Registered Nurses Association Of Ontario Research Articles

RNAO's Best Practice Guidelines Program

This report focuses on the complex process that the Registered Nurses' Association of Ontario (RNAO) has developed for the development of quality best practice guidelines. In addition, the publishing of a guideline is not the end of the process but the beginning of the implementation, evaluation

Best Practice Recommendations for the Prevention and Treatment of Pressure Ulcers

The purpose of this article is to enhance the professional nurses' knowledge of the best practice recommendations for the prevention and treatment of pressure ulcers. This continuing education activity is intended for physicians and nurses with an interest in wound care. After reading this article and taking this test, the reader should be able to: 1. Interpret the pathway to assess and treat pressure ulcers. 2. Differentiate the Registered Nurses' Association of Ontario (RNAO) levels of evidence. 3. Identify the scientific evidence for treatment recommendations.

The IWJ editor‐in‐chief discusses the World Union Congress 2008 with the chair of meeting

Dr Gary Sibbald (GS), president-elect of the World Union of Wound Healing Societies (WUWHS) and chair of the third meeting, discusses the innovative structure of the meeting with the International Wound Journal. Q: What is unique and innovative about the third congress of the WUWHS? GS: The organising principle of the Toronto 2008 meeting is the evaluation of the evidence base in wound care, which will be considered in the context of efficacy, efficiency and effectiveness to form a framework for best clinical practice. The synthesis of these three major pillars of evidence-informed practice will provide clinicians with a new and comprehensive way of reviewing their practice and ensuring that their care is patient focused. Q: How does the scientific programme support this innovative design? GS: The scientific programme is divided into streams that provide an in-depth review of a range of clinical problems. The keynote addresses will echo the importance of evidence and patient care. An expert panel will discuss the clinical significance of evidence-based medicine, Stephen Lewis will examine health care systems, advocacy and AIDS in Africa, and Marla Shapiro, MD, will focus on life/work balance and her own experiences. The closing plenary session will present highlights from each stream and provide participants with a congress overview. Toronto 2008 also takes a pioneering approach to evidence, choosing to evaluate evidence quality according to the type of information, from guidelines to preclinical data. This methodology allows a broader range of knowledge to be considered in developing a clinical strategy, and it is being used in the development of a comprehensive set of evidence-based summaries on all major topics in wound care. These summaries provide clinicians with rapid access to up-to-date practical information in a quick and easy web-based format. Q: To which health care professionals will this congress be of interest? GS: Toronto 2008 is being hosted by the University of Toronto, with the active participation of the following co-hosting groups: the Canadian Association of Wound Care, Canadian Association of Enterostomal Therapists, Registered Nurses Association of Ontario, National Pressure Ulcer Advisory Panel and American Professional Wound Care Association. The scientific programme will be relevant to all clinicians irrespective of professional background, researchers and teachers working in the field of wound healing and tissue repair caring for patients with wounds of all aetiologies. Q: What is next for the WUWHS? GS: Toronto 2008 is a key step in building the WUWHS as an international association. After the congress, we will focus on disseminating the educational toolkits developed at the meeting and sharing expertise between associations. Register now to participate in this ground-breaking congress (www.wuwhs2008.com).

Food Insecurity in Canada

Dietitians of Canada (DC) Position Paper: “Individual and Household Food Insecurity in Canada” (1). I found the article most enlightening and believe it requires support not only from the DC membership but from other health professionals as well. I am concerned, however, with the advice given by DC to its members. The article includes the statement that dietitians cannot work alone, yet the majority of recommendations made require dietitians to shoulder much of the responsibilities individually. This does not embody DC’s vision which states that DC is the “voice of the profession, ” having the responsibility of pulling dietitians together so that they can present a strong and united voice in the health and political arena. Rather than encouraging their members to join external coalitions independently, vote wisely, practice professionally, incorporate client-empowering strategies and self-educate, DC should establish a task force to address these proposals. The task force responsibilities would include: 1. Informing DC members of community and political groups that are working to improve conditions for the socially disadvantaged and the working poor. 2. Initiating or supporting public forums to bring this issue of food insecurity and poverty to the general public for their support. 3. E-mails to politicians can be written centrally (rather than individually) and sent collectively to ensure the ‘voices’ of a large number of concerned professionals are heard. 4. DC should strengthen professional ties with its sister professions: the Canadian Medical Association (CMA) with a membership of over 60,000, the Registered Nurses Association of Ontario (RNAO) with over 20,000 RN members and the Canadian Association of Social Workers (CASW) with 15,000 members. These associations have very strong lobby groups that address the social and political issues they feel they can change. 5. Finally, and most importantly, is the need for a central research registry sponsored by DC that would coordinate the historical and ongoing studies that reflect the problems and requirements of their clients. The research recommendation proposed in the position paper did not recognize the need for food insecurity surveillance research, even though it explicitly states that “Canada lacks a coordinated, systematic plan for monitoring food insecurity” (1). The registry would have as its main function the securing of grants/funds for nutrition research. Establishment of a long-term, professionally supported research program would improve the evidence-based knowledge of food insecurity and afford DC the respect it deserves. Karen Chapman, RN, MScN, PhD(c) The Clinical Investigation Unit The Hospital for Sick Children Toronto, ON

The relevance of psychosocial variables and working conditions in predicting nurses’ coping strategies during the SARS crisis: An online questionnaire survey

