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MCNHR/WRHA Research Day Coming Out of Silos: Working Together to Improve
Health Care Outcomes
May 23, 2014, COLLEGE OF NURSING UNIVERSITY OF MANITOBA
PROGRAM MCNHR/WRHA Research Day
Coming Out of Silos: Working Together to Improve Health Care Outcomes May 23, 2014
Basic Medical Sciences Building, University of Manitoba
AGENDA
8:00‐8:30 Registration (John Doupe Concourse, Basic Medical Sciences Building) 8:30‐8:45 Welcome: Dr. Beverly O’Connell Dean, Faculty of Nursing & Krista Williams, on behalf of Winnipeg Regional Health Authority Nursing Leadership (Theatre A, Basic Medical Sciences Building) 8:45‐9:30 Keynote Presentation: Dr. Brenda Roe, 2014 Dr. Helen Preston Glass Researcher in Residence Regional Research Day. Continence Care: An Evidence Synthesis of Cochrane Reviews on bladder training and toileting programmes. (Theatre A, Basic Medical Sciences Building) 9:30‐10:00 Refreshment Break and Poster Session (John Doupe Concourse, Basic Medical Sciences Building) 10:00‐12:15 Oral Presentations (Theatre A, Basic Medical Sciences Building) 12:15‐1:30 Lunch and Networking (John Doupe Concourse, Basic Medical Sciences Building) 1:30‐2:00 Seeding Idea Pitch Session (Theatre A, Basic Medical Sciences Building) 2:00‐2:05 Sigma Theta Tau: Dr. Donna Martin (Theatre A, Basic Medical Sciences Building) 2:05‐3:30 Refreshment Break/Seeding Idea Discussions (John Doupe Concourse, Basic Medical Sciences Building) 3:30 Seeding Reporting Back/Closing Remarks Dr. Diana Clarke, MCNHR Director and Associate Dean, Research (John Doupe Concourse, Basic Medical Sciences Building)
MCNHR/WRHA Research Day Coming Out of Silos: Working Together to Improve Health Care Outcomes
KEYNOTE SPEAKER
Brenda Roe, PhD, MSc, BSc (Hons), RN, RHV, FRSH 2014 Dr. Helen Glass Researcher in Residence
Professor of Health Research, Edge Hill University, United Kingdom
Dr. Roe is a Fellow of the Queen’s Nursing Institute and Fellow of the Royal Society for Public Health. She is an Editor of the Journal of Advanced Nursing and was one of the founding editors of the Cochrane Incontinence Review Group (1996-2000) with particular responsibility for reviews on behavioural interventions for the management of urinary incontinence. She has served as an invited member on a number of international consultations, government and research council committees, recently on the MRC College of Experts for the Health Services and Public Health Research Board (2006-2009) and Co-Chaired the NHS R&D Programme Services for Older People in Primary Care co-ordinated by Halton and St Helens PCT (2005-2008). Brenda has been a Non-Executive Director for a number of Health Authorities and NHS Trusts. She was awarded a Harvard Education Center Fellowship, Department of Health Postdoctoral Research Fellowship, World Health Organisation Fellow and received the RCN/Molnlycke award for excellence in continence care. She has been an invited visiting international scholar at the Universities of Washington, USA; Alberta, Canada; Deakin and Edith Cowan, Australia. She is an honorary fellow at the Personal Social Services Research Unit, University of Manchester and Non-Executive Director of Mersey Care NHS Mental Health Trust.
Research Day
Planning Committee Members: Volunteers: Lorraine Avery Natasha Basova Diana Clarke, Chair Hannah Curtis Diane Cepanec Chantel Ducey Anna Fedorwicz Lindsay Wiebe Diane Heywood Veronika Zot Diana McMillan Asha Pereira James Plohman Jannell Plouffe Genevieve Thompson Lai Chun Yee Lisa Wolfe‐Ulrich, Recorder
Campus Map
Oral Presentations Authors: Ogechi Asagwara, RNBN, MN Student University of Manitoba Darlene Grantham, MN,CHPCN(C),CCHN(C),CON(C) Jannell Plouffe, RN, NP, BScN, MN, DNP Abstract title: Advance Care Planning: Supporting the Role of Nursing in Discussions of Future Clinical Care Abstract: The Winnipeg Regional Health Authority outlines advance care planning as the shared responsibility of the “health care team.” Advance care planning is the preparation for future clinical care, established by ongoing discussions and communication between patients, families and the health care team. The discipline of nursing, as a significant member of the interdisciplinary health care team should therefore excel in the implementation of this intervention. Currently however, nurses defer advance care planning discussions to physicians and in fact, do not view this intervention as part of their clinical role. In this current position, the positive outcomes of advance care planning, including increased satisfaction with care and decreased ethical dilemmas for staff are not being seen and the complete clinical care needs of patients are not being met. To advance beyond this current position the discipline of nursing must be supported and empowered to initiate their role in this valued intervention. This quality improvement project aimed to inform, facilitate and support the role of nursing in advance care planning practices. Supported by an informative learning session, a clinical based assessment tool was introduced to nursing staff in acute care. The assessment tool, designed to assist the nurse in advance care planning communication with not only patients and families but with interdisciplinary team members as well, was shown to be effective. This quality improvement project was successful in facilitating and empowering the discipline of nursing to become more engaged in advance care planning, meeting the comprehensive clinical care needs of patients.
Authors: Daryl Dyck, RN, MN, IIWCC, Clinical Nurse Specialist, Deer Lodge Centre Aynsley Allen, Speech Language Pathologist, Deer Lodge Centre Abstract title: Rethinking Chronic Care: A Place for New Beginnings? Abstract: Health care institutions are continuously challenged by the number of increasingly complex medical patients entering their facilities. Due to medical and/or functional issues the care for some of these patients is too involved to allow them to safely return home. The Chronic Care facility is often the destination for patients with complex needs ‐ a place where expectations for improvement are limited, and further decline is anticipated. This paper describes the experiences of one chronic care unit in Winnipeg, Manitoba, where examples of the opposite have been realized. Quality of life focused care, in conjunction with strong nursing leadership and interdisciplinary collaboration, have resulted in interesting outcomes. These outcomes include: gastrostomy tube removal, tracheostomy decanulations, discharges to the community, and improved staff and patient satisfaction. These units’ experiences have raised some fundamental questions: What is the vision for managing the complex patient and what is chronic care?
Authors: Sarah Eisbrenner, MScPT Julie Rempel, BMRPT, HSC Physiotherapy Abstract title: Improving Awareness of Physiotherapy Caseload Assignments on GA5 Neurosurgery Abstract: Background: As part of quality improvement, HSC Physiotherapy administers an annual satisfaction survey to our multidisciplinary teams. A recurring theme from the neurosurgery team is poor communication of physiotherapy caseload assignments. With our self‐assignment model the ward team is unsure which of the 3 ward therapists is assigned to each patient. The absence of a method to communicate caseload assignments contributes to interruptions, wasted time, frustration and compromised patient safety. Methods: To address this issue, a Lean project was initiated in collaboration with the ward team including unit manager, nursing, unit assistants, allied health, and rehabilitation assistants. A value stream map and the A3 problem solving tools were used. Results: The proposed solution was a whiteboard system. The physiotherapists’ names with their corresponding patients were written on the whiteboards. Feedback from our neurosurgery team was positive. Less time was used trying to identify the physiotherapist for a certain patient and patient safety improved because staff now knew which therapist to address questions regarding patient handling. With feedback from the team adjustments to the system were implemented; the rehabilitation assistant rather than the physiotherapists now updates the whiteboards. Comments: This project highlights the usefulness of quality improvement using Lean methodology to improve collaboration, communication and patient care. We were able to devise a simple, low cost and successful solution to an issue that has been identified using clinical stakeholder satisfaction surveys. In collaboration with our team members it continues to be a success and a long term solution on our ward.
