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

Clinical BPGs

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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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    Care Transitions Gap Analysis

    Organizational assessment tool to assist with implementation and evaluation of the RNAO Care Transitions BPG by comparing current practice to evidence-based practice. Source: Registered Nurses' Association of Ontario's Long-Term Care Best Practices Program, Toronto, ON.

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    The goal of the document is to act as a tool promoting standardization in transitional care practices for complex patients. The tool describes the benefits of using common practices.

    Reference: Health Quality Ontario. (nd) Adopting a Common Approach to Transitional Care Planning: Helping Health Links Improve Transitions and Coordination of Care. Retrieved from http://www.hqontario.ca/Portals/0/documents/qi/health-links/bp-improve-package-traditional-care-planning-en.pdf

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    This guide provides an interview process from introduction to closing that supports accurate and comprehensive medication information is communicated consistently across transitions of care.

    Reference: Institute for Safe Medication Practices (ISMP) Canada, In collaboration with SaferHealthcareNow (2012). Best Possible Medication History Interview Guide. Retrieved August 8,2016 from https://www.ismp-canada.org/download/MedRec/SHN_medcard_09_EN.pdf

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    The link takes you to the care plans and plan of care section 24 to 29 of the Ontario Regulation 79/10 made under the Long-Term Care Homes Act, 2007, Government of Ontario. Retrieved from https://www.ontario.ca/laws/regulation/r10079

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    The Health education fact sheet supports resident/family to understand that they are an important part of the health-care team. Speaking with members of the health-care team will help them get the information they need to understand any changes in their health and what it means for the situation.

    Reference: Registered Nurses’ Association of Ontario (2014). Care Transitions. Toronto, ON, Canada: Author. http://rnao.ca/bpg/guidelines/care-transitions

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    The Care Transitions Education Project (CTEP) delivers educational models to increase nurses’, nursing students and cross continuum team members’ knowledge and skills for executing effective patient care transitions and lets nurses practice them during interactive learning activities and experiences. The modules require the learner to sign in.

    Reference: Care Transitions Education Project. (nd). Retrieved from http://www.caretransitionseducation.org/

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    A quality improvement initiative looks at communication during shift report identifying 4 key themes as opportunities to improve upon. Improvement outcomes are shared in the article.

    Reference: Johnson C.,Carta, T., & Throndson, K. (2015) Canadian Nurse. Communicate with me: Information exchange between nurses. Retrieved from https://www.canadian-nurse.com/articles/issues/2015/march-2015/communicate-with-me-information-exchanges-between-nurses

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    This article looks at communication as being a key culprit in compromising patient safety in hand-over. Suggestions are given for strategies on how to approach hand-overs from shift to shift consistently, how to include patient and family along with potential barriers

    Reference: World Health Organization. (2007) Patient Safety Solutions. Communication during patient handovers. 1 (3). Retrieved from http://www.who.int/patientsafety/solutions/patientsafety/PS-Solution3.pdf

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    Article focuses on key processes to include in shift.

    Reference: Wagner, A. (2015). Communication is key: The importance of effective hand-off reporting. Minority Nurse. Retrieved from http://minoritynurse.com/communication-is-key-the-importance-of-effective-hand-off-reporting/  

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    Complementary health-related therapies are enjoying growing popularity among the general public. An increasing number of nurses have been asking the College of Nurses of Ontario whether it is appropriate for nurses to provide complementary therapies, and what criteria exist to guide nurses in their use of these therapies. This CNO document discusses nursing interventions and complementary therapies.

    Reference: College of Nurses of Ontario Practice Guideline (2014) Complementary Therapies. Retrieved from http://www.cno.org/globalassets/docs/prac/41021_comptherapies.pdf

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    Nurses have ethical and legal responsibilities to maintain the confidentiality and privacy of client health information obtained while providing care. One way that nurses maintain boundaries and build nurse-client relationships based on trust is by respecting clients’ rights around confidentiality and privacy. This practice standard reviews nurses’ accountability regarding privacy and confidentiality.

