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

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

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.

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

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

Source: https://rnao.ca/bpg/guidelines/promoting-safety-alternative-approaches-use-restraints?_ga=2.257239755.1702348378.1602485970-1685849072.1567072300 

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- A Proactive Approach to Bladder and Bowel Management. 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 and Care of Adults at Risk for Suicidal Ideation and Behaviour. 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 and Management of Venous Leg Ulcers. Toronto, ON.

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

This guideline provides best practice recommendations in three main areas:

• Practice recommendations are directed primarily to those who provide direct care to persons in health-system settings and in the community.

• Education recommendations are directed to those responsible for staff and student education.

• System, organization, and policy recommendations apply to managers, administrators, policy-makers, nursing regulatory bodies, academic institutions, and government bodies.

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

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

This best practice guideline (BPG) provides evidence-based recommendations to nurses and the interprofessional health team who support adults experiencing the last 12 months of a progressive life-limiting illness, and their families and caregivers. 

Registered Nurses’ Association of Ontario (2020). A Palliative Approach to Care in the Last 12 months of Life. Toronto, ON: Author.

Retrieved from: https://rnao.ca/bpg/guidelines/palliative-approach-care-last-12-months-life

© 2020 RNAO. All rights reserved

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

This presentation reviews strategies of sizing and distribution for improving continence product usage. Developed by Deb Jenkins, APN, Improving Continence Care Collaborative Co-lead, SHRTN Community of Practice. December 2011.

The 4AT is a validated rapid assessment test for delirium and cognitive impairment. It is widely used in routine clinical practice in the UK and internationally. It is free for download and use.

Reference: MacLullich, A., Ryan, T. and Cash, H. (2014). 4AT Rapid Assessment Test for Delirium. Retrieved from http://www.the4at.com/

This is a comprehensive guide for caregivers caring for a stroke survivor by March of Dimes program, Stroke Recovery Canada. It provides information and tips on stroke recovery for caregivers.
Reference: March of Dimes. (n.d.). Stroke Recovery Canada. Caregivers guide to stroke recovery (2nd ed).

Retrieved from: https://tbrhsc.net/wp-content/uploads/2014/12/2011_caregiver_resource.pdf

This handout features promising practices to help move long-term care homes towards becoming safe, welcoming and inclusive spaces for the 2SLGBTQI+ community. It was developed as a supplement to the presentation delivered at the AdvantAge Ontario Convention on “A Home for All: Making Long-Term Care Welcoming for 2SLGBTQI+ People” in May 2019. This work stems from the Ontario Centres for Learning, Research and Innovation in Long-Term Care (CLRI)’s Supporting Diversity and Inclusion Advisory Group.

This model guides all activities related to hospice palliative care, and develop local standards of practice.  The model is built on an understanding of health, the illness and bereavement experiences, and the role hospice palliative care plays in relieving suffering and improving quality of life. 

Copyright © 2002, Canadian Hospice Palliative Care Association. All Rights Reserved.

The Abbey Pain Scale is an instrument designed to assist in the assessment of pain in patients who are unable to clearly articulate their needs, for example, patients with dementia, cognition or communication issues. The scale does not differentiate between distress and pain, so measuring the effectiveness of pain-relieving interventions is essential.

Abbey, J; De Bellis, A; Piller, N; Esterman, A; Giles, L; Parker, D and Lowcay, B. Funded by the JH & JD Gunn Medical Research Foundation 1998 – 2002. This document may be reproduced with this acknowledgment retained.

https://www.apsoc.org.au/PDF/Publications/Abbey_Pain_Scale.pdf

Key facts about the abuse of older people in both community and institutional settings globally is presented, including emerging evidence that indicates the prevalence of abuse of older people increased during the COVID-19 pandemic. Consequences, risk factors and prevention of abuse of older people is discussed.

https://www.who.int/news-room/fact-sheets/detail/abuse-of-older-people#:~:text=Even%20if%20the%20proportion%20of,to%202%20billio

Copyright @ 2023 WHO 

Health HQ Neuropathic Pain Resources - This website provides access to resources related to neuropathic pain.

https://www.painhq.org/

Toolkit contains easy to use resources to support uptake of the guideline at practice, education, policy, organizational and systems levels. The toolkit includes a E-Learning course (4 modules) on Elder Abuse for leadership and staff with various knowledge-based activities and supplementary resources.

Reference: Registered Nurses' Association of Ontario. (2015). Addressing Abuse of Older Adults: An RNAO Initiative-Best Practice Success Kit. Toronto, ON: Author. Retrieved from http://rnao.ca/bpg/initiatives/abuse-and-neglect-older-adults-pan-canadian-best-practice-guideline-initiative

Canadian Centre for Effective Practice has developed resources for the care of adults living with mental health and addiction. Keeping Your Patients Safe: A Guide to Primary Care Management of Mental Health and Addictions-related Risks and Functional Impairments Tool is designed to assist primary care providers in identifying, assessing and managing risks in a patient with diagnosed, undiagnosed or changing mental health conditions.

Reference: Canadian Centre for Effective Practice (2017). Adult Mental Health. Retrieved from https://thewellhealth.ca/mentalhealthrisk 

Advance Care Planning, Goals of Care, and Treatment Decisions & Informed Consent- Frequently Asked Questions (FAQ)

Copyright @ 2022 Canadian Palliative Care Network

This link takes you to the AdvantAge Ontario Website for implementation resources, you can scroll down to find a section on Minimizing Restraining and Use of Personal Assistance Services Devices (PASDs). Under this section there are documents related to: 1) Policy, procedure and training package and 2) Appendix materials, including: i) physical restraint monitoring, ii) restraint audit tool, and iii) least restraint, last resort training presentation.  

Copyright: AdvantAge Ontario 

Website: www.advantageontario.ca   

This document contains a sample policy and procedures to support compliance and meet the requirements of s. 20(1) and (2) of the Long-Term Care Homes Act, 2007 and its Regulation.

AdvantAge Ontario Long-Term Care Homes Act (LTCHA) Implementation Member Support Project resources are confidential documents for AdvantAge members only. Any review, retransmission, dissemination or other use of, or taking of any action in reliance upon this information, by persons or entities other than the intended recipients is prohibited without the approval of AdvantAge.

Reference: Ontario Association of Non-Profit Homes and Services for Seniors. (2012). Zero tolerance for abuse and neglect: Sample policies and procedures. Retrieved from http://www.oanhss.org/MediaCentre2/LTCHomesActCentralseeSiteNavigation/LTCHA_Resources.aspx?WebsiteKey=112387af-5c3c-42f5-bfce-85c542bee396
 

Appendix H from the RNAO A Proactive Approach to Bladder and Bowel Management in Adults — Fourth Edition is a systematic approach to dealing with constipation and fecal incontinence. 

Registered Nurses’ Association of Ontario (RNAO). A proactive approach to bladder and bowel management in adults. 4th ed. Toronto (ON): RNAO; 2020. (p. 132).

