Implementing and sustaining evidence-based practices in long-term care.

Clinical BPGs

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    This best practice guideline is focused on preventing and addressing abuse and neglect of older adults throughout various health-care institutions and community settings in Canada. It outlines recommendations for nurses and other health-care providers, educators, health-care organizations, advocacy groups, nursing regulatory bodies and governments. Implementation resources in development include an e-learning course, a health education fact sheet, and a personal digital assistant (PDA) version of the guideline.

    This guideline is part of an initiative funded by the Government of Canada’s New Horizons for Seniors Program and builds on a collaborative project between the Canadian Nurses Association (CNA) and RNAO, titled Promoting the Awareness of Elder Abuse in Long-Term Care.

    Registered Nurses’ Association of Ontario. (2014). Preventing and Addressing Abuse and Neglect of Older Adults: Person-Centred, Collaborative, System-Wide Approaches. Toronto, ON: Registered Nurses’ Association of Ontario. Retrieved from https://rnao.ca/sites/rnao-ca/files/Preventing_Abuse_and_Neglect_of_Older_Adults_English_WEB.pdf

     

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    Increase your comfort, confidence and competence in this practice area, in order to enhance safety for your clients and to lower the impact of suicide to society. The goal of this best practice guideline is to provide nurses with recommendations, based on the best available evidence, related to the assessment and care of adults at risk for suicidal ideation and behaviour.

    Registered Nurses’ Association of Ontario. (2009). Assessment and Care of Adults at Risk for Suicidal Ideation and Behaviour. Toronto, ON, Canada: Author. Retrieved from http://rnao.ca/bpg/guidelines/assessment-and-care-adults-risk-suicidal-ideation-and-behaviour

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    It will provide direction to all nurses and the interprofessional team who provide care in all health-care settings to people (>15 years of age) with type 1 and/or type 2 diabetes and who have established diabetic foot ulcers. This best practice guideline provides evidence-based recommendations that will assist interdisciplinary teams with assessment and management of clients who are over the age of fifteen with established diabetic foot ulcers.

    Registered Nurses’ Association of Ontario (2013). RNAO Assessment and Management of Foot Ulcers for People with Diabetes. Toronto, ON: Author. This work is funded by the Ontario Ministry of Health and Long-Term Care. Retrieved from: http://rnao.ca/bpg/guidelines/assessment-and-management-foot-ulcers-people-diabetes-second-edition
     

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    The guideline contains recommendations for best nursing practices in the assessment and management of pain for Registered Nurses (RNs) and Registered Practical Nurses (RPNs). It is acknowledged that the individual competency of nurses varies between nurses and across categories of nursing professionals (RNs and RPNs) and is based on knowledge, skills, attitudes, critical analysis and decision making which is enhanced over time by experience and education. This guideline is endorsed by the International Association for the Study of Pain.

    Registered Nurses’ Association of Ontario. (2013). Assessment and management of pain. (3rd Ed.). Toronto, ON: Author. Retrieved from https://rnao.ca/sites/rnao-ca/files/AssessAndManagementOfPain_15_WEB-_FINAL_DEC_2.pdf

     

     

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    The purpose of this Guideline is to present evidence-based recommendations that apply to the decisions and best practices of interprofessional teams working to assess and manage existing pressure injuries in people 18 years of age and above. This Best Practice Guideline (BPG) replaces the RNAO BPG Assessment and Management of Stage I to IV Pressure Ulcers (2007). It provides evidence-based practice, education and policy recommendations for interprofesssional teams across all care settings who are assessing and providing care to people with existing pressure injuries. Moreover, this Guideline refers to “pressure ulcers” as “pressure injuries.” This new terminology aligns with the National Pressure Ulcer Advisory Panel (NPUAP).