    Reference: College of Nurses of Ontario (2009) Confidentiality and Privacy—Personal Health Information Retrieved from http://www.cno.org/globalassets/docs/prac/41069_privacy.pdf

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    Nurses have ethical and legal obligations for obtaining consent. The ethical obligations related to consent are discussed in the Ethics practice standard under the section Client Choice. This practice guideline replaces and updates the guide produced in June 1996 after the legislation, the Health Care Consent Act (HCCA) and the Substitute Decisions Act (SDA), was enacted. This practice guideline provides an overview of the major features of the legislation, pertinent definitions, the steps nurses need to take to obtain consent and the Guidelines for Nurses Advocating for Clients Found Incapable of Making Certain Decisions. It replaces an earlier Guide to the Health Care Consent and Substitute Decisions Legislation for RNs and RPNs. It does not address consent under the Mental Health Act.

    Reference: College of Nurses of Ontario Practice Guideline (2009) Consent Retrieved from http://www.cno.org/globalassets/docs/policy/41020_consent.pdf

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    Practice standards are documents that help nurses understand their responsibilities and legal obligations in order to make safe, effective and ethical decisions in nursing practice. This practice guideline outlines when nurses have the appropriate authority and competence to perform a particular procedure.

    Copyright © College of Nurses of Ontario 2013.

    College of Nurses of Ontario. (2013). Authorizing Mechanisms. Toronto, ON, Canada: Author. Retrieved from http://www.cno.org/en/learn-about-standards-guidelines/standards-and-guidelines/.

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    This paper from the Institute for Safe Medication Practices in Canada (ISMP). A multi-incident analysis of delayed medication doses after transitions of care.

    Reference: Institute for Safe Medication Practices in Canada (2016) Delayed Treatment after Transitions of Care: A Multi-Incident Analysis Retrieved from https://www.ismp-canada.org/download/safetyBulletins/2016/ISMPCSB2016-07-DelayedTreatment.pdf?utm_source=safetybulletin&utm_medium=email&utm_campaign=sbv16i07#page=1

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    Les présentes lignes directrices sur les pratiques exemplaires, Développement et maintien des soins de santé interprofessionnels : optimisation des résultats pour le patient/client, l’organisme et le système sont conçues pour favoriser des milieux de travail sains. L’objectif de l’élaboration de ces lignes directrices était de déterminer les attributs des soins interprofessionnels qui permettront d’optimiser les résultats de qualité pour les patients/clients, les fournisseurs, les équipes, l’organisation et le système. Les présentes lignes directrices déterminent les pratiques exemplaires pour faciliter, améliorer et maintenir le travail d’équipe ainsi que la collaboration interprofessionnelle, et pour accroître les résultats positifs pour les patients/clients, les systèmes et les organisations. Elles sont fondées sur les meilleures données probantes existantes; lorsque ces données étaient limitées, les recommandations ont été fondées sur un consensus basé sur des opinions d’experts.

    Association des infirmières et infirmiers autorisés de l’Ontario (2013). Développement et maintien des soins de santé interprofessionnels : optimisation des résultats pour le patient/client, l’organisme et le système. Toronto, Canada: Association des infirmières et infirmiers autorisés de l’Ontario. http://rnao.ca/bpg/language/d%C3%A9veloppement-et-maintien-des-soins-de-sant%C3%A9-interprofessionnels-optimisation-des-r%C3%A9sul

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    The College of Nurses of Ontario has developed this practice guideline to provide direction to nurses when they disagree with a plan of care or when they believe a client has not given informed consent to a plan.

    Reference: College of Nurses of Ontario (2009) CNO Practice Guideline Fact Sheet - Disagreeing With the Plan of Care. Retrieved from http://www.cno.org/globalassets/docs/prac/41017_fsdisagreeing.pdf

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    Practice standards are documents that help nurses understand their responsibilities and legal obligations to enable them to make safe, effective and ethical decisions when practising. This practice standard aims to help nurses understand the regulatory and legislative requirements for documentation.

    College of Nurses of Ontario. (2008). Documentation, Revised 2008. Toronto, ON: Author. Retrieved from https://www.cno.org/globalassets/docs/prac/41001_documentation.pdf


     

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    This learning module reviews documentation and how it is important component of nursing practice and interprofessional documentation that occurs

    Reference: College of Nurses of Ontario (2010) Documentation- Learning Module. Retrieved from http://www.cno.org/en/learn-about-standards-guidelines/educational-tools/learning-modules/documentation-2010/

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    Une pratique efficace des soins infirmiers dépend d’une relation thérapeutique efficace entre le client et l’infirmière. Cette Ligne directrice porte sur les qualités d’une relation thérapeutique efficace, sur les possibilités qu’elle offre, sur l’état des connaissances et sur les connaissances requises afin de pouvoir travailler efficacement dans une relation thérapeutique. Afin qu’une relation thérapeutique puisse être instaurée avec succès, les valeurs du milieu de travail et les caractéristiques essentielles de l’établissement doivent être en place et doivent être compatibles avec cet objectif. Une feuille de travail sur le niveau de préparation de votre établissement est compris.