Appendix G from the RNAO A Proactive Approach to Bladder and Bowel Management in Adults — Fourth Edition shows how the best practice guideline recommendations can be applied in the clinical setting. 

Registered Nurses’ Association of Ontario (RNAO). A proactive approach to bladder and bowel management in adults. 4th ed. Toronto (ON): RNAO; 2020. (p.131).

The Alternative Approaches List is a table with examples and suggested alternatives and patient behaviours.

All request to adapt the Alternative Approaches to Restraint use must be directed to the Ottawa Hospital, Department of Nursing Professional Practice

This Alzheimer Canada website section provides resources for health care professionals.  Ambiguous Grief and Loss, Pain, End of Life and Culture Change, is a resource that addresses the issue of loss and grief while supporting those living with dementia and their caregivers.

Retrieved from: https://alzheimer.ca/en/help-support/i-have-friend-or-family-member-who-lives-dementia/managing-ambiguous-loss-grief

©2024 Alzheimer Society of Canada. All rights reserved.

This organization provides support to families and clients affected by Alzheimer’s disease. Links are provided to a chapter near you. Web site is also available in French.  Website: www.alzheimer.ca/en/on.

The Website is copyrighted by the Alzheimer Society of Canada.

Anxiety symptoms are extremely common. In the primary care setting, a major task is to determine whether the symptoms are a reaction to a distressing situation, indications of an anxiety or other psychiatric disorder such as depression, or signs of a non-psychiatric condition. This resource provides clinical tools for screening, assessment, diagnosis, and treatment.

Reference: Centre for Addiction and Mental Health (2022). Anxiety Disorders. Retrieved from https://www.camh.ca/en/professionals/treating-conditions-and-disorders/anxiety-disorders

Appendix F - provides a summary of related approaches and tools for assessing fall risk. The tools are categorized as follows: gait and balance; general fall risk and fear of falls. It is important for the organization to review the findings to support selection of tools for settings and population(s) served noting that other tools are available that address specific risk factors.

This resource describes two mnemonics for wound assessment. ‘NERDS’ is used to systematically assess for superficial critical colonization (localized infection) and STONEES to access deeper and surrounding infection (systemic infection) in people with pressure injuries. NERDS: N – non-healing wound; E – exudate; R – red and bleeding. D – debris; and S – smell. STONEES: S – size; T – temperature: O – os; N – new or satellite areas of breakdown: E – exudate; E – erythema and/or edema (cellulitis); and S – smell.

Reference: Registered Nurses Association of Ontario (RNAO). 2016. Appendix K: Assessment for Infection. Assessment and Management of Pressure Injuries for the Interprofessional Team, Third Edition. Accessed July 28, 2016 http://rnao.ca/sites/rnao-ca/files/PI_BPG_FINAL_WEB_June_10_2016.pdf  pp. 135-136.

This table from Appendix K pages 152-153 of the BPG Delirium, Dementia and Depression in Older Adults: Assessment and Care (2016) helps us reflect on our own attitudes, skills and knowledge about dementia and provides tips for successful interpersonal skills with residents with dementia.

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

The Behaviour Monitoring Log from Penn Nursing Science helps determine the meaning of untoward events through examining patterns of behaviours/occurrences.

Adapted from: Strumpf, N., Robinson, E.J.P., Wagner, J.S., & Evans L.K. (1998). Restraint-Free Care: Individual Approaches for Frail Elders. New York: Springer Publishing, pp. 44-46. Reprinted with permission from Penn Nursing Science.

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

This leaflet on bladder and bowel incontinence is written is simple language.  It provides practical solutions to dealing with incontinence.  It is aimed at family’s supporting a relative with dementia, but is suitable for staff in long term care homes. 

Reference:

The Canadian Continence Foundation. No date. Bladder and Bowel Problems in People Living with Dementia. Accessed Mar. 18, 2018. http://www.canadiancontinence.ca/pdfs/Dementia-English.pdf

Copyright © 2018 The Canadian Continence Foundation

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.

Canadian Dementia Resource and Knowledge Exchange (CDRAKE) and Alzheimer Knowledge Exchange (AKE) have amalgamated to create this new hub of dementia resources. Contained within are links to Behaviour Support Ontario (BSO), Psychogeriatric Resource Consultants (PRC) and many resources pertinent to dementia and responsive behaviours.

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
 

A powerpoint presentation that succinctly describes ways to prevent Catheter-associated Urinary Tract Infections based on the CDC guideline.

Reference: Centre for Disease Control and Prevention. (CDC). 2009. Catheter-associated Urinary Tract Infections Toolkit. http://www.cdc.gov/HAI/pdfs/toolkits/CAUTItoolkit_3_10.pdf.

Numerous resources available with a simple search engine within this website

Reference: Centre for Suicide Prevention [Online] Available: https://www.suicideinfo.ca/resources/ 

Copyright: The Centre for Suicide Prevention Web Site is offered to you conditioned on your acceptance without modification of the terms, conditions, and notices contained herein. Your use of the Centre for Suicide Prevention Web Site constitutes your agreement to all such terms, conditions, and notices.

A short, easy guide to help keep ageism out of your writing. These guidelines for age-inclusive communications address: what is ageism and why should we care; terminology to avoid and preferable terms; ageist imagery vs age-positive images; and avoiding ageist storylines

Cinq mesures à adopter pour vous protéger Fiche de renseignements pour la sensibilisation en matière de santé. Association des infirmières et infirmiers autorisés de l’Ontario (2014, juillet).

Cinq mesures à adopter pour vous protéger . Toronto, ON, Canada: Auteur. Récupérée de http://rnao.ca/bpg/guidelines/fact-sheets/cinq-mesures-%C3%A0-adopter-pour-vous-prot%C3%A9ger

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 helpful table from Appendix D (page 127) of the BPG Delirium, Dementia and Depression in Older Adults: Assessment and Care (2016) helps to distinguish among delirium, dementia and depression where features are often similar or overlapping.

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

The Comprehensive Geriatric Assessment (CGA) Toolkit is comprised of multiple resources for the personalized and person-centred care of the elderly. This link will take you to the page where you will find descriptions and possible signs and symptoms of the different types of abuse. A description and link for the Elder Assessment Instrument (EAI): Screening tool for elder mistreatment is provided, as are interventions that should be carried out based on the findings of the conducting clinician. Additional resources like hand-outs, videos and other tools are also available in the toolkit.

Reference: https://www.cgakit.com/elder-abuse

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

This practice guideline provides an overview of the major features of the legislation, pertinent definitions, the steps nurses need to take to obtain consent and the Guidelines for Nurses Advocating for Clients Found Incapable of Making Certain Decisions. It replaces an earlier Guide to the Health Care Consent and Substitute Decisions Legislation for RNs and RPNs. It does not address consent under the Mental Health Act.

