.
A gap analysis was completed and determined there was no standardized assessment for suicidal ideation or behaviours used in our long-term care homes. There were no staff training resources specific to how to approach residents with suicidal ideation and community and organizational supports available to help these individuals. The analysis also found further education was required surrounding residents with depression and dementia and how to engage with families to support resident mental health.
The working group used the Zero Suicide Toolkit which was implemented by Niagara Region Public Health in partnership with St. Joseph’s Health Care in London, Ontario to educate and empower staff at all levels to take an active role in suicide prevention, identification, and management. Training was provided to RNs and RPNs, along with leadership team members to understand the new policies and procedures to reflect the work completed by this working group.
Admitting nurses now screen for suicidal ideation or attempt/behaviours for all new admissions. If there is any previous documentation of such on admission, a standardized screening assessment is completed to determine the risk for the specific resident.
To bring transformation and sustainable change in health care, frontline leadership should be supported, encouraged, and valued. Nurses and allied health staff have the creativity, insight, and expertise to drive meaningful change from the bottom up. They are on the ground every day and have the knowledge and skillset to implement evidence-based practices. They understand how to implement policies and procedures in assessments and engage patients to receive optimal results. Yet, change in health care is a top-down approach and not grass-rooted (1).
We need to create a future in which opportunities exist to optimize the front line’s skill set to create leaders at multiple levels of the organization to have clear, strategic, and sustained goals and vision, which is driven by those who make the change happen every day (1).
Change is not easy in health care and can cause fear, fatigue, and burden for staff. However, change can effectively be led by frontline staff who are involved in the decision-making, planning, implementation, and evaluation process. This is crucial to value the change, have buy-in, influence the change, have a voice in directing the change, and be prepared for it (2). Changes that are initiated by the professionals themselves may be the easiest to implement and are rarely resisted. Changes that are clearly communicated, with an explanation, allow for preparation and increase the chances for success (2). Within the healthcare organization, no change is possible without the support of frontline staff. As change agents, the frontline leaders use their knowledge and skills to lead and influence change while building an environment of trust and collaboration in the team (1).
With the support of Resident and Family-Centered Care Best Practice Guidelines, we chose to enhance the bathing routines within our Long-Term Care home. Champion PSWs diligently strives to improve the quality of bathing routines to include personal preferences, diversity and cultural practices. Champions had conversations with residents and families to learn about their personal habits and routines. The conversations were compiled to create a visual bath board of individualized care routines for team members. The board allows for team involvement, flexibility, improved communication and adaptability amongst team members. This enables high quality care to be provided to each resident.
Bathing practices are influenced by cultural backgrounds and lifestyle preferences. Each resident is unique and has their own set of preferences. By accommodating the residents’ needs and wishes, the care team can provide a more enjoyable experience for residents. Some residents do not enjoy the bathing experience, due to past personal experiences, so it is important to work with the residents to minimize personal expressions surrounding bathing
Our Champion PSW’s goal with creating this visual bath board was to also minimize staff anxieties surrounding bathing. The PSW created a board where staff could look at their care assignments for the day and get a quick “synopsis” of each resident’s preferences and feel confident about the care they are providing. Team members rotate through the bathing schedule to share equal participation in the bathing routines. This is a great way to engage team members with the bathing process and become familiar with the resident routines. Everybody is involved and can share their input allowing for valuable feedback in improving quality initiatives.
Thus, through improving one aspect of resident care routines, we hope to continue supporting the diverse population within our Long-Term Care Home and provide better quality of life outcomes.
Title: Embracing an Interdisciplinary Approach to implement Palliative Care Guidelines
Authors: Ashley Guay, MAG, CTRS and R/TRO and Liza Reantaso, RN, BScN
Purpose and Main Points:
Humber Meadows was the first facility internationally to open with the Best Practice Spotlight Pre-Designation, helping to set an exciting milestone. Since receiving our pre-designation, we have set out on a path to not only to ensure the home’s alliance with BPSO guidelines but ensure that the meaning behind it was understood and embraced.