    Association des infirmières et infirmiers autorisés de l’Ontario (2006). Établissement de la relation thérapeutique. Toronto, Canada : Association des infirmières et infirmiers autorisés de l’Ontario. http://rnao.ca/bpg/guidelines/establishing-therapeutic-relationships

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    Practice standard are documents that help nurses understand their responsibilities and legal obligations to enable them to make safe, effective and ethical decisions when practising. This practice standard aims to help nurses understand the ethical values and practice standards that the nursing profession in Ontario must uphold. It also provides scenarios of ethical situations in which there is a conflict of values.

    College of Nurses of Ontario. (2019). Ethics [PDF file]. Retrieved from https://www.cno.org/globalassets/docs/prac/41034_ethics.pdf

     

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    Le but de cette ligne directrice est de fournir aux infirmières autorisées, aux infirmières auxiliaires autorisées et aux autres prestataires des soins de santé des recommandations fondées sur les données probantes en matière de facilitation de l'apprentissage axé sur les besoins du client qui encourage les clients à prendre les mesures nécessaires pour assurer leur propre santé et qui leur permet de le faire. Voici les questions cliniques abordées par cette ligne directrice : 1. Comment les infirmières peuvent-elles faciliter de façon efficace l'apprentissage axé sur les besoins du client? 2. Quelles sont des méthodes/stratégies d'enseignement efficaces pour l'apprentissage axé sur les besoins du client? 3. Comment les infirmières peuvent-elles évaluer l'apprentissage du client? Cette directive s'appliquera à tous les domaines des soins infirmiers incluant cliniques, l'administration et l'éducation.

    Association des infirmières et infirmiers autorisés de l'Ontario (2012). Facilitation de l'apprentissage axé sur les besoins du client. Toronto, Canada : Association des infirmières et infirmiers autorisés de l'Ontario. http://rnao.ca/bpg/language/facilitation-de-lapprentissage-ax%C3%A9-sur-les-besoins-du-client

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    This table is a theoretical framework to understand the psychological stages individuals may go through as they adapt to a transition

    Reference: Registered Nurses’ Association of Ontario (2014). Care Transitions. Toronto, ON, Canada: Author. http://rnao.ca/bpg/guidelines/care-transitions pp22

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    On, June 17, 2016, Bill C-14 received royal assent, making it possible for eligible people to receive medical assistance in dying in Canada. The law establishes safeguards for clients and offers protection to health professionals who provide medical assistance in dying, along with people who assist in the process in accordance with the law. To help Ontario nurses understand their accountabilities, the College has released a new Guidance on Nurses’ Roles in Medical Assistance in Dying. The College will continue to monitor any changes that impact this guidance and modify this information as required..

    Reference: College of Nurses of Ontario, 2016. Medical Assistance in Dying - New guidance document for nurses. Retrieved from: http://www.cno.org/globalassets/4-learnaboutstandardsandguidelines/maid/maid-june-23-final.pdf

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    This resource provides guidelines that support, give direction and improve services for adults with a developmental disability when applying to, moving into and residing In a Long-Term Care Home. It outlines the importance of planning, choice and consent and adults with developmental disabilities receiving appropriate developmental services and supports in a LTC home. Following these guidelines demonstrates the integrated and co-ordinated approach to care within and between the Developmental Services (DS) and LTC home sectors.

    Reference: QUEEN'S PRINTER FOR ONTARIO, 2012-14 - LAST MODIFIED: OCTOBER 18, 2017. RETRIEVED OCTOBER 31,2017 FROM http://www.mcss.gov.on.ca/en/mcss/publications/developmentalServices/ltc_home_guidelines.aspx 

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    This article describes the challenges involved and potential solutions for improving the quality of transitional care.