    This Guideline provides best practice recommendations in three main areas:

    • Practice recommendations are directed primarily to the front-line interprofessional teams who provide care for people with existing pressure injuries across all practice settings.
    • Education recommendations are directed to those responsible for interprofessional team and staff education, such as educators, quality improvement teams, managers, administrators, and academic institutions.
    • System, organization, and policy recommendations apply to a variety of audiences, depending on the recommendation. Audiences include managers, administrators, policy-makers, health-care professional regulatory bodies, and government bodies.

    Registered Nurses’ Association of Ontario. (2016). Assessment and Management of Pressure Injuries for the Interprofessional Team, Third Edition. Toronto, ON: Author. Retrieved from: http://rnao.ca/bpg/guidelines/pressure-injuries

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    This new guideline is designed to apply to all domains of nursing practice, including clinical, administration, and education, to assist nurses to become more comfortable, confident and competent when caring for clients undergoing care transitions. It is important that nurses, working in collaboration with the interprofessional team promote safe and effective care transitions. Care transitions depends on effective communication and coordination of client care by all interprofessional team members and with the client, their family and caregivers.

    Registered Nurses’ Association of Ontario. (2014). Care transitions. Toronto, ON, Canada: Author. https://rnao.ca/sites/rnao-ca/files/Care_Transitions_BPG.pdf

    French translation - Transitions des soins https://rnao.ca/sites/rnao-ca/files/TransitionsDesSoins-RNAO.pdf

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    This nursing Best Practice Guideline (BPG) is intended to replace the RNAO (2010) BPGs Screening for Delirium, Dementia and Depression in Older Adults and Caregiving Strategies for Older Adults with Delirium, Dementia and Depression. It is to be used by nurses and other members of the interprofessional health-care team to enhance the quality of their practice pertaining to delirium, dementia, and depression in older adults, ultimately optimizing clinical outcomes through the use of evidence-based practices.

    Registered Nurses’ Association of Ontario. (2016). Delirium, Dementia, and Depression in Older Adults: Assessment and Care. Toronto, ON, Canada: Author. Retrieved from http://rnao.ca/bpg/guidelines/assessment-and-care-older-adults-delirium-dementia-and-depression

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    This guideline focuses on recommendations for adults, aged 18 years and older, who have reached the part of the illness trajectory that includes the last days and hours of life. This guideline will provide evidence- based recommendations for Registered Nurses and Registered Practical Nurses on best nursing practices for end-of-life care during the last days and hours.

    Registered Nurses’ Association of Ontario (2011). End-of-life care during the last days and hours. Toronto, ON: Author. Retrieved from https://rnao.ca/sites/rnao-ca/files/End-of-Life_Care_During_the_Last_Days_and_Hours_0.pdf

     

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    This guideline provides evidence-based recommendations for RNs and RPNs on best nursing practices for oral health care. This guideline focuses on recommendations for assessing oral health, and strategies and interventions related to oral care. 

    Registered Nurses’ Association of Ontario (2008). Oral health: Nursing assessment and intervention. Toronto, ON: Author. Retrieved from https://rnao.ca/sites/rnao-ca/files/Oral_Health_-_Nursing_Assessment_and_Interventions.pdf

    This work is funded by the Ontario Ministry of Health and Long-Term Care.

    Translations for this Guideline: Igiene del cavo orale - Valutazione e interventi infermieristici (Italian)

                                                     La santé buccodentaire : Évaluation des soins infirmiers et interventions (French)

     

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    Reduce the frequency and severity of constipation among older adults through the use of adequate hydration and dietary fibre, regular consistent toileting and physical activity. Achieving and maintaining a pattern of normal bowel elimination will prevent constipation, decrease the use of laxatives, and improve the quality of life for older adults. Published: 2005 Supplement: 2005 Revised: 2011

    Registered Nurses’ Association of Ontario. Prevention of Constipation in the Older Adult Population. (2011). Toronto, ON: Author.  Retrieved from: http://rnao.ca/bpg/guidelines/prevention-constipation-older-adult-population.