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

This conversation sheet from Alzheimer Canada informs how dementia can affect intimacy and sexuality. Strategies are provided for caregivers. There is also a section to support LGBTQ persons with dementia.

The Alzheimer Society is Canada’s leading health charity for people living with Alzheimer’s disease and other dementias. For more information visit the home page www.alzheimer.ca  

These tips and interventions help caregivers to examine their own practices and best strategies to prevent escalation of behaviours.

Provided by the Milwaukee County Mental Health Division, Milwaukee, WI

Adapted from Dr. Gudeman's Interaction with Patient on Interventions with De-Escalating Patient 10/99

The Decision Making Framework provides an ethical approach for choosing care strategies following the observation of a deliberate act.

Retrieved from http://ccethics.com/ethics-service/decision-making-framework/ 

A one time, single resident risk assessment for dehydration based of the University of Iowa Dehydration BPG.

References:

Mentes, J. C. & The Iowa Veterans Affairs Nursing Research Consortium. (2004). Evidence-Based Practice Guideline: Hydration management. Iowa City, IA: The University of Iowa Gerontological Nursing Interventions Research Center Research Translation and Dissemination Core.

Mentes, J. C. & Iowa-Veterans Affairs Research Consortium. (2000). Hydration management. Journal of Gerontological Nursing, 6-15.

Appendix G from pages 133-134 of Delirium, Dementia and Depression in Older Adults: Assessment and Care (2016) identifies risk factors and related interventions for delirium.

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

Indigenous Cognitive and Aging Awareness Research Exchange (I-CAARE) offers a number of factsheets, a health wheel and pathway for persons with dementia and their caregivers. The indigenous perspective may provide added support and comfort to families as they journey through dementia.

Reference: Indigenous Cognitive and Aging Awareness Research Exchange (2023). Dementia Factsheets. Retrieved from: https://www.i-caare.ca/factsheets 

©  2023 ICARE

This document from Mood Disorders Society of Canada considers a variety of strategies to manage depression in older persons.

Reference: Mood Disorders Society of Canada (n.d.) Depression in Elderly, retrieved from http://mdsc.ca/documents/Consumer%20and%20Family%20Support/Depression%20in%20Elderly%20edited%20Dec16%202010.pdf 

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  

Copyright © 2017 The Joint Commission, One Renaissance Boulevard, Oakbrook Terrace, IL 60181

All materials posted on this site are subject to copyrights owned by The Joint Commission. The Joint Commission hereby provides limited permission to the user (you) of this site to reproduce, retransmit, or reprint for such user's own personal use part or all of any document on this site as long as the copyright notice and permission notice contained in such document or portion thereof is included in such reproduction, retransmission, or reprinting. All other reproduction, retransmission, or reprinting of all or part of any document found on this site is expressly prohibited, unless The Joint Commission has expressly granted its prior written consent. All other rights reserved. See Permissions/Reprints Policy.

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.

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

Behavioral pain assessment scale for the elderly presenting with verbal communication disorders, DOLOPLUS consists in an observation form consisting of 10 items divided into 3 sub-groups proportionally to the observed frequency (5 somatic items, 2 psychomotor items and 3 psychosocial items).

Retrieved from: https://www.doloplus.fr/pdf/doloplus-en.pdf

Copyright

This resource uses a generic classification to describe wound dressings, local wound care outcomes and care considerations.

Web Source: Appendix S of Assessment and Management of Pressure injuries for the Interprofessional Team, Third Edition http://rnao.ca/sites/rnao-ca/files/PI_BPG_FINAL_WEB_June_10_2016.pdf 

Reference: Registered Nurses’ Association of Ontario. (2016). Appendix S of Assessment and Management of Pressure Injuries for Interprofessional Team, Third Edition. Toronto, Canada: R. G. Sibbald, J. A. Elliott, E. A. Ayello, and R. Somayaj Glasgow P.148

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 L of Diabetic foot ulcers: Prevention, assessment and management, Third edition. Toronto, Canada: Author. pp. 121-125.
 

This resource has been designed to teach Registered Nurses (RNs), Registered Practical Nurses (RPNs) and Unregulated Care Providers how to implement the recommendations outlined in the RNAO Best Practice Guideline, Assessment and Management of Stage I to IV Pressure Ulcers.

There are two parts to this program; Part A is directed towards RNs and RPNs while Part B is aimed towards Unregulated Care Providers (UCP). These materials are for use by the workshop facilitator, and include a list of components, questionnaires and case studies for participants, and answer keys.

Retrieved from: http://rnao.ca/bpg/guidelines/resources/assessment-and-management-pressure-ulcers-education-program

This is a series of animated learning resources that have been created to enhance the capacity of those working with seniors and to adopt a common approach to identify and respond to elder abuse. As you move through each training module, you will be prompted by a coach who will act as your guide to make sure you maximize your learning.

Reference: Elder Abuse Ontario. (n.d.). Elder Abuse Training Tools: Interactive Animated Learning Resources_Recognizing Financial and Emotional Abuse. Retrieved from Training Tools - Elder Abuse Prevention Ontario (eapon.ca)

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

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

A fact sheet with a concise overview of Urinary Tract Infections associated with catheter use. Available in poster/printable formats. Suitable for patients, families and health care providers.

Reference: Centre for Disease Control and Prevention (CDC). 2015. FAQ’s about Catheter-associated Urinary Tract Infections. http://www.cdc.gov/hai/pdfs/uti/CA-UTI_tagged-BW.pdf.
 

Alzheimer Society Ontario's Finding Your Way® helps people living with dementia, their families, caregivers and communities to recognize the risk of going missing, be prepared for incidents of going missing, and ensure that people with dementia can live safely in the community. At this link you will find free On-line Learning about keeping people with dementia safe. You will also find a Living Safely with Dementia Resource Guide and an interactive resource guide. http://findingyourwayontario.ca/ 

Alzheimer Society of Canada (2018). Finding Your Way. http://findingyourwayontario.ca/ 

2018 Alzheimer Society of Canada

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 GDS is a screening tool to facilitate the assessment of depression in older adults. It is available in both long form and short form versions and also in multiple languages.

Reference: Yesavage, J. A., Brink, T. L., Rose, T. L., Lum, O., Huang, V., Adey, M., & Leirer, V. O. (1983). Development and validation of a geriatric depression screening scale: A preliminary report. Journal of Psychiatric Research, 17(1), 37–49. Retrieved from https://web.stanford.edu/~yesavage/GDS.html

This link takes you to the resources that include pain assessment terminology and Power Point presentations.

Reference: Sigma Theta Tau International for the Center for Nursing Excellence in Long Term Care 2013. Pain assessment terminology and narrated power point presentations. Retrieved from http://www.geriatricpain.org

This resource is a glossary of terms used throughout the best practice guideline: Diabetic foot ulcers: Prevention, assessment and management. 