Objectives The purpose of this investigation was to examine the relationship between psychosocial variables and working conditions, and nurses’ coping methods and distress in response to the severe acute respiratory syndrome (SARS) crisis in Canada. Participants and procedure The sample consisted of 333 nurses (315 women, 18 men) who completed an Internet-mediated questionnaire that was posted on the Registered Nurses’ Association of Ontario (RNAO) website between March and May 2004. The questionnaire was restricted to respondents who had to authenticate their RNAO membership with a valid username and password before accessing the questionnaire. This served a dual purpose: to ensure that only RNAO nurses completed the questionnaire and thereby safeguarding the generalizability of the findings; and second, to prevent any one nurse from contributing more than once to the overall sample. Results Correlational analysis yielded several significant relationships between psychosocial variables and working conditions, and the traditional correlates of burnout and stress. Three multiple regression analysis revealed that the model we evolved—including higher levels of vigor, organizational support, and trust in equipment/infection control initiative; and lower levels of contact with SARS patients, and time spent in quarantine—predicted to lower levels of avoidance behavior, emotional exhaustion, and state anger. Conclusions By employing models of stress and burnout that combine psychosocial variables and working conditions, researchers can account for significant amounts of variance in outcomes related to burnout. These findings highlight the importance of vigor and perceived organizational support in predicting nurses’ symptoms of burnout. For healthcare administrators, this means that a likely strategy for assuaging the negative outcomes of stress should address nurses’ psychosocial concerns and the working conditions that they face during novel times of crisis.

Education: professional and lay: Focus on pediatric pain: the advanced clinical practice fellowship (ACPF) program: a collaboration between the registered nurses association of Ontario, the University of Ottawa and the Children's Hospital of Eastern Ontario (CHEO)

The Registered Nurses Association of Ontario (RNAO), through funding from the Ministry of Health and Long-Term Care (MOHLTC), developed an Advanced Clinical Practice Fellowship (ACPF) program for registered nurses to promote nursing knowledge and expertise and to improve client outcomes in Ontario. To date 164 ACPF fellowships have been funded and a number of them have focused on pain. ACPF fellows receive joint funding from RNAO and the sponsoring organization and dedicate 450 hours to the fellowship. This unique program enabled two nurses from the CHEO to step away from the bedside and focus their time and attention on learning about paediatric pain. Through the mentorship of a University of Ottawa, School of Nursing faculty member, both nurses developed ambitious learning plans that acted as a road map to help them reach their personal learning goals. In addition, both fellows contributed substantially to the work of the hospital with respect to improving pain assessment and management practices in the areas of acute and chronic pain. The power of this program is that it provides practicing nurses with an opportunity to suspend their practice and to focus on reading, thinking, writing and expanding their clinical skill set around a topic that is salient to their clinical practice. The organization benefits from nurses that are newly energized and can better advocate for a system that supports evidence-based best practices. Two initiatives that came from the fellowships include a pain resource nurse program and nursing representation on a multidisciplinary quality improvement team to develop a chronic pain service. In this presentation we will describe the ACPF program and its impact on both the nurses and the organization with respect to improved pain practices.

What will change in nursing practice over the next five years?

The answer: “It depends.” The question in the title is by no means easy to answer. There are too many variables – independent, interdependent and dependent – all of which will affect the final outcome. I think a much easier question for me to answer would be “What should change”; but I digress. My task is to reflect on what will change in nursing practice over the next five years. Since the early 1990s, healthcare has undergone major reform in order to reduce or maintain costs while attempting to increase the quality of outcomes. Such strategies as downsizing, restructuring, rightsizing and re-engineering were utilized in order to achieve “system reform.” However, system reform requires an alignment of structure, process and outcome. All too often over the past 10 to 15 years, the focus of system reform has been on structure for example, the Sinclair restructuring commission and the reform of Community Care Action Centres. In addition, consumer knowledge and expectations have increased, the client population has continued to age and technology has continued to outpace social norms, morals and values. Issues identified in the 1980s by such groups as the Registered Nurses Association of Ontario (RNAO) and the Canadian Nurses Association (CNA) continue to be issues today. In 1981, the RNAO held a Think Tank on Nursing Leadership. In its report on the Think Tank (RNAO 1982), the RNAO identified issues that included educational entry level to the profession, specialization, changing roles in institutional and primary care, ethical decision-making, professional rights and responsibilities and adequacy of nursing manpower. The presence or absence of nursing leadership was also identified as having a major effect on the quality of client care. These issues made the need for strong and effective leadership a priority for the profession in the future. The recommendations that arose from the Think Tank are still current. What Will Change in Nursing Practice Over the Next Five Years?

Nursing best practice guidelines: the RNAO (Registered Nurses Association of Ontario) project.

Best practice guidelines, although a recent phenomenon, have become a global movement in nursing. Scholars, practitioners, healthcare organizations, governments and the nursing associations have a unique opportunity to enhance quality and demonstrate joint accountability to patients, the healthcare system and the public as a whole. This article offers insight into the Registered Nurses Association of Ontario (RNAO) Nursing Best Practice Guidelines Project. Funded as a multi-year project by the Ministry of Health and Long-Term Care in 1999, the RNAO project is leading nursing's best practice guideline movement in Canada and reaching others abroad.