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    Preventing Falls and Reducing Injury from Falls (3rd ed.) replaces the RNAO (2011) BPG Prevention of Falls and Fall Injuries in the Older Adult, which was originally published in 2002 and then revised in 2005 and 2011. Whereas previous editions focused on older adults in hospital and long-term-care settings, the scope of this third edition has been expanded to include in all adults (>18 years) at risk for falls and receiving care from nurses and other health-care providers across the health-care continuum, including those living in the community.

    The purpose of this guideline is to outline evidence-based approaches for preventing falls and reducing fall injuries for adults. Recommendations are provided at the following three levels:

    • Practice recommendations are directed primarily toward nurses who provide direct clinical care to adults at risk for falls across the continuum of care, including (but not limited to): primary care, home care, hospital care, and long-term care settings. The secondary audience of the practice recommendations includes other members of the interprofessional team who collaborate with nurses to provide comprehensive care. All of the recommendations are applicable to the scope of practice of registered nurses and nurse practitioners (general and extended classes); however, many are also applicable to other health-care providers.
    • Education recommendations are directed at individuals and organizations responsible for the education of healthcare providers, such as educators, quality improvement teams, managers, administrators, academic institutions, and professional organizations.
    • Organization and policy recommendations are directed at those managers, administrators, and policy-makers responsible for developing policy or securing the supports required within health-care organizations that enable the implementation of best practices. For optimal effectiveness, recommendations in these three areas should be implemented together.

    Registered Nurses’ Association of Ontario.  (2017).  RNAO Prevention of Falls and Reducing Injury from Falls Best Practice Guideline. (4th Ed.).  Toronto, ON: Registered Nurses’ Association of Ontario. )

    http://rnao.ca/bpg/guidelines/prevention-falls-and-fall-injuries

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    The Promoting Continence Using Prompted Voiding guideline can be used for implementation of a treatment program of prompted voiding for older adults with urinary incontinence. The goals of prompted voiding are to: •Reduce the frequency and severity of urinary incontinence episodes; •Prevent the complications associated with urinary incontinence; and •Improve quality of life. Revised: 2005 Revised: 2011

    Registered Nurses’ Association of Ontario. Promoting Continence Using Prompted Voiding Best Practice Guideline. (2011). Toronto, ON: Author.
    Retrieved from: http://rnao.ca/bpg/guidelines/promoting-continence-using-prompted-voiding  This work is funded by the Ontario Ministry of Health and Long-Term Care.

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    Nurses require knowledge and evidence on the use of alternative approaches to the use of restraints. The promotion of safe evidence based care is the goal to prevent the untoward incidents from the use of restraints. This guideline offers nurses a model which will help them to examine their approach to the use of restraints within their practice.

    Registered Nurses’ Association of Ontario. (2012). Promoting Safety: Alternative Approaches to the Use of Restraints. Toronto, ON, Canada: Author. Retrieved from http://rnao.ca/bpg/guidelines/promoting-safety-alternative-approaches-use-restraints.

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    This guideline focuses its recommendations on three areas: 1.Practice recommendations directed at the nurse 2.Education recommendations directed at the competencies required for practice 3.Organization and Policy recommendations addressing the importance of a supportive practice environment as an enabling factor for providing high quality nursing care, which includes ongoing evaluation of guideline implementation. Supplement: 2007

    This best practice guideline provides evidence-based recommendations for nurses who are not specialists in the area of Diabetes. These recommendations assist nurses to conduct risk assessments for foot ulcers, provide basic education for the prevention of foot ulcers and   implement the appropriate interventions when there is a high risk for ulcer or amputation present.
    Registered Nurses’ Association of Ontario (2007). RNAO Reducing foot Complications for People with Diabetes. Toronto, ON: Author. Retrieved from: http://rnao.ca/bpg/guidelines/reducing-foot-complications-people-diabetes

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    Define early interventions for pressure ulcer prevention, and to manage Stage I pressure ulcers.