Reference: Registered Nurses’ Association of Ontario, (2024). Appendix A of Diabetic foot ulcers: Prevention, assessment and management, Third edition. Toronto, Canada: Author. pp. 86-95.

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/

This guide is intended to help health care/hospice palliative care professionals and volunteers to have a conversation with and/or respond to patients or their families around Medical Assistance in Dying (MAiD).

Reference: Palliative Care and Medical Assistance in Dying (MAiD) in Canada (2017, June). Retrieved from https://www.chpca.ca/wp-content/uploads/2019/12/chpca-maid-booklet-eng-12page-final-web.pdf

This 25-minute video shows how to demonstrate an approach to oral health assessment in long term care. It is part 1 of the RNAO Long-Term Care Best Practices Program - Oral Health Assessment Series (3 parts)- 2015. Author Ibo MacDonald Retrieved from https://www.youtube.com/watch?v=sgFlgumtbJE&t=419s

Downloadable practical implementation resources on implementing Person-Centred Language in Patient Documentation

Regional Geriatric Program of Toronto ( 2022) Implement Person-Centred Language in Patient Documentation retrieved from Implement Person-Centred Language in Patient Documentation | Regional Geriatric Program of Toronto (rgptoronto.ca)

Implementing a Palliative Approach to Care in Long Term Care: An Implementation Guide and Resource Toolkit that aligns with the expanded Palliative Approach to Care requirements within the Fixing Long-Term Care Act, 2021 (FLTCA). The document is divided into 3 sections, each section starts with content related to the section’s theme, followed by a comprehensive list of resources, including hyperlinks. 
1. Key concepts in a palliative approach to care
2. Mentorship, education and support to build competency and capacity
3. Implementing a palliative approach to care

Retrieved from: https://www.palliativecareswo.ca/docs/LTCH_Resource_%20Guide.pdf  

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

This IADIT tool is an excellent resource on skin care for incontinent people. It has clear pictures, definitions and short descriptions of skin changes and rashes.

Copyright © 2008 Joan Junkin. All rights reserved. Please send request for permissions to IADIT@medbiopub.com.  

1. Bliss DZ, Zehrer C, Savik K, et al. Incontinence-associated skin damage in nursing home residents: a secondary analysis of a prospective, multicenter study. Ostomy Wound Manage. 2006;52:46–55.

2. Institute for Healthcare Improvement. Prevent Pressure Ulcers: How-To Guide. May 2007. Available at: http://www.ihi.org/nr/rdonlyres/5ababb51-93b3-4d88-ae19- be88b7d96858/0/pressureulcerhowtoguide.doc  

3. Gray M, Bliss DB, Ermer-Seltun J, et al. Incontinence-associated dermatitis: a consensus. J Wound Ostomy Continence Nurs. 2007;34:45-54.

4. Junkin J, Selekof JL. Prevalence of incontinence and associated skin injury in the acute care inpatient. J Wound Ostomy Continence Nurs. 2007;34:260-269.

This definitive report on incontinence was commissioned by the Canadian Continence Foundation. It provides an overview of both urinary and fecal incontinence in Canada. There are statistics and cost estimates on the burden of incontinence, as well as advocacy recommendations. A discussion on treatments for urinary incontinence is included.

Reference: The Canadian Continence Foundation. 2014. Incontinence: The Canadian Perspective. Accessed Mar. 18, 2018. http://www.canadiancontinence.ca/pdfs/en-incontinence-a-canadian-perspective-2014.pdf 

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.

The expert panel for the BPG Facilitating Client Centred Learning (2012) developed the L.E.A.R.N.S. Model, which describes how to support effective learning. LEARNS stands for Listen, Establish, Adopt, Reinforce, Name, Strengthen and refers to the nurse/client interaction.

Reference: Registered Nurses’ Association of Ontario (2012). Facilitating Client Centred Learning. Toronto, Canada: Registered Nurses’ Association of Ontario. pp. 19-20. http://rnao.ca/bpg/guidelines/facilitating-client-centred-learning

Les lignes directrices sur les pratiques exemplaires portent principalement sur le personnel infirmier, les équipes soignantes et les processus qui favorisent la mise en place de milieux de travail sains. Ces lignes directrices traitent de la gestion et de l’atténuation des conflits interpersonnels au sein des équipes de soins de santé. Elles partent du principe que même s’il est possible d’éviter certains conflits, des conflits sains peuvent également être bénéfiques.

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

This e-resource offered by Baycrest provides six sections of learning including understanding depression, signs and symptoms, self-check, causes, types and treatments for late-life depression.

Reference: Baycrest Health Sciences (2016) Late-Life Depression. Retrieved from http://www.baycrest.org/educate/mental-health/depression/

© 2016 BAYCREST HEALTH SCIENCES - ALL RIGHTS RESERVED. UNAUTHORIZED COPYING, REPRODUCTION, REPUBLISHING, UPLOADING, DOWNLOADING, POSTING, TRANSMITTING OR DUPLICATING ANY OF THE MATERIAL FOUND ON THIS WEBSITE IS PROHIBITED. Your use of this site constitutes your agreement to abide by these Terms of Use. Baycrest reserves the right, in their sole discretion, to modify, alter or otherwise update these Terms of Use at any time and you agree to be bound by such modifications, alterations or updates. You agree to review these Terms of Use on an ongoing basis. Baycrest hereby grants you a personal, non-exclusive, non-assignable and non-transferable license to use and display, one copy of any Material and/or software that you may download from this site, including, but not limited to, any files, codes, audio or images incorporated in or generated by the software (collectively called the “Downloaded Material”) provided, however, that you must maintain all copyright and other notices contained in such Downloaded Material. You acknowledge and agree that you may not sublicense, assign or otherwise transfer this license or the Downloaded Material and that no title to the Downloaded Material has been or will be transferred to you from Baycrest or anyone else. You also agree that you will not alter, disassemble, decompile, reverse engineer or otherwise modify the Downloaded Material.

The link will take you to the document that the Law Commission of Ontario released entitled Legal Capacity, Decision-Making and Guardianship, this  report provides a number of recommendations designed to reduce opportunities for elder abuse.

Law Commission of Ontario (2017) Legal Capacity, Decision-making and Guardianship. Toronto, On. Retrieved from:  http://www.lco-cdo.org/wp-content/uploads/2017/03/CG-Final-Report-EN-online.pdf

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: How to Safely Transfer In and Out of Bed is a two minute Osteoporosis Canada video discusses and demonstrates how to safely transfer residents in and out of bed.

LTC Series - Personal Support Worker: Proper Positioning for Sitting is a one and a half minute Osteoporosis Canada video discusses and demonstrates how to properly position residents for sitting.

Fiche de renseignements pour la sensibilisation en matière de santé.

Association des infirmières et infirmiers autorisés de l’Ontario (2002, Novembre). Maîtriser sa douleur. Toronto, ON, Canada: Auteur. Récupérée de http://rnao.ca/sites/rnao-ca/files/Maitriser_sa_douleur_0.pdf.

