Resources: Client Centred Care 

The following resource is designed to assist Long-Term Care (LTC) homes with the implementation of the Client Centred Care Best Practice Guideline. Documents found in this resource are evidence-based, but it is not a program plan. Each LTC home is unique and each home is in various stages of guideline implementation. LTC homes are advised to use the resource at their discretion. For those resources that have copyright notations, it is recommended that LTC homes obtain permission from the primary author prior to implementing them within their setting. The Toolkit is a dynamic resource, and is being updated and revised on a regular basis by the LTC Best Practices Initiative team. Visit this site often to see what's new!

The word client, patient, resident and person will be used interchangeably so that the resources can be used in any practice setting. In certain circumstances the resident substitute decision maker may be involved in the process.

Disclaimer
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Acknowledgement
References for Client Centred Care

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Best Practices/Standards
ResourceLink
RNAO Client Centred Care Best Practice Guideline (BPG)
RNAO Client Centred Care Best Practice Guideline (BPG) Supplement

Please review the supplement first as it updates information found in the original guideline. 

 

RNAO Soins axés sur les besoins du client

RNAO Lignes directrices sur les pratiques exemplaires en soins infirmiers.

RNAO Client Centred Care PDA Guideline

Condensed version of the Client Centred Care BPG viewable on Personal Digital Assistants (PDAs) or mobile phones.

RNAO Soins axés sur les besoins du client
Congregate living and the law as it affects older adults

Is a document prepared by the Advocacy Centre for the Elderly that looks at the law as it applies to congregate living situations including long term care.

Gap Analysis Worksheet on Client Centred Care
Updated February 2014.
RNAO Client Centred Care - French Supplement

Soins axés sur les besoins du client Supplément.

Resident's Bill of Rights

The resident bill of rights can be found in the Nursing Homes Act, R.S.O. 1990, c. N.7.  Source: http://www.acelaw.ca/appimages/file/Residents_Rights_Insert.pdf 

Resident's Bill of Rights: Aphasia Institute Pictoral Version

The pictographic version of the Ontario Resident's Bill of Rights was designed by the Aphasia Institute and funded by the Ontario Ministry of Health and Long-Term Care through the Seniors Health Research Transfer Network (SHRTN) initiative.

Resident’s Bill of Rights: "Every Resident" Advocacy Centre for the Elderly (ACE) and Community Legal Education Ontario (CLEO)

An education booklet designed to explain the Bill of Rights that pertains to every resident living in long-term care in Ontario.

Sunnybrook Nursing Standards: A Framework for Practice

Comparison of College of Nursing Standards and Sunnybrook Health Sciences Centre Nursing Standards for the Nurse-Person Process including 6Rs (Really listening, Responding to Concerns, Respecting Choices, Reporting, Recording, and Reviewing Feedback)

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Risk Assessment Tools
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Assessment Tools
ResourceLink
Sample of Report Card

A tool to demonstrate areas of strengths and areas for improvement.

Tools and Practical Suggestions to create your own survey at less cost

Tools and practical suggestions for resident satisfaction surveys are featured in this article by written by Dr. Emma Stodel for the Manrex Educational Series: A reprinted document from Long Term Care Magazine.

Picker Patient Centred Care Institute

This comprehensive guide was developed for care homes in the United States by two non-profit organizations the Planetree Foundation and the Picker Institute with input from residents, families staff and management.

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Planning & Implementation Tools
ResourceLink
RNAO Toolkit: Implementation of Best Practice Guidelines, Second Edition

This Toolkit was designed to assist health care settings in maximizing the potential of Clinical Practice Guidelines through systematic and well-planned implementation. It was also designed to accompany the Nursing Best Practice Guidelines (NBPGs) developed by the Registered Nurses' Association of Ontario (RNAO) in order to facilitate their implementation.

RNAO's Best Practice Guideline Implementation: Project Plan

This project plan is intended to be used as an example in organizations wishing to develop an implementation strategy of their own. The project plan demonstrates how and when implementation of the RNAO BPG will occur, by showing the major milestones of the project, and the activities and resources required to meet these goals.

RNAO's Sustainability of Best Practice Guideline Implementation

Examine sustainability of guideline implementation through strategies associated with sustainability.
Using the Ottawa Model,learn a framework for sustainability and investigate considerations for evaluating success.

Implementation Strategies for Client Centred Care

Page 5 of the RNAO Client Centred Care supplement outlines implementation strategies for client centred care.