    This best practice guideline assists nurses who work in diverse practice settings to identify adults who are at risk of pressure ulcers. This guideline focuses its recommendations on: • Practice Recommendations including assessment, planning, intervention and discharge/transfer of care • Educational Recommendations for supporting the skills required for nurses working with adults at risk for pressure ulcers • Organization & Policy Recommendations addressing the importance of a supportive practice environment as an enabling factor for providing high quality nursing care, which includes ongoing evaluation of guideline implementation.

    Revised: 2011 Supplement: 2005

    This best practice guideline assists RN’s and RPN’s to identify adults who are at risk for pressure ulcers and provides direction to nurses in defining early interventions.

    Registered Nurses’ Association of Ontario (2013). Risk Assessment and Prevention of Pressure Ulcers Best Practice Guideline (rev.2011) Toronto, ON: Author. Retrieved from: http://rnao.ca/bpg/guidelines/risk-assessment-and-prevention-pressure-ulcers

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    Supporting Adults who Anticipate or Live with an Ostomy is a best practice guideline (BPG) that provides nurses and the interprofessional team with evidence-based recommendations for the most effective strategies to support adults (18 years and older) who anticipate or live with an ostomy. The purpose of this BPG is to (a) promote self-management, (b) enhance access and delivery of care, and (c) lead to positive health outcomes in adults who anticipate or live with an ostomy.

    The BPG has 6 evidence-based recommendations that address the following: access to Nurses Specialized in Wound, Ostomy, and Continence (NSWOC) to support comprehensive care, the need for a standardized ostomy care program within health service organizations, guidance on the prevention of parastomal hernias, and quality of life assessments in adults who anticipate or live with an ostomy.

    This BPG can be used by nurses across the continuum of care and in all domains of practice—such as clinical, research, education, policy, and administration—and members of the interprofessional team. It can also be used by organizations in which they are employed. The evidence-based recommendations in this BPG are applicable to all practice settings where adults who anticipate or live with an ostomy are accessing services (such as, but not limited to, acute care, long-term care, community settings, and rehabilitation settings).

    Registered Nurses’ Association of Ontario. (2019). Supporting adults who anticipate or live with an ostomy. Toronto, ON: Author. Retrieved from https://rnao.ca/sites/rnao-ca/files/bpg/OSTOMY_FINAL_WEB.pdf 

     

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    The Person-and Family-Centred Care best practice guideline can be used to enhance the quality of partnerships between health-care providers with individuals accessing care, ultimately improving clinical outcomes. It is important to acknowledge that person- and family-centred care focuses on the whole person as a unique individual and not just on their illness or disease. By viewing the individual through this lens, health-care providers come to know and understand the person’s life story, experience of health, the role of family in the person’s life, and the role they may play in supporting the person to achieve health.

    This guideline provides best practice recommendations in three main areas: • Practice recommendations are directed primarily to those who provide direct care to persons in health-system settings and in the community. • Education recommendations are directed to those responsible for staff and student education. • System, organization, and policy recommendations apply to managers, administrators, policy-makers, nursing regulatory bodies, academic institutions, and government bodies.

    Recommendations in these three areas are most effective when implemented together. This guideline replaces the previous BPG Client Centred Care.

    Registered Nurses’ Association of Ontario (2015). Person-and family-centred care. Toronto, ON, Canada: Author. https://rnao.ca/sites/rnao-ca/files/FINAL_Web_Version_0.pdf
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    Ce guide fournit des recommandations fondées sur des preuves pour IA et IAA sur les meilleures pratiques en matière de soins buccodentaires de soins infirmiers. Ce guide met l'accent sur les recommandations pour l'évaluation de la santé buccodentaire et stratégies et interventions de soins liés à l'oral.

    Registered Nurses' Association of Ontario (2008). Santé bucco-dentaire : Soins infirmiers évaluation et Intervention. Toronto, Ontario: auteur. Récupéré de https://rnao.ca/sites/rnao-ca/files/BPG_Oral_Health_French.pdf

    Ce travail est financé par le Ministère de la Santé et des Soins de longue durée.