Why should I be concerned about foot ulcers?

Foot ulcers increase the risk of infection (a germ or bacteria that invades and damages the tissues) and may reduce your quality of life. While most foot ulcers heal, when they are left untreated, they could lead to foot amputations. This could lead to lost income, longer hospital stays and a need for special therapy.

Retrieved from: http://rnao.ca/bpg/guidelines/fact-sheets/managing-foot-ulcers-people-diabetes

Medical assistance in dying (MAID) has been legal in Canada since 2016. Nurse practitioners, physicians, pharmacists, and “persons aiding practitioners” (including nurses) are permitted to help those who have explicitly requested MAID.
Resources:

• CNA Statement on the Passage of Bill C-14 (media release)
• Code of Ethics for Registered Nurses
• Palliative care and end-of-life resources

© Copyright 2022 Canadian Nurses Association

The Ministry of Health and Long-term Care (MOHLTC) has provided an update on medical assistance in dying (MAID) implementation pieces. This webpage is to provide the general public, patients and providers with MAID-specific information, guidance and resources.

Retrieved from http://www.health.gov.on.ca/en/pro/programs/maid/default.aspx

Table 19 provides a list of medication resources for use in fall prevention and reduction of injury from falls.

A list of medications that can impact on skin integrity

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

A list of the major drug groups that can contribute to urinary incontinence. Registered Nurses’ Association of Ontario (RNAO). A proactive approach to bladder and bowel management in adults. 4th ed. Toronto (ON): RNAO; 2020.

This WHO webpage, Mental Health of Older Adults, recognizes dementia and depression in older adults as a global public health issue and identifies interventions.

Website full of educational resources with a great search engine pertaining to suicide and the elderly.

Reference: Baycrest [Online] Available: http://www.baycrest.org

Your use of this site constitutes your agreement to abide by these Terms of Use. Baycrest reserves the right, in their sole discretion, to modify, alter or otherwise update these Terms of Use at any time and you agree to be bound by such modifications, alterations or updates. You agree to review these Terms of Use on an ongoing basis. Baycrest hereby grants you a personal, non-exclusive, non-assignable and non-transferable license to use and display, one copy of any Material and/or software that you may download from this site, including, but not limited to, any files, codes, audio or images incorporated in or generated by the software (collectively called the “Downloaded Material”) provided, however, that you must maintain all copyright and other notices contained in such Downloaded Material. You acknowledge and agree that you may not sublicense, assign or otherwise transfer this license or the Downloaded Material and that no title to the Downloaded Material has been or will be transferred to you from Baycrest or anyone else. You also agree that you will not alter, disassemble, decompile, reverse engineer or otherwise modify the Downloaded Material.

A useful tool for assessing early stage dementia.  For more information or feedback on MoCA^© contact Dr Z. Nasreddine at info@mocatest.org.

Nasreddine, Z.  (2003). Welcome to the Montreal Cognitive Assessment.   Quebec, QC, Canada: Center for Diagnosis & Research on Alzheimer’s disease.  Retrieved from www.mocatest.org.  Copyright Dr Z. Nasreddine 2003 to 2013 - The Montreal Cognitive Assessment - MoCA^© - All rights reserved.

This website contains resources to assist when an individual with dementia is looking at transitioning to long-term care. The Alzheimer Society of Canada webpage has resources to support decision-making.

Reference: Alzheimer Society of Canada (2016), "Alzheimer Society of Canada, Long Term Care”. Retrieved from: https://alzheimer.ca/en/help-support/im-caring-person-living-dementia/long-term-care/moving-long-term-care

The Mutual Action Plan (MAP) takes into account the resident's individual style of learning and communicating.

MAP Behavioural Profile - Draft 2009/11/18 adapted from: Safe Management Group Inc. 2008. Copyright 2009, Ontario Shores Centre for Mental Health Sciences. All rights reserved.

Reproduction in whole or in part by any means without written consent of Ontario Shores is prohibited by law.

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. 

My Transitional Care Plan© summarizes information to facilitate successful transitions in care for older adults presenting with, or at risk of, responsive behaviours or complex mental health, substance use or neurological conditions (166). It provides a synopsis of essential information that should be communicated to members of the interprofessional team to prepare and facilitate a transition in care. The tool is written in first person to promote person-centred care, and health and social service providers should collaborate with persons and their support network when completing the form. My Transitional Care Plan© can be built within an electronic health record. The form is also available in French (166).

Registered Nurses' Association of Ontario. (2023). Appendix H of Transitions in Care and Services. (Second Ed.). Toronto, ON: Author.  pp 123-124

https://ltctoolkit.rnao.ca/sites/default/files/resources/My%20Transitional%20Care%20Plan%C2%A9-Appendix%20H.pdf

Source: Reprinted with permission from: Behavioural Supports Ontario (BSO). 

The National Pressure Injury Advisory Panel (NPIAP) serves as the authoritative voice for improved patient outcomes in pressure ulcer prevention and treatment through public policy, education and research.

Website: https://learn.npiap.com 

Neuropsychiatric Inventory (NPI) is used to assess behavioural and psychological symptoms in clients with dementia. It evaluates the frequency and severity of the following symptoms: delusion, hallucinations, agitation, depression/dysphoria, anxiety, euphoria/jubilation, and apathy/indifference, disinhibition, irritability/lability, motor behaviour without a purpose, sleep alteration, and eating disorder. It is used to assess behavioural and psychological symptoms in patients

Reference: Wood S, Cummings JL, Hsu M-A, Barclay T, Wheatley MV, Yarema KT, Schnelle JF. The use of the Neuropsychiatric Inventory in nursing home residents, characterization and measurement. Am J Geriatr Psychiatry 2000; 8: 75-83. http://www.dementia-assessment.com.au/behavioural/NPI.pdf

NPUAP Pressure Injury Stages webpage provides definitions for the new pressure injury stages.

Reference: National pressure ulcer advisory panel (n.d.). NPUAP Pressure Injury Stages. Copyright 2013. Retrieved from http://www.npuap.org/resources/educational-and-clinical-resources/npuap-pressure-injury-stages/

This table discusses two tools which can provide a quick assessment of nutrition status: Canadian Nutrition Screening Tool and the Subjective Global Assessment

Reference: Registered Nurses Association of Ontario (RNAO). 2016. Appendix M: Nutrition Screening and Assessment Tools. Assessment and Management of Pressure Injuries for the Interprofessional Team, Third Edition. Accessed July 28, 2016 http://rnao.ca/sites/rnao-ca/files/PI_BPG_FINAL_WEB_June_10_2016.pdf  pp. 138.

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 website provides information and resources about the P.I.E.C.E.S.™ program. "Putting the P.I.E.C.E.S.™ Together" represents Physical, Intellectual, Emotional, Capabilities, Environment, Social, and are the cornerstones of the philosophy and care of the P.I.E.C.E.S.™ approach.