Authors:
Bunmi Fatoye, MD, CCFP, FRCPC, Medical Officer of Health, Winnipeg Regional Health Authority Carolyn Hill‐Carroll, RN, BN, MN, CCHN(C), Clinical Nurse Specialist, Population and Public Health, Winnipeg Regional Health Authority Cheryl Cusack, RN, PhD (C), Clinical Nurse Specialist, Winnipeg Regional Health Authority Deanna Betteridge, BESS, MSc, Manager, Physical Activity Promotion (on leave), Winnipeg Regional Health Authority Kim Bailey Sarah Prowse, BA Kin, Physical Activity Promotion Manager, Winnipeg Regional Health Authority
Abstract title: Fusion and Synergy: Development of the Strategic Directions Group in WRHA Population and Public Health Abstract: Purpose: Collaboration is a key strategic direction in the Winnipeg Regional Health Authority (WRHA). In the
program area of Population & Public health (PPH), practitioners work in partnership with the community and a variety of health agencies to promote population health. However, there is a dearth of research literature about the application of inter‐professional collaboration (IPC) within PPH leadership teams. Action: This quality improvement project intends to capitalize on inter‐professional practice within PPH services. An overview of IPC was discussed at the PPH Leadership team meeting in June 2013. In December 2013, the team participated in a self‐assessment activity using “Eight Indicators of High Performing Collaborative Care Teams” as a framework. The indicators were adapted for a leadership team, from the WRHA “Advancing Collaborative Care Teams: A Guide for Teams and Facilitators." Results: The PPH leadership team is currently developing a new Strategic Directions Group whose terms of reference will be founded upon principles of IPC. Role clarity, goals and operating procedures, decision‐making and authority, and timeliness of meetings with the appropriate staff in attendance, and fidelity to IPC are some of the major challenges in changing from the current structures to one that will better support team functioning and collaborative leadership. Learning Outcomes: This presentation will be of interest to individuals interested in promoting inter‐professional collaboration in leadership environments.
Authors: Debbie Frechette, Health Sciences Centre Isabelle Jarrin, Health Sciences Centre Diana Clarke, RN, PhD, College of Nursing, University of Manitoba Abstract title: We don’t do it that way anymore: Better mental health acute care through science Abstract: Thoughtful and judicious implementation of research findings and other clinically relevant evidence has significantly influenced the direction of inpatient mental health care at the Health Sciences Centre, Winnipeg. Notable changes in practice have transformed the climate of patient care from one of custodial care, (waiting for the drugs to kick in ), to proactively and collaboratively working with patients, employing all possible biopsychosocial modalities to assist the patient in their recovery from mental illness. As examples, early identification of patients at risk for aggression has reduced the injury rates for both staff and patients, employing the Six Core Strategies for violence and seclusion reduction has almost eliminated the use of seclusion, and more actively and strategically using individuals with lived experience of mental illness as peer support workers are a few of the evidence‐informed practice changes that have taken place. Much of the programs climate of enthusiastically embracing change has been built on a long‐standing relationship between program administration and clinicians at Health Sciences Centre, and researchers and graduate students from the University of Manitoba. Over the last decade, Health Sciences Centre staff and managers have participated in, and more recently, initiated a series of clinically‐focused research projects that have had safer and more effective patient care as the goal.
Author: Amber Gilberto, BScPN, RPN, MPN Student, Brandon University and OSI Clinic at Deer Lodge Centre
Abstract title: Using a contemporary nursing model to guide the recovery process for Veterans Affairs clients attending the Winnipeg Operational Stress Injury clinic Abstract: In 2012 Winnipeg Operational Stress Injury (OSI) clinic staff began to examine the length of treatment, number of repeat referrals and complex cases including clients who had not engaged in treatment, dropped out, plateaued and/or destabilized in spite of service utilization. By examining the gaps in services the development a new mental health nursing role called “continuing care” emerged. The inclusion of a more recovery based initiative created the opportunity for additional programming that was more conducive to rehabilitation that extended beyond the confines of evidence based trauma treatments. It had been our experience that a significant percentage of clients referred to the OSI clinic for assessment and evidence based treatment; do not fit into a linear process. Thus the need for a more individualized and less structured approach to recovery was emerging at the clinic. Due to the diversity and multitude of roles within the CF, there warrants both a standardized albeit individualized model of care where our philosophy of recovery is more shared than the way in which we have implemented our services in the past. A solution to the concerns expressed could be the introduction of a Contemporary Model of Rehabilitation developed by Dr. Joyce Mikal Flynn, a nurse, a professor and author from Sacramento California, U.S.A. This six stage model of rehabilitation may provide us with a more realistic way to view recovery from Operational Stress Injuries. Using such a model to more formally guide our clinic process could provide our system with a common language and better understanding of the client’s progress and future direction in this very personal journey. By considering such a model, assessment of one’s progress, limitations and what is required in order to transcend, would be perhaps more clearly identified. This philosophy and model created as a result of Dr. Joyce Mikal Flynn’s doctorial research is fully explained in her book and broken down into easy steps in her manuals.
Authors: Isabelle Jarrin, RPN, BScPN, BA, MN, Graduate, University of Manitoba & CNS Health Sciences Centre Marie Edwards, RN, PhD, Associate Professor, College of Nursing, University of Manitoba Elaine Mordoch, RN, PhD, Assistant Professor, College of Nursing, University of Manitoba Abstract title: The Place of Ethics in Mental Health Nurses’ Clinical Judgment in the Use of Seclusion Abstract: Seclusion is an intervention used in mental health settings, with nurses playing a key role in decisions related to secluding a patient. The purpose of this interpretive description study was to explore the place of ethics in mental health nurses’ clinical judgements on seclusion use. Data collection involved interviews of nine registered psychiatric nurses and eight registered nurses. Nurses described their experiences with seclusion and identified factors that impacted their decision to seclude. Ethical tensions related to seclusion use were outlined. Two themes were identified. The complexity of promoting safety and preventing harm illustrates nurses’ sometimes competing responsibilities to keep people safe, understanding of power differentials and patient vulnerability, and recognition of the various types of harms that can arise with seclusion. The importance of knowing for ethical action with seclusion use highlights the role of knowing oneself, the patient, other team members, and the unit in judgments to seclude.
Authors: Laura MacDonald, RDH, BScD(DH), Med, Associate Professor, School of Dental Hygiene, College of Dentistry, Faculty of Health Sciences, University of Manitoba Marlene Stern, O.T. Reg (MB), Regional Director, Occupational Therapy and Co‐Community Area Director‐St Boniface/St Vital, Winnipeg Regional Health Authority Susan Bowman, BMR(PT), Manager of Physiotherapy/Orthopedic Technology Services (Acting Manager for Occupational Therapy, Speech Language Pathology & Recreation), Winnipeg Regional Health Authority Others: Leah Weinberg, Ruby Grymonpre, University of Manitoba Tracey Theile, Cathy Rippin‐Sisler, Rebecca Neto, Carol Deckert, Winnipeg Regional Health Authority Abstract title: Shared Leadership in Developing an IPE Curriculum Model for Pre‐Licensure and Practicing Health Professionals: A Model of Collaboration Abstract: The Winnipeg Regional Health Authority (WRHA) and the University of Manitoba (UM) Interprofessional Education (IPE) Initiative (‘the Initiative’) collaborated to develop a shared IPE and interprofessional collaborative practice (ICP) curriculum model and learning continuum blueprint. The goal was to construct a model to help the Initiative prepare collaborative‐ready, entry‐to‐practice professionals and help the WRHA build upon the foundation of knowledge developed at UM and advance WRHA staff knowledge of the IPC competencies. A joint working committee was formed with representation from the WRHA and the Initiative; co‐chairs were from each group, respecting shared leadership, an IPC competency. The committee committed to group process, IPC and work place cultural safety, and IPE process of learning about, from, and with each other. Vital was discussion about perspectives of practice, perceptions of curriculum purpose and design. The IPE for Collaborative Person‐Centered Practice curriculum model and learning continuum blueprint has three dimensions: IPC learning outcomes; development of expertise (process and sequence); and evaluation and assessment. Two key lessons regarding the WRHA~UM IPE collaboration are: 1) value the ‘about, with, from’ IPE process to be true to IPC and 2) embrace dialogue and discourse as a means of advancing IPC literacy and valuing IPC cultural safety which occurs when communities (e.g. educational institutions and practice settings) engage in collaborative practice.
Author: Shelley Marchinko, RN, MN, Instructor, College of Nursing, University of Manitoba Diana Clarke, RN, PhD, College of Nursing, University of Manitoba Abstract title: The Wellness Planner: Increasing Empowerment and Improving Quality of Life in Individuals Living with Mental Illness Abstract: Coordination of required mental health services has often presented a challenge from the user’s point‐of‐view. Resulting gaps in care can lead to increased use of crisis services, more frequent hospitalizations, and impaired quality of life. However, clients, when provided with the tools and skills, could be empowered to become involved in coordinating much of their own care and services. This presentation will review the use of the “Wellness Planner” designed as an intervention to help manage living with chronic mental illness and its effects
on personal empowerment, satisfaction with care and services, and overall quality of life. This study proposed an innovative approach to building some of these capacities by testing the use of an adaptation of a client‐held medical record in booklet form. The booklet, referred to as the Wellness Planner, includes components which have been empirically demonstrated as effective such as a crisis plan and self‐management techniques. The study utilized a pre‐post‐test design with clients of Adult Mental Health Programs at an inner city Winnipeg hospital. It was hypothesized that using the booklet would increase the participants’ perception of continuity of services, satisfaction with services, sense of empowerment, and perceived quality of life. All hypotheses were confirmed along with qualitative data which showed a positive acceptance of the booklet amongst participants. The positive findings of the study support the use of the Wellness Planner as a means in which health care providers can be instrumental in mental health promotion and empowering patients in self‐care and recovery. The next phase of this project will encompass a collaborative process with health care providers within the Winnipeg Regional Health Authority to implement a summer 2014 roll‐out campaign of the newest version of the Wellness Planner.
Authors: Donna Martin, RN, PhD, College of Nursing, University of Manitoba Shirley Thompson, PhD, Natural Resources Institute, University of Manitoba Amanda Johnson, PhD, Kinesiology and Recreational Management, University of Manitoba Barry Lavallee, PhD, Community Health Sciences, Faculty of Medicine, University of Manitoba Myrle Ballard, PhD, Postdoctoral Fellow, Universite de Sainte‐Boniface Janice Linton, Aboriginal Health Librarian, University of Manitoba Abstract title: A Critical Ethnography Examining Little Saskatchewan First Nation Community Members’ Experiences of Induced Displacement: A Multidisciplinary Team Guided by Elders Abstract: In 2011, all members of Little Saskatchewan First Nation experienced an emergency evacuation due to a human‐made flood. To date, over 200 of the 700 on‐reserve community members reside in urban hotels or temporary housing in Winnipeg. Negative outcomes of forced relocation include premature deaths, suicides, miscarriages, mental health disorders, youth involvement in gangs, marital break‐ups, along with worsening of chronic illnesses. Researchers from various disciplines (health, environmental science, recreational management, library science) are proposing a study to systematically document the health impacts of being displaced from the perspectives of Little Saskatchewan First Nation community members. In this oral paper, we describe how an advisory council and multidisciplinary team will work together to design the project from its inception to completion. The study will be guided by three Elders and these frameworks: determinants of Aboriginal peoples’ health, ecohealth, sustainable livelihoods framework, and the Circle Model. This study will facilitate the development of a network of First Nation communities and government organizations that are committed to promoting health, resiliency, and self‐determination for those displaced. The study has practical significance in that it will determine strategies to mitigate the negative impacts of displacement. Findings will be used to develop recommendations for policy and program development and service delivery models to First Nations Peoples experiencing displacement due to natural disasters (forest fires, floods) or industrial development (hydro‐electricity, mining, oil). This study may serve as a template for other projects that link environmental health and human health.
Author: Beverly O'Connell, RN, PhD, College of Nursing, University of Manitoba Michelle Lobchuk, RN, PhD, College of Nursing, University of Manitoba Loreley Greenslade, MSc, College of Nursing, University of Manitoba Abstract title: The Effectiveness of Clinical Handover Abstract: Background: Clinical handover is an important process that is required for the accurate transmission of clinical patient information across shifts. Transmission of patient information between nursing shifts plays a critical role in ensuring continuity of care and maintaining patient health and safety. Objective: The objective of this project was to evaluate the effectiveness of a newly introduced handover process. Three medical units participated in the project. A new bedside handover process was introduced on one of the units. Nurses on all three units were surveyed before (n=46) and eight months after (n=43) handover process was introduced, using a valid and reliable tool that assesses nurses’ perceptions of handover. Findings: Nurses identified an increase in patients’ involvement with the bedside handover (Mean=2.20 vs. 3.61, p<.05), and an enhanced ability of the nurses to check on patients during handover (Mean=2.38 vs. 5.89, p<.001). They also noted that, following the introduction of bedside handover, nurses experienced more interruptions (Mean=2.31 vs. 5.50, p<.001), and also felt that important information was not being given to them during the bedside handover (Mean=2.31 vs. 3.53, p<.05). Nurses expressed concerns about patient privacy, but also noted that bedside handover was faster and provided more accurate, up to date information. Of the 15 nurses who were regularly involved in bedside handovers at post‐evaluation, only six indicated that they preferred the bedside over other handover locations. Conclusion: Further research is necessary using larger sample sizes that evaluate the strengths and weaknesses of the different types of handover.
Author: Carolyn Perchuk, RN, MN, Clinical Nurse Specialist, Population/Public Health, WRHA Abstract title: Collaboration and Partnership as an Organizational Culture Abstract: The Healthy Child Manitoba Office (HCMO) is a unique Government of Manitoba office that is built on the premise of collaboration, with the intent being to bring the cabinet ministers of the different sectors together for mutual benefit. This research project exemplifies collaborating and building partnerships as part of HCMOs organizational culture. Within this culture HCMO developed a partnership with the regional health authorities to implement a home visiting program, Families First. The program relies on the pre‐existing Public Health Nursing home visiting service to access families. Funding is provided to the health authorities for staffing, training and resources by HCMO. The health authority implements the service working with HCMO and provides specified program surveillance data. The research project presented here was completed by developing a partnership agreement between the University of Manitoba and HCMO for a graduate nursing student to access their data bases and assess outcomes in terms of success in affecting school readiness. This shows the ongoing
positive approach towards building partnerships. The commitment to creating partnerships allows academic institutions, governments and groups such as the health authorities to work together. It capitalizes on partner's resources and expertise to build knowledge that can be used to create systems, affect change in systems, and contribute to quality improvement.
Author: Beverley Temple, RN, MN, PhD, College of Nursing, University of Manitoba, St. Amant Research Centre Charmayne Dube, BMR (O.T.), M. Sc, Ph.D, Director of Foster Care Provider Programs and Supported Independent Living Services, New Directions for Children, Youth, Adults and Families Dr. Toby Martin, Director, St. Amant Research Centre Rose Schwarz, Manager Human Resources, St. Amant Chris Fyfe, Risk Manager, St. Amant Research Project Manager: Lesley Anne Fuga Research Assistant: Trevor Farley Abstract title: Injuries by Carers of People with ID/DD Displaying Challenging Behaviours: A Mixed Methods Study by a Unique Team Abstract: Aim: The aim of this research is to understand how workplace injury occurrence relates to staff education and training about challenging behaviour, to staff perspectives about their use of information from the training sessions, and to the factors most commonly associated with injuries. Method: This mixed methods study includes three phases. The phases were: 1) a one year retrospective audit of injury reports from all programs of St.Amant and program manager interviews related to reporting and injuries; 2) prospective audit of injury reports and interviews with direct care workers who were injured; 3) interviews with trainers to determine their perspective of the fit of training to the issues being presented by the providers. Team: The team who participated in this study includes two researchers from the St.Amant Research Centre, one from another community agency and Human Resources and Risk Management. A project manager and nursing student research assistant in addition to good statistical support have been crucial to accomplishing the study aims. Significance: The presentation will highlight the importance of this unique research team’s ability to develop more immediate responses to the issues being raised during the research and follow‐up. The study is important to a variety of paid support personnel and disciplines who are involved with the care and support of people with intellectual disabilities who display challenging behaviour. The principles learned from the study could be transferable to many other populations including Alzheimer’s and Acquired Brain Injury as examples.
Author: Kim Toews, RPN, ADPN, BSPN, Project Manager of Towards Flourishing Research Project Marion Ross, RN, Lactation Consultant, Provincial Coordinator for Families First Abstract title: Towards Flourishing: Mental Health Promotion for Families
Abstract: Objective: This multi‐layered mental health promotion strategy aims to improve post‐partum parents’ mental health, strengthen public health workforce capacity in mental health promotion, support collaboration between mental health and public health systems, and create and sustain mechanisms for effective mental health promotion in community settings across Manitoba. Target Groups: The Towards Flourishing Strategy is embedded within Manitoba’s home visiting Public Health program, Families First. Public Health and Mental Health professionals are working together to improve service delivery for recipients of this service. Investigators of this research project represent: Manitoba Centre for Health Policy; Healthy Child Manitoba; and the Winnipeg Regional Health Authority. Methods: This participatory research project includes process and outcome evaluation. Interviews and focus groups were conducted, content analysis performed, and the results were used to refine the strategy during our pilot phase. Trial stage evaluation is ongoing and a mixed method approach will offer qualitative and qualitative results related to our strategy. Project results will be offered in early 2015. Activities: A curriculum was created and staff training was delivered to a combination of Public Health and Mental Health professionals. Knowledge exchange between systems occurs regularly. Mental Health Promotion Facilitators operationalize the strategy by supporting the Public Health staff with: enhanced mental health screening, facilitation of access to resources, and collaboration between services. Early Results from Pilot Sites: Results from interviews and focus groups show positive impacts on practice and collaboration. Families reported a positive experience with the Towards Flourishing mental health promotion strategy.
Author: Zulfiya Tursunova, PhD, College of Nursing, University of Manitoba Abstract title: A qualitative study of Filipino Caregivers’ Experiences and Perceptions of Interactions with Health Care Providers in Manitoba Abstract: Objective: The main objective of this pilot study was to capture Filipino caregivers’ perceptions of their interactions with health care providers in chronic and/or serious life‐threatening conditions. Design: This pilot study employed a qualitative method with five female caregivers and five female or male patients who were Filipino immigrants in Winnipeg. Audio‐recorded interviews were guided by a semi‐structured open‐ended interview script. Transcripts of audio‐recorded interview data were analyzed using content analysis and occurred simultaneously with data collection. Results: The study findings revealed that challenges in communication and decision‐making were major obstacles in receiving quality of care by immigrant caregivers and patients from health care providers. Healthcare providers tended to address patients formally, keep strict boundaries around social interaction, and ignore verbal and non‐verbal aspects of communication such as greetings, asking questions, and trying to comprehend caregivers’ and patients’ perspectives of care needs. This interaction reinforced health care
provider’s power in the health care provider‐caregiver relationship. Caregivers and patients preferred Filipino health care providers for ease of communication, comfortable expression of needs and feelings in identifying pain and distress, and, satisfaction with enhanced provision of care. Conclusion: This study’s findings demonstrated that health care providers need to comprehend on how to empower caregivers and patients in their dialogue to enhance quality of care of immigrant people living in Canada.
Authors: Tanya Welch, RN, MN, Surgery Educator, Health Sciences Centre Tricia Carta, RN, MN, Clinical Nurse Specialist ‐ Burn Program Abstract title: Pyxis: The Water Cooler of Health Care Abstract: Medication administration is acknowledged as a process where patient safety can be compromised easily (Bennett, 2010). Canadian researchers, Trbovich, Prakash, Stewart, Trip, and Savage (2010b) reported that nurses were interrupted up to 14 times in an hour when administering medications. Interruptions during medication administration can potentially lead to steps missed in the safety checks by nurses, thereby putting patients at risk for medication errors. A “No Interruption Zone” (p. 22) is touted to be the best process to reduce these interruptions as suggested by The Institute of Safe Medication Practice (Anthony, Wiencek, Bauer, Daly & Anthony, 2010). Mitigating strategies presented in the literature, such as a "No Interruption Zone", have been shown to have a positive impact on patient safety. The objective of this quality improvement project was to improve patient safety by raising the awareness of healthcare personnel, patients, and the general public regarding distractions and interruptions that can fragment the medication administration process thereby leading to potential errors. With this rationale we implemented a “No Interruption Zone” on two surgical units following the principles of LEAN with the goal of waste reduction which included fewer delays, recounts, and restarts (waste = waiting, patient waiting for pain medication). Direct observations were completed and revealed nurses were interrupted at least once or 33% of the time at the Pyxis machine. Following implementation and education of a "No Interruption Zone", direct observations revealed that nurses were interrupted only 16% of the time when at the Pyxis with an average time reduction of 15 minutes.
Authors: Dr. Roberta Woodgate, RN, Phd, (Principal Investigator), College of Nursing, University of Manitoba Margaret Synyshyn, RN, MA (Principal Knowledge User), Manitoba Adolescent Treatment Centre Dr. Gary Altman, University of Manitoba Dr. Mariette Chartier, University of Manitoba Dr. Evelyn Forget, University of Manitoba Pamela Wener, MEd., B.M.R. (O.T.) (C), University of Manitoba Dr. Colleen Metge, Winnipeg Regional Health Authority Susan Chipperfield, MSc, CPRP, Winnipeg Regional Health Authority Jeanette Edwards, MHA, BOT, CHE, Winnipeg Regional Health Authority Dr. Randy Goossen, Winnipeg Regional Health Authority Dr. Rob Santos, Healthy Child Manitoba Dr. Keith Hildahl, Manitoba Adolescent Treatment Centre
Tara Brousseau Snider, BA, Mood Disorders Association of Manitoba Dr. Carolyn Peters, New Directions Dr. Peter Kondra, Hamilton Family Health Team Dr. Nick Kates, McMaster University Dr. Rashhi Ahmed, CancerCare Manitoba Fran Schellenberg, BSW, Manitoba Government Abstract title: The Manitoba PHSI Team: An Innovative Shared Mental Health Care Model in Primary Care to Improve Access and Quality of Mental Health Services for Youth Abstract: Despite the fact that mental health problems are the leading health problems faced by youth, it is estimated that fewer than 25% of youth in need of treatment receive those specialized services, and less than 7% receive a diagnosis by their doctor. Given the treatment gap, and considering the number of youth affected by mental illness, there is an urgent need for researchers, knowledge users (KUs), service providers, and policy‐makers to search for practical and effective solutions that will lead to improved access to mental health care for youth and their families. In order to close this gap in mental health care for youth, researchers, and KUs from a number of agencies/organizations/institutes including the Winnipeg Regional Health Authority (WRHA), Healthy Child Manitoba, and the University of Manitoba plan to implement and evaluate an innovative Shared Mental Health Care model in primary care that will be enhanced by integrating stepped care within the model. Our Health Systems Improvement (HSI) initiative will help to ensure that youth receive the right care, at the right time, by the right person, which ultimately will lead to improved mental health outcomes for youth. The HSI initiative will be implemented in two sites in the Winnipeg Health Region. The project is feasible given the commitment and involvement of KUs in supporting the implementation and evaluation of the HSI initiative. Our HSI initiative supports the Mental Health Commission of Canada’s recommendation and WRHA’s strategic directions to integrate mental health services for youth in primary care.
Poster Presentations Authors: Parnali Dhar Chowdhury, PhD Candidate, Natural Resources Institute, University of Manitoba C. Emdad Haque, Professor, Natural Resources Institute, University of Manitoba Abstract title: Role of Primary Care Providers in Dengue Prevention and Control: Practitioners’ and Local Laypersons’ Perspectives in Bangladesh Abstract: Dengue fever (DF) and dengue haemorrhagic fever (DHF) are major public health threats in Bangladesh, particularly in large urban areas as they appeared to affect significant number of population in every two to three years cycle. Since about one third of the population of the City of Dhaka live below the poverty line, most of them seek treatment at the primary health care (PHC) clinics and are not admitted in hospitals. During the field investigation, it was found that PHC practitioners in Dhaka do not rank dengue as an important emerging arboviral disease and suggest patients to take appropriate control measures or seeking hospital admission. It was also found that PHC facilities vary in different socioeconomic status areas in Dhaka city and local layperson’s knowledge, attitudes, and practice are also vary with the information dissemination by the PHC practitioners. In
this study, we assert that primary care practitioners, as the first point of patient contacts, can play a critical role in advising patients suspected of having dengue to take early preventive measures to intervene into the chain of dengue transmission. Effective communications with patients by primary care providers can not only help mobilising the larger community for undertaking immediate preventing measures, they can also result in collective perception and behaviour change in the long run. Our study results concluded that appropriate policy formulation and implementation are necessary to involve primary care providers in the control and prevention of dengue in the urban communities.
Authors: Darlene Grantham, RN, MN, CHPCN (C), CCHN (C), CON (C) Clinical Nurse Specialist, Oncology HSC Jannell Plouffe, RN NP, MN, DNP, Director of Clinical Education, HSC Lesley Degner, RN, PhD, FCAHS & Distinguished Professor Abstract title: Exploration of Advance Care Planning Discussions: The Cancer Patient’s Perspective Abstract: Advanced Care Planning: Goals of Care was implemented by the regional health authority in 2011, and as with any change, the dispersal of the knowledge does not equate with a simultaneous incorporation into clinical care. This pilot study embodied the Hospital's vision of Patient’s First in an attempt to understand the patient perspective of Advanced Care Planning: Goals of Care one year post implementation of the policy and intense education. This qualitative research study utilized appreciative inquiry with a convenience sample of clients receiving care on three clinical units acute care setting with a diagnosis of cancer. Despite a small sample, utilizing the knowledge gained from ‘listening to the patients’ has translated into further exploration of how to enable the health care team to engage patients in their clinical decision making with end of life care. This research informed the site leaders and clinicans that despite embracing this policy / practice change we had not yet translated this knowledge into practice. This poster presentation will share the key learning's for application in practice settings as well as recommendations for further research.
Authors: Christine Johnson, RN, MN, GNC(C), CNS Rehab Geriatrics, Health Sciences Centre Tricia Carta, RN, MN, CNS, Burns, HSC Karen Throndson, RN, MN, CNS Cardiology Jocelyn Preston, RN, MN, CNS, HIV Clinic (now retired), HSC Abstract title: Talk to Me: Exploring Information Exchanges Between Nurses Abstract: Effective communication is an essential component to improving patient safety and the continuity of quality care. However, when consulting clinicians seek out information from nursing colleagues, quite often gaps are evident. This results in the clinician having to acquire information elsewhere which causes unnecessary delays in care. A quality improvement project using the LEAN methodology was undertaken to understand the barriers and facilitators of information exchanges between nurses. Many factors influenced the quality of information provided such as inconsistent documentation, poor plan of care, variable communication patterns and consistent patient assignments. This project highlighted the importance of improving patient safety through
standardized communication processes although questions remain about what is the best communication tool to achieve this goal. Regardless, some efforts have been made to move forward with plans to improve communication based on the findings of this project. Overall it was noted that change does not come easy when a significant change in practice is implemented even if it can be shown to improve patient outcomes. This poster will highlight the issues that led to the development of this project along with the project findings, discussion and recommendations for future direction.
Authors: Dr. Alan Katz, Professor, College of Medicine Ms. Gayle Halas, Research Associate, College of Medicine Ms. Leah Goertzen, MA Graduate Student, Faculty of Kinesiology and Recreation Management Ms. Janet Rothney, Librarian, Health Sciences Libraries Dr. Annette Schultz, Associate Professor, College of Nursing Ms. Pamela Wener, Associate Professor, Department of Occupational Therapy Abstract title: Lessons Learned from A Multidisciplinary Research Review Team: Scoping the Literature to Improve Population Health Abstract: Background: Multidisciplinary research teams enhance research initiatives by converging diverse perspectives into a single study. This poster will highlight the process of completing a team scoping review protocol. The protocol builds upon the exemplar scoping review framework methodology developed by Arksey and O’Malley in 2005. Discussion: This poster provides information about four subjects: (1) the team’s process using the six steps of Arskey and O’Malley’s framework to complete a scoping review about physical activity interventions for primary prevention, (2) strengths and challenges experienced by the multidisciplinary team, (3) lessons learned, and (4) recommendations for team scoping reviews. The goal of this poster is to add to the discussion about multidisciplinary initiatives to advance research methods examining broad topics. Summary: A scoping review is an ideal method to explore vast topics and identify gaps for future research. Each of the six steps provided by Arksey and O’Malley’s framework provided valuable guidance for the team. These steps included: Stage 1: Identifying the research question; Stage 2: Identifying relevant studies; Stage 3: Study selections; Stage 4: Charting the data; Stage 5: Collating, summarizing and reporting the results; Stage 6: Incorporating consultation with stakeholders as a knowledge translation component of scoping study. Diverse team members were beneficial for certain steps such as identifying relevant studies. Consequently, diversity also posed challenges including understanding distinct terminology used by team members from different disciplines. The required process of establishing interpretation during the research process enhanced knowledge translation of the results for comprehensive dissemination with stakeholders.
Authors: Diana McMillan, RN, PhD, Associate Professor, College of Nursing, University of Manitoba Marie Edwards, RN, PhD, Associate Professor, College of Nursing, University of Manitoba
Abstract title: Assessment, contributing factors, and perceived consequences of sleep health in student nurses Abstract:
Introduction: Adequate amounts and quality of sleep are vital to physical and mental well‐being, cognitive and motor learning, and reducing the risks of injury and error. Sleep health in student nurses was recognized as a significant knowledge gap with enhanced understandings of sleep health offering the potential to guide both educational health and safety practices. Methods: Following ethical and access approval, a cross‐sectional descriptive‐exploratory, web‐based survey of undergraduate baccalaureate student nurses was conducted. Participants were asked to complete three self‐report questionnaires: Pittsburgh Sleep Quality Index (PSQI; Buysse, 1989); Epworth Sleepiness Scale (ESS; Johns, 1991); and the Student Sleep Health Survey (SSHS; authors). In addition, a 35‐item tool was created and administered; addressing demographics, sleep health issues, time demands (i.e., domestic, academic, work), sleep and work schedules, and perceptions of health and safety during and following clinical practice. Results: Respondents included 262 baccalaureate nursing students (90% female; age 24.7 ± 5.3 years), in years two (n=90), three (n=93), and four (n=78) from a large mid‐western Canadian University. Most participants considered their current domestic responsibilities to be medium (48%) or high (25%); 23% had dependents. Forty‐two percent had paid employment while attending university. Students reported usually obtaining 6.6 ± 1.2 hours of night‐time sleep and 5.6 ± 1.4 hours prior to clinical practice; 66% indicated inadequate sleep quantity and 52% indicated that sleep quality was poor or fair. Daytime sleepiness per ESS was 9.7 ± 4.1 overall, and worst in third year students (10.4 ± 4.4). Sleep issues contributed to moderate to extreme stress in over half (57.6%) of the respondents. Nursing students reported fatigue‐related personal work injuries/near injuries (4.6%), patient safety incidents (13.7%), and accidents/near accidents on the drive home (8.4%). Conclusion: This study identifies a number of sleep‐related health and safety concerns for student nurses and their patients. Findings will help target effective curriculum changes and sleep health education strategies.
Support: Nursing Endowment Fund, Faculty of Nursing, University of Manitoba
Authors: Donna Martin, PhD, University of Manitoba Lisa Albensi, MSN, Seven Oaks General Hospital (SOGH) Lorna Guse, PhD, University of Manitoba Adrienne Pearson, BN, ET, SOGH Mary Montgomery, OT, SOGH Stephanie Van Haute, BSN, SOGH Kendra Gierys, BN, SOGH Ember Benson, MN, SOGH Sharon Stimpson, BN, SOGH Maria Froese, BMR‐PT, SOGH Mavis Lam, RD, SOGH
Abstract title: A Pressure Ulcer Prevention Program in an Acute Care Hospital: A Multidisciplinary Team Approach Abstract: Pressure ulcers (PUs) are one indicator of the quality of health care. The prevalence of PUs in acute care hospitals in Canada is estimated at 25.1%. In a local hospital, the prevalence rate of PUs is 32.7%. In this oral presentation, we describe how a multidisciplinary health care team identified and implemented strategies to reduce the prevalence rate of PUs. The team comprised of a physiotherapist, an occupational therapist, a dietician, and several nurses developed and implemented a hospital‐wide pressure ulcer prevention program (PUPP). The PUPP included the establishment of specialized mattresses, new products for patients with incontinence, a public/staff awareness campaign, and an online tutorial. The team, identifying the importance of determining the effectiveness of PUPP, proposed a mixed methods study using a pre‐test/post‐test design, an observational PU prevalence survey, and individual or focus group interviews. Health care aides, licensed practical nurses, registered nurses and allied health care professionals will be invited to complete an anonymous survey before and after an online tutorial about PU prevention. A repeat chart audit and PU prevalence observational survey will be conducted two months after the launch of the PUPP. Following analysis of the quantitative data, hospital staff will be invited to participate in a semi‐structured, audio‐recorded interview to explore their perceptions of the PUPP. The audio‐recordings of the interviews will be transcribed verbatim. Transcripts will be read and reread in a process of thematic analysis to describe hospital staff’s experience of the PUPP. Results will be used to identify effective PU prevention strategies.
Authors: Nelson O. Oranye, PhD (Faculty of Health Sciences, College of Med. Rehab) Bernadine Wallis, RNBN, M.Ed. (Faculty of Health Sciences, College of Nursing) Gail Archer‐Heese, O.T. Reg. (MB)(WRHA/ HSC) Kim Roer, O.T. Reg. (MB)(WHRA/SBGH) Zaklina Aguilar, Research Assistant Abstract title: Do Personal Factors or Types of Physical Task Predict Workplace Injury? Abstract: Several studies have looked at the importance of a variety of employee factors and job characteristics in predicting workplace injury and absence from work. Personal factors, such as younger age, being married and being a male, higher education, and perceived self‐efficacy have been found to be positively associated with lower injury rates, although the impact of age on injury rates is not consistent throughout the literature. Job characteristics including physical tasks, pre‐injury job tenure, job involvement, high work demands and work pace are reported to have strong relationships with workplace injury. Based on current research findings, identification of predictors of workplace injury and work absence are inconclusive. Our research team includes two members from the Faculty of Health sciences (one college of medical rehabilitation and one college of nursing) and two WRHA Workplace Injury Prevention Managers, and an RA from Occupational Therapy. A survey of workers experience with musculoskeletal injuries (MSI) was carried out in three healthcare facilities in Winnipeg. A total of 118 workers completed the survey, out of which 46.6% had experienced a workplace injury within the last 5 years. All physical factors except for climbing and sitting were significant for MSI. The findings from this study support the view that physical tasks associated with a job, rather than the occupational group or personal characteristics were more significant predictors of MSI. We recommend that policies should focus on
addressing the physical characteristics of work, irrespective of the occupational groups.
Authors: Jannell Plouffe, RN, NP K. Valeri, RN K. Doerksen, RN P. Griffith, RN, RPN T. Welch, RN B. Yarjau, RN Health Science Centre, Winnipeg Regional Health Authority Abstract title: The Implementation of a Large Scale Pressure Ulcer Prevention Plan Abstract: Objective: To determine if a multidimensional education tool kit (intervention) delivered the necessary components to decrease the prevalence and incidence of pressure ulcers. Design: Outcome evaluation, convenience sample. Setting: Tertiary acute care hospital in Western Canada. Participants: Inpatient population from six clinical programs. Measurements and Main Results: Simplicity Theory (Chater, 1999) along with Lewins (1958) change management principles provided the theoretical framework for the intervention. Baseline prevalence (16%) and incidence (9.5%) of pressure ulcers, decreased by 30 and 10% respectively. Documentation improved from 79 to 87% on the admission skin assessment with a cost avoidance of 270,000 dollars. Critical incident reporting increased from 15 to 100%. Conclusion: Pressure ulcer reduction is a strategic priority of the Regional Health Authority and hospital, hospital insurer and Accreditation Canada. Despite pressure ulcer reduction being designated as a priority mandate, the translation of knowledge into clinical practice still poses challenges. This study would suggest the traditional dispensing of this knowledge through policy and guidelines, even with high level mandate, is insufficient to change practice and clinical patient outcomes. The merging of quality, research, patient engagement into learning theory are required ingredients in the formula to improve an important patient safety.
Authors: Doris Sawatzky‐Dickson, RN, MN, Clinical Nurse Specialist, Health Sciences Centre Barbara Wheeler, RN, MN, Clinical Nurse Specialist, St. Boniface Hospital Nicole Sneath, RN, NP, Neonatal Nurse Practitioner, Health Sciences Centre Abstract title: Neonatal Pain and Sedation Assessment and Management: An Interprofessional Approach Abstract:
Neonatal patients provide practitioners with a particular challenge in assessing and managing their levels of pain and sedation. We formed an interprofessional working group with representatives from both St. Boniface Hospital (SBH) and Health Sciences Centre (HSC) Neonatal Intensive Care Units (NICU). Our hypothesis is that assessment and management of neonatal pain is strongly influenced by personal experiences and the culture of the unit. The goal of the group is to outline best practices and to provide guidelines and education in order to implement them. The first task of the group was to collect data from patient charts to review medication use. The data was a retrospective comparison looking at 30 infants born weighing less than 1250g from each of the hospitals. This data provided the baseline for later comparison. The second project of the group was to survey staff to evaluate the perceptions of health care professionals working with neonates. The study identified knowledge and understanding of pain assessment and management issues and potential barriers to implementing recommended practices. The Neonatal Pain and Sedation Survey tool was adapted with permission from the authors of the Neonatal Nurses Survey, Byrd, Gonzales and Parsons (2009). Staff from nursing, medicine, respiratory therapy and pharmacy working in both hospital NICUs were invited to complete the survey on‐line or on paper. Responses were received from 138 staff members. The results from both the medication use review and the Neonatal Pain and Sedation Survey are now being used to revise practice guidelines and to develop educational sessions and other knowledge translation strategies.
Author: Fiona Smith, RPN, RN, MN, PhD (Candidate), University of Manitoba Abstract title: Appreciative Inquiry: A Positive Approach to Research with Families of Transgender Youth Abstract: Background Research approaches that include families of transgender youth in generating knowledge may help to reduce stigma and improve health outcomes for transgender youth. Aim This paper will explore Appreciative inquiry (AI) as a possible approach for research with transgender youth and their families. Results AI is a well‐developed approach to organizational change and evolving research method. It has been associated with evaluation research, knowledge translation and with studies seeking to engage marginalized populations. Conclusions The principles of AI are consistent with social constructionist approaches to helping relationships, and resonate for many health professionals. Maintaining critical awareness of context is essential to avoid perpetuating silence and stigma through inattention to structural and power imbalances.
Author: Jill Sutherland, MHS, BSc, RTT, Radiation Therapy Department, Radiation Oncology Program, CancerCare Manitoba
Abstract title: Patient Information in Radiation Therapy: Strategies to Meet Patient Needs Abstract: Cancer patients actively seek information about their disease and its treatment, yet patients report that the information they receive is not adequate. Radiation oncology professionals are well suited to be information advocates because of the supportive relationships that they often develop with their patients. There are clear benefits to meeting patient information needs and detriments associated with a lack of information. In order for radiation oncology professionals to meet information needs, they must be aware of the diverse information needs of cancer patients and individual preferences for the amount, content, and timing of information. A variety of methods can be used to deliver information and the effectiveness of these methods is discussed. A review of the literature also reveals effective strategies for meeting information needs. These strategies are presented in the context of themes such as effective communication, promoting recall and understanding, assessing health literacy, and using tools to assess information needs.
Authors: Jill Sutherland, MHS, BSc, RTT ‐ CancerCare Manitoba Lauren McLaughlan, RTT, CTIC ‐ CancerCare Manitoba Abstract title: The Timing of Breast Cancer Patient Education: Its Influence on Satisfaction Abstract: Purpose: To explore whether the timing of patient education sessions influences levels of satisfaction in women treated for breast cancer. Methods: Two groups of participants, 350 women total, were surveyed retrospectively via a postal questionnaire. Participants from group 1 received a patient education session following their first radiation therapy treatment. Group 2 received a patient education session on the same day as their computed tomography (CT) simulation appointment. Data were analyzed using descriptive and inferential statistics. Results: No significant difference in the levels of satisfaction was found between the 2 groups. Satisfaction levels were high in both groups across all measures; however, satisfaction levels were lowest when participants were asked how satisfied they were with the information provided about support services. Discussion: The timing of patient education did not significantly influence the level of patient satisfaction among the study participants. When given a choice, the majority of patients stated they preferred to receive a patient education session on the same day as their CT simulation vs other time points. Conclusion: Patient preference for the timing of education sessions should be accommodated whenever possible; however, it also is reasonable to consider the operation requirements of the department when scheduling education sessions.
Authors: Pamela Wener, OT Reg. (MB), PhD (C) Roberta Woodgate, RN, PhD, College of Nursing, University of Manitoba Abstract title: Initiating and Sustaining Interprofessional Collaboration: A Practice Model Abstract: Background: Increasingly interprofessional collaboration is an expectation of the health system. However, lacking is a model that describes the structures and processes that facilitate interprofessional collaboration. Objectives: This presentation will share the results of a qualitative, grounded theory study that explored the intricacies of interprofessional collaboration within a shared care context and from the perspective of the health care providers and program leaders. Methods: Health care professionals (N=42) were recruited (N=42). Data were collected using individual in‐depth semi‐structured interviews (19) and focus groups (7). Using constant comparison, the first seven interviews were coded to develop a frame that was used to code the remaining individual interviews and create a preliminary model. Focus group interviews were similarly coded, and were used to expand on the preliminary model, examine the relationships between the categories, and gain consensus on the model. Results: The core category of Interprofessional Patient‐Centred Collaboration involves four domains: The condition of Perceived Need, the structure of Co‐location, and the processes of Fitting‐in, and Developing and Maintaining Mutually Collaborative Relationships. Implications: Identifying and describing the structures and processes that providers use to facilitate interprofessional collaboration deepens our understanding of the complexities of interprofessional collaboration. The resulting model of interprofessional collaboration may be tested for its applicability to a variety of health care context.
Author: Wright C., RN, BN Abstract title: Factors Contributing to ED Nurses’ Experience of Moral Distress and Turnover: A Practitioner Ethnography Abstract: Purpose: This study will investigate the relationship between moral distress and nursing turnover in emergency departments (ED). Moral distress is defined as being unable to do the right thing because of institutional constraints despite having acknowledging what the right thing is. Design: The author will utilize practitioner ethnography to discover and explore how moral distress contributes to nursing turnover within tertiary ED’s. Sample/Setting: Recruitment of nurses will be completed through active invitation within two tertiary ED’s. The invitations are to be distributed to nurses via work newsletters and work drop boxes, along with study details,
and a request for interested nurses to contact the researcher for further information. Methods: Once the author receives written consent, semi‐structured, audio‐recorded interviews will be conducted. Verbatim written recordings of the audio‐recorded interviews will be combined with field notes about the interview process and a reflective journal. Recruitment will cease once data saturation is achieved. Collected data is to be recorded in an analytic cycle with scientific rigor being demonstrated by using a second independent researcher to independently review the collected data; furthermore the preliminary findings will be mailed to the participants with an invitation to provide the researcher with additional feedback or clarification. Significance: Demonstrating that moral distress experienced by ED nurses influences nursing turnover will assist hospital administrators to prioritize coping methods within professional development education at a unit level and encourage other methods to reduce moral distress.
Seeding Ideas
Authors: Isabelle Jarrin, RPN, BScPN, BA, MN Anne‐Marie Brown, RN, MN, JD Dr. Mary Shariff, PhD, Faculty of Law Abstract title: Protecting the Psychological Well‐Being of Health Care Providers: Exploring the Contribution of a CISM Team Abstract:
Since the publication of the Institute for Healthcare Improvement report “To Err is Human”, adverse events have
been a significant concern in healthcare. In response, new processes intended to uncover the root causes of
adverse events, have been implemented. Although this work has focused on patients, more recently the impact
on health care workers is being discussed. For example, the Canadian Healthcare Association recently released a
policy position “strongly encouraging its members and all health system stakeholders to adopt and take action
to implement the standard on Psychological Health and Safety in the Workplace” developed by the Canadian
Standards Association (CSA).1
Critical incidents (CI)2 can result in harm for some health care providers.3 Reactions have included; psychological
distress4, anxiety, grief and depression.5 Additionally, some health care providers have developed post‐traumatic
1 Canadian Healthcare Association, Psychological Health and Safety in Canadian Healthcare Settings, online: The Canadian Healthcare Association <http://www.cha.ca/wp‐content/uploads/2012/11/CHA_Psychological‐Hlth‐Safety_policy‐statement‐
FINAL.pdf> at 1. 2 Critical incidents are defined in The Regional Health Authorities Act and in practice. CI’s can include the following terms; adverse events, patient safety events, medical errors. CI’s defined in practice are events that significantly impact a health care provider and can include; death of child, unanticipated death or cumulative stress. 3 Deborah Seys et al, “Health Care Professional as Second Victims after Adverse Events: A Systematic Review” (2012) 36:2 Evaluation and Health Professions 135. 4 Ibid at 147.
stress disorder.6 These reactions have impacted quality of life7 and caused some individuals to leave their jobs.8
Moreover, these reactions can lead to future suboptimal patient care.9 Accordingly, measuring risk of harm to
health care providers associated with critical incidents is important.
The goal of this discussion is to generate ideas about potential methodologies to gather information about
health care provider’s experiences with psychological support following critical incidents. The project could
contribute to the literature on health care provider’s experiences with critical incidents and the impact of
organizational support programs. Additionally, the data could support further amendments to Workplace Safety
and Health legislation.
Authors: Danna Ferry, RN Dr. Pamela Monk, Podiatrist Abstract title: Diabetes Foot Health and Protection Program: A Podiatrist/ RN Collaborative Practice Abstract: One of the most devastating and costly complications of diabetes is lower limb amputation! Evidence demonstrates that preventing foot complications for those with diabetes benefits from a multidisciplinary, collaborative team approach but this type of care is only consistently available to those in this region who already have a serious foot lesion complicated by infection or fracture. Dr Pamela Monk, a Podiatrist in the UK since 1985, worked in the National Health Service within multidisciplinary collaborative diabetes teams in hospital and community settings. She has experience in planning, organising and provision of podiatric services for those with diabetes including both prevention and treatment of complications. Danna Ferry RN Foot Health Nurse at Youville Diabetes Centre and Dr. Monk have collaborated to create a foot health program based in the community that delivers accessible, comprehensive and effective preventative foot health services suitable to start at diagnosis, before and after specialist care and throughout the lifespan. Together they developed a comprehensive neurovascular and biomechanical lower limb assessment (with ABI) that they use to establish clients’ level of risk for foot complications, plan treatment, education and follow up.
5 Albert Wu & Rachel C Steckelberg, “Medical Error, Incident Investigation and the Second Victim: Doing Better but Feeling Worse” (2012) 21:4 BMJ Quality and Safety 267. 6 Supra note 3 at 148. 7 Leslie Hall & Susan D Scott, “The Second Victim of Adverse Health Care Events” (2012) 47 Nursing Clinics of North America 47 383 at 387. 8 Supra note 5 at 267. 9 David L B Schwappach & Till A Boluarte, “The Emotional Impact of Medical Error Involvement on Physicians: A Call for
Leadership and Organizational Accountability” (2008) 138:1‐2 Swiss Med Weekly 9.
For the past 2 years this assessment has improved foot health outcomes in their practice at Youville Diabetes Centre. Their “Seed Idea” is to use this comprehensive lower limb assessment as the basis for standard preventative care for the feet of all those with diabetes and to be integrated into all the present health care sites in the region that deliver diabetes care.
Authors: Jannell Plouffe, RN, NP, Health Sciences Centre Kristen. Valeri, RN, Winnipeg Regional Health Authority Abstract title: R does not = QI; R + QI = PE Abstract: This curious algebraic equation is not math; but the formula describing patient engagement (PE) partnerships in the conduct of nursing research. This presentation will describe how merging quality improvement (QI) methodologies with research (R) leads to patient engagement and partnerships in generation of knowledge. The research question surrounded determination of the effectiveness of pressure ulcer toolkit on the reduction of pressure ulcers in the acute care setting, but generated unanticipated outcomes supporting patient engagement.
Author: Doris Sawatzky‐Dickson, RN, MN, Clinical Nurse Specialist, New NICU Clinical Lead Abstract Title: Neonatal Intensive Care: New Building, New Unit, New Concept: How do we know we got it right? Abstract: Currently there are three physically distinct units in which neonates are cared for at the Health Sciences Centre. Within the Women’s Hospital is the 24 bed Intermediate Care Nursery (IMCN) with a satellite area of 6 beds on the 3rd floor of the Thorlakson Building. Neonatal Intensive Care Unit (NICU) in Children’s Hospital has 17 beds. They were designed in the 1980s using an open concept. The units share medical staff and allied health staff. The geographical separation of Women’s Hospital, and the NICU at Children’s Hospital results in the most vulnerable newborns requiring transfer via the Health Sciences Center tunnel system, a distance of ¼ mile, and two elevator trips. Reviews of bed usage also indicated that additional neonatal resources are required. The decision was made to physically integrate the two nurseries into one NICU with 60 beds in the new Women’s Hospital. Each baby space has been designed to international NICU standards which includes single patient rooms. The core objective of the new NICU will be to optimize the human potential of each neonate. Ten driving philosophies have been identified that impact the operational and physical characteristics of the new NICU. These are: • Commitment to an integrated perinatal service • Commitment to family‐centred care • Commitment to support developmental care
• Ensuring adherence to privacy • Ensuring patient safety • Meeting the academic mission of the HSC (related to the University of Manitoba) • Use of evidence‐based practice • Use of a multidisciplinary clinical care team • Maximizing staff resources • Optimizing the use of state‐of‐the‐art technology. The question becomes how do we know that we have upheld these philosophies within the new design?
Author: Dr. Beverley Temple, RN, PhD Abstract Title: Improving Nursing Students’ belief and use of Evidence in Practice. How can academia and practice collaboration create the context? Abstract: Nursing students often are not interested in the research course during their undergraduate education. They are
more interested in becoming a ‘real’ nurse, practicing skills and interpersonal skills. In two studies related to
Beliefs and Use of Evidence, practicing nurses and clinical educators differed in important ways. In the Evidence
Based Beliefs Scale, Clinical teachers scored higher overall; but in the Evidence Based Implementation Scale
nurses in practice scored higher than clinical teachers. This may be related to context of the health care
organizations. How do we create that context for new nurses to value Evidence Based Practice and an
appreciation of the context where they use best evidence in their practice every day. This discussion group will
ask the question of participates to brainstorm – “How can academia and practice collaborate to create the
context for new nurses?”
MCNHR Collaborations Database: A New Portal for Research or Quality Improvement Projects or Ideas!
The Manitoba Centre for Nursing and Health Research is developing a collaborations database. The purpose of the Collaborative Research and Quality Improvement Database is to increase collaborations on new and existing projects and to foster collaborations for future projects. The database is a forum for researchers, clinicians and administrators to register a project or idea with the MCNHR and invite others to collaborate as part of the team. This database can be used by researchers, clinicians and administers to help foster the development of a collaborative team for a research or quality improvement project. This database can also be used by graduate students to help identify opportunities for research including projects that can be pursued as part of their thesis and dissertation research. If you have a research or quality improvement project or idea and you are looking for collaborators including researchers, graduate students, clinicians and administrators, please complete and submit your projects/Ideas using the form on our website: http://umanitoba.ca/faculties/nursing/mcnhr/ Click on the “collaboration form” link. You can also scan the below QR code with your smartphone to be taken to our website:
The information you provide on the form will appear in a table on our website with your email address to contact you for more information.
SAVE THE DATE!
Next year’s MCNHR/WRHA Collaborative Research Day is pleased to bring on a new partner, the Canadian
Association of Nursing Research (CANR)! Mark your calendars for May 15, 2015 which will feature a keynote
presentation from our 2015 Researcher in Residence, Dr. Cheryl Forchuk from University of Western Ontario
Thank you to our all our generous sponsors!
Event Sponsorship by:
Door Prizes and Promotional Items provided by:
Canadian Association for Nursing Research
College of Registered Nurses of Manitoba
College of Registered Psychiatric Nurses of Manitoba
Health Sciences Centre
Reh-Fit Centre
Rexall (Portage and Maryland)
Seven Oaks Wellness Institute
St. Boniface Hospital
Travelodge
University of Manitoba Bookstore