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    The Promoting Continence Using Prompted Voiding guideline can be used for implementation of a treatment program of prompted voiding for older adults with urinary incontinence. The goals of prompted voiding are to: •Reduce the frequency and severity of urinary incontinence episodes; •Prevent the complications associated with urinary incontinence; and •Improve quality of life. Revised: 2005 Revised: 2011 Registered Nurses’ Association of Ontario. Promoting Continence Using Prompted Voiding Best Practice Guideline. (2011). Toronto, ON: Author. Retrieved from: http://rnao.ca/bpg/guidelines/promoting-continence-using-prompted-voiding This work is funded by the Ontario Ministry of Health and Long-Term Care.

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    This guideline focuses its recommendations on three areas: 1.Practice recommendations directed at the nurse 2.Education recommendations directed at the competencies required for practice 3.Organization and Policy recommendations addressing the importance of a supportive practice environment as an enabling factor for providing high quality nursing care, which includes ongoing evaluation of guideline implementation. Supplement: 2007

    This best practice guideline provides evidence-based recommendations for nurses who are not specialists in the area of Diabetes. These recommendations assist nurses to conduct risk assessments for foot ulcers, provide basic education for the prevention of foot ulcers and implement the appropriate interventions when there is a high risk for ulcer or amputation present.

    Registered Nurses’ Association of Ontario (2007). RNAO Reducing foot Complications for People with Diabetes. Toronto, ON: Author. Retrieved from: http://rnao.ca/bpg/guidelines/reducing-foot-complications-people-diabetes

  • Show description [+]

    This guideline focuses its recommendations on three areas: 1.Practice recommendations directed at the nurse 2.Education recommendations directed at the competencies required for practice 3.Organization and Policy recommendations addressing the importance of a supportive practice environment as an enabling factor for providing high quality nursing care, which includes ongoing evaluation of guideline implementation. Supplement: 2007

    This best practice guideline provides evidence-based recommendations for nurses who are not specialists in the area of Diabetes. These recommendations assist nurses to conduct risk assessments for foot ulcers, provide basic education for the prevention of foot ulcers and implement the appropriate interventions when there is a high risk for ulcer or amputation present.

    Registered Nurses’ Association of Ontario (2007). RNAO Reducing foot Complications for People with Diabetes. Toronto, ON: Author. Retrieved from: http://rnao.ca/bpg/guidelines/reducing-foot-complications-people-diabetes

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    This Best Practice Guideline Supplement complements the RNAO Risk Assessment and Prevention of Pressure Ulcers BPG (2005). It provides higher levels of evidence for earlier recommendations and includes additional recommendations based on current research.
    Registred Nurses' Association of Ontario. (2011). Risk Assessment and Prevention of Pressure Ulcers BPG Supplement. Toronto, ON: Author. 

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    Define early interventions for pressure ulcer prevention, and to manage Stage I pressure ulcers. This best practice guideline assists nurses who work in diverse practice settings to identify adults who are at risk of pressure ulcers.

    This guideline focuses its recommendations on: • Practice Recommendations including assessment, planning, intervention and discharge/transfer of care • Educational Recommendations for supporting the skills required for nurses working with adults at risk for pressure ulcers • Organization & Policy Recommendations addressing the importance of a supportive practice environment as an enabling factor for providing high quality nursing care, which includes ongoing evaluation of guideline implementation. Revised: 2011 Supplement: 2005

    This best practice guideline assists RN’s and RPN’s to identify adults who are at risk for pressure ulcers and provides direction to nurses in defining early interventions.

    Registered Nurses’ Association of Ontario (2013). Risk Assessment and Prevention of Pressure Ulcers Best Practice Guideline (rev.2011) Toronto, ON: Author. Retrieved from: http://rnao.ca/bpg/guidelines/risk-assessment-and-prevention-pressure-ulcers