    Reference: Fancott, C. (2011). The Change Foundation. Interventions and measurement tools related to improving the patient experience through transitions in care: A summary of key literature. Retrieved from http://www.hqontario.ca/Portals/0/modals/qi/en/processmap_pdfs/resources_links/care%20transitions%20literature%20review.pdf

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    Cette ligne directrice sur les pratiques exemplaires en soins infirmières et infirmiers est un document détaillé comportant les ressources nécessaires au soutien de la pratique basée sur des données probantes. Un milieu de travail sain, c’est un milieu de pratique qui maximise la santé et le bien-être des infirmières, des résultats de qualité chez le patient ou client, le rendement de l’organisation et du système, et les retombées sociales, y compris des collectivités en meilleure santé.

    Association des infirmières et infirmiers autorisés de l’Ontario (2013). Lignes directrices sur le développement et le maintien du leadership infirmier, Deuxième edition. Toronto, ON, Canada: Auteur. Récupérée de http://rnao.ca/bpg/language/lignes-directrices-sur-le-d%C3%A9veloppement-et-le-maintien-du-leadership-infirmier

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    This website will assist families when an individual with dementia is looking at transitioning to long-term care. The Alzheimer Society of Canada webpage has resources for the following areas to support decision-making:

    • Considering the move to LTC Home
    • Preparing for a move
    • Handling moving day
    • Adjusting after a move
    • Caregiver stress assessment checklist
    • LTC Home evaluation checklist
    • What to bring on moving day checklist
    • Transition to LTC e-learning module
    • All about me

    Web Address: http://www.alzheimer.ca/en/Living-with-dementia/Caring-for-someone/Long-term-care

    Reference: Alzheimer Society of Canada (2016)“ Alzheimer Society of Canada, Long Term Care” retrieved from http://www.alzheimer.ca/en/Living-with-dementia/Caring-for-someone/Long-term-care

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    The medical assisstance in dying information page on the College of Nurses of Ontario website is where you will find important updates, information and resources that impact nurses in Ontario. Visit this site often as the page will be updated as more information becomes available.

    Reference: College of Nurses of Ontario (2016) Retrieved from www.cno.org/maid

     

     

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    This poster provides a clear visual of the importance of accurate information in safe patient care. It identifies negative outcomes of poor communication.

    Reference: Institute for Safe Medication Practices (ISMP) Canada, Medication Communication Failures Impact EVERYONE! (2012). Retrieved August 15,2016 from https://www.ismp-canada.org/download/MedRec/MedRec_Communication_Failures_Impact_English_Oct_2012.pdf

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    Med Rec is a formal process to ensure accurate and comprehensive medication information is communicated consistently across transitions of care. This site provides information that can support medication reconciliation policies and procedures within organizations.

    Reference: Institute for Safe Medication Practices (ISMP). (2012). Medication Reconciliation. Retrieved from http://www.ismpcanada.org/medrec/

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    The Medication practice standard describes nurses’ accountabilities when engaging in medication practices, such as administration, dispensing, medication storage, inventory management and disposal.

    Reference: College of Nurses of Ontario (2015) CNO Practice Standard-Medication Retrieved from http://www.cno.org/globalassets/docs/prac/41007_medication.pdf

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    Website offers information to help healthcare professionals understand how poor transitions impact care delivery and how to improve transitions. Available is a compendium with a collection of resources including white papers, journal articles, and website links available to professionals and interested consumers for their practices.

    Reference: National Transitions of Care Coalition (nd). Retrieved from http://www.ntocc.org/WhoWeServe/HealthCareProfessionals.aspx

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    Nurse shift changes require the successful transfer of information between nurses to prevent adverse events and medical errors. Patients and families can play a role to make sure these transitions in care are safe and effective. This handbook gives you an overview of and a rationale for nurse bedside shift report. It also provides step-by-step guidance to help you put this strategy into place and addresses common challenges. Reference: Agency for Healthcare Research and Quality (2013)Strategy 3:Nurse Bedside Shift Report Implementation Handbook Retrieved September 29,2016 from https://view.officeapps.live.com/op/view.aspx?src=http%3A%2F%2Fwww.ahrq.gov%2Fsites%2Fdefault%2Ffiles%2Fwysiwyg%2Fprofessionals%2Fsystems%2Fhospital%2Fengagingfamilies%2Fstrategy3%2FStrat3_Implement_Hndbook_508.docx

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    This resource provides nurses at Royal Children’s Hospital in Melbourne (Australia) with a consensus based approach to communicating handover requirements of patients in their care. It includes points that should be considered for different types of handover-“short/long break handovers”, “transfer of patient to another clinical area” handover; “direct patient care handover” and “non clinical activities”.