RNAO Best Practice Champion Network

RNAO provides free training and networking opportunities to nurture skills in implementing best practice guidelines for individuals and teams.

RNAO's ABCs for BPGs

A workbook designed to introduce nurses and other interprofessional team members in Long-Term Care to the basics of best practice guideline implementation.

RNAO Trousse: Mise en oeuvre des lignes directrices sur les pratiques exemplaires, Deuxième édition

Mise en place des lignes directrices pour la pratique clinique.

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Quality Improvement Tools
ResourceLink
Health Quality Ontario (HQO) | Qualité des services de santé Ontario

This link provides information and resources about quality improvement and related initiatives in Ontario.
En haut de la page principale, il y a un hyperlien pour la version française de ce document.

Health Quality Ontario: Quality Improvement Guide for Long-Term Care (English)

This document provides information and tips on using various quality improvement tools.

Health Quality Ontario: Residents First Tools and Resources, Change Packages and External Resources

This website provides links to downloadable information to help with project accessibility and efficiency through the use of quality improvement tools.

Institute for Healthcare Improvement (IHI): Model for Improvement

Developed by Associates in Process Improvement. A simple tool that offers a wide range of resources and teaching tools to help health-care professionals lead effective improvement efforts, enhance clinical outcomes, and reduce risks

PDSA Worksheet

The Plan-Do-Study-Act (PDSA) or Deming Cycle worksheet is a quality improvement tool that is an excellent method to first identify the possible ideas for improvement and then test each of them out thoroughly. This is done in a rapid succession of small tests, each test trying out different variations or combinations of ideas.

PDSA Cycle Log Worksheet

The Plan-Do-Study-Act (PDSA) or Deming Cycle worksheet is used to track rapid PDSA cycles developed to improve processes in general practice for program implementation.

IHI (Institute for Healthcare Improvement) Interactive Tools

This area of Workspace features interactive tools to help you in your improvement work. Just enter your data and the interactive tool will automatically calculate and graph the appropriate measures for you. The first two interactive tools we are introducing are powerful tools to help organizations make their processes safer: The Trigger Tool for Measuring Adverse Drug Events (ADEs) and the Failure Modes and Effects Analysis (FMEA) Tool. NOTE: Registration is required to be able to use the tools on this site.

The Breakthrough Series: IHI’s Collaborative Model for Achieving Breakthrough Improvement

The Breakthrough Series model is based on a collaborative approach and used by many organizations worldwide to improve the delivery of patient care. 

Institute for Healthcare Improvement. IHI Innovation Series white paper. The Breakthrough Series: IHI’s Collaborative Model for Achieving Breakthrough Improvement. Boston, Massachusetts: Institute for Healthcare Improvement; 2003
 

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Additional Implementation Resources
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Policies and Procedures
ResourceLink
Resident Centered Care Policy

This is a sample of a client centred care policy from Essex Long Term Care Best Practice Workgroup entitled Resident Centred Resource Kit (pages 4 to 7).  Other policies related to Client Centred Care may be:
Advanced Care Directives, Abuse Prevention, Behaviour Management, Privacy/Confidentiality, Care Conferences, Resident’s Council.
 

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Care Planning
ResourceLink
Client Centered Care Plan Fact Sheet

Practice recommendations and MOHLTC Resident Assessment Instrument/Minimum Data Set (RAI- MDS) Education recommendations related to Resident Assessment Protocols (RAPS) and Care Planning. Care Plan prompts and examples of generic vs. client centered care planning statements are also included.

Documentation: Provider-driven vs. Client-centered

These are sample of progress notes demonstrating the contrast between provider (staff) driven vs. client centred documentation.  Source: Sunnybrook Health Sciences Centre.

Ottawa Decision Support Framework

The Ottawa Decision Support Framework asserts participants’ decisional needs will affect their decision quality which in turn affects their actions and behaviour, health outcomes, emotions and appropriate use of health services. The decision support framework can be a valuable tool in ensuring complex health decisions are focused on the resident.

Ottawa Decision Support Framework Tools

Tools that were used to operationalize the variables in the Ottawa Decision Support Framework are listed in the website link. A sample of each tool is provided, along with a User Manual describing the tool's properties, scoring and directions for administration.
Read more...

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Education Resources
ResourceLink
Self Learning and PowerPoint Presentations
Client Centred Care e-Learning Course

This is an interactive computer based self-learning tool designed to build on existing knowledge, skills and experience of all health care providers and to help integrate evidence-based recommendations into practice.

Consent, Capacity and Substitute Decision-Making The Basics

 Mental Capacity in law is issue or task specific. A resident is not globally incapable just because they have been admitted to long term care, this document helps the reader to understand consent, capacity and substitution decision-making.

Resident Created Profile: Persons living in LTC sharing their life

Sample profile created by residents themselves. It is suggested that homes create a similar set with their own residents. This profile can be used for orientation and education. Source: Sunnybrook Health Sciences Centre.

Client Centred Care PowerPoint Presentation

Created by the RNAO Long-Term Care Best Practice Coordinators to provide an overview of client centred care.

Resident Created Profile: A Personal view of waiting

Sample profile created by residents themselves. It is suggested that homes create a similar set with their own residents. This profile can be used for orientation and education. Source: Sunnybrook Health Sciences Centre.

Resident Centred Care in Long-Term Care: A Self Learning Package

This self-directed learning package is designed to support the implementation of the RNAO BPG Client Centred Care in the long-term care sector. The main objective of the package is to help nurses begin to think about the principles of resident centred care, and the ways that they can improve the provision of care to residents in the long-term care home.

Resident Created Profile: A personal view of living with early onset Alzheimer’s Disease

Sample profile created by residents themselves. It is suggested that homes create a similar set with their own residents. This profile can be used for orientation and education. Source: Sunnybrook Health Sciences Centre.

Charts
Fact Sheets / Pamphlets / Pocket Cards / Logos
RNAO Health Education Fact Sheet: Putting Patients First

This fact sheet is targeted towards patients to help them better understand the role and responsibility of a nurse within the health care system. 

RNAO Placer les patients à l’avant-plan

RNAO Fiche de renseignements pour la sensibilisation en matière de santé.

Title: Integrating eHealth in Your practice

 A fact sheet prepared by RNAO’s e-Health initiative. Suggestions help to keep the focus on the resident/client when using technology.

Tool on Consent and Capacity (Ontario Edition)

This pocket card produced by the National Initiative for Care of the Elderly (NICE) and Advocacy Centre for the Elderly (ACE) helps practitioners to reach informed consent and determine resident capacity for decision making. 

What is a Healthy Healthcare Organization

 A RNAO Healthy Work Environments fact sheet for residents/”patients” and family on what a healthy health care organization is, how they will know it is healthy and what they as a “patient” can help to do to contribute to a healthy organization. Healthy work environments go hand and hand with providing client centred care.

Pocket Cards

Patient centred care questions for initiating discussion.  Created by Sunnybrook Health Sciences Centre.

Videos
UHN Video Clip: "What Patient Centred Care Means To Me"

A video clip from nine individuals discussing what inspires them to care for patients and families. Each story brings the unique perspective of the individuals based on their past experiences. Run time is 10:40 min.  Source: University Health Network (UHN): /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;} http://www.uhn.ca/about_uhn/nursing/site/practice/pcc/video_series/index.html

MAREP Multimedia Resources

This is a listing of client centred care audiovisual resources from MAREP (Murray Alzheimer Research & Education Program), University of Waterloo.   

Strategies for Leadership : Patient- and Family-Centred Care

A video and toolkit prepared by AHA partnered with the Institute for Family-Centered Care, a non-profit organization that serves as a resource for consumers, practitioners and policymakers who want to advance the practice of family-centered care.  Source: http://www.aha.org/aha/issues/Quality-and-Patient-Safety/strategies-patientcentered.html

Websites
Elder Abuse Awareness and Education: CNA NurseONE

NurseONE.ca supports an approach to preventing elder abuse that is centred on the motto "recognize, reveal and deal". On NurseOne you will find information about the Prevention of Elder Abuse Centres of Excellence (PEACE) project, a collaboration between the Canadian Nurses Association and RNAO that involved 10 long term care homes across Canada.

OLTCA Photo Exhibit and Irene Borins Ash

Irene Borins Ash is a Toronto social worker and photographer. Her website features photographs and stories on aging through the perspective of long-term care residents. Based on her interviews with long-term care residents, she had collected 25 images with text exhibit that exposes myths about aging and long term care.
Public viewing of the Irene Borins Ash exhibit was made possible by OLTCA (Ontario Long Term Care Association) in partnership with G. Raymond Chang School of Continuing Education at Ryerson University. The photos are posted on the OLTCA website as indicated on the link.
 

Education Resources
Lesson/Workshop Planning: Education Program 2 Day

Agendas for 2 day long workshops (offered one month apart).  Many of the activities are found in the tools following this agenda). Source: Sunnybrook Health Sciences Centre.