This resource from Interior Health, is a pain assessment tool useful for scoring pain levels of people with dementia who are unable to verbally express their pain. It focuses on assessing behaviours and provides a score rating of mild, moderate or severe pain levels.

Retrieved from: https://www.interiorhealth.ca/sites/default/files/PDFS/810310-pain-assessment-advance-dementia-scale.pdf

Warden, V., Hurley, A. & Volicer. L. (2003). Development and psychometric evaluation of the pain assessment in advanced dementia (PAINAD) scale. JAMDA, 4(1), 9 -15. Horgas, A., & Miller, L. (2008). Pain assessment in people with dementia. American Journal of Nursing, 108(7), 62-70.

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 explains pelvic muscle exercises, how they may help incontinence, and how to properly perform them.

Reference:

Retrieved June 22, 2018 from http://www.canadiancontinence.ca/pdfs/pelvicmuscleexercises.pdf

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.

This list of suggestions helps staff provide an approach to minimize responsive behaviours.

Registered Nurses’ Association of Ontario. (2009). Appendix D-9 of Preventing and Managing Violence in the Workplace. Toronto, ON, Canada: Author. pp.  118. Retrieved from http://rnao.ca/bpg/guidelines/preventing-and-managing-violence-workplace.  This work is funded by the Ontario Ministry of Health and Long-Term Care.

OSACH Website: www.osach.ca/

This policy and procedure for pain assessment and management provides examples for inclusion of evidence –based recommendations in an organization’s policy to address acute and chronic pain. This document was created prior to the LTCHA (2007).
Toronto Best Practice in LTC Initiative. (2006). Policy and Procedure: Pain Assessment and Management. Retrieved 2013, from http://rgp.toronto.on.ca/torontobestpractice/Policyprocedurepainassessmentmanagement.pdf

This Canadian Stroke Best Practices Post-stroke checklist considers common impairments after a stroke and suggests possible referrals.

The Code of Conduct (Code) is a practice standard describing the accountabilities all nurses registered in Ontario have to clients, employers, colleagues and the public. It explains what people can expect from nurses. The Code also describes what nurses must do to maintain professionalism, competence and ethical behaviour to deliver safe client care. All nurses (Registered Nurses, Registered Practical Nurses, and Nurse Practitioners) are expected to uphold this practice standard, regardless of their role, title or responsibility.

Retrieved from: https://www.cno.org/globalassets/docs/prac/49040_code-of-conduct.pdf

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/

Pressure Ulcer Scale for Healing (PUSH) Tool 3.0 was developed by the National Pressure Ulcer Advisory Panel (NPUAP) as a valid and reliable tool to assess the change in status of pressure ulcers over time.

The link takes you to the NPUAP website where you will find the tools and information on use and copyright.

• PUSH Tool (web version)
• PUSH Tool (PDF version)
• Reprint Agreement (PDF)
• Information and Resgistration Form
• Instructions for Using PUSH
• Copyright Policy and Contract

Reference: National Pressure Ulcer Advisory Committee (1998). Accessed Sept. 14, 2016. Retrieved from: http://www.npuap.org/resources/educational-and-clinical-resources/push-tool/

This poster outlines key steps in the development of a pressure ulcer Quality Improvement plan. The poster is intended for use as a worksheet that can support the needs of individual organizations.

Reference: Health Quality Ontario, (2011), Pressure Ulcer Change Poster, http://www.hqontario.ca/portals/0/Documents/qi/rf-poster-pressure-ulcers-en.pdf

The fact sheet is a tool to increase awareness of the regulatory mandate on educating and preventing client abuse and provide further resources to support nurses in the prevention of abuse in practice.

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 table uses graphs, pictures and words to illustrate the impact of high, medium and low bacterial contamination/colonization on wound healing.

Reference: Registered Nurses Association of Ontario (RNAO). 2016. Appendix J: Progression from Bacterial Balance to Bacterial Damage. Assessment and Management of Pressure Injuries for the Interprofessional Team, Third Edition. Accessed July 28, 2016 http://rnao.ca/sites/rnao-ca/files/PI_BPG_FINAL_WEB_June_10_2016.pdf  pp.130-133.

This presentation shares strategies for managing bladder and bowel problems in stroke survivors. It describes normal bladder and bowel function, urinary incontinence and the effects of stroke on assessment and management of bladder and bowel incontinence. It connects nursing restorative services and incontinence.

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/

This table from page 71 of the Delirium, Dementia, and Depression in Older Adults: Assessment and Care BPG (2016) looks at predisposing and precipitating risk factors as well as signs of depression.

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 document from Mood Disorders Society of Canada provides helpful information on suicide risk and support strategies.

Reference: Mood Disorders Society of Canada (n.d.) Risk of Suicide. Retrieved from http://mdsc.ca/documents/Consumer%20and%20Family%20Support/Risk%20of%20suicide.pdf

© Copyright 2016 Mood Disorders Society of Canada | All Rights Reserved | Powered by Dreamconcepts 

This best practice guideline focuses on collaborative practice between RNs, RPNs and NPs and fostering healthy work environments for these nurses.

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

While the primary focus of this guideline is on mental health crises, its application has relevance to all settings and populations who experience developmental, situational, community or environmental crises. It is intended that this guideline will enhance the understanding of crisis intervention and standardize its practice, as well as enhance professional nursing practice. Supplement: 2006

.

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

The BPG assists nurses in exploring how the decision making process can ensure that appropriate structures and supports are in place to maximize the nursing care and outcomes and minimize the potential for abuse of residents/patients/clients.

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

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

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

This guideline is to be used to enhance the safety of health service organizations and academic institutions through the adoption of evidence based practices. Safe and healthy work environments are an enabler for nurses and other health workers to optimize clinical outcomes for those receiving care. 

Registered Nurses Association of Ontario (2019) Preventing Violence, Harassment and Bullying Against Health Workers. Toronto, ON. retrieved from Preventing Violence, Harassment and Bullying Against Health Workers | Registered Nurses' Association of Ontario (rnao.ca)

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

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-Establishing Therapeutic Relationships. Toronto. ON

The aim of this guideline is to provide evidence-based recommendations for registered nurses, registered practical nurses and other health-care providers 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)

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.

This document outlines interventions that can be used with residents exhibiting signs of aggression, disorientation, frequent falls and or inappropriate behaviours.

Used with permission from Caressant Care

Information on the importance of person and family centred care and how it can improve the health care experience of clients, families and health providers. There are also resources such as: inventory of person and family centred care; fact sheets that summarize the concept of person and family centred care and a short video demonstrating the difference between “usual care and person centred care”.

© 2015 Saint Elizabeth Health Care Retrieved from https://www.saintelizabeth.com/Home.aspx
 

The Ontario Primary Care Medication Reconciliation Guide provides quality improvement strategies for implementing, sustaining and measuring medication reconciliation in primary care settings in Ontario (167). A sample medication reconciliation form can be found on pages 43 and 44 of the guide. The Ontario Primary Care Medication Reconciliation Guide is also available in French.

