Tag Archives: Doran

Interim Report: Home Care Nursing Health Human Resources – Building and Sustaining a Quality Nursing Workforce

Posted on by mkoh

Research Team

Diane Doran, RN, PhD, FCAHS
Dan Laporte, Research Manager, NHSRU
Sang Nahm, Data Analyst, NHSRU
Laureen Hayes, Research Officer,
NHSRU Roshan Khan, Research Officer, NHSRU

Executive Summary

Ontario faces enormous health care challenges driven by realities that include: a shortage of nurses, an aging workforce, issues in inter-professional care, advancing technologies, increasing patient complexity, and a need for chronic-disease management. Underlying all of this is a recognized concern about the available supply of the nursing workforce and projected shortages of Registered Nurses in Canada of almost 60,000 full-time equivalents (FTEs) by 2022 (Tomblin Murphy, 2009). Effective strategies are needed to address the impending nursing shortage, particularly in sectors such as home care and Long-Term Care (LTC), where demand for health care is expected to increase and where disparities in nursing services supply and demand have been the most glaring. Furthermore, new possibilities in service delivery are being created, through the Ontario provincial government’s Aging at Home (AAH) strategy (MOHLTC, 2009), which emphasize community-based partnerships and an integrated continuum of services. Researchers, home care nurses, nurse leaders and policy makers need to work together to generate the evidence required to support the goals of effective chronic disease management and improved outcomes for Ontario’s diverse population.

This study was designed to generate evidence about effective strategies for recruiting and retaining home care nurses and sustaining home care nursing capacity, in order to meet the health needs of Ontario’s diverse population. It is the researchers’ intention that the findings of this study will assist with creating solutions for attracting nurses to under-resourced areas by improving the prospects for rewarding, long term employment for home care nurses through the creation of policy change. A second goal of this applied research project is to inform policy decisions, through valid research, about effective strategies for optimizing the utilization of RNs and RPNs in community practice settings.

The primary objectives of the study currently underway at the Nursing Health Services Research Unit (NHSRU) are to:

  1. Determine how decisions, on the utilization and allocation of Registered Nurses (RNs) and Registered Practical Nurses (RPNs), are currently being made in Ontario home care provider agencies; investigate the feasibility of, and provide input into, the development of an RN/RPN Utilization Toolkit for the home care sector.
  2. Compile a detailed demographic profile of nurses working in the home care sector and identify areas of concern/strength related to current trends in the home care nursing workforce.
  3. Evaluate the unique challenges of attracting and retaining early, mid and late career nurses to the home care sector and describe factors or policy initiatives that may be instrumental in attracting new graduates to community nursing as an employment choice.

To date, researchers have completed a detailed demography of visiting home care nurses working in Ontario, and are in the process of administering surveys to a stratified sample of 900 early, mid and late career nurses in this sector.  Concurrent with the survey administration, interviews with a sample of home care (HC) decision makers are being conducted by NHSRU staff. Interview questions have been developed to address issues associated with the allocation and utilization of RN/RPNs in Ontario’s home care settings.

View Full PDF Report

Environmental Scan: Stakeholder Preferences for Dissemination

Posted on by jleeming

Research Team:

Andrea Baumann,
Diane Doran,
Theresa Noonan,
Laurie Kennedy,
Dan Laporte,
Marianne Koh

 

This environmental scan of the Nursing Health Services Research Unit’s (NHSRU) stakeholders will be used to engage users of evidence in the program of research. In order to obtain salient information, seven nursing leaders were interviewed in 2011 and a 15-question online stakeholder survey was conducted. The scan, which is presented in two sections, identifies audience-specific NHSRU research topics and highlights dissemination vehicle preferences. All stakeholders said they would like the NHSRU to host web conferences, and we are planning these for fall 2011. The scan was completed as part of the NHSRU’s contract with the Ministry of Health and Long-Term Care (MOHLTC). Results will be incorporated into the NHSRU Knowledge Transfer Strategy and will be evaluated. Section I provides action items, a discussion of hot topics in nursing and the results of the interviews and survey. Section II focuses on decision makers and provides a detailed summary of survey findings. It includes the questions for the environmental scan and the online survey results and template.

 

View PDF Report

Interim Report: Evaluating the Impact of Ontario’s Late Career Nurse Initiative

Posted on by mkoh

Research Team
Diane Doran, RN, PhD, FCAHS
Dan Laporte, Research Manager, NHSRU
Autumn Chilcote, Research Officer, NHSRU
Paul Rizk, Research Officer, NHSRU
Ping Zou, Research Assistant, NHSