All Clinical Resources

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.

The best practice guideline (BPG) A Proactive Approach to Bladder and Bowel Management in Adults, Fourth Edition replaces the RNAO BPGs Promoting Continence Using Prompted Voiding and Prevention of Constipation in the Older Adult Population, both of which were last updated in 2011. This BPG provides evidence-based recommendations for effective strategies to support adults (aged 18 years and older) who live with urinary incontinence, fecal incontinence and/or constipation that will improve quality of care and lead to positive health outcomes.

The BPG includes good practice statements on conducing a focused initial assessment and recommendation areas that address the following: toileting strategies, physical activity, adequate intake of fibre and/or fluids, interprofessional approach and bowel protocol.

This BPG can be used by nurses, members of the interprofessional team and caregivers across the continuum of care and in all domains of practice such as administration, clinical, education, policy and research.  The evidence-based recommendations in this BPG are applicable to all practice settings where persons who live with urinary incontinence, fecal incontinence and/or constipation are accessing services (e.g., acute care, long-term care, primary and community care, and rehabilitation settings).

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.

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

This BPG replaces two RNAO BPGs: Reducing Foot Complications for People with Diabetes (7) published in 2007 and Assessment and Management of Foot Ulcers for People with Diabetes (8) published in 2013. These BPGs were merged because of the overlapping clinical concepts in each BPG.

The purpose of this third edition guideline is to provide nurses and members of the interprofessional team, persons at risk of or living with a Diabetic Foot Ulcers (DFU) and their care partners with evidence-based recommendations on the prevention, assessment and management of DFUs.

Registered Nurses’ Association of Ontario (2024). RNAO Diabetic foot ulcers: Prevention, assessment and management, Third edition. Toronto, ON: Author. Retrieved from: http://https://rnao.ca/bpg/guidelines/diabetic-foot-ulcer

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

The purpose of this guideline is to outline evidence-based approaches for preventing falls and reducing fall injuries for adults.

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

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

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).

A tool to assist with comparing your organization’s current practice with evidence-based RNAO best practice recommendations.

Registered Nurses Association of Ontario (2022) Gap Analysis-Adult Asthma Care- Promoting Control of Asthma. Toronto. ON

A tool to assist with comparing your organization’s current practice with evidence-based RNAO best practice recommendations.

Registered Nurses Association of Ontario (2022) Gap Analysis-Delirium, Dementia and Depression in Older Adults . Toronto, ON.

A tool to assist with comparing your organization’s current practice with evidence-based RNAO best practice recommendations.

Registered Nurses Association of Ontario (2022)Gap Analysis-End-of-Life Care During Last Days and Hours. Toronto. ON

A tool to assist with comparing your organization’s current practice with evidence-based RNAO best practice recommendations.

Registered Nurses Association of Ontario (2022) Gap Analysis -Oral Health Supporting Adults Who Require Assistance. Toronto, ON.

A tool to assist with comparing your organization’s current practice with evidence-based RNAO best practice recommendations.

Registered Nurses Association of Ontario (2022)Gap Analysis- Palliative Approach to Care in the Last 12 Months of Life. Toronto. ON

A tool to assist with comparing your organization’s current practice with evidence-based RNAO best practice recommendations.

Registered Nurses Association of Ontario (2022) Gap Analysis Preventing and Addressing Abuse and Neglect of Older Adults. Toronto, ON

A tool to assist with comparing your organization’s current practice with evidence-based RNAO best practice recommendations.

Registered Nurses Association of Ontario (2022) Gap Analysis Promoting Safety: Alternative Approaches to the Use of Restraints. Toronto, ON

A tool to assist with comparing your organization’s current practice with evidence-based RNAO best practice recommendations.

Registered Nurses Association of Ontario (2022) Gap Analysis Assessment & Management of Pain 3rd edition. Toronto, ON.

A tool to assist with comparing your organization’s current practice with evidence-based RNAO best practice recommendations.

Registered Nurses Association of Ontario (2022) Gap Analysis-Engaging Clients Who Use Substances. Toronto, ON

A summary of the recommendations of RNAOs Best Practice Guideline on Preventing Falls and Reducing Injury from Falls (4th ed.).

The purpose of this guideline is to provide nurses, members of the interprofessional team and other collaborators (i.e., administrators and policy-makers) with evidence-based recommendations for risk assessment, prevention, and treatment of pressure injuries . 

This BPG provides evidence-based recommendations for nurses, and the interprofessional team, and persons and their caregivers across all care settings and sectors. The recommendations address the prevention of pressure injuries for at-risk people, and the assessment and management of those living with pressure injuries.

Overall, the scope includes: all domains of nursing practice; all health-care settings and sectors; all populations across the lifespan (e.g., pediatric, adult and older adult), including their caregiver/chosen family and all types of pressure injuries, including those medical device-related.

Registered Nurses’ Association of Ontario. (2024).   Pressure injury management: Risk assessment, prevention and treatment, Fourth Edition. Toronto, ON: Author. Retrieved from: https://rnao.ca/bpg/guidelines/pressure-injuries

On April 11, 2023, changes to Ontario Regulation 246/22 (the "Regulation") under the Fixing Long-Term Care Act, 2021 (the "Act") came into effect.
Informed by engagement with key partners and stakeholders, as well as feedback from the public, the Ministry of Long-Term Care (the "Ministry") has refined the regulatory framework with consideration of the lived experience of residents and long-term care homes and emerging needs in the sector.

Retrieved from: https://www.ontario.ca/laws/regulation/220246

The resource list includes standardized terms used when referring to support surfaces. The National Pressure Injury Advisory Panel, (NPIAP) developed these terms and definitions to allow for standard, and clear language when describing support surfaces. Key terms are listed and the full publication can be accessed here: https://cdn.ymaws.com/npiap.com/resource/resmgr/s3i/ Finalized_T&D_2024.pdf

Source: National Pressure Injury Advisory Panel (NIPAP). Support surfaces standards initiative (S31): Terms and definitions related to support surfaces. NIPAP; 2019.

Reference: Registered Nurses’ Association of Ontario, (2024). Appendix O of Pressure injury management: Risk assessment, prevention and treatment - Fourth edition. Toronto, Canada: Author. pp. 113-114.

The case study and its accompanying discussion guide were developed for educational purposes in long-term care homes to promote use of the RNAO Delirium, Dementia, and Depression in Older Adults: Assessment and Care BPG. This resource provides the necessary instructions to hold a facilitated discussion with long-term care staff.  Overall goals of the case study and discussion guide are to:

• Actively engage participants in discussions about delirium, dementia, and depression
• Help long-term care staff identify the differences between delirium, dementia, and depression
• Help long-term care staff become familiar with key resources they can use at the point-of-care to support identification of delirium, dementia, and depression
• Reinforce best practices for the care of delirium, dementia, depression in older adults

Reference: Registered Nurses’ Association of Ontario. (2017). 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

5 Questions to Ask about Your Medications is a guide to help persons and their support network start conversations with health providers about their medications (168). Ensuring persons are active partners in their care, and ensuring they receive important information about their medications helps promote medication safety. It may be particularly helpful for persons to ask the following five questions about their medications when attending appointments with their primary care providers, communicating with their community pharmacist, and when preparing for a transition from hospital to home. The 5 Questions to Ask About Your Medications resource is available in 30 languages.

Source: Reprinted with permission from: Institute for Safe Medication Practices (ISMP) Canada, The Canadian Patient Safety Institute (CPSI), Patients for Patient Safety Canada (PFPSC), et al. 5 questions to ask about your medications [Internet]. Toronto (ON): ISMP Canada; 2016. Co-published with CPSI and CFPSC. Available from: https://www.ismp-canada.org/download/MedRec/MedSafety_5_questions_to_ask_poster.pdf. 

Registered Nurses' Association of Ontario. (2023). Appendix K of Transitions in Care and Services. (Second Ed.). Toronto, ON: Author.  pp. 128 . 

This Guide summarizes the main points of The Substitute Decisions Act. It should not be used as a substitute for the legislation, and it is not a substitute for legal advice. To make the legislation easier to understand, the Guide avoids legal terminology wherever possible.

A presentation on improving continence care developed in 2004 by the IC-5 project with Ontario Women’s Health Council.

This guide was developed by Saint Elizabeth and Yee Hong Centre for Geriatric Care to share the experiences and insights after implementing person-centred care (PCC) workshops with personal support workers (PSWs) within the two organizations. Reference: Saint Elizabeth. (October 2013). A practical guide to implementing person-centred care education for PSWs in the home, community and long-term care sectors.

This template is helpful in identifying and altering the antecedent and consequences to change behaviour.

Source: Omelan, C. (2006). CME: Approach to Managing Behavioural Disturbances in Dementia. Canadian Family Physician, February, 52, p. 193 Reprinted with permission from the Canadian Family Physician

This fact sheet from The Canadian Continence Foundation provides an overview of fecal incontinence, lifestyle changes and treatments. Available in a print out version. 

Retrieved from: https://www.canadiancontinence.ca/fecal-incontinence

This website provides an overview of the Accreditation Canada program for long-term care called, Qmentum Global for Long-Term Care.
Reference: Accreditation Canada (n.d.). Qmentum Global for Long-Term Care.

Retrieved from: https://accreditation.ca/qmentum-global/ltc/

An assessment tool that uses the mnemonic OPQRSTUV to assist health care professionals systematically assess people who screen positively for the presence or risk of any type of pain and who can self report.

Figure 1 (page 21) RNAO BPG Assessment and Management of Pain 3rd Edition (2012) http://rnao.ca/bpg/guidelines/assessment-and-management-pain

Adapted from "Symptom Assessment Acronym "OPQRSTUV", in Fraser Health Authority, 2012, Hospice Palliative Care Program Symptom Guidelines. Retrieved from https://www.fraserhealth.ca/-/media/Project/FraserHealth/FraserHealth/Health-Professionals/Professionals-Resources/Hospice-palliative-care/SymptomAssessmentRevised_Sept09.pdf

This link takes you to the Health Canada website where you can access the guidance on hospital beds related to entrapment.

Learn how to participate in advance care planning process in Ontario. The Speak Up Ontario website provides in formation on Advance Care Planning as a process of thinking about and sharing your wishes for future health and personal care. It can help you tell others what would be important if you were ill and unable to communicate.

This document contains sample program objectives, policy, procedures, staff training materials and tools related to fall prevention. (Member login is not required. The documents may be accessed by scrolling to the bottom of page.)

Copyright 2011.

This link will take you to the document developed by AdvantAge Ontario to support program objectives, policy, procedures and staff training materials and tools that meet minimum requirements of the LTCH Act and Regulation.

Retrieved from www.advantageontario.com 

The ACE Website provides materials for public education on prevention of elder abuse. Materials include information on powers of attorney, consumer protection and legal issues affecting older persons.

Advocacy Centre for the Elderly (ACE) (2013) Retrieved from http://acelaw.ca

An algorithm to guide oral assessment and intervention. The algorithm summarizes the recommendations to help oral care teams to understand how to implement them into practice.

This heart-warming video shows how music can transform the life of a resident with dementia.

Reference: Sundance Film Festival. (2014, January 7) Alive Inside: A Story of Music & Memory Featurette - Documentary HD. Retrieved from https://youtu.be/8HLEr-zP3fc

This decision tree from The Ottawa Hospital provides a visual decision making guide to determine risk and restraint alternatives.

All requests to adapt the Alternative to Restraints Decision Tree must be directed to the Ottawa Hospital, Department of Nursing Professional Practice

This link takes you to the Alzheimer Society Canada publication which discusses types of restraints, least restraint for persons with dementia and what to do when restraint free strategies are ineffective.

Alzheimer Society of Canada. (2007). Restraints. Toronto, Ontario, Canada: Author. Retrieved from http://www.alzheimer.ca/en/We-can-help/Resources/Alzheimer-Society-brochures-and-publications.

A Successful story of a Falls Prevention Program.

The Oral Health Assessment Tool (OHAT), provides a systematic way to assess an oral cavity.

Registered Nurses’ Association of Ontario (2020). Appendix J – Sample 2 of Oral Health: Nursing Assessment and Intervention. Toronto, Canada: Author. p. 118.

Source: Chalmers, J., King, P., Spencer, A., Wright, F., & Carter, K. (2005). The oral health assessment tool – validity and reliability. Australian Dental Journal, 50(3). 191-199. Reprinted with the permission.

An extensive list of validated assessment and screening tools. Tools not only assess for history of abuse but also assess for possibility of future abuse, and quality of care being given.

Registered Nurses’ Association of Ontario. (2014). Appendix G of Preventing and Addressing Abuse and Neglect of Older Adults: Person-Centred, Collaborative, System-Wide Approaches. Toronto, Canada: Registered Nurses’ Association of Ontario. pp 105-110. http://rnao.ca/sites/rnao-ca/files/Preventing_Abuse_and_Neglect_of_Older_Adults.pdf

Bates-Jenson Wound Assessment Tool (BWAT) is a validated tool that measures the status of a wound. It is most appropriate for use by experienced wound-care clinicians as a discriminative tool to fully describe wounds during the initial wound assessment. 

Retrieved from: https://www.woundscanada.ca/docman/public/health-care-professional/1428-bwat/file 

Reference: Bates-Jensen, Barbara (2001). Bates-Jenson Wound Assessment Tool (BWAT). Copyright 2001 Barbara Bates-Jensen

The BSO-DOS^© is an observational tool that helps to identify patterns of behaviour for care planning purposes. It is based on the former DOS. Simple registration is required to access this free tool. A user guide and resource manual are available.

This intervention toolkit provides links to universally recognized behavioural assessment tools for common responsive behaviours. The toolkit describes possible behavioural causes and a range of strategies to help with care planning.

Reference:Central East Local Health Integration Network (LHIN) Behavioural Supports Ontario Education Committee (n.d.) Central East LHIN Behavioural Supports Ontario Intervention Tool Kit, retrieved from http://centraleast.behaviouralsupportsontario.ca/Uploads/ContentDocuments/Intervention%20Tool%20Kit_Version%201_May_2016.pdf  

Acknowledgements: This tool was created by the Central East Local Health Integration Network (LHIN) Behavioural Supports Ontario Education Committee. Acknowledgment to the Psychogeriatric Resource Consults of the Central East Region for developing this tool. Thank you to the Central East Long-Term Care Homes for contributing to the development of the tool.

Disclaimer: Permission to use, copy, modify, and distribute this material for educational, research, and not-for-profit purposes, without fee and without a signed licensing agreement, is hereby granted, provided that the above copyright notice, this paragraph and the following paragraphs appear in all copies, modifications, and distributions. Contact Terry Donaghue, Technology Transfer & Industrial Liaison, Mount Sinai Hospital, & The Samuel Lunenfeld Research Institute, 600 University Avenue, Toronto, ON Canada M5G 1X5, Tel. (416) 586-8225, Fax (416) 586-3110, E-mail: donaghue@mshri.on.ca for commercial licensing opportunities.

The Bereavement Risk Assessment Tool, or BRAT, is a psychosocial assessment tool used by care teams to communicate personal, interpersonal and situational factors that may place a caregiver or family member at greater risk for a significantly negative bereavement experience.

A sample Jeopardy game illustrates a fun way to evaluate learning.  

This oral health care planning guideline provides information on a standard protective care regimen, additional oral care treatment, oral care and changed behaviour and palliative care considerations. An Oral Health Care Plan guide is included.

Source: Government of South Australia © 2012 SA Health

A comprehensive assessment of bladder and bowel function for LTC residents developed by the LTC BPC Project with Toronto Best Practice Steering Committee and Northwest Continence Collaborative (2005). Includes list of medications that affect continence and treatment options.

Reference: Toronto Best Practice Committee and Northwest Continence Collaborative (2006). Bladder & Bowel Continence Assessment.. Toronto.

Sources: AHCPR. 2006. Urinary Incontinence. http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat6.section.10079. ; Brigham & Women’s Hospital. 2004, Urinary incontinence http://www.brighamandwomens.org/medical/HandbookArticles/Urinaryincontinence.pdf. ; The Hartford Institute for Geriatric Nursing. 2001. Urinary incontinence. http://www.hartfordign.org/publications/trythis/issue11.pdf. ; IC-5 Continence Project, 2005, http://www.hospitalreport.ca/projects/QI_projects/IC5.html.  Rehabilitation Nursing Foundation. 2002. Constipation. www.rehabnurse.org. ; RNAO. 2005, Preventing Constipation; Prompting Continence. http://www.rnao.org/bestpractices.  ; Royal Women’s Hospital. 2005. Urinary incontinence, http://www.rwh.org.au/rwhcpg/womenshealth.cfm?doc_id=3661.  ; Singapore Ministry of Health. 2003, http://www.moh.gov.sg/cmaweb/attachments/publication/Nursing_Management_of_Patients_with_Urinary_Incontinence_1-2003.pdf.  U.S. National Library of Medicine and U.S. National Institute of Health. 2006. Drugs, supplements. < http://www.nlm.nih.gov/medlineplus/druginformation.html 

This BP Blogger presents credible bite-size pieces of information on dispellings myths related to stroke including prevention, transient ischemic attacks (TIAs), response to signs and symptoms of a stroke, and prevalence of stroke in long-term care.

© Copyrighted. All Rights Reserved MLvanderHorst.

This BP Blogger presents credible bite-size pieces of information that dispels stroke and exercise myths.

© Copyrighted. All Rights Reserved MLvanderHorst.

This BP Blogger presents credible bite-size pieces of information on dispellings myths related to perception problems after a stroke.

© Copyrighted. All Rights Reserved MLvanderHorst.

The brainXchange™ provides resources to support improving the quality of life for persons with, or at risk of having brain-health needs related to dementia, mental health and neurological conditions related to brain health changes or aging.

Retrieved from: https://brainxchange.ca/

© 2024 brainXchange™ 

Appendix Q from the RNAO A Proactive Approach to Bladder and Bowel Management in Adults — Fourth Edition shows pictures of stools to help improve assessment of constipation.

Registered Nurses’ Association of Ontario (RNAO). A proactive approach to bladder and bowel management in adults. 4th ed. Toronto (ON): RNAO; 2020. (p. 147).

This website from Dalhousie University focuses on oral health care resources as a result of oral health activities in long term care homes. Resources include a manual, education videos, oral care tool kits, assessment and care planning tools and guidelines for organizationally mapping oral care.

This site provides information on recognizing scams, frauds and identity theft and how to address and report them.

Reference: Canadian Anti-Fraud Centre, Government of Canada, 2015. This site provides information on recognizing scams, frauds and identity theft and how to address and report them. http://www.antifraudcentre-centreantifraude.ca/index-eng.htm

The CCSMH has developed guidelines including The Assessment and Treatment of Mental Health Issues in Long-Term Care Homes, as well as guidelines on a range of related topics such as Delirium, Depression and Suicide Prevention.  Website: http://www.ccsmh.ca/en/projects/ltc.cfm

The CHPCA is the national voice for hospice palliative care in Canada. Advancing and advocating for quality end-of-life/hospice palliative care, its work includes public policy, public education and awareneness.  Website www.chpca.net.

The Canadian Journal of Pain is an open access journal that publishes research from all disciplines involved in the study of pain, including the clinical and basic sciences, epidemiology, and health policy and health systems. The Canadian Journal of Pain is the Official Journal of the Canadian Pain Society.

The journal aims to advance the understanding and treatment of pain by providing clinicians, scientists and other health care professionals with an interdisciplinary forum in which to share cutting-edge information about new developments in the field of pain, including chronic and neuropathic pain.

The journal operates a single anonymized peer review policy. Source: Canadian Journal of Pain. (2024).  Copyright © 2024 Informa UK Limited 

https://www.tandfonline.com/action/journalInformation?show=aimsScope&journalCode=ucjp20

Canadian Stroke Best Practices is an online repository of tools, resources and programs that support health care professionals working in stroke care. Reference: Canadian Stroke Best Practices (n.d.). Professional Resources. 

Retrieved from: https://www.strokebestpractices.ca/resources/professional-resources

This link provides information and support for professionals on palliative and end-of-life care, loss and grief.  There is a list of clinical tools and useful resources to enhance palliative and end life care. Website www.virtualhospice.ca.

This information fact sheet is developed as a supplement to the RNAO Nursing Best Practice Guideline document for nurses. The nursing best practice guideline End-of-life Care During the Last Days and Hours is available for public viewing and free to download at www.rnao.ca/bestpractices.

Registered Nurses’ Association of Ontario. (2011).  Care In The Last Days And Hours Of Life.  Toronto, Canada: Author.  Retrieved from https://rnao.ca/sites/rnao-ca/files/Care_in_the_Last_Days_and_Hours_of_Life.pdf

This tool is used to determine reasons caregivers attribute using physical restraints with the elderly.

Developed by Lois Evans and Neville Strumpf (1986). University of Pennsylvania School of Nursing: revised 1990 & 2010.

Website: www.nursing.upenn.edu
 

This guideline has illustrations and procedures on how to do intermittent catheterizations in adult.

Reference: Vahr, S. Cobussen-Boekhorst, H, Eikenboom, J, Geng, V, Holroyd, S, Lester, M, Pearce, I and Vandewinke, C. 2013. Evidence-based Guidelines for Best Practice in Urological Health Care Catheterisation Dilatation, urethral intermittent in adults. European Association of Urology Nurses. http://nurses.uroweb.org/wp-content/uploads/2013_EAUN_Guideline_Milan_2013-Lr_DEF.pdf.
 

Centre for Suicide Prevention site contains a large collection of suicide prevention, intervention, and postvention resources, including Plus 65- a resource toolkit specific to seniors.

Reference: Centre for Suicide Prevention Website: http://www.suicideinfo.ca/

The Checklist of Nonverbal Pain Indicators (CNPI), was designed to observe and measure pain behaviors in cognitively impaired elders.

Retrieved from: https://www.caltcm.org/assets/Pain-file/checklist%20nonverbal%20pain%20indicators.pdf

Feldt KS. The checklist of nonverbal pain indicators (CNPI). Pain Manag Nurs. 2000 Mar;1(1):13-21. Horgas AL. Assessing pain in persons with dementia. In: Boltz M, series ed. Try This: Best Practices in Nursing Care for Hospitalized Older Adults with Dementia. 2003 Fall;1(2). The Hartford Institute for Geriatric Nursing. www.hartfordign.org

Diseases such as chronic obstructive pulmonary disease or congestive heart failure run a more fluctuating course and result in death in a less predictable timeframe than diseases such as renal disease or dementia. Each exacerbation can lead to remission (and future exacerbation) or death; knowing which will occur on any given admission is extremely challenging. General indicators of poorer prognosis (life expectancy of only weeks to many weeks) include poor performance status, impaired nutritional status and a low albumin level.

Registered Nurses’ Association of Ontario. (2011). Appendix E of End-of-Life Care During the Last Days and Hours. Toronto, Canada: Author. pp103-105 .

This open textbook chapter discusses the types of ostomies and ostomy appliances, reviews physical and emotional assessments, provides checklists with steps for changing ostomy and urostomy appliances, with photographs, and discusses safety considerations. Included is a video on evidence-based research on ostomy care and a video on illiostomy and urostomy care.

Web Address or Source: https://opentextbc.ca/clinicalskills/chapter/10-6-ostomies/  

If you are an instructor who is using this book for a course, please let us know. For more information about this project, please contact opentext@bccampus.ca.

Disclaimer The field of health care is constantly changing and evolving. Procedures and policies in schools and health care agencies will change in accordance with research and practice. This resource will require updates to remain in accordance with these changes, but the authors do not assume responsibility for these updates. Health care professionals must ensure that they have a strong foundation of knowledge in medical conditions and surgical procedures related to clinical skills and techniques before using this resource to guide their practice. Health care professionals should always put agency policy above the information in this resource and be mindful of their own safety and the safety of others. Any health care professional using this resource should do so in the appropriate environment and under the supervision of other relevant health care professionals, in accordance with their governing professional body and within their scope of practice. It is the responsibility of any health care professionals using this book to take all appropriate safety precautions and to determine best practice unique to the patient and the context of the situation. The authors do not assume responsibility for any injury or damage to persons or property pertaining to the use of the material and information in this resource.

On Mar. 17, 2021, the federal government passed Bill C-7 to amend the Criminal Code to expand eligibility for Medical Assistance in Dying (MAID). 

Retrieved from: https://www.cno.org/en/trending-topics/medical-assistance-in-dying/ 

© 2022 College of Nurses of Ontario

This tool helps the resident and caregiver discuss individualized behavioural triggers and preferred measures of response.

Reprinted with permission from St. Joseph`s Health Care. Hamilton, Ontario

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: https://cdn.who.int/media/docs/default-source/integrated-health-services-(ihs)/psf/patient-safety-solutions/ps-solution3-communication-during-patient-handovers.pdf?sfvrsn=7a54c664_4&ua=1

This resource compares different types of chronic wounds to assist health providers in differentiating wounds they may see in clinical practice.

Source: National Pressure Injury Advisory Panel (NIPAP). Support surfaces standards initiative (S31): Terms and definitions related to support surfaces. NIPAP; 2019. Available from: https://cdn.ymaws.com/npiap.com/resource/resmgr/s3i/Finalized_T&D_2024.pdf

Reference: Registered Nurses’ Association of Ontario, (2024). Appendix P of Pressure injury management: Risk assessment, prevention and treatment - Fourth edition. Toronto, Canada: Author. pp. 115-116.

This table lists common components of universal falls precautions that health care organizations can determine which precautions are applicable to their setting.

Appendix O from the RNAO A Proactive Approach to Bladder and Bowel Management in Adults — Fourth Edition is a comprehensive list of physical, emotional and other factors that contribute to constipation.

 Registered Nurses’ Association of Ontario (RNAO). A proactive approach to bladder and bowel management in adults. 4th ed. Toronto (ON): RNAO; 2020. (p.144-145)

Nurses have professional and legal obligations for obtaining consent. The College's Consent practice guideline provides an overview of the major features of the relevant legislation, pertinent definitions and the steps that nurses need to take to obtain consent.

A fact sheet on preventing constipation for patients and families with recommendations for action based on the RNAO Constipation BPG. Available in French.

The 5 questions in this tool are used to assess care preferences of patients if they become upset or have difficulty dealing with emotions.

Copyright NY State Psychiatric Institute, Reprinted with permission from David J. Hellerstein, MD.

This debriefing tool provides examples of questions to ask the resident after they have been restrained or secluded.

Used with permission: Stone Institute of Psychiatry, Northwestern Memorial Hospital Chicago, IL

This resource describes the variety of abuse and neglect that can occur and will assist homes in planning a comprehensive education program.

Registered Nurses’ Association of Ontario. (2014). Appendix D of Preventing and Addressing Abuse and Neglect of Older Adults: Person-Centred, Collaborative, System-Wide Approaches. Toronto, Canada: Registered Nurses’ Association of Ontario. Pp 97-99.rnao.ca/sites/rnao-ca/fi..._Adults_English_WEB.pdf

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

This comprehensive factsheet provides information to assist with the prevention and management of bladder and bowel problems in people with dementia.
Reference: Australian Government (2016). Dementia and bladder and Bowel Control, retrieved Aug. 4, 2022 from https://www.health.gov.au/resources/publications/dementia-and-bladder-and-bowel-control. 

Learn more about living with dementia in these videos from Teepa Snow. She has used multi-modal therapies to support people living with dementia and their caregivers. You will find links to the following videos:

• Dementia 101
• Teepa's GEMS
• Brain Changes
• Challenging Behaviours
• Meaingful Activities, and
• Music

You can also visit the website http://teepasnow.com/

Refrence: Video Links for Tips from Teepa, 2016. Retrieved from http://teepasnow.com/resources/teepa-tips-videos/

The Leading Change Toolkit includes two frameworks- the Social Movement Action (SMA) Framework and the Knowledge-to-Action (KTA) Framework. Both frameworks outline the concept of implementation and its interrelated components. The toolkit is based on available evidence, theoretical perspectives and consensus. We recommend the Leading Change Toolkit for guiding the implementation of any BPG in health care or social service organizations, including academic centres

Reference: Registered Nurses’ Association of Ontario, (2024). Appendix M of Diabetic foot ulcers: Prevention, assessment and management, Third edition. Toronto, Canada: Author. pp. 126-127.
 

This is a “Sentinel Event Action Alert” , a complimentary publication of The Joint Commission Issue 56, February 24, 2016 “Detecting and treating suicide ideation in all settings” Through this alert, The Joint Commission aims to assist all health care organizations providing both inpatient and outpatient care to better identify and treat individuals with suicide ideation

Reference: Joint Commission on Accreditation of Healthcare Organizations (JCAHO). (2016). Detecting and treating suicide ideation in all settings. [Online]. Available: https://www.jointcommission.org/assets/1/18/SEA_56_Suicide.pdf  

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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. 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.

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

This risk assessment triage referral form is an example form for primary health providers to utilize when requesting referrals to a specialized wound care team.

Reference: Registered Nurses’ Association of Ontario, (2024). Appendix G of Diabetic foot ulcers: Prevention, assessment and management, Third edition. Toronto, Canada: Author. pp. 113.

This table provides an outline of the distinguishing features of incontinence-associated dermatitis and pressure injuries. It may help health providers differentiate between the two types of wounds.

Source: Reprinted with permission from: Beeckman D et al. Proceedings of the Global IAD Expert Panel. Incontinence associated dermatitis: moving prevention forward. Wounds International 2015. Available from: http://www.woundsinternational.com

Reference: Registered Nurses’ Association of Ontario, (2024). Appendix Q of Pressure injury management: Risk assessment, prevention and treatment - Fourth edition. Toronto, Canada: Author. pp.117.

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: https://www.cno.org/en/learn-about-standards-guidelines/educational-tools/learning-modules/documentation-2010/

The recommendations within this BPG focus on quality of life, emphasizing a holistic approach to care that incorporates the person’s individuality and preferences, and that recognizes the person and family as the unit of care. Figure 2 identifies complex issues persons and their families may face when receiving palliative care, which are categorized into eight equally important domains.

https://bpgmobile.rnao.ca/sites/default/files/Figure%202%20Domains%20of%20Issues%20Associated%20with%20Illness%20and%20Bereavement.pdf 

This fact sheet provides signs and symptoms of dry mouth and treatment options. Topics covered include: how saliva functions, causes, risk factors, prevention, treatment and maintenance interventions.

Developed by Registered Dietitians, this short, easy to read document provides definitions related to ostomies and provides a nutritional guide for the first 6 – 8 weeks after ostomy surgery as well as for after 6 – 8 weeks. It includes foods that may be problematic for people living with ostomies.

Reference: Eating Well after Ostomy Surgery. Jan 2013. Alberta Health Services. Retrieved from: http://www.albertahealthservices.ca/assets/info/nutrition/if-nfs-eating-well-after-ostomy-surgery.pdf  

Copyright: This handout may not be reproduced without permission for non-profit education purposes. This handout may not be changed without written permission from NutritionResources@albertahealthservices.ca 

© Alberta Health Services (Jan 2013) D) Reference:

RNAO clinical BPGs included education recommendations directed to those responsible for the academic and in-service education of nursing students, nurses and the interprofessional team. These recommendations outlined core content and training strategies required for entry-level health programs, continued education and professional development.

Reference: Registered Nurses’ Association of Ontario, (2024). Appendix D of Pressure injury management: Risk assessment, prevention and treatment - Fourth edition. Toronto, Canada: Author. pp. 92-96.

A List of educational resources compiled by the development panel as a resource for nurses and their clients in learning more about suicidal ideation and behaviour. This is not intended to be an inclusive listing.

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 

Elder Abuse Ontario (EAO)) (formerly known as ONPEA, The Ontario Network for the Prevention of Elder Abuse) is a provincial, charitable, non-profit organization focused on supporting the implementation of The Ontario Strategy to Combat Elder Abuse and has been doing so since 2002. EAO has resources that are useful for LTC homes under the ‘Help for Seniors’ section of their website.

Reference: Elder Abuse Ontario (EAO). 2017. Help for Seniors. Accessed Feb. 6, 2017 https://eapon.ca/

NICE (National Initiative for the Care of the Elderly) provides information tools and online resources for older adults covering caregiving, elder abuse, legal and financial matters, end-of-life planning, and physical and mental health. 
The following provides access to NICE's online library of resources and Information Tools addressing elder abuse issues specifically for seniors in Canada.

Retrieved from: https://www.nicenet.ca/elder-abuse

The brainXchange End of Life Care section contains presentation slides and resources on end of life care, including care related to persons in the final stages of dementia.

Website: http://brainxchange.ca/Public/Resource-Centre-Topics-A-to-Z/End-of-Life-Care.aspx

© 2016 brainXchange

The CNA Code of Ethics for Registered Nurses (2017) is a statement of the ethical values of registered nurses and nurses licensed in extended roles, such as nurse practitioners. It demonstrates nurses’ commitment to persons with health-care needs and persons receiving care. The Code is both aspirational and regulatory.

https://www.cna-aiic.ca/en/nursing/regulated-nursing-in-canada/nursing-ethics

Author: Canadian Nurses Association, 2017

Cette ligne directrice a été élaborée afin d'aborder la question de l'évaluation et du traitement des personnes qui ont un diagnostic avéré de plaies du pied causées par le diabète. Elle fournit des recommandations fondés sur les données probantes à toutes les infirmières ainsiqu'aux membres de l'équipe pluridisciplinaire qui prodiguent des soins dans des établissements de santé à des personnes (âgées de plus de 15 ans) atteintes de type 1 ou de type 2, qui sont atteintes de plaies du pied causées par le diabète.

Association des infirmières et infirmiers autorisés de l'Ontario (2013). Évaluation et traitement des plaies du pied chez les personnes atteintes de diabète (2e édition). Toronto, Ontario : Association des infirmières et infirmiers autorisés de l'Ontario. Récupérée de : http://rnao.ca/bpg/guidelines/assessment-and-management-foot-ulcers-people-diabetes-second-edition

This resource from the Nation Pressure Injury Advisory Panel (NPIAP), is an example of a validated classification system used to classify pressure injuries.

Source: © National Pressure Injury Advisory Panel September 2016 Source: Reprinted with permission from the National Pressure Injury Advisory Panel (NPIAP). Pressure injury and stages [Internet]. Schaumburg (IL): NPIAP. 2016. Available from: https://cdn.ymaws.com/npiap.com/resource/resmgr/NPIAP-Staging-Poster.pdf 

Reference: Registered Nurses’ Association of Ontario, (2024). Appendix H of Pressure injury management: Risk assessment, prevention and treatment - Fourth edition. Toronto, Canada: Author. pp. 102.

Appendix F is an example of a preventative care bundle which may be used to educate residents, family and caregivers. It features the SSKIN bundle (Skin inspection, Surface, Keep moving, Incontinence & moisture and Nutrition).

Source: Reprinted with permission from: Wounds Canada. Pressure injury prevention: SSKIN bundle [Internet]. North York (ON): Wounds Canada; [date unknown]. Available from: https://www.woundscanada.ca/health-care-professional/education-health-care-professional/11-patient-caregiver/741-sskin-bundle

Reference: Registered Nurses’ Association of Ontario, (2024). Appendix F of Pressure injury management: Risk assessment, prevention and treatment - Fourth edition. Toronto, Canada: Author. pp. 99.

These validated assessment tools will assist health providers in conducting a comprehensive assessment of a diabetic foot ulcer and provide a baseline for the diabetic foot ulcer. Examples of diabetic foot classification tools and wound progression tools are provided.

Reference: Registered Nurses’ Association of Ontario, (2024). Appendix H of Diabetic foot ulcers: Prevention, assessment and management, Third edition. Toronto, Canada: Author. pp. 114.

Ce document est un exemple de l'outil d'évaluation de la santé bucco-dentaire holistique et fiable de l'outil d'évaluation orale (THROAT).

Association des infirmières et infirmiers autorisés de l’Ontario (AIIAO). Appendix J Santé buccodentaire : Soutenir les adultes qui ont besoin d’aide. 2e  édition. Toronto (Ont.) : RNAO 2020 https://rnao.ca/sites/rnao-ca/files/bpg/translations/Oral_Health_FR.pdf  
 

This interview guide Subjective Experience of Being Restrained (SEBR) can be used with patients in hospital and then in nursing homes.

Copyright 1986 University of Pennsylvania School of Nursing

Website: www.nursing.upenn.edu/

A fall prevention toolkit for planning events, information on evidence informed and evaluated fall prevention programs, resources and tools for practitioners and promotional materials for organizations.

The Falls Risk Management (FRM) Post‐Falls Review sets out to describe the elements that are required for a post‐falls review within a comprehensive FRM strategy to support patient safety and quality improvement.  https://www.fallpreventionmonth.ca/uploads/2019%20toolkit/Post%20Falls%20Review.pdf

Alberta Health © 2023 Government of Alberta

This resource from the CDC (Center for Disease Control and Prevention) National Healthcare Safety Network, is a fact sheet suitable for health care providers which provides a concise overview of urinary tract infections.

Available at: https://www.cdc.gov/nhsn/faqs/faq-uti.html  Last Reviewed: March 19, 2024

The Fixing Long-Term Care Act, 2021 (FLTCA) was proclaimed into force to regulate Ontario's long-term care home sector.
The Long-Term Care Homes Act, 2007 (LTCHA) was revoked, which means it is no longer in force. The new Act also includes a new regulation.

Government of Ontario (2021) Fixing Long-Term Care Act, 2021. Toronto ( ON) retrieved from Fixing Long-Term Care Act, 2021, S.O. 2021, c. 39, Sched. 1 (ontario.ca)

A flow chart that summarizes the steps, context, and considerations in falls prevention and injury reduction.

This scale's purpose is to determine how nurses feel about certain situations in which they are involved with patients. All statements concern nursing care given to the dying person and/or his/her family. Where there is a reference to a dying patient, assume it refers to a person who is considered to be terminally ill, with six months or fewer to live.

Source: Folmelt, K. American Journal Hospice Palliative Care (Vol. 8, Issue 5) pp. 37-43 Copyright 1991 By Sage Publication

Registered Nurses' Association of Ontario. (2011). Appendix G of End-of-Life Care During the last Days and Hours. Toronto, ON: Author pp. 108-109

Retrieved from http://rnao.ca/sites/rnao-ca/files/End-of-Life_Care_During_the_Last_Days_and_Hours_0.pdf

A tool to assist LTC homes in completing a gap analysis regarding how they are doing in their home with Person and Family Centred Care from a front-line viewpoint. This tool was developed by staff at Woodingford Lodge as part of the LTC BPSO® pre-designation journey.

The Geriatric Depression Scale, is a screening tool used to assessment depression in older adults. It is available in both long form and short form versions and also in multiple languages. The link below is for the long form.

Yesavage JA, Brink TL, Rose TL, et al. Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res 1983; 17:37-49

Retrieved from: https://integrationacademy.ahrq.gov/sites/default/files/2020-07/Update%20Geriatric%20Depression%20Scale-30.pdf

These open-access interactive geriatric learning modules are based on the Geriatrics interprofessional interorganizational Collaboration (GiiC) toolkit developed by the RGPs of Ontario. Users take on a senior character and follow their journey through the health system. Registration is required to access the eLearning Modules.

Retrieved from: https://geriatricessentialselearning.ca/ 

This link takes you to the Geriatric Pain website http://www.geriatricpain.org

The website was created to provide nurses who work in LTC environments with access to free best practice pain assessment tools and resources to help manage pain in older adults, including quality improvement processes focused on pain management

This resource is a glossary of terms used throughout the best practice guideline.  Appendix A of Prevention injury management: Risk assessment, prevention and treatment, Fourth edition. Toronto, Canada: Author. pp. 81-87.

Reference: Registered Nurses’ Association of Ontario, (2024).

A best practice guideline on preventing Catheter-associated Urinary Tract Infections. For use by infection prevention staff, administrators, nurses, and other healthcare providers across the continuum of care. Developed by the Centre for Disease Control and Prevention.

Reference: Healthcare Infection Control Practices Advisory Committee (HICPAC) and Centre for Disease Control and Prevention. (CDC). 2009. Guideline for Prevention of Catheter-associated Urinary Tract Infections. http://www.cdc.gov/hicpac/pdf/CAUTI/CAUTIguideline2009final.pdf.

This guidelines outline the importance of planning, choice and consent and adults with developmental disabilities receiving appropriate developmental services and supports in a long-term care home. The commitment to developing these guidelines and to following them also demonstrates the integrated and co-ordinated approach to care within and between the developmental services and long-term care home sectors.

Reference: King's Printer for Ontario, 2012 to 24. Retrieved from: https://www.ontario.ca/page/guidelines-supporting-adults-developmental-disability-when-applying-moving-and-residing-long-term-care-home

The Advocacy Centre for the Elderly (ACE) website provides various information related to health care consent and advance care planning, frequently asked questions and resources.

https://www.acelaw.ca/legal-topic/health-care-consent-advance-care-planning/

Copyright © 2024 The Advocacy Centre for the Elderly (ACE). All rights reserved.

This section of the brainXchange website focuses on health care consent and advance care planning, with many presentations and resources available to help when caring for persons at the end of life.

Reference: Title: brainXchange, Health care consent and advance care planning (2016). This section of the brainXchange website focuses on health care consent and advance care planning, with many presentations and resources available to help when caring for persons at the end of life. Website: http://brainxchange.ca/capacity.aspx

This assessment tool is used primarily by mental health professionals to “estimate” a persons’ probability of violence.

Reprinted with permission from Ronald Roesch, Professor, Director of Mental Health Law and Policy Institute, Simon Fraser University

Website: http://kdouglas.wordpress.com/hcr-20/

Hollister Education has developed an online course in Ostomy Care that offers healthcare professionals the opportunity to learn more about this specialized area of care. There are a total of five lessons that may be viewed in any order, with an assessment at the conclusion of each lesson. Topics include:

• Lesson 1: Ostomy overview
• Lesson 2: Pouching systems
• Lesson 3: Ostomy accessories
• Lesson 4: Problem solving
• Lesson 5: Education and resources

Each lesson contains a glossary of terms and reference resources.

Web Address or Source: http://www.hollister.ca/en-ca/ostomycare/ostomycareprofessionalresources/hollisterostomycareelearning  

Intellectual Property:

Unless otherwise specified, all content and the intellectual property rights in such content included on this Web site, such as works, images, pictures, dialogues, music, sounds, videos, documents, drawings, figures, logos, menus, Web pages, graphics, colors, schemes, tools, fonts, designs, diagrams, layouts, methods, processes, functions and software (collectively, “Content”), are the property of Hollister. You may not reproduce, publish, distribute, display, modify, create derivative work from, or exploit in any way, in whole or in part, the Content without getting prior express written consent from us.

The Hospice Palliative Care Ontario offers many educational resources for caregivers including Advance Care Planning and Health Care Consent for Health Service Providers. There is also a Palliative Care Core Course for Interdisciplinary staff which covers pain and symptom management, ethical decisions, communication and end of life in dementia. Materials are freely accessible.

Reference: Title: Hospice Palliative Care Ontario (2015) Description: The Hospice Palliative Care Ontario offers many educational resources for caregivers including Advance Care Planning and Health Care Consent for Health Service Providers. There is also a Palliative Care Core Course for Interdisciplinary staff which covers pain and symptom management, ethical decisions, communication and end of life in dementia. Materials are freely accessible. Website: http://www.hpco.ca/

This table compares different types of chronic wounds to assist health providers in differentiating wounds they may see in clinical practice.

Reference: Registered Nurses’ Association of Ontario, (2024). Appendix I of Diabetic foot ulcers: Prevention, assessment and management, Third edition. Toronto, Canada: Author. pp. 115-116 .

Watch a video of nurses implementing the Assessment and Management of Pain Guideline into their practice. 

RNAO (2009) Implementation of Pain Assessment and management Guideline

Source: http://www.youtube.com/watch?v=Ssymdf8CFQ4&feature=channel_page.

This website provides all Ontario health care practitioners the information and resources they need to:

• Prepare people and their Substitute Decision-Makers (SDMs) for future decision-making (Advance Care Planning).
• Support decision-making by engaging people and caregivers in decision-making conversations when needed (Goals of Care Discussions

Hospice Palliative Care Ontario (2022) Improving Person-Centred Conversations retrieved from Welcome to HPCO's Online Learning Portal (pcdm.ca)

This collaboration between LGBT and mainstream organizations examines why the LGBT population face additional obstacles to successful aging. It also looks at what groundwork needs to be in place for these obstacles to be overcome . Copyright © 2015 Movement Advancement Project ©

Reference: LGBT Movement Advancement Project (MAP), & Services and Advocacy for Gay, Lesbian, Bisexual, and Transgender Elders (SAGE). (2010). Improving Lives of the LGBT older adults. Retrieved from https://lgbtmap.org/improving-the-lives-of-lgbt-older-adults

A fact sheet on urinary continence for patients and families with recommendations for action based on the RNAO Continence BPG. Available in French.

This screening guide provides a systematic method that can be used by health providers for foot ulcer prevention and ongoing screening after an ulcer or complication occurs. 

Reference: Registered Nurses’ Association of Ontario, (2024). Appendix D of Diabetic foot ulcers: Prevention, assessment and management, Third edition. Toronto, Canada: Author pp. 104-105.

Example signage of Intentional Hourly Rounding Poster from Fraser Health, British Columbia, Canada.

Pallium Canada provides palliative care education to all health providers through workshops, e-learning and more.

Website: http://pallium.ca/

This table from page 76-77 of the Delirium, Dementia, Depression in Older Adults: Assessment and Care BPG (2016) reviews interventions for depression, including psychotherapy, psychological/social and antidepressants.

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

This powerpoint presentation for health care providers, shows how to distinguish between the types of urinary incontinence and interventions to treat urinary incontinence.  A poster and patient handout are also part of this module which is also available in french.
 

Spencer, Martha ( 2019) Introduction to Urinary Incontinence- Clinician Learning Series.Ontario. Retrieved from https://www.rgptoronto.ca/resource/introduction-to-urinary-incontinence-clinician-learning-series/ 

The IWGDF risk stratification system allows health providers to establish foot screening and examination frequency based on resulting risk categories.

Reference: Registered Nurses’ Association of Ontario, (2024). Appendix E of Diabetic foot ulcers: Prevention, assessment and management, Third edition. Toronto, Canada: Author. pp. 106.

Fiche de renseignements pour la sensibilisation en matière de santé.

Association des infirmières et infirmiers autorisés de l’Ontario. (2003, Juilet). La constipation: La prévention est maître. Toronto, Canada: Auteur.

L'objectif de cette prochaine édition de la ligne directrice sur les pratiques exemplaires (LDPE) est de fournir aux infirmières, à l'équipe interprofessionnelle et aux soignants des recommandations fondées sur des données probantes pour la prestation de soins bucco-dentaires aux adultes (18 ans et plus) qui : (a) favoriseront une approche interprofessionnelle de la prestation soins bucco-dentaires, (b) améliorer la prestation des interventions de soins bucco-dentaires, et (c) conduire finalement à des résultats positifs en matière de santé bucco-dentaire pour les personnes.

Le BPG se concentre sur la prestation de soins bucco-dentaires dans tous les établissements de santé aux adultes qui ont besoin d'aide pour les soins bucco-dentaires dans un continuum qui va de la mise en place de fournitures de soins bucco-dentaires à une assistance physique complète pour les soins bucco-dentaires. Cette LDPE fournit des recommandations pour soutenir la prestation de soins bucco-dentaires, y compris une supervision, une incitation et une assistance appropriées, tout en préconisant l'indépendance et l'autonomie de la personne.

Association des infirmières et infirmiers autorisés de l’Ontario (AIIAO). Santé buccodentaire : Soutenir les adultes qui ont besoin d’aide. 2e  édition. Toronto (Ont.) : RNAO 2020
https://rnao.ca/sites/rnao-ca/files/bpg/translations/Oral_Health_FR.pdf 

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

A complete toolkit for educational purposes. Composed in 2008 and content uploaded in 2016. Key elements of the CCSMH Late Life Suicide Prevention Toolkit include: • DVD - Suicide Assessment & Prevention for Older Adults: Life Saving Tools for Health Care Providers • CCSMH National Guidelines for Seniors’ Mental Health: The Assessment of Suicide Risk and Prevention of Suicide • Clinician pocket-card • PowerPoint presentation • Facilitator’s Guide with tips for using the Toolkit in a variety of ways

Reference: Canadian Coalition for Seniors’ Mental Health (2008) Late Life Suicide Prevention Toolkit, Facilitators Guide. Available at http://ccsmh.ca/wp-content/uploads/2016/03/FacilitatorsGuide.pdf 

© Canadian Coalition for Seniors’ Mental Health, 2008 In order to meet the educational needs of your learners, some materials in the toolkit may be modified. Please acknowledge that the information was provided by the Canadian Coalition for Seniors’ Mental Health Late Life Suicide Prevention Toolkit.

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.

 Ce travail est financé par le Ministère de la Santé et Ministère des Soins de longue durée d'Ontario

Tables 10, 11 and 12 list of risk factors that include fall risk factors, health conditions associated with increased risk of falls, and factors associated with increased risk of falls injury.

LTC Series - Personal Support Worker: Practicing Sit to Stands Daily is a two and a half minute Osteoporosis Canada video discusses and demonstrates how to do daily sit to stand exercises for long term care residents.

Developed by a Canadian research team who has been funded by the Canadian Institutes for Health Research to explore the ethical, policy, and practice implications of Medical Assistance in Dying for Nurses. As part of our knowledge translation strategy, a Reflective Guide for Nurses that addresses six main areas of nursing practice in relation to Medical Assistance in Dying: nurses’ experiences, making moral sense, best practices, common dilemmas, and self-care. The Reflective Guide includes a video that provides a compelling insight into a few nurses’ experiences with Medical Assistance in Dying. This free guide can be used for individual study or as part of an educational offering.

https://www.maidreflectiveguide.ca/

Author: CIHR IRSC, Funding from CIHR: CIHR Project Grant PJT-148655; CIHR Project Grant PJT-169144

This tool is designed to help family physicians and nurse practitioners (primary care providers) develop and implement a management plan for adult patients with Chronic Non Cancer Pain (CNCP) in the primary care setting. CNCP is defined as pain that typically persists or recurs for more than 3 months or past the time of normal tissue healing.1,2,3,4 This tool applies to, but is not limited to pain conditions such as osteoarthritis (OA), low back pain (LBP), musculoskeletal (MSK) pain, fibromyalgia (FM) and neuropathic pain (NP). This tool focuses on a multi-modal approach to manage CNCP.

Web Address or Source: https://thewellhealth.ca/wp-content/uploads/2017/03/CEP_CNCP_Main_V1.pdf

This tool can be used to guide healthcare professionals with assessment of patient pain. It includes diagrams of the human body to help patients locate the pain they experience and questions to prompt the patient to describe the intensity, quality, causes, effects, and contributing factors of their pain.

Retrieved from: https://www.sdsma.org/resources/PrescriptionDrugsToolkit/Patient%20Assessment%20Tool%20-%20McCaffrey%20Initial%20Pain%20Assessment%20-%2020170814.pdf

Reference: McCaffrey M, Pasero C. (1999). McCaffrey Initial Pain Assessment Tool

On June 16, 2016, the federal government passed legislation to amend Canada’s Criminal Code and established a federal framework for Medical Assistance in Dying (MAID) for individuals who meet pre-defined eligibility criteria.

MAID, as defined by the Government of Canada, refers to: The administering by a medical practitioner or nurse practitioner of a substance to a person, at their request, that causes their death. The prescribing or providing by a medical practitioner or nurse practitioner of a substance to a person, at their request so that they may self-administer the substance, and in doing so, cause their own death. As part of its efforts to implement a consistent approach to the MAID process in Ontario, the Ministry of Health and Long-Term Care (MOHLTC) has engaged the Centre for Effective Practice (CEP) to develop a resource to support clinicians (physicians and nurse practitioners) with the provision of MAID. Retrieved from: https://thewellhealth.ca/maid/

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: https://www.ismp-canada.org/medrec/

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 (2023) CNO Practice Standard-Medication Retrieved from: https://www.cno.org/globalassets/docs/prac/41007_medication.pdf

Copyright © College of Nurses of Ontario, 2023.

Appendix P from the RNAO A Proactive Approach to Bladder and Bowel Management in Adults — Fourth Edition is a list of the major drug groups that can contribute to constipation. 

Registered Nurses’ Association of Ontario (RNAO). A proactive approach to bladder and bowel management in adults. 4th ed. Toronto (ON): RNAO; 2020 (p. 146).

This Government of Ontario website contains the Mental Health Act 1990 and Regulation that falls under it.

Reference: Mental Health Act 1990 Website: https://www.ontario.ca/laws/statute/90m07

The Mental Health First Aid courses focus on the most common mental health disorders related to substances, mood, anxiety, trauma and psychosis.

Reference: Mental Health Commission of Canada (2017). Mental Health First Aid Canada. Retrieved from http://www.mentalhealthfirstaid.ca/en/course-info/courses  

© 2017 Mental Health Commission of Canada

The Mini-Cog is a brief screening instrument to determine memory recall and clock drawing ability. A positive screen would suggest more in-depth assessment for cognitive impairment. Mini-Cog instrument, instructions and scoring are provided.

Reference: Borson, S. (n.d.). Mini-Co. Retrieved from https://mini-cog.com/

Mini-Cog™ © S. Borson. All rights reserved. Reprinted with permission of the author solely for clinical and educational purposes. May not be modified or used for commercial, marketing, or research purposes without permission of the author (soob@uw.edu). v. 01.19.16

This website contains many useful resources for understanding depression, bipolar disorder, suicidality. There is an education tab with links to training modules. Useful supportive strategies can be found under the support tab.

Reference: Website: http://mooddisorderscanada.com/ 

Music and Memory looks at how music can enrich the lives of long-term care residents with cognitive impairment.

Reference: Blanchard, Laurie (2016). Music and Memory. Retrieved from http://libguides.lib.umanitoba.ca/ld.php?content_id=25047510

My Personhood Summary© surfaces a person’s life experiences, important relationships, personal preferences, and other psychosocial and environmental factors that influence individuals’ daily lives.

My Transitional Care Plan© (MTCP) summarizes meaningful information that contributes to the facilitation of successful transitions across sectors for older adults presenting with, or at risk of, responsive behaviours/ personal expressions associated with dementia, complex mental health, substance use and/or other neurological conditions. 

National Initiative for the Care of the Elderly (NICE) is an international network of researchers, practitioners, and students dedicated to improving the care of older adults in Canada and abroad. The website includes various resources, some specific to dementia care and caregiving.

Reference:National Initiative for the Care of the Elderly (NICE) Website: http://www.nicenet.ca/

Pauktuutit Inuit Women of Canada is the national organization that represents all Inuit women in Canada. Pauktuutit has been active in abuse prevention and building capacity to address abuse issues since its inception in 1984. Pauktuutit brought together individuals, agencies and groups who share a common interest in preventing abuse in Inuit communities, to collaborate on the development and implementation of this unique national,community-based strategy.

Reference: Pauktuutit Inuit Women of Canada. (2006). National Strategy to Prevent Abuse in Inuit Communities and Sharing Knowledge, Sharing Wisdom: A Guide to the National Strategy. Ottawa, ON: Author. Retrieved from http://pauktuutit.ca/wp-content/blogs.dir/1/assets/InuitStrategy_e.pdf

Asks persons to rate their pain from 0 to 10

• Scored 0-10 with the anchors of 0 being ‘no pain’ and 10 being ‘pain as bad as it can be’ Used in adults, older adults, and adolescents and children over age 8.
• Well established evidence of reliability, validity, and ability to detect change
• No equipment is needed to administer this measure
• High feasibility (quick and easy to use)

Reference:

Registered Nurses’ Association of Ontario. (2013). Appendix E of Assessment and Management of Pain, Third Edition.Toronto, Canada: Author. 81-82.

McCaffery, M., Beebe, A., et al. (1989). Pain: Clinical manual for nursing practice, Mosby St. Louis, MO

The Office of the Public Guardian and Trustee (“OPGT”) delivers a unique and diverse range of services that safeguard the legal, personal and financial interests of certain private individuals and estates. Services are provided by multi-disciplinary teams of dedicated staff with experience in the health care, social work and financial planning fields. They receive professional support from lawyers, accountants and investigators. A brief description of many of the services offered by the OPGT is set out in the website.

Reference: Office of the Public Guardian and Trustee (OPGT)

Website: https://www.attorneygeneral.jus.gov.on.ca/english/family/pgt/overview.php

Bullying (also known as harassment) happens when a person or a group of people repeatedly hurts, threatens, or scares a peer. Bullying awareness and prevention activities have been traditionally aimed at younger generations, even though the behaviours occur across the life course and can affect older adults where they live and socialize. This factsheet summarizes the definition of bullying, causes, impacts on older adults, strategies for prevention, and available services in Ontario. 

Adapted from: A&O and CNPEA Info-graph on Older Adults and Bullying 2020

The Ontario Palliative Care Network is a partnership of community stakeholders, health service providers and health systems planners who are developing a coordinated and standardized approach for delivering palliative care services in Ontario. In the website Resources section can be found many useful palliative care tools, guidance and evidence, reports and legislative updates.

Web Address or Source:www.ontariopalliativecarenetwork.ca/

 Ontario Regulation 246/22 was made under The Fixing Long-Term Care Act, 2021 (FLTCA) was proclaimed into force to regulate Ontario's long-term care home sector April 11, 2022.
 

Government of Ontario (2022) Ontario Regulation 246/22. Toronto ( ON) retrieved from O. Reg. 246/22: GENERAL (ontario.ca)

Ontario Regulation 246/22 was made under The Fixing Long-Term Care Act, 2021 (FLTCA) was proclaimed into force to regulate Ontario's long-term care home sector April 11, 2022.

Government of Ontario (2022) Ontario Regulation 246/22. Toronto ( ON) retrieved from O. Reg. 246/22: GENERAL (ontario.ca)

This link to the RNAO Interest Group website leads to resources and information regarding the benefits of membership and the role of interest group members in leading, promoting and influencing wound related public policy in Ontario.

Reference: Ontario Wound Interest Group. Website http://ontwig.rnao.ca

The Opiod Manager condenses key elements from the Canadian Opiate Guideline into a workable format for prescribing opiates for persons with chronic, non-cancer pain.

Reference: National Opiod Use Guidelines Group (2010), Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain Practice Toolkit, Opioid Manager. Retrieved from http://nationalpaincentre.mcmaster.ca/opioidmanager/

© 2016 McMaster University

This is a comprehensive collection of audits to review oral care in long term care. It contains instructions and audits on: dental equipment; Denture and denture supplies; Oral care supplies in residents’ care caddie; Oral care practices; POC/Flowsheet; Actual Resident Assessment of oral care; Admission Process; Levels of assistance and behaviours; Annual Assessment; Quarterly Assessment; Annual evaluation of oral care education; and Resident and Family Information.

This booklet is a group of tools that long term care or other health care organizations can use to collect baseline data on the status of oral care. Tools included are: RAI-MDS indicators; audits for oral supplies and care on charts; and an oral health knowledge survey.

This is a link to a series of six videos that describes the specialized oral care required for patients with the challenges of xerostoma (dry mouth), dysphasia (difficulty swallowing) and mucositis (inflamed oral tissues).

This is a link to videos on thirteen oral health topics that can be used for staff education. Series 10 on Oral Health and Stroke July 2012 is specific for care of stroke survivors. It provides information on how oral health issues can cause a stroke, oral health care of stroke survivors and preventing oral disease. The other videos in the series also support education on oral health assessment tool (OHAT), infection control, oral care, halitosis, tooth brushing, denture care, oral care planning.
Reference: Terry Kirkpatrick. (2013). Oral health. [Video series].

Retrieved from: https://www.youtube.com/watch?v=muIm-pT4N0M

Les normes d’exercice informent les infirmières de leurs responsabilités et expliquent leur rôle au public. Le présent document a pour objectif d’aider les infirmières à comprendre leurs responsabilités et à prendre des décisions en matière de contention. La contention, qu’elle soit physique, environnementale ou chimique, est un moyen controversé visant à restreindre les mouvements d’un client ou à maîtriser son comportement.

Copyright © Ordre des infirmières et infirmiers de l’Ontario, 2009.

Ordre des infirmières et infirmiers de l’Ontario. (2006).  La contention. Toronto, ON, Canada: Auteur. Récupérée de http://www.cno.org/fr/exercice-de-la-profession/normes-et-directives-professionnelles/.

Organizational data collection tool that can be used when restraints are used as a “last resort”.

All requests to use or adapt the Appendix: The Ottawa Hospital Organizational Audit Form must be directed to the Ottawa Hospital, Department of Nursing Professional Practice for permission.

Ostomy Canada Society (OCS) is a non-profit volunteer organization for people with ostomies and their families. The OCS website has practical ostomy care information on a variety of topic with good visuals. Resources are aimed at patients and families, but are applicable to health care professionals.

Reference: Ostomy Canada Society. 2017. Accessed Aug. 22, 2017 https://www.ostomycanada.ca/

Copyright © Ostomy Canada Society. All Rights Reserved.

This resource from the Canadian Continence Foundation provides a list of some medications used for overactive bladder treatment.

Retrieved from: https://static1.squarespace.com/static/65a5be5a40b6451450a341e1/t/66576f2b08d96963095e44db/1717006123689/OABEn-2016.pdf

PACSLAC is a tool to observe and assess both common and subtle pain behaviours. Copyright © Shannon Fuchs-Lacelle and Thomas Hadjistavropoulos. The PACSLAC may not be reproduced without permission. For permission to reproduce the PACSLAC, please contact the copyright holders (Thomas.Hadjistavropoulos@uregina.ca).

Retrieved from: https://gerocentral.org/wp-content/uploads/2013/12/Pain-Assessment-Checklist-for-Seniors-with-Limited-Ability-to-Communicate-PASLAC.pdf

This quality standard addresses palliative care for people who are living with a serious, life-limiting illness, and for their family and caregivers. The goal of palliative care is to relieve pain and suffering, and to improve a person’s quality of life. This quality standard focuses on care for people in all settings, including home and community, hospice, hospital, and long-term care.

The Website contains numerous end-of-life resources for health care professionals.

Copyright: End of Life Curriculum Project, a joint venture of the US Veterans Administration and SUMMIT, Stanford University Medical School

Retrieved from http://palliative.stanford.edu/

PPS may be used for several purposes. It is an excellent communicatiuon tool for quickly describing a patients current functional level.

The Victoria Hospice Palliative Performance Scale (PPS, version 2) is an 11-point scale  communication tool for describing the current functional level and appears to have prognostic value.  The PPS provides a framework for measuring progressive decline over the course of illness.  If you wish to print any of these tools for your use, please go to https://victoriahospice.org/wp-content/uploads/2019/12/PPSv2-English-Sample.pdf to download a copy of Victoria Hospice's reprint and use permission request form.

 © Victoria Hospice Society, 2006.

PaP uses the Karnofsky Performance Scale (KPS) and 5 other criteria to generate a numerical score from 0 to 17.5 to predict 30 day survival (higher scores predict shorter survival).

Registered Nurses’ Association of Ontario. (2011).  Appendix D of End-of-Life Care During the Last Days and Hours. Toronto, Canada: Author. pp. 102-103.  Copyright (1999), with permission from Elsevier.

Reprinted from Journal of Pain and Symptom Management, Vol. 17, No. 4, Maltoni, M, Nanni, O, Pirovano, M., Scarpi, E., Indelli, M, Martini, C, et al., Successful Validation of he Palliative Prognostic Score in Terminally ill Cancer Patient, 240-247

The Parkinson Canada website contains several useful resources for LTC including a Guide to the Non-Motor Symptoms of Parkinson's Disease (client and physician versions). These guides cover cognitive dysfunction, dementia, anxiety, depression, delusions and impulse control in Parkinson's disease. Also available is a booklet specific to the LTC sector as well as a medication booklet.

Reference: Parkinson Canada website, retrieved from http://www.parkinson.ca/

A 30 minute presentation for LTC is a collaboration between the RNAO LTC Best Practice Co-ordinators Deirdre Boyle and Shaila Aranha; and the Regional Stroke Rehabilitation and Community Coordinator, Eileen Britt, from the Central South Regional Stroke Network.

This is part one of a four part Stroke Education series to support LTC staff in their fall prevention and management program. The objectives are to:

• Identify risk factors for falls for residents with Stroke.
• Understand the relationship between fall prevention and management, pain management, reducing and supporting behaviors, and preventing pressure injuries in residents with Stroke.
• Discuss the importance of an inter-professional team approach in Stroke Care.
• Understand how to Integrate evidence-based resources in planning and improving care for residents with Stroke.

This 25-minute video shows a range of unhealthy changes and common abnormalities that can be found during oral assessments of residents living in long term care homes. How to do an oral assessment is reviewed. It is Part 2 of the RNAO Long-Term Care Best Practices Program - Oral Health Assessment Series (3 parts).

A 30 minute presentation for LTC is a collaboration between the RNAO LTC Best Practice Co-ordinators Deirdre Boyle and Shaila Aranha; and the Regional Stroke Rehabilitation and Community Coordinator, Eileen Britt, from the Central South Regional Stroke Network.

This is part three of the four part Stroke Education series to support LTC staff to:

• Identify risk factors to prevent responsive behaviours for residents with Stroke.
• Understand the relationship between reducing and supporting behaviors, pain assessment and management, falls prevention and management and preventing pressure injuries in residents with Stroke.  
• Discuss the importance of an inter-professional team approach in Stroke Care.
• Understand how to Integrate evidence-based resources in planning and improving care for residents with Stroke.

Partnerships in Dementia Care Alliance (PiDC) helps to change culture in long-term care and community settings to enhance dementia care. Examples of culture change in LTC homes is included.

Reference: Partnerships in Dementia Care Alliance Website: https://uwaterloo.ca/partnerships-in-dementia-care/

The Patient Oriented Discharge Summary (PODS) is an easy-to-use discharge summary designed for persons transitioning from hospital to home (164). Most traditional discharge summaries are dense documents with technical terms and are designed to communicate information to primary care providers, rather than persons receiving care. PODS was co-created with persons and their support network, including individuals with limited health literacy and language barriers, to help persons understand important information when leaving a hospital. The resource uses plain language, large fonts, space for persons to take notes and is available in 15 languages.

Registered Nurses' Association of Ontario. (2023). Appendix G of Transitions in Care and Services. (Second Ed.). Toronto, ON: Author.  pp. 121-122.

This resource from the Canadian Continence Foundation explains pelvic muscle exercises, how they may help with incontinence and how to properly perform them.

Retrieved from: https://static1.squarespace.com/static/65a5be5a40b6451450a341e1/t/662badc92a66f708cd6df4cf/1714138569848/pelvicmuscleexercises.p

Learn more about the benefits of Person-Centred Care (PCC) with this educational video that defines the fundamental concepts of PCC.

This individualized de-escalation plan considers cause and effect and solutions focused on the resident’s strengths.

Reprinted with permission from The Massachusetts Department of Mental Health

This article published for US library of Medicine article compares depressed in patients with and without CCPD in terms of suicidal behaviour and associated psychopathology.

Reference: Dervic, Kanita et al. “Cluster C Personality Disorders in Major Depressive Episodes: The Relationship Between Hostility and Suicidal Behavior.” Archives of suicide research : official journal of the International Academy for Suicide Research 11.1 (2007): 83–90. PMC. Web. 22 Dec. 2017. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3779124/ 

This is the Behavioural Supports Ontario (BSO) website that supports staff with pledging their commitment to Person and Family Centered. Posters and a report are also available to support adaption of Person and Family Centred Approach.

A detailed policy and procedure for preventing dehydration in LTC residents. It was developed by the Toronto Best Practice Implementation Steering Committee.

Reference: Toronto Best Practice in LTC initiative working group , (December 2006), Policy and Procedure: Hydration Management Toronto Best Practice in LTC Initiative, date retrieved, June 8 2015,

Table 20 is a description of resources available to support post fall assessments.

RNAO resource page 105, Appendix M. Listed interventions as potentially beneficial to providing supportive care in postvention. 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 

Pan Pacific Pressure Injury Alliance outlines some considerations for risk assessment and treatment of pressure injuries in people with dark skin tones. Additionally, it includes classification based on the NPIAP/EUPAP classification system with examples of each stage in people with dark skin tones.

Source: Reprinted with permission from: Pan Pacific Pressure Injury Alliance (PPPIA). Pressure ulcers in people with dark skin tones: PPPIA; 2014. Available from: https://talleygroup.com/medias/documents/PPPIA-Pressure-Ulcers-in-People-with-Dark-Skin-Tones-PosterA3L-01604484440.pdf   Reference:

Registered Nurses’ Association of Ontario, (2024). Appendix I of Pressure injury management: Risk assessment, prevention and treatment - Fourth edition. Toronto, Canada: Author. pp. 103.

This webpage provides links to illustrations for each of the new pressure injury stages.

Copyright: These illustrations can be downloaded by clicking on the links below directly to your computer at no cost, if for educational purposes. There is no cost to use these illustrations; however donations to support the work of NPUAP are graciously accepted. For profit uses of the drawings are subject to a charge, please contact Jen Bank for more information. **Use of drawings is permitted for educational purposes only.

Reference: National pressure ulcer advisory panel (n.d.). Pressure Injury Staging Illustrations. Retrieved from http://www.npuap.org/resources/educational-and-clinical-resources/pressure-injury-staging-illustrations/

This table developed through the Residents First Initiative provides examples of clinical and organizational change strategy options in the area of pressure ulcers.
Health Quality Ontario. (2011, February). Pressure Ulcers – Clinical and Organizational Change Concepts and Ideas.
Retrieved from: http://www.hqontario.ca/quality-improvement/long-term-care/tools-and-resources

This tool provides a consistent method of collecting skin tear prevalence data.

Web Address: http://journals.lww.com/aswcjournal/Fulltext/2013/10000/International_Skin_Tear_Advisory_Panel__A_Tool_Kit.7.aspx Please refer to this link for further information how to apply for permission for re-use

Reference: International Skin Tear Advisory Panel: A Tool kit to aid in the Prevention, Assessment and treatment of skin Tears using a Simplified Classification System. Advances in Skin and Wound Care. 26 (10): 459-476, October 2013

The recommendations in this document from Wound Canada,  are based on the best available evidence and are intended to support the clinician, the patient, his/her family and the health-care team in planning and delivering the best clinical practice. Two foundational papers supplement this document with additional evidence-informed information and recommendations that are general to all wound types: “Skin: Anatomy, Physiology and Wound Healing,” and “Best Practice Recommendations for the Prevention and Management of Wounds.”

© 2018 Canadian Association of Wound Care All rights reserved. 1525r3E

https://www.woundscanada.ca/doclink/bpr-prevention-and-management-of-skin-tears/eyJ0eXAiOiJKV1QiLCJhbGciOiJIUzI1NiJ9.eyJzdWIiOiJicHItcHJldmVudGlvbi1hbmQtbWFuYWdlbWVudC1vZi1za2luLXRlYXJzIiwiaWF0IjoxNjQyMDk3MTc2LCJleHAiOjE2NDIxODM1NzZ9.iJkbdhFNBHe9XhHP6u6KB9MjPKWj8rQwLfoz5yzeCdU

This Website provides local, provincial, federal and multicultural links to elder abuse resources. It also provides strategies to minimize the risk of elder abuse.
Reference: https://www.peacyr.ca/

Disclaimer: The Prevention of Elder Abuse Committee of York Region has a mission to reduce elder abuse by increasing awareness. The committee does not provide services or assistance.

This project was designed to identify relevant principles, screening and intervention tools and approaches and prevention strategies being used in First Nations communities to address/prevent abuse of older adults.

April Struthers, Georgina Martin, Alison Leaney Project Team BC Association of Community Response Networks December 2009

This poster defines dehydration and explains the shows the risk factors related to dehydration and strategies to prevent dehydration.

Reference: Developed by the Elder friendly environments Coalition (2008). 

https://ltctoolkit.rnao.ca/sites/default/files/resources/continence/Continence_EducationResources/OtherAvailableResources/Poster_PromotingHydrationinOlderAdults.pdf

A systematic approach to encouraging incontinent people to become continent. Registered Nurses’ Association of Ontario (RNAO). A proactive approach to bladder and bowel management in adults. 4th ed. Toronto (ON): RNAO; 2020. 

This tool is designed to be used with tools included in the ISTAP Risk Reduction Program.

Web Address: http://journals.lww.com/aswcjournal/Fulltext/2013/10000/International_Skin_Tear_Advisory_Panel__A_Tool_Kit.7.aspx Please refer to this link for further information how to apply for permission for re-use

Reference: International Skin Tear Advisory Panel: A Tool kit to aid in the Prevention, Assessment and treatment of skin Tears using a Simplified Classification System. Advances in Skin and Wound Care. 26 (10): 459-476, October 2013

The Website provides excellent resources focussed on the intersection of the LGBTQ community and aging. Some resources are available for download and some resources can be purchased.

Copyright with Rainbow Health Ontario

Reference: Rainbow Health Ontario Website (n.d.). Retrieved from http://www.rainbowhealthontario.ca/resource-search/

Les recommandations contenues dans cette Ligne directrice sont axées sur trois volets : (1) les recommandations relatives à la pratique professionnelle, axées sur les infirmières, (2) les recommandations relatives à la formation, axées sur les compétences requises pour la pratique, et (3) les recommandations relatives à l’établissement et aux politiques, qui traitent de l’importance d’un milieu favorable en tant que facteur nécessaire à la prestation de soins infirmiers de haute qualité, notamment une évaluation continue de la mise en place de la Ligne directrice. Supplément : 2007 Cette ligne directrice sur les pratiques exemplaires fournit des recommandations pour les infirmières qui ne sont pas des spécialistes dans le secteur du diabète. Ces recommandations aident des infirmières pour conduire des évaluations des risques pour des ulcères de pied, fournissent l'éducation de base pour la prévention des ulcères de pied et mettez en application les interventions appropriées quand il y a un à haut risque pour le présent d'ulcère ou d'amputation.

Association des infirmières et infirmiers autorisés de l’Ontario. Réduction des complications des plaies du pied chez les diabétiques. Association des infirmières et infirmiers autorisés de l’Ontario, Toronto, Canada, 2007. Recuperé de : http://rnao.ca/bpg/guidelines/reducing-foot-complications-people-diabetes

This resource list helps you identify key contacts in addressing elder abuse. Complete the contact details for your local resources.

Reference:Registered Nurses’ Association of Ontario. (2014). Appendix H of Addressing and Preventing Abuse and Neglect of Older Adults: Person-Centred, Collaborative, System-Wide Approaches. Toronto, ON: Registered Nurses’ Association of Ontario. , pp.112-114. http://rnao.ca/bpg/guidelines/abuse-and-neglect-older-adults
 

This resource lists topics and other Registered Nurses’ Association of Ontario (RNAO) guidelines, and resources from other organizations that align with the Transitions in Care and Services best practice guideline (BPG).

Registered Nurses' Association of Ontario. (2023). Appendix B of Transitions in Care and Services. (Second Ed.). Toronto, ON: Author.  pp. 93-94. 

This link takes you to the website of Executive office of Health and Human Services (EOHHS) with resources on Restraint/Seclusion Reduction Initiative and Boston Medical Centre Person De-escalation Plan and Intensive Residential Program.

Website: http://www.mass.gov/eohhs/gov/departments/dmh/

Examples of 4 pressure injury risk assessment tools, however this list is not an exhaustive. These tools were identified, by the expert panel and external reviewers or through the systematic review process. The most common, valid, and reliable wound assessment tools for use in adults are the following (not in order of importance):

Braden scale; Norton scale; interRAI Pressure Ulcer Risk Scale (PURS) and the Waterlow scale.

Source: Table adapted from Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline. The International Guideline 2019. interRAI PURS Pressure Ulcer Risk Scale (PURS) from Canadian Institute for Health Information. interRAI Home Care (HC) Outcome Scales [job aid]. Ottawa, ON: CIHI; 2024

Reference: Registered Nurses’ Association of Ontario, (2024). Pressure injury management: Risk assessment, prevention and treatment - Fourth edition. Toronto, Canada: Author. pp. 100-101.

A comprehensive list of physical, environmental, functional and other factors that contribute to fecal incontinence. Registered Nurses’ Association of Ontario (RNAO). A proactive approach to bladder and bowel management in adults. 4th ed. Toronto (ON): RNAO; 2020.

The aim of this guideline is to provide evidence-based recommendations  to facilitate client centred learning that promotes and enables clients to take action for their health.

Registered Nurses Association of Ontario (2012) Facilitating Client Centred Learning. Toronto. ON Retrieved from Facilitating Client Centred Learning | Registered Nurses' Association of Ontario (rnao.ca)

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.

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.

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.

This nursing best practice guideline will address the therapeutic relationship and its central importance to  practice.

Registered Nurses Association of Ontario (2002)  Establishing therapeutic Relationships. Toronto, ON retrieved from Establishing Therapeutic Relationships | Registered Nurses' Association of Ontario (rnao.ca)

This Best Practice Guideline focuses on nursing teams and processes that foster healthy work environments. The focus for the development of this guideline was managing conflict among nursing and healthcare teams with the view that while some conflict is preventable, healthy conflict can also be beneficial.

For the purpose of this document, conflict is defined as: a phenomenon occurring between interdependent parties as they experience negative emotional reactions to perceived disagreements and interference with the attainment of their goals (Barki & Hartwick, 2004).

Registered Nurses’ Association of Ontario. (2012). Managing and Mitigating Conflict in Health-care Teams. Toronto, ON: http://rnao.ca/bpg/guidelines/managing-conflict-healthcare-teams

Cette ligne directrice fournit des recommandations fondées sur les données probantes à l'intention des infirmières autorisées et des infirmières auxiliaires autorisées, relatives à l'évaluation et à la prise en charge de personnes ayant une colostomie, une iléostomie ou une urostomie, y compris l'évaluation et la prise en charge de la peau péristomiale. Cette ligne directrice met l'accent sur trois domaines des soins : préopératoire, postopératoire et suivi. Tous les individus stomisés, d'un bout à l'autre du continuum des soins, y compris les besoins de la famille et des fournisseurs de soins, sont pris en considération. Cette ligne directrice devrait s'appliquer à tous les domaines des soins infirmiers, y compris la pratique clinique, l'administration et l'éducation.

Référence : Registered Nurses' Association of Ontario. (2009). les soins de stomie et de la gestion. Toronto, Ontario : auteur. Récupérée de :http://rnao.ca/bpg/translations/soins-et-prise-en-charge-des-stomies

he purpose of the Transitions in Care and Services guideline is to provide evidence-based recommendations for nurses and members of the interprofessional team, organizations and the health system to support safe and effective transitions in care for pediatric (17 years and younger) and adult (18 years and older) persons and their support network. This BPG recognizes that persons and their support network who are encountering a transition in care are experts in their health and decision-making. Collaboration among the interprofessional team, the person receiving care and their support network is therefore essential to achieving improved health outcomes. 

This BPG replaces the RNAO BPG Care Transitions published in 2014 (5). https://rnao.ca/bpg/guidelines/transitions-in-care

Registered Nurses’ Association of Ontario (RNAO). Transitions in care and services. 2nd ed. 2023, Toronto (ON).

This nursing best practice guideline will address the therapeutic relationship and its central importance to nursing practice

Registered Nursing Association of Ontario (2002) Establishing Therapeutic Relationships. Toronto, ON Retrieved from Establishing Therapeutic Relationships | Registered Nurses' Association of Ontario (rnao.ca)

La ligne directrice sur les pratiques exemplaires (LDPE) Une approche proactive de la gestion de la vessie et des intestins chez les adultes Quatrième édition, remplace les LDPE de la RNAO Favoriser la continence par le déclenchement de la miction et Prévention de la constipation chez les personnes âgées - Lignes directrices sur les pratiques, toutes deux mises à jour pour la dernière fois en 2011. Cette LDPE fournit des recommandations fondées sur des preuves pour des stratégies efficaces pour soutenir les adultes (âgés de 18 ans et plus) qui vivent avec l'incontinence urinaire, l'incontinence fécale et/ou la constipation qui amélioreront la qualité des soins et mèneront à des résultats de santé positifs.

Le LDPE comprend des énoncés de bonnes pratiques sur la réalisation d'une évaluation initiale ciblée et des domaines de recommandation qui traitent des éléments suivants : stratégies d'élimination des toilettes, activité physique, apport adéquat de fibres et/ou de liquides, approche interprofessionnelle et protocole intestinal.

Ces LDPE peuvent être utilisées par les infirmières, les membres de l'équipe interprofessionnelle et les soignants dans tout le continuum de soins et dans tous les domaines de pratique tels que l'administration, la clinique, l'éducation, les politiques et la recherche. Les recommandations fondées sur des données probantes de ce LDPE s'appliquent à tous les milieux de pratique où les personnes qui vivent avec une incontinence urinaire, une incontinence fécale et/ou une constipation accèdent à des services.

Registered Nurses' Association of Ontario (2020)  Une approche proactive de la gestion de la vessie et des intestins chez les adultes retrieved from Bladder_and_Bowel_Management_FINAL_WEB_FR_LR_0.pdf (rnao.ca)

Appendix B is a list of topics and resources that align with the best practice guideline: Diabetic foot ulcers: Prevention, assessment and management.

Reference: Registered Nurses’ Association of Ontario, (2024). Appendix b of Diabetic foot ulcers: Prevention, assessment and management, Third edition. Toronto, Canada: Author pp. 96.

Cette trousse d'outils a été conçu pour aider les établissements de santé à maximiser le potentiel de LDPE, par le biais de mise en œuvre systématique et bien planifiée. Il a été également conçu pour accompagner les soins infirmiers pratiques recommandées (NBPGs) mis au point par la Registered Nurses' Association de l'Ontario (RNAO) afin de faciliter leur mise en œuvre.

This tool helps the resident identify their responses to stress and their individualized coping strategies.

Copyright Centre for Addiction and Mental Health (2008). Reprinted with permission from CAMH

Appendix S from the RNAO A Proactive Approach to Bladder and Bowel Management in Adults — Fourth Edition provides systematic approaches to decreasing constipation.

Registered Nurses’ Association of Ontario (RNAO). A proactive approach to bladder and bowel management in adults. 4th ed. Toronto (ON): RNAO; 2020. (p. 150-151).

This document provides two examples of oral care plans for long-term care. 

This self-screening tool provides a systematic method for foot ulcer prevention and ongoing screening, which can be used by individuals and care partners.

Reference: Registered Nurses’ Association of Ontario, (2024). Appendix F of Diabetic foot ulcers: Prevention, assessment and management, Third edition. Toronto, Canada: Author. pp. 107-112.

The article highlights the basics of shared governance and how to establish committees and outlines the role of a quality committee.

Reference: Ward. J. (nd) Retrieved from http://www.nursetogether.com/shared-governance-what-exactly-it

This decision tree can be used to this determine if a siderail is a restraint or if alternatives are available.

Source: Talerico, K. & Capezuti, E. Myths and Facts About Side Rails: Despite Ongoing Debates About Safety and Efficacy, Side Rails Are Still a Standards Component of Care in Many Hospitals. So How Do You Determine Their Safe Use? AJN: American Journal of Nursing, Volume 101, Issue 7, pp. 43-48. Reprinted with permission from Wolters Kluwer Health

A one-time, single resident assessment for 30 signs and symptoms of dehydration.

Author and Date unknown

Cette affiche du Regional Geriatric Program de Toronto nous donne 6 stratégies pour prévenir et soutener le délire.

© 2019 Regional Geriatric Program of Toronto. All Rights Reserved.

These presentation slides contain information related to the risks, assessment , prevention and treatment of skin tears in long term care.

Reference: Mings, D., (2013) Skin Tear Management. RNAO Skin and Wound webcast series.

This pathway is recommended to determine those at risk and in need of a skin tear risk reduction program.

Web Address: http://journals.lww.com/aswcjournal/Fulltext/2013/10000/International_Skin_Tear_Advisory_Panel__A_Tool_Kit.7.aspx

Please refer to this link for further information on how to apply for permission for re-use

Reference: International Skin Tear Advisory Panel: A Tool kit to aid in the Prevention, Assessment and treatment of skin Tears using a Simplified Classification System. Advances in Skin and Wound Care. 26 (10): 459-476, October 2013.

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 .

Ce travail est financé par le Ministère de la Santé et Ministère des Soins de longue durée de l'Ontario

This tool is utilized when exploring the spiritual aspects of end-of-life.  ©1999 Christina Puchalski, M.D.

Retrieved from  The George Washington Institute for Spirituality & Health https://smhs.gwu.edu/gwish/clinical/fica/spiritual-history-tool 

A validated fall risk self-assessment tool developed by the Greater Los Angeles VA Geriatric Research Education Clinical Center and affiliates.

https://www2.gov.bc.ca/assets/gov/people/seniors/health-safety/pdf/staying_independent_checklist_interactive.pdf

Seniors BC, Authors: Vivrette, Rubenstein, Martin, Josephson & Kramer, 2011). This brochure is adapted with the permission of J.Stevens, R.Vivrette, J.Kramer, & L. Rubenstein

This information from the Colostomy Association in Britain provides practical suggestions for the most common stoma problems such as Ballooning; Constipation/Diarrhoea; Odour; Pancaking; etc.

Web Address: Colostomy Association. 2017. Stoma Problems. Accessed Aug. 22, 2017 at: http://www.colostomyassociation.org.uk/index.php?p=201&pp=3&page=Problematic%20Stomas

Reference: Colostomy Association. 2017. Stoma Problems. Accessed Aug. 22, 2017 at:  http://www.colostomyuk.org/information/stoma-problems/ 

This resource features the Arksey and O’Malley framework (186), a scoping review conducted to explore the current evidence on culturally safe strategies that can be used in the care of persons with diabetes or, at risk of or living with diabetic foot ulcers and their care partners.

Reference: Registered Nurses’ Association of Ontario, (2024). Appendix C of Diabetic foot ulcers: Prevention, assessment and management, Third edition. Toronto, Canada: Author pp. 97-103.

This presentation outlines the assessment and management of the types of pain experienced following a stroke.

This Government of Ontario website contains the Substitute Decisions Act and Regulations that fall under it.

Reference: Substitute Decisions Act 1992 Website: https://www.ontario.ca/laws/statute/92s30

This clinician pocket-card provides suicide information and is based on the Canadian Coalition for Seniors Mental Health national guideline: The Assessment of Suicide Risk and Prevention of Suicide

Reference: Canadian Coalition for Seniors Mental Health (2000). National Guidelines for Seniors Mental Health- The Assessment of Suicide Risk and Prevention of Suicide Brochure. Retrieved from http://ccsmh.ca/wp-content/uploads/2016/03/CCSMH_suicideBrochure.pdf  

The CAMH Suicide Prevention and Assessment Handbook is a quick, comprehensive and interactive starting point for staff across all clinical programs on the subject of suicide assessment and management. It provides key clinical information, current CAMH tools and resources, and further population-specific resources.

Reference: Canadian Association of Mental Health (CAMH). (2015). Retrieved from https://www.camh.ca/en/hospital/health_information/a_z_mental_health_and_addiction_information/suicide/Documents/sp_handbook_final_feb_2011.pdf 

A website from Government of Canada about suicide, prevention, risk factors, how to get help. It reviews potential risks, prevention, factors that may increase risk and resources along with overview of federal initiative in suicide prevention.

Reference: https://www.canada.ca/en/public-health/services/suicide-prevention.html 

https://www.canada.ca/en/public-health/services/publications/healthy-living/overview-federal-initiatives-suicide-prevention.html 

Supportive and Palliative Care Indicator Tool SPICT™ helps clinicians identify people with one or more general indicators of poor or deteriorating health and clinical signs of life-limiting conditions for assessment and care planning.
A single page tool that includes general (i.e. weight loss, hospital admissions, etc.) and broad specific disease indicators (i.e. breathlessness at rest for heart and respiratory disease). Also includes an assessment paradigm.

Venous leg ulcers can occur in both men and women; and may develop as a result of any injury to the leg or conditions such as varicose vein, blood clot in the leg, multiple pregnancies, overweight and standing for long periods of time (e.g., job related situations). They can take long time to heal and are costly to treat. Venous leg ulcers can also cause you to not be able to move and get around.

Retrieved from: http://rnao.ca/bpg/fact-sheets/taking-care-your-legs

This comprehensive website from the Canadian Continence Foundation has resources on both urinary and fecal incontinence. Including information about bladder health, causes of urinary incontinence, diagnosis and treatment of urinary incontinence, pamphlets and videos. 

Reference: The Canadian Continence Foundation. Retrieved at: https://www.canadiancontinence.ca/

The Fixing Long-Term Care Act, 2021 (FLTCA) was proclaimed into force to regulate Ontario's long-term care home sector.
The Long-Term Care Homes Act, 2007 (LTCHA) was revoked, which means it is no longer in force. The new Act also includes a new regulation.

Government of Ontario (2021) Fixing Long-Term Care Act, 2021. Toronto ( ON) retrieved from Fixing Long-Term Care Act, 2021, S.O. 2021, c. 39, Sched. 1 (ontario.ca)

The Fixing Long-Term Care Act, 2021 (FLTCA) was proclaimed into force to regulate Ontario's long-term care home sector.
The Long-Term Care Homes Act, 2007 (LTCHA) was revoked, which means it is no longer in force. The new Act also includes a new regulation.

Government of Ontario (2021) Fixing Long-Term Care Act, 2021. Toronto ( ON) retrieved from Fixing Long-Term Care Act, 2021, S.O. 2021, c. 39, Sched. 1 (ontario.ca)

The link takes you to screening questionnaires for neuropathic pain that incorporates the persons signs and symptoms.

https://cdn-links.lww.com/permalink/aap/a/aap_40_3_2015_02_20_brulotte_rapm2014-216_sdc2.pdf

Source: Bennett M, The LANSS Pain Scale: The Leeds assessment of neuropathic symptoms and sign. Pain 2001;92: 147- 157

The Ontario Palliative Care Competency Framework A Reference Guide for Health Professionals and Volunteers - The Health Services Delivery Framework aims to provide guidance on how to optimize the current palliative care delivery model to ensure that the right care is provided by the right provider at the right time. This document focuses on adults with a progressive, life-limiting illness, who would benefit from palliative care along with the supports required for their families and caregivers. The document emphasizes the important role of education in building capacity for palliative care, as well as the need for providers to have the necessary competencies.

Reviews how to support workplace and colleagues as a result of suicide, along with workplace bullying and strategies to minimize suicide rates.

Reference: The workplace suicide prevention toolkit: Center for Suicide Prevention, Canadian Mental Health Association; https://www.suicideinfo.ca/wp-content/uploads/2017/05/Workplace-Toolkit.pdf 

© Center for suicide prevention, All contents of the Centre for Suicide Prevention Web Site are: © Centre for Suicide Prevention and/or its suppliers. All rights reserved.

The link takes you to the COllege of Nurses of Ontario webcast on Therapeutic Nurse-Client Relationship – Maintaining Boundaries

Amy Edmondson, Novartis Professor of Leadership and Management at Harvard Business School, describes three key actions to foster a psychologically safe work environment. In a 4 minute video she highlights;

1. Frame the work – leaders need to let workers know why the work is so important and remind people the work done in health care is uncertain and there is a potential for error. It is suggested in the video the need to be open and bring full self to work

2. Model fallibility –Leaders need to be inclusive “hey I may miss something, I need your help” she suggest leaders actively get input from others.

3. Embrace, thank people and close the loop.

A toolkit from Mental Health Commission of Canada information and access to resources on suicide grief, immediate aftermath, advocacy, information for first nations and capacity building tools.

Reference: Available online: Toolkit for survivors of suicide loss and Postvention professionals; https://www.mentalhealthcommission.ca/English/initiatives/11889/tool-kit-survivors-suicide-loss-and-postvention-professionals 

© (2013) Mental Health Commission of Canada. All rights reserved. All materials (including the organization and presentation of such material) on this Web site (the "Materials") are the property of MHCC and its licensors and may be protected by intellectual property laws including laws relating to copyrights, trade-marks, trade-names, internet domain names and other similar rights. Access and use of this Web site is provided by MHCC to accept identified and agree to the listed Terms of Use; such as the information must only be used for lawful purposes, no interference to the website, visit the terms of use periodically as it is updated regularly.

This information sheet from the Canadian Continence Foundation- describes what bladder training is, provides tips to decide whether bladder training is feasible and how to get started.

Retrieved from: https://static1.squarespace.com/static/65a5be5a40b6451450a341e1/t/662badf174edb437138841a2/1714138610191/TrainingYourBladder.pdf

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/ 

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/

Management of Chronic Non-Cancer Pain – Center for Effective Practice
“This tool is designed to help family physicians and nurse practitioners (primary care providers) develop and implement a management plan for adult patients with chronic non-cancer pain (CNCP). This tool applies to, but is not limited to pain conditions such as osteoarthritis, low back pain, musculoskeletal pain, fibromyalgia and neuropathic pain.”

U-FIRST! Is a proven and effective approach to working with people with dementia. Through dialogue and a case-based approach, learners will have more confidence in working with people with responsive behaviours. Training is especially designed for people working in community care, acute care and long-term care. For more information visit www.u-first.ca.  Permission to post obtained from Cathy Conway.

The educational website contains:

• A narrated presentation about pain and dementia
• A downloadable resource pack for family members, and
• A downloadable pain-log and the PAINAD assessment tool (Warden, Hurley, Volicer, 2003)

A facilitator's toolkit of background material, a planning guide, promotional material, and supplemental information for organizations who wish to conduct a workshop using he materials.

Retrieved from: http://brainxchange.ca/Public/Resource-Centre-Topics-A-to-Z/Pain.aspx

This link takes you to the CDRAKE and AKE combined activities to form an exciting new network.

This falls prevention poster lists approaches for safe environments, mobility, fall risk reduction and engaging patients and families.

Sources: Degelau et al., 2012; Scott, 2013; Wallis & Campbell, 2011.

Registered Nurses’ Association of Ontario.  (2017).  RNAO Prevention of Falls and Reducing Injury from Falls Best Practice Guideline. (4th Ed.).  Toronto, ON: Author. Pg. 115

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

This resource highlights a treatment plan for an elderly person with a diagnosis of memory impairment who develops a urinary tract infection that results in delirium. 

© 2022 Alzheimer's Society.

The Centre for Effective Practice provides the BPSD Discussion Guide designed to help providers understand, assess, and manage residents in long-term-care homes with behavioural and psychological symptoms of dementia, with a focus on antipsychotic medications.

Reference: Centre for Effective Practice (2016). Use of Antipsychotics in Behavioural and Psychological Symptoms of Dementia (BPSD) Discussion Guide. Retrieved from https://cep.health/media/uploaded/UseofAntipsychotics_LTC2016-2.pdf

© April 2016. Version 2. Centre for Effective Practice Inc. All Rights Reserved.

This PHO resource provides basic facts about asymptomatic bacteriuria

Reference: Public Health Ontario, 2014, Asymptomatic Bacteriuria Fact Sheet. Retrieved from http://www.publichealthontario.ca/en/Pages/default.aspx

This resource can be used by health care providers at the long-term care homes (LTCHs) when consulting or meeting with friends and families of residents who have questions about a LTCH’s approach to managing suspected UTIs.

Reference: Public Health Ontario (PHO). Revised 2016. Retrieved from https://www.publichealthontario.ca/-/media/Documents/U/2016/uti-faq-residents-families.pdf?sc_lang=en

This policy and procedure is part of Public Health Ontario’s Urinary Tract Infection (UTI) Program. It is a comprehensive policy that could be adapted by long term care homes and other health care organizations. It is complimented by a guidance document available on the PHO website.

Reference: Public Health Ontario (PHO). Revised 2019. UTI Program: Sample policy and procedure for assessment and management of urinary tract infections (UTIs) in non-catheterized residents. Retrieved from https://www.publichealthontario.ca/-/media/Documents/U/2018/uti-sample-policy-procedure.pdf?sc_lang=en

Public Health Ontario (PHO) has developed the Urinary Tract Infection (UTI) Program in response to concerns about the overuse of antibiotics for presumed UTI's in residents in long-term care homes (LTCHs) and the associated antibiotic-related harms. The Program contains a number of tools for assessment, planning, implementation and evaluation of a program to reduce UTI’s in LTC homes.

Reference: Public Health Ontario (PHO), 2019. Urinary Tract Infection (UTI) Program.

Retrieved Aug. 4, 2022 from https://www.publichealthontario.ca/en/Health-Topics/Antimicrobial-Stewardship/UTI-Program

© 2022 Ontario Agency for Health Protection and Promotion

Webinar Presentation by Vision Nursing Home's Kathleen Waller, BPSO Lead and Charge Nurse An overview of Vision Nursing Home's journey through their BPSO year one candidacy while implementing the Best Practice Guideline on Prevention of Falls and Fall Injuries in the Older Adult. It highlights strategies and processes during implementation and for sustainability, includes challenges and successes, data collection, monitoring and evaluation.

This pamphlet has an algorithm to help decide on whether and to whom to report elder abuse, as well as elder abuse resources in Ontario. This is one of a suite of resources from Elder Abuse Ontario in the Helping Seniors section of their website.

Web Source: Elder Abuse Ontario. 2015. What To Do If You Suspect Elder Abuse. http://www.elderabuseontario.com/what-is-elder-abuse/help-for-seniors/educational-materials-for-seniors/

Reference: Elder Abuse Ontario. 2015. What To Do If You Suspect Elder Abuse. Accessed Feb. 2, 2017 at file:///C:/Users/sumani/Downloads/What-To-Do-If-You-Suspect-Elder-Abuse-2016.pdf

This pamphlet is helpful in preparing families and caregivers for understanding the final stage of life.  

Prepared by Ida Tigchelaar, RN, Palliative Care Pain & Symptom Management/Education Consultant, Oxford & Elgin Counties of Ontario.

This CNO document discusses the 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

Wound infection assessment tools, NERDS© and STONEES© are methods used to systematically assess for superficial critical colonization (localized infection) and deeper and surrounding infection (systemic infection), respectively, in people with pressure injuries. The methods described in this resource are suggestions that were identified through the systematic review and by feedback from the expert panel or external reviewers. Both kinds of infections must be treated in order to avoid delays in wound healing.

Reference: Registered Nurses’ Association of Ontario, (2024). Appendix N of Pressure injury management: Risk assessment, prevention and treatment - Fourth edition. Toronto, Canada: Author. pp. 111-112.

Wounds Care (formally CAWC) s a non-profit organization dedicated to the advancement of wound prevention and management by being the leading knowledge mobilization organization relating to wounds in Canad

The wounds canada website provides information on the role of the organization and educational offerings that support the advancement of wound care in Canada.