Source: Reprinted with permission from: Institute for Safe Medication Practices (ISMP) Canada, Health Quality Ontario (HQO). Ontario primary care medication reconciliation guide [Internet]. Toronto (ON): ISMP Canada; 2015. Co-published with HQO. Available from: https://www.ismp-canada.org/ download/PrimaryCareMedRecGuide_EN.pdf.

Registered Nurses' Association of Ontario. (2023). Appendix J of Transitions in Care and Services. (Second Ed.). Toronto, ON: Author.  pp. 126-127.

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

https://www.ihi.org/resources/tools/sbar-tool-situation-background-assessment-recommendation

Reference: Institute for Healthcare Improvement (IHI): ©2023 Institute for Healthcare Improvement. All Rights Reserved.

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 link takes you to resources with tips and information to assist long-term care homes in integrating the stroke care plans into their existing care plan libraries. 

There are twelve stroke care specific care plans on: Activities of Daily Living; Behaviour Change; Bladder and Bowel Continence; Cognition; Communication; Depression; Leisure; Mobility, Positioning & Transfers; Nutrition, Hydration & Swallowing; Pain; Perception and Skin Care & Hygiene

This table from pages 83-84 of the Delirium, Dementia, and Depression in Older Adults: Assessment and Care BPG (2016) informs nurse educators of relevant content for designing education sessions for those caring for clients with delirium, dementia and depression.

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 clinician pocket card supports assessment resources for the assessment and prevention of suicide in older adults. The Geriatric Suicide Ideation Scale and the Harmful Behaviours Scale mentioned on the clinician pocket-card can be used by health care providers with appropriate training.

Reference: Canadian Association of Mental Health (CAMH) Clinician Pocket Care Suicide Assessment and Prevention for Older Adults (2015). Retrieved from http://ccsmh.ca/wp-content/uploads/2016/03/CCSMH_suicideBrochure.pdf 

Website full of resources with a great search engine pertaining to suicide and the elderly.

Reference: Centers for Disease Control and Prevention (CDC) [Online] Available: https://www.cdc.gov/ViolencePrevention/suicide/ 

Copyright: Information that is created by or for the US government on this site is within the public domain. Public domain information on CDC Stacks may be freely distributed and copied. However, it is requested that in any subsequent use of this work, CDC be given appropriate acknowledgment.

Canadian Coalition for Seniors’ Mental Health, Suicide Assessment & Prevention for Older Adults, Life Saving Tools for Health Care Providers.

Web Address or Source: http://ccsmh.ca/projects/suicide/  

© 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.

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.

Symptom Management Algorithm for pain in adults with cancer developed by Cancer Care Ontario.

Cancer Care Ontario (2018) Symptom Management Algorithm- Pain in Adults with Cancer retrieved from https://www.cancercareontario.ca/en/symptom-management

Pressure ulcers or bedsores are caused by constant pressure that damages the skin and underlying tissue. They can develop in a very short time period and take longer to heal. They may have a huge impact on your every day life, as normal activities can be restricted while the ulcer heals.

If you spend long periods of time in a bed, chair or wheelchair and have lost your feeling in your lower body, you maybe at increased risk of getting pressure ulcers. In most cases, pressure ulcers can be prevented.

Retrieved from: http://rnao.ca/bpg/fact-sheets/taking-pressure-preventing-pressure-ulcers
 

The Confusion Assessment Method (CAM) is a standardized evidence-based tool that enables non-psychiatrically trained clinicians to identify and recognize delirium quickly and accurately in both clinical and research settings. The CAM includes four features found to have the greatest ability to distinguish delirium from other types of cognitive impairment.

https://geriatrictoolkit.missouri.edu/cog/Confusion-Assessment-Method-delirium.pdf

The Hartford Institute for Geriatric Nursing, 2019. Donna McCabe, DNP, APRN-BC, GNP

© 2003 Sharon K. Inouye, MD, MPH Inouye, S., van Dyck, C., Alessi, C., Balkin, S., Siegal, A. & Horwitz, R. (1990).

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 National GSF Centre’s guidance for clinicians to support earlier identification of patients nearing the end of life leading to improved proactive person-centred care.  This updated 6th edition of the GSF PIG, renamed as Proactive Identification Guidance and formally known as Prognostic Indicator Guidance, aims to enable the earlier identification of people nearing the end of their life who may need additional supportive care. This includes people who are nearing the end of their life following the three main trajectories of illness for expected deaths – rapid predictable decline e.g. cancer, erratic decline e.g. organ failure and gradual decline e.g. frailty and dementia

MAID (medical assistance in dying), is an option during end of life that has substantial consequences for nursing practice. The goal of this toolkit is to facilitate how you may think about MAID as it relates to both your life and your nursing practice. This reflective Guide for Nurses examines six areas of nursing practice in conjunction to Medical Assistance in Dying: nurses’ experiences, making moral sense, best practices, common challenges, and self-care. It includes a video capturing nurses' experiences with MAID and this resources can be used in a group setting or independently. 

Please note that this reflective guide was not designed to instruct you about the MAID legislation or the specific policies to guide your practice. To be competent to provide care you will need to familiarize yourself with the MAID legislation, your healthcare region policies, and your professional standards.

Retrieved from: https://www.maidreflectiveguide.ca/

Research Team Credit: Barbara Pesut, Sally Thorne, Michael Banwell, Michael Burgess, Kenneth Chambaere, Madeleine Greig, Margaret Hall, Josette Roussel, Catharine J. Schiller, Janet Storch, Carol Tishelman, David Kenneth Wright

Funding from Canadian Institutes for Health Research: CIHR Project Grant 

The RGP of Eastern Ontario is a coordinated network of specialized geriatric services, from hospital to home. Their clinical services, teaching and research are committed to optimizing the health and independence of seniors in the Champlain region. Website: http://www.rgpeo.com/en.aspx

This resource describes the variety of theories as to why elder abuse and neglect can occur and will assist homes in planning a comprehensive education program.

Registered Nurses’ Association of Ontario. (2014). Appendix E of Preventing and Addressing Abuse and Neglect of Older Adults: Person-Centred, Collaborative, System-Wide Approaches. Toronto, Canada: Registered Nurses’ Association of Ontario. Pp 100-102. http://rnao.ca/sites/rnao-ca/files/Preventing_Abuse_and_Neglect_of_Older_Adults.pdf

This site from Capital District health Authority, Halifax, Nova Scotia includes a vignette showing a daughter recognizing that her mother's behaviour has changed suddenly and therefore is not just related to her dementia. Delirium is described in the video and the site includes other information and resources for delirium.

Reference: This is not My Mom Website: http://thisisnotmymom.ca/

Ideas to conduct a conference with individuals and families to assist with decision making at end-of-life.

Registered Nurses’ Association of Ontario (2011). Appendix H of End-of-Life Care During the Last Days and Hours. Toronto, ON: Author. pp. 109-110.

Tools to Support Early Identification for Palliative Care. The aim of this document is to support providers and system level leadership in earlier identification of patients who would benefit from palliative care.

A detailed, 8 page assessment of urinary and bowel continence issues that can be completed by a staff. Treatment options are suggested and a client record sheet is included.

Reference: Registered Nurses’ Association of Ontario (2006). Transdisciplinary Patient/Client Continence Assessment Tool. Toronto, Canada: Registered Nurses’ Association of Ontario. Retrieved from: http://ltctoolkit.rnao.ca/sites/default/files/resources/continence/Continence_AssessmentTools/RNAO_TransdisciplinaryPatientClient_Continence.pdf

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

PSHSA - Public Services Health and Safety Association © 2024.Retrieved from: https://www.pshsa.ca/transition-of-care-healthcare-web-tutorial

This resource includes the key components of successful transitions to long-term care after a stroke: 1. Assessment and Care Planning. 2. Rehabilitation and Restorative Care; and 3. Support and Education for the Person with Stroke and Their Family. These include recommendations  specifically to persons with stroke who are new or living in long-term care at the time of their stroke. This resource is also useful for chronic or continuing care settings.

Reference - Heart and Stroke Foundation (2019). 6th edition. Section 5. Transition to Long-Term Care Following a Stroke. Retrieved from https://www.strokebestpractices.ca/recommendations/managing-stroke-transitions-of-care/transition-of-patients-to-long-term-care-following-a-stroke

Appendix E pages 128-130 of the BPG Delirium, Dementia and Depression in Older Adults: Assessment and Care (2016) identifies the major types of dementia and a description of each.

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

The University of Tasmania, Australia, offers a free online course on Understanding Dementia. The course is delivered over 7 week, in order to obtain the most from this course, participants should expect to spend approximately 3 hours per week engaging with the course content and activities. 

This link takes you to the College of Nurses of Ontario website and includes information on understanding restraints and the key accountabilities nurses have related to restraint use.

This powerpoint presentation aimed at health care providers, describes bladder physiology, classifies and identifies medications that contribute to incontinence and pharmacological treatments used for urinary incontinence. It is also available in french

Alston, Jillian ( 2020) Urinary Incontinence & Medications- Clinician Learning Series. Ontario. Retrieved from https://www.rgptoronto.ca/resource/urinary-incontinence-medications-clinician-learning-series/

This presentation gives a summary of the research evidence on UTI’s in Long Term Care. It discusses challenges in diagnosis, treatment and prevention of UTI’s. Developed by Barbara Grace Cowie, RN MN, Nurse Continence Advisor, Advanced Practice Nurse, West Park Healthcare Centre.

This is a one-page algorithm that is part of Public Health Ontario’s Urinary Tract Infection (UTI) Program. It clearly describes signs and symptoms of UTI’s and promotes ‘watchful waiting’ as an acceptable alternative before treating probable UTI’s. Is suitable for posting on a bulletin board.

Reference: Public Health Ontario (PHO). 2019. Assessment algorithm for urinary tract infections (UTIs) in medically stable non-catheterized residents. Accessed Mar. 13, 2019. http://www.publichealthontario.ca/en/BrowseByTopic/IPAC/Documents/UTI_Assessment_Algorithm.pdf

© 2019 Ontario Agency for Health Protection and Promotion

This fact sheet is part of Public Health Ontario’s Urinary Tract Infection (UTI) Program. It succinctly describes the evidence for not using dipsticks to diagnose UTI’s. Is suitable for sharing with staff, residents and families.

Reference: Public Health Ontario (PHO). Revised 2019.Urinary Tract Infection (UTI) Program Evidence to Support Discontinuing the Use of Dipsticks to Diagnose a UTI in Residents of Long-Term Care Homes (LTCHs) https://www.publichealthontario.ca/-/media/Documents/U/2016/uti-dipsticks.pdf?sc_lang=en

This PowerPoint presentation is part of Public Health Ontario’s Urinary Tract Infection (UTI) Program. It provides an overview of how to implement a UTI program.

Reference: Public Health Ontario (PHO). 2017.  UTI Program (PHO) Management of UTIs in Non-catheterized Long-Term Care Home Residents. http://www.publichealthontario.ca/en/BrowseByTopic/IPAC/Documents/UTI_Presentation_Orientation_Education_Program.pdf

© 2017 Ontario Agency for Health Protection and Promotion

This Public Health Ontario resource provides a list of UTI symptoms, contrasts between non-catheterized and catheterized residents and when not to send a specimen.

Reference: Public Health Ontario, 2014, When To Collect A Urine Specimen For Culture And Sensitivity Fact Sheet. Retrieved from https://www.publichealthontario.ca/-/media/Documents/U/2016/uti-urine-collection.pdf?sc_lang=en

This is a comprehensive list of reasons for delirium that need to be considered before assuming that a change in mental status is due to a UTI. 

Public Health Ontario (2019).UTI Program (PHO)- Causes of Delirium and Mental Status Changes retrieved from https://www.publichealthontario.ca/-/media/Documents/U/2016/uti-delirium-mental-status.pdf?sc_lang=en

© 2022 Ontario Agency for Health Protection and Promotion

This is a brightly coloured, one page pamphlet/poster that describes signs of elder abuse and gives resources. This is one of a suite of resources from Elder Abuse Ontario in the Helping Seniors section of their website.

Reference: Elder Abuse Ontario. 2015. Warning Signs of Elder Abuse. Accessed Feb. 2, 2017 from http://www.elderabuseontario.com/what-is-elder-abuse/help-for-seniors/educational-materials-for-seniors/

This Hamilton Health Sciences patient education resource provides an overview of ostomies, signs of malnutrition and dehydration and offers food and fluid choices to try, explaining possible effects of these choices and the reasons for these choices.

Reference: What to eat and drink when you have a high output ostomy. (Nov. 2009). Hamilton Health Sciences. Retrieved from: http://www.hamiltonhealthsciences.ca/documents/Patient%20Education/HighOutputOstomyWhatToEat-trh.pdf  

© Hamilton Health Sciences, 2009 PD 6629 - 11/2009 dpc/pted/HighOutputOstomyWhatToEat-trh.doc dt/November 4, 2009

This document offers talking points on the connection between oral and overall health. Oral health can influence other body systems, while therapies for chronic diseases can have an impact on the oral cavity and nurses can use this fact sheet while talking to residents and families about the importance of oral hygiene.  

Source: Canadian Dental Hygienists Association www.cdha.ca.

This WHO site consists of suicide data, prevention videos and the mhGAP Intervention Guide with a module on self-harm/suicide.

Reference: Retrieved from http://www.who.int/mental_health/suicide-prevention/en/  

© Copyright World Health Organization (WHO), 2017. All Rights Reserved.

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.