Lesson/Workshop Planning: Education Program 8 Week

Course outline for an 8 week client centred care course offered in 2 hour sessions. Many of the activities are found in the tools following this agenda). Source: Sunnybrook Health Sciences Centre.

Lesson/Workshop Planning: Course confirmation notice

Source: Sunnybrook Health Sciences Centre.

Lesson/Workshop Planning: Course Checklist for Facilitator

Source: Sunnybrook Health Sciences Centre.

Workshop Presentation #1

Day 1 PowerPoint presentation to assist a facilitator(s) in guiding the focus for 2-full day workshops on client centred care. The recommended number of participants is 25 working in groups of 5.  From Sunnybrook Health Sciences Centre.

Workshop Presentation #2

Day 2 PowerPoint presentation to assist a facilitator(s) in guiding the focus for 2-full day workshops on client centred care. The recommended number of participants is 25 working in groups of 5.  From Sunnybrook Health Sciences Centre.

Icebreaker: Getting to Know You

Getting to Know You is an activity for participants to get to know each other.  Source:  Nadine Janes, RN; PhD, Manager, Professional Practice & Advanced Practice Nurse, Extended Practice, West Park Healthcare Centre, Toronto.

Icebreaker: Knowing and Engaging Participants

Knowing and Engaging Participants is an activity for participants to get to know each other. Source: J. Hollett, PCC Project Manager, UHN, Toronto.

Icebreaker: Shield Activity

Shield activity an exercise to uncover personal values in the participants work.  Source:  Sunnybrook Health Sciences Centre.

Values Resources – Values Exercise

The value exercise is an activity to demonstrate where client/family, management, and staff stand in regards to the certain values.  Source: Pillemer, Karl & Meador, Rhoda (1997). Partners in Caregiving: Cooperative Communication Between Families and Nursing Homes, Cornell University, Ithaca, NY.

Listening Resources – Communication: Guided Imagery

Guided Imagery is an exercise to experience being listened to. Developed by J. Hollett, RN; MSc; Patient Centred Care Manager, University Health Network, Toronto.

Listening Resources – Communication: The art of listening

The 5 Rs of the Nurse-Person Process are Really listening, Responding to concerns, Respecting choices, Reporting and Recording.  Developed by Ferrer, Erlinda (2005). Really Listening. Nursing Voice (Summer), p. 10.  Sunnybrook Health Sciences Centre.

Dialogue Resources: Communication: Dialogue Analysis

This is a collection of resources/worksheets to introduce client centred dialogue in class and as assignments between classes. Source: Contributing Authors: M. E. Nicholson, RN, MSc. PhD(c)., Sunnybrook Health Sciences Centre.

Dialogue Resources: Communication: Exercise/Dialogue Sheets

This is a collection of resources/worksheets to introduce client centred dialogue in class and as assignments between classes. Source: Contributing Authors: M. E. Nicholson, RN, MSc. PhD(c)., Sunnybrook Health Sciences Centre.

Dialogue Resources: Communication: 4 A’s of CCC

This is a collection of resources/worksheets to introduce client centred dialogue in class and as assignments between classes. Source: Contributing Authors: Janice Beitel, RN, BSN, MScN, CNCC(c), CNN(c) Professional Practice Leader Trillium Gift of Life Network, and Jane Hollett, RN, MSc. PCC Project Manager, University Health Network, Toronto.

Dialogue Resources: Communication - Getting to Know the Person

This is a collection of resources/worksheets to introduce client centred dialogue in class and as assignments between classes. Source: Source: Nadine Janes, RN; PhD, Manager, Professional Practice & Advanced Practice Nurse, Extended Practice, West Park Healthcare Centre, Toronto.

BP Blogger “Consent and Capacity Issue” - Spring 2013
From the Research Institute for Aging - Schlegel Villages, a 2-page document outlining myths and facts about consent and capacity issues.
Dialogue Resources: Communication - Dialogue with a partner exercise

This is a collection of resources/worksheets to introduce client centred dialogue in class and as assignments between classes. Source: J. Hollett, RN, APN, MSc. PCC Project Manager, University Health Network, Toronto.

Dialogue Resources: Communication - Sample questions according to 4 core processes

This is a collection of resources/worksheets to introduce client centred dialogue in class and as assignments between classes. Source: Sunnybrook Health Sciences Centre.

Blocks to Communication

Examples of communication blocks and its definition as opposed to a client centred communication. Developed by: Sunnybrook Health Sciences Centre and University Health Network, Toronto.

Blocks to Communication Resources: Communication - 7 Hard to break Habits

"Hard to break habits" are reflection exercises to raise awareness of common blocks to communication. Sample document of blocks of communication and alternatives are included as well as a blank form to identify blocks to communication and client centred alternatives. Based on article by J. Beitel (1998). Illuminations File: Illuminations Newsletter of the International Consortium of Parse Scholars, 7(3), 3-5.  Source: Sunnybrook Health Sciences Centre.

Resources for discussion and reflection: Myths and Challenges - Debunking Client Centred Care Myths & Misconceptions

Developed by: Sunnybrook Health Sciences Centre, Toronto.

Resources for discussion and reflection: Haiku Poem Exercise

Developed by J. Hollett, RN, APN, MSc. PCC Project Manager, University Health Network, Toronto.

Resources for discussion and reflection: Keeping the CCC Flame Burning - Ideas to Integrate PCC into Clinical Staff Meeting Agendas

Source: J. Hollett, RN, APN, MSc. PCC Project Manager, University Health Network, Toronto.

Evaluation of Learning Experiences: Workshop Evaluation Tools

Sample of workshop evaluation tools.  Source: J. Hollett, RN, APN, MSc. PCC Project Manager, University Health Network, Toronto.
 

Evaluation of Learning Experiences: Workshop Evaluation Tools

Sample of workshop evaluation tool.  Source:  Sunnybrook Health Sciences Centre.

Evaluation of Learning Experiences: Jeopardy Game Sample

The sample Jeopardy Game illustrates a fun way to evaluate learning.  Source:  Sunnybrook Health Sciences Centre.

Evaluation of Learning Experiences: Blank Jeopardy Template

This is a source for blank templates to make your own Jeopardy Game.  

Other Resources
What we heard: Long Term Care Quality Consultation 2008

A synthesis of a consultation process hosted by the MOHLTC (Ministry of Health and Long Term Care) and SHRTN (Seniors Health Research Transfer Network) in 2008. Over 600 participants from LTC. Five common themes identified.

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Evaluation
ResourceLink
RNAO Evaluating Your Success

From RNAO’s Toolkit: Implementation of Clinical Practice Guidelines, Chapter 5, pages 57-64.

The Evaluation Center – Western Michigan University

This contains checklists and tools for planning your evaluation.

Public Health Agency of Canada - A Guide to Project Evaluation: A participatory approach | Guide d'évaluation de projet: Une démarche participative

This evaluation guide provides an easy-to-use comprehensive framework for project evaluation. 
En haut de la page principale, il y a un hyperlien pour la version française de ce document. 

A Person/Family Survey: Knowing the person questionnaire

This is an evaluation form designed to interview clients about their experience as recipients of client centred care. Source: Sunnybrook Health Sciences Centre.

A Chart Review for client centred care

This is a 2-part Chart Review. Part 1 evaluates nursing documentation from a client centred care perspective and Part 2 evaluates pain management from a client centred care perspective. Source: Sunnybrook Health Sciences Centre.

RNAO Évaluation de votre succès

Faits saillants chapitre entier et une partie de boîte à outils liant qui est déjà mentionné dans la section de planification. Source de L’Association des infirmières et infirmiers autorisés de l’Ontario: Trousse sur la marche à suivre. Mars 2002, page 59-66.

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Recommended Readings/References
ResourceLink
Does your care plan tell my story?

Coker, E. (1998). Documenting aspects of personhood in Long Term Care. Journal of Holistic Nursing, 16(4), 435-452

Long Term Care Homes can access journal articles through the Seniors Health Knowledge Network (http://www.shrtn.on.ca/resources)

Figuring it Out in the Moment: A Theory of Unregulated Care Providers' Knowledge Utilization in Dementia Care Settings

Authors: Janes, Nadine1; Sidani, Souraya2; Cott, Cheryl3; Rappolt, Susan4
Source: Volume 5, Number 1, March 2008 , pp. 13-24(12)

Long Term Care Homes can access journal articles through the Seniors Health Knowledge Network (http://www.shrtn.on.ca/resources)
 

Creative Training Openers and Energizers: Book order information

This website provides a link to the information for purchasing additional references for icebreakers/openers. The book entitled, 50 Creative Training Openers and Energizers Innovative Ways to Start your training with a BANG! Bob Pike CSP,CPAE; Lynn Solem (2000). Jossey-Bass/Pfeiffer & Creative Training Techniques Press. San Francisco, CA, includes actual tools for facilitators to use.

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