    Reference: Retrieved from The Royal Children Hospital Melbourne on September 1, 2016, http://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Nursing_clinical_handover/

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    The purpose of this document is to review the literature, consolidate current guidelines, and provide a set of expert recommendations to help practicing surgeons, anesthesiologists, and allied health care professionals manage older adults during the perioperative period. Section IV speaks directly to care transitions following surgery with supporting resources in the appendices. The best practices guideline is provided through American College of Surgeons and American Geriatrics Society

    Reference: ACS NSQIP/American Geriatrics Society (2016) Retrieved August 8,2016 from https://www.facs.org/~/media/files/quality%20programs/geriatric/acs%20nsqip%20geriatric%202016%20guidelines.ashx

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    This link takes you to the plan of care section 6 and 7 of the Long-Term Care Homes Act, 2007, S.O. 2007, c. 8. Government of Ontario. Retrieved from https://www.ontario.ca/laws/statute/07l08

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    Practice guidelines are documents that help nurses understand their professional responsibilities and legal obligations in order to make safe, effective and ethical decisions in nursing practice. This practice guideline helps nurses understand their roles and responsibilities in preventing and managing conflict with clients and colleagues.

    College of Nurses of Ontario. (2018). Professional Standards, Revised 2002. Toronto, ON, Canada: Author. Retrieved from http://www.cno.org/globalassets/docs/prac/41006_profstds.pdf

    Copyright © College of Nurses of Ontario, 2009.

     

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    Nursing is a profession that is focused on collaborative relationships that promote the best possible outcomes for clients. These relationships may be intraprofessional, with multiple members of the same profession working collaboratively to deliver quality care within and across settings. This practice guideline focuses on three factors—the client, the nurse and the environment—to support nurses in making decisions that are specific to their intraprofessional responsibilities when providing client care.

    Reference: College of Nurses of Ontario Practice Guideline (2014) RN and RPN practice: The Client, the Nurse and the Environment. Retrieved from http://www.cno.org/globalassets/docs/prac/41062.pdf

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    This webcast is based on the RN and RPN Practice: The Nurse, the Client and the Environment practice document which discusses concepts that apply to RNs and RPNs in all roles in all practice settings.

    Reference: College of Nurses of Ontario (2013) RN and RPN practice: The Client, the Nurse and the Environment. Retrieved from http://www.cno.org/en/learn-about-standards-guidelines/educational-tools/webcasts/rn-and-rpn-practice-the-nurse-the-client-and-the-environment-webcast/

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    The goal of this best practice guideline is to strengthen collaborative practice among nurses, because effective collaborative practice is essential for working in health-care organizations. In this guideline, we focus on collaborative practice amongst three types of nursing professionals – registered nurse (RN), registered practical nurse (RPN) and nurse practitioner (NP) – and explore what fosters healthy work environments for them, aware that collaboration must align with the needs of the patient or client. This best practice guideline was developed to assist nurses, nursing leaders, other health professionals and senior managers to enhance positive outcomes for patients/clients (individual/family/group/community), nurses, and the organization through intra-professional collaborative practice. This guideline was based on the best available evidence and where evidence was limited, the best practice recommendations were based on the consensus of expert opinion. This guideline identifies:

    • best practices for intra-professional practice; and
    • the organizational culture, values and relationships, and the structures and processes required, for developing and sustaining effective intra-professional nursing practice among nurses.

    Registered Nurses’ Association of Ontario. (2016). Intra-professional collaborative practice among nurses. Toronto, ON, Canada: Author. Retrieved from: https://rnao.ca/sites/rnao-ca/files/bpg/Intra-professional_Collaborative_Practice_042017.pdf

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    For the purpose of this document, Interprofessional is defined as: Multiple health disciplines with diverse knowledge and skills who share an integrated set of goals and who utilize interdependent collaboration that involves communication, sharing of knowledge and coordination of services to provide services to patients/clients and their care-giving systems.

    This best practice guideline, Developing and Sustaining Interprofessional Health Care: Optimizing patients/clients, organizational, and system outcomes is intended to foster healthy work environments. The focus in developing this guideline was identifying attributes of interprofessional care that will optimize quality outcomes for patients/clients, providers, teams, the organization and the system.