The Palliative Approach to Care and End of Life BPG was one of the first guidelines we chose to implement as a home, seeing an importance for supporting Residents and families. This has been done by ensuring we align ourselves with the Fixing Long Term Care Act, Ontario Regulations, Residents’ Bill of Rights. As a home we have made it one of our highest priorities to foster an environment of evidence-based practices and innovative approaches.
We have created a strong interdisciplinary team on our journey of implementing a palliative approach, utilizing some of our over 70 best practice champions which include frontline staff and managers. We will look at how we encouraged staff participation and the external projects and consultants we used to help us in advocating for the BPSO approach.
Results and Benefit to Participants
Participants who attend will learn Humber Meadows interdisciplinary approach taken from the planning before opening, the implementation to present day and how we plan to sustain this. Those that attend will also walk away with a strong understanding of how our home embraced the palliative care guidelines, encouraging everyone involved both internally and externally, to embrace it too. We will share an Indepth view into the successes, the barriers and the steps taken to continue moving forward as a home embracing our BPSO pre-designation.
St. Joseph’s Health Care strives to integrate cultural diversity in health care to ensure we are supporting nurses, to in turn provide best patient care. Our integration has three components, each targeted at supporting three different groups of Internationally Educated Applicants (IEA): Supervised Practice Experience Partnership (SPEP) Program applicants; Internationally Educated Nurses (IEN) working within the organization; and IEAs that are not part of our organization. Staff integration is supported via the development of a SPEP specific orientation, providing resources and coalitions to support and maintain IEAs as they transition into registered nurses in Ontario, and supporting the integration of newly registered nurses into our clinical areas.
The SPEP program has doubled in the past year to 19 successful applicants with positive feedback on the initiatives we have established. The SPEP program now offers in person SPEP specific orientation and transition phases. Team huddles and coalitions with CARE Centre for Internationally Educated Nurses have had positive outcomes for the applicants.
The Clinical Scholar Program supports IENs working within the organization. The Clinical Scholar Nurses (CSNs) mentor at the bedside to support IENs with critical thinking, documentation, patient assessment, and confidence. To do this we have provided education to our CSNs, nurses, staff, human resources, and leaders to better support integration into the health care system. Building coalitions with CARE and our Equity Diversity Inclusion and Belonging department to continue to build on workplace integration for and by all staff.
We have connected with IENs and IEAs to build on longer term goals. We have partnered with the CARE Centre for Internationally Educated Nurses to support IEAs and IENs with observation experiences within the organization.
Study Title: The University of Calgary in Qatar’s Experience on Implementing and Integrating Best Practice Guidelines into the Nursing Curriculum to Foster Evidence-Based Practice Among Nursing Students
Abstract
Aim: This presentation aims to detail the integration of the Registered Nurses Association of Ontario (RNAO) Best Practice Guidelines (BPGs) into the nursing curriculum at the University of Calgary in Qatar (UCQ) and to describe the impact it has had on the students. As the first academic institution in the Middle East to become an RNAO Best Practice Spotlight Organization (BPSO) in 2021, UCQ is committed to sharing its experience as a BPSO to advance the quality of nursing education in the region.
Methods: A scaffolded approach was used to incorporate BPGs across four academic years, which was structured to prepare graduates to apply BPGs in their professional practice. Concepts in the UCQ curriculum were aligned with applicable courses and matched with potentially relevant BPGs.
Results: The integration led to improved student competence in evidence-based practice and enhanced patient care outcomes, as evidenced by student evaluations through practical exams, case studies, reflective assignments, clinical care plans, and graduate surveys. Despite being relatively new as a BPSO, UCQ was able to fully integrate an increasing number of BPGs into its concept and competency-based curriculum each academic year.
Conclusion: UCQ's approach serves as a model for integrating RNAO BPGs into the nursing curricula of academic institutions in the region. The successful implementation of BPGs helped enhance the students' use of evidence-based knowledge in their studies and clinical placements. This fostered an Evidence-Based Practice (EBP) culture and instilled the need to advocate for healthcare excellence in their own professional practice.
This project explores the vital intersection of inclusion, diversity, equality, accessibility, and anti-racism (IDEAA) within the context of healthcare, focusing on falls prevention initiatives. By integrating IDEAA principles into healthcare practices, we aim to create a more equitable and accessible environment for both patients and healthcare professionals.