    This guideline identifies best practices to enable, enhance and sustain teamwork and interprofessional collaboration, and to enhance positive outcomes for patients/clients, systems and organizations. It is based on the best available evidence; where evidence was limited, the recommendations were based on the consensus of expert opinion.

    Registered Nurses’ Association of Ontario. (2013). Developing and Sustaining Interprofessional health care. Toronto, ON: http://rnao.ca/bpg/guidelines/interprofessional-team-work-healthcare

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    Gain knowledge in leadership practices that result in healthy outcomes for nurses, patients/clients, organizations and systems. This guideline addresses:

    • System resources that support effective leadership practices and behaviours for formal leaders and nurses at the point of care
    • Organizational culture, values and resources that support effective leadership practices and behaviours at all levels
    • Personal resources that support effective leadership practices across the continuum of care
    • Anticipated outcomes of effective nursing leadership

    2nd Edition, 2013

    Registered Nurses’ Association of Ontario. (2013). Developing and Sustaining Nursing Leadership. Toronto, ON, Canada: Author. Retrieved from http://rnao.ca/bpg/guidelines/developing-and-sustaining-nursing-leadership

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    Effective nursing practice is dependent on an effective therapeutic relationship between the nurse and the client. This guideline addresses the qualities and capacities of an effective therapeutic relationship, the state of knowledge, and the knowledge needed to be effective. To implement a therapeutic relationship successfully, an organization's characteristics and workplace values must be supportive and in place. An organization readiness assessment based on the best practice recommendations is provided. Supplement: 2006

    Registered Nurses’ Association of Ontario. (2002). Establishing therapeutic relationships. Toronto, ON, Canada: Author. Retrieved from https://rnao.ca/sites/rnao-ca/files/Establishing_Therapeutic_Relationships.pdf

     

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    The purpose of this best practice guideline is to provide evidence-based recommendations related to nurses and other health care professionals providing effective client centred learning. This guideline will address the following areas: • How can nurses effectively facilitate client centred learning? • What are effective teaching delivery methods/ strategy for client centred learning? • How do nurses assess client learning? This guideline will be applicable to all domains of nursing including clinical, administration, and education.

    Registered Nurses’ Association of Ontario. (2012). Facilitating client centred learning Toronto, ON: https://rnao.ca/sites/rnao-ca/files/BPG_CCL_2012_FA.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. Retrieved from https://rnao.ca/sites/rnao-ca/files/FINAL_Web_Version_0.pdf

     

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    Chronic diseases are unlike any acute illness, in that they require considerable professional self-management support over the client’s lifetime, related life management skills, and long term regular follow-up with healthcare professionals. Over the last decade, a dramatic rise in the prevalence of chronic health conditions has emerged, altering the way in which care is sought, managed, delivered and received. The purpose of this guideline is to provide evidence-based recommendations for Registered Nurses and Registered Practical Nurses across the continuum of care in self-management support. These recommendations identify strategies and interventions that enhance an individual’s ability to manage their chronic health condition.

    Registered Nurses’ Association of Ontario. (2010). Strategies to support self-management in chronic conditions: Collaboration with clients. Toronto, ON: Author. Retrieved from https://rnao.ca/sites/rnao-ca/files/Strategies_to_Support_Self-Management_in_Chronic_Conditions_-_Collaboration_with_Clients.pdf

     

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    Increase your knowledge in promoting family health through interventions and supports provided during expected (i.e. birth, school, adolescence, aging, and death) as well as unexpected (i.e. trauma/accidents, chronic illness, developmental delay and disability) life events. Focusing on the family is an integral component of nursing practice. This guideline was developed to promote and facilitate continuing education, reflection and reaffirmation of the importance of caring for families. Supplement: 2006

    Registered Nurses’ Association of Ontario. (2002). Supporting and Strengthening Families Through Expected and Unexpected Life Events. Toronto, ON, Canada: Author. Retrieved from http://rnao.ca/bpg/guidelines/supporting-and-strengthening-families-through-expected-and-unexpected-life-events

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    This toolkit offers resources to support the use of SBAR. SBAR offers a simple way to help standardize communication and allows parties to have common expectations related to what is to be communicated and how the communication is structured.

    Reference: Institute for Healthcare Improvement (IHI) : SBAR Toolkit (2016) Retrieved September 29,2016 from http://www.ihi.org/resources/pages/tools/sbartoolkit.aspx

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    Le but de la présente ligne directrice est de promouvoir les pratiques fondées sur des données probantes, qui sont associées aux soins axés sur les besoins de la personne et de la famille, et d'aider les infirmières et d'autres fournisseurs de soins de santé à acquérir les connaissances et les compétences nécessaires pour améliorer leur pratique de ces soins. Les recommandations aideront les infirmières et d'autres fournisseurs de soins de santé à obtenir le savoir requis pour collaborer et établir des relations habilitantes avec des personnes et leur famille qui font appel aux services de santé, afin d'optimiser la santé et le bien-être au cours de leur vie. Cette approche fondée sur des données probantes, et combinée à une perspective qui reconnaît la place de la personne au centre des soins de santé, permettra d'améliorer l'expérience de cette personne et sa satisfaction à l'égard des soins et des services offerts par le système de santé. Elle s'applique à tous les domaines de la pratique des soins infirmiers, y compris les secteurs clinique, administratif et éducatif.

    Cette ligne directrice recommande des pratiques exemplaires dans trois domaines principaux : ■ Les recommandations au sujet des pratiques exemplaires ont été rédigées principalement à l'intention des infirmières et d'autres fournisseurs de soins de santé dans l'équipe interprofessionnelle qui offre des soins directs à des personnes dans les milieux de soins du système de santé (p. ex., soins actifs, soins de longue durée et soins à domicile) et dans la collectivité (p. ex., soins primaires, équipes de santé familiale et santé publique). ■ Les recommandations en matière d'éducation s'adressent à ceux qui sont responsables de la formation du personnel et des étudiants, tels que les éducateurs, les équipes d'amélioration de la qualité, les gestionnaires, les administrateurs ainsi que les établissements d'enseignement universitaire et professionnel. ■ Les recommandations sur le système, l'organisation et la politique s'appliquent à divers publics selon le type de recommandation. Les publics comprennent les gestionnaires, les administrateurs, les décideurs, les organismes de réglementation en soins infirmiers, les établissements d'enseignement et les organismes gouvernementaux. Pour obtenir une efficacité optimale, les recommandations dans ces trois secteurs doivent être mises en œuvre simultanément. Cette ligne directrice remplace le soin centré au client précédent .

    Association des infirmières et infirmiers autorisés de l’Ontario. (2015). Soins axés sur les besoins de la personne et de la famille. Toronto (Ontario) : Association des infirmières et infirmiers autorisés de l’Ontario http://rnao.ca/bpg/language/soins-ax%C3%A9s-sur-les-besoins-de-la-personne-et-de-la-famille

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    Les maladies chroniques sont différentes des maladies aiguës qui, dans la plupart des cas, nécessitent l'attention spécialisée, intensive et rapide d'un professionnel de la santé et peuvent inclure un suivi limité. Au cours des dix dernières années, une augmentation considérable de la prévalence des états chroniques est apparue, modifiant la façon dont les soins sont demandés, gérés, fournis et reçus. Le but de cette ligne directrice est de fournir aux infirmières autorisées et aux infirmières auxiliaires autorisées des recommandations fondées sur les données probantes en matière de soutien de l'autogestion. Ces recommandations présentent des stratégies et des interventions qui améliorent la capacité d'un individu à prendre en charge son état chronique. Association des infirmières et infirmiers autorisés de l'Ontario. (2010).

    Stratégies permettant de soutenir l'autogestion des états chroniques : la collaboration avec les clients Toronto, Canada. Association des infirmières et infirmiers autorisés de l'Ontario. http://rnao.ca/bpg/language/strategies-permettant-de-soutenir-lautogestiondes-etats-chroniques-la-collaboration-ave

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    At the core of nursing is the therapeutic nurse-client relationship. The College's Therapeutic Nurse-Client Relationship, Revised 2006, practice standard describes the expectations for all nurses in establishing, maintaining and terminating a therapeutic relationship.

    Retrieved from: http://www.cno.org/Global/docs/prac/41033_Therapeutic.pdf

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    At the core of nursing is the therapeutic nurse-client relationship. The College's Therapeutic Nurse-Client Relationship, Revised 2006, practice standard describes the expectations for all nurses in establishing, maintaining and terminating a therapeutic relationship.

    College of Nurses of Ontario. (2006).  Therapeutic nurse-client relationship. [PDF document]. Retrieved from https://www.cno.org/globalassets/4-learnaboutstandardsandguidelines/prac/learn/modules/tncr/pdf/tncr-chapter3.pdf

     

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    Cette feuille d’information de l’ASSSP vise à offrir aux parties du lieu de travail de l’information qui peut contribuer à améliorer la transition des pratiques thérapeutiques. L’amélioration de la transition des soins peut améliorer la sécurité des employés et des clients.

    Reference: http: Public Services Health & Safety association (2017). Retrieved October 31, 2017 from http://www.pshsa.ca/products/transition-des-soins-batir-un-systeme-plus-sur/ 

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    This Public Services Health & Safety Association (PSHSA) Fast Facts is intended to provide workplace parties with information that can help improve transition of care practices. Improving transitions in care results in improved employee and client safety.

    Reference: Public Services Health & Safety association (2017). Retrieved October 31,2017 from http://www.pshsa.ca/products/transition-of-care-fast-fact/ 

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    This 15 minute Public Services Health & Safety Association (PSHSA) web tutorial describes the transition of care process, challenges and opportunities to improve practice when supporting those going through a healthcare transition of care.

    Reference: http: Public Services Health & Safety association (2017). Retrieved October 31,2017 from http://www.pshsa.ca/product/transition-of-care/ 

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    Stroke patients are among the largest patient population receiving long-term care. The transition by stroke survivors and their families is known to be a stressful and challenging time as they adjust to new roles, altered functional and cognitive abilities, and changes in living setting for patients admitted to long-term care following an acute stroke. This Transition of Patients to Long-Term Care Following a Stroke Canadian Stroke Best Practice Recommendations identify what is required to have a successful transition.

    Reference: Canadian Stroke Best Practice Recommendations. Managing Stroke Transitions of Care (July 2016). Retrieved from: http://www.strokebestpractices.ca/index.php/transitions/transition-of-patients-to-long-term-care-following-a-stroke/

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    This resources looks at identifying patient’s health goals and coordination of the continuity of care during acute illness. It includes a description of the “10 Essential Elements of TCM”, that include: primary coordination by a nurse with advanced knowledge of the senior population; continuity of medical care between hospital and primary care providers; active engagement of patient and family caregivers with a focus on meeting goals; a multidisciplinary approach; nurse-doctor collaboration and communication among patient, family and health care providers. Appendix F in RNAO Best Practice Guideline Care Transitions, Transition Care Model page 85

    Reference: Penn Nursing Science University of Pennsylvania School of Nursing Retrieved from: http://www.nursing.upenn.edu/media/transitionalcare/Pages/default.aspx

    Copyright © 2016 Penn Nursing Science, University of Pennsylvania School of Nursing

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    Cette nouvelle ligne directrice est conçue pour tous les domaines de la pratique des soins infirmiers, y compris le volet clinique, l'administration et l'éducation, dans le but d'aider les infirmières à se sentir plus à l'aise, plus confiantes et plus compétentes lorsqu'elles prodiguent des soins à des clients pendant une transition des soins. Il est important que les infirmières, lorsqu'elles collaborent avec leur équipe pluridisciplinaire, connaissent les clients, leur famille et leurs aidants et travaillent avec eux pour encourager les transitions de soins sûres et efficaces. L'efficacité des transitions des soins dépend de soins pluridisciplinairesG coordonnés qui mettent l'accent sur une communication continue entre les professionnels et les clients. Cette recommandation est approuvée par Agrément Canada.

    Association des infirmières et infirmiers autorisés de l'Ontario (2014). Transitions des soins. Toronto : Association des infirmières et infirmiers autorisés de l'Ontario. http://rnao.ca/bpg/language/transitions-des-soins

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    This Care Transitions change package provides information that can be used sequentially to complete a specific task (or series of tasks), or can be used selectively and independently, depending on the user’s needs. This package includes an overview of transitions of care, four (4) key evidence-informed change concepts, and a deeper dive into the change concepts.

    Reference: Health Quality Ontario (2013)Transitions of Care: Evidence Informed Improvement Package Retrieved September 1,2016 from http://www.hqontario.ca/Portals/0/documents/qi/health-links/bp-improve-package-transitions-en.pdf

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    This CNO document discusses nurses’ role when working with unregulated care providers.

    Reference: College of Nurses of Ontario (2013) Working With Unregulated Care Providers Retrieved from http://www.cno.org/globalassets/docs/prac/41014_workingucp.pdf