The project highlights the importance of embracing diversity in healthcare settings, including considerations for cultural competence, language access, and inclusivity in care delivery. It also addresses the significance of anti-racism efforts in combating systemic inequalities and promoting fair treatment for all individuals.
Additionally, this project will showcase the integration of IDEAA principles in falls prevention, highlighting the collaborative efforts with diverse stakeholders. It will emphasize the importance of cultural competence, language access, and anti-racism in creating inclusive healthcare environments. By promoting awareness, dialogue, and action, the project aims to foster a healthcare system that values and prioritizes inclusion, diversity, equality, accessibility, and anti-racism, ultimately leading to improved patient outcomes and a more supportive workplace culture.
This alignment with the Leading Change Toolkit ensures that the project not only achieves its immediate objectives but also contributes to a broader culture of inclusivity and continuous improvement in healthcare.
This presentation highlights the use of an academic Best Practice Spotlight Organization (BPSO) initiative to advance equity, diversity, inclusion, and ability (EDIA) through nursing education at Nipissing University. This initiative is part of a larger effort to infuse evidence-based best practices throughout the undergraduate nursing curriculum, moving beyond mere representation to engage students in creating more inclusive and socially just nursing practices.
Structured as a collaborative group activity, students are encouraged to explore the multifaceted aspects of cultural diversity in their communities, examining how different cultural backgrounds influence patient care and the nurse-client relationship. Utilizing resources like the Registered Nurses Association of Ontario’s (RNAO) Social Movement Action Framework and Best Practice Guidelines on Embracing Cultural Diversity in Healthcare, students are empowered to identify needs and develop a comprehensive nursing intervention. Described as a Best Practice project, the interventions are shared as a practice-ready initiative designed to meet the specific needs of an underserved community and foster more inclusive healthcare experiences. Initiatives include creating patient/client education materials and staff training using a variety of digital media forms.
The Best Practice Guideline projects result in various outputs, including poster displays, presentations, and social media content, many of which could be incorporated into students' current professional practices. Through such projects, the program aims to equip future nurses with the necessary skills, knowledge, and empathy to advance EDIA values in nursing and effectively integrate these critical concepts into the workplace culture of Ontario nurses.
Purpose: This presentation describes the implementation of a Palliative Approach to Care in the Last 12-Months of Life and the End-Of-Life (EOL) During the Last Days and Hours Best Practice Guidelines (BPGs) at the Wexford Residence. The Wexford Residence team will share how they enhanced practices by integrating recommendations from the BPGs, considering the values, beliefs, preferences, and cultural needs of residents and families.
Background: The Wexford Residence Inc is a vibrant seniors residence comprising of independent apartments, long-term care, and a senior community centre, situated in Scarborough. Designated as a Best Practice Spotlight Organization (BPSO) designate in June 2021, it embarked on its third designate year implementing two BPGs focused on palliative care and EOL care.
Methods: Leveraging the knowledge-to-action implementation framework, the interprofessional team identified several areas of focus to advance palliative and EOL programs within the home. During the pandemic, several initiatives were temporarily suspended. As we strive to reinstate these programs, we've recognized a shift in our resident demographics, prompting us to prioritize awareness of residents' spiritual and cultural beliefs in their care. These change initiatives include: revising our palliative and EOL care guide; enhancing our Honour Guard ceremony to be more inclusive with a moment of silence; redesigning our care cart to offer literature that reflects diversity, transitioning from the Bible to a more inclusive selection, and replacing hymn CDs with nature or calming CDs; and updating our community resource list to include contacts for various religious supports.
Results/Implications: The presentation offers valuable insights into the integration of best practices in palliative and EOL care within a diverse residential and community setting. Attendees will gain actionable strategies and concepts gleaned from the Wexford Residence’s experiences, which they may consider on their own journey implementing RNAO BPGs and delivering a holistic approach to care for residents.
Imagine a healthcare environment where every patient, regardless of their background, receives the highest quality of care, and every staff member feels valued and supported. We are turning this vision into reality by leveraging the (BPSO) principles to foster equity, diversity, and inclusion (EDI) within our Emergency Program. Objective: This presentation aims to illustrate how Lakeridge Health is using BPSO principles to advance EDI. We will highlight the initiatives, methods, and outcomes of this journey, emphasizing the critical role of nursing professionals in creating a more inclusive and equitable healthcare environment. Main Points: 1. Commitment: Lakeridge Health is dedicated to creating an inclusive, diverse, equitable, accessible, and anti-racist environment, a promise to our staff and community. 2. BPSO Framework: Utilizing the BPSO framework, we are establishing a solid foundation for advancing EDI in our Emergency Program to form an Inclusion, Diversity, Equity, Accessibility, and Anti-racism (IDEAA) ED Team. 3. Projects and Initiatives: Building on successful initiatives like the Sickle Cell IHI project, we aim to enhance access to quality care for the Black community and extend similar projects across all our EDs. 4. Engagement and Visibility: Strategies to increase public visibility and staff engagement include implementing a staff newsletter with diversity highlights and hosting a "Discovery Day" for BiPOC high school students interested in healthcare careers. Outcomes and Results: The IDEAA ED Team will act as a catalyst for fostering an inclusive environment where nurses can thrive to improve patient care outcomes, increased staff satisfaction and retention, and build a stronger connection with our diverse community. Benefit to Symposium Participants: Attendees will gain practical insights and strategies for using the BPSO framework to advance EDI in their own organizations. Participants will leave inspired to implement similar initiatives, understanding that every team member plays a crucial role in this journey.
Elgin County has utilized the principles of the Person and Family Centred Care BPG to advance equity, diversity and inclusion in our Long Term Care Homes. The teams used an interdepartmental approach between recreation programming and dietary services and a collaborative partnership with residents and families. This has been successful through detailed planning, effective communication and general feedback and input from all stakeholders. Team members from front line to management were empowered to contribute and engage in our equity, diversity and inclusion initiative.
We began this journey in April of 2023 by assessing and identifying areas of improvement around diversity and inclusion. Through this, we began the first phase of our planning process, involving several discussions and formal meetings between recreation and dietary services, helping us to create a common goal. For our residents, families and staff, we shared our thought process and the exciting opportunity for everyone to be involved monthly by sharing family recipes, past and current travel history and simply a moment to reminisce and embrace differences. We called this initiative “COUNTRIES OF DISCOVERY”. The purpose was to introduce and educate a chosen country for the month, engage residents in a variety of culturally and inclusive based activities throughout and give residents the opportunity to taste meals, regardless of diets and textures, from the chosen country which are prepared in-house from the talented dietary teams. We have been successful in engaging team members through shared input with excitement, advanced research, culturally appropriate attire for the day and decorations around the Homes.
AON Health LTC Homes implemented two Best Practice Guidelines (BPG)’s concurrently in our path to become a BPSO designate. We introduced the project to our staff through committees, team meetings, and in department communication; encouraging staff to become BPG Champions – providing them with t-shirts and buttons we produced. BPSO was introduced to residents and families through postings in the home, attending resident council, special events, and articles in our monthly newsletters. For staff, information regarding action plans and progress, committee meeting dates and minutes, and ongoing opportunities to become BPG Champions was posted in common areas that all staff access, to ensure optimum visibility. After reviewing practices utilized in other organizations, our teams selected Purposeful Rounding as a process we felt would benefit our residents and further enhance the quality of our care delivery and approach. A decision was made to roll the program out gradually by identifying our residents at higher risk through our Falls Prevention Committee and our Behavioural Supports Coordinator. We have expanded the percentage of residents on the program slowly throughout the home and are proud that our efforts have contributed to a declining trend in injuries from falls and responsive behaviours amongst residents.
Visibility continues with BPSO as a standing topic on agendas for meetings, ongoing information to residents and families. Each home purchased a pull up banner to display at every opportunity, information was included in our home Facebook pages and, on the AON corporate website. Once our designation was received, an additional banner has been purchased and is on display in our main lobby, as is our framed certificate.
The City of Ottawa LTC Homes have been working on implementing the Oral Care Best Practice Guidelines. We have collaborated with multiple community resources to ensure adequate education and knowledge transfer to our staff. We would like to create a poster to showcase work done to date and how using community partners has improvement our Resident's Quality of Life and increased staff confidence providing oral care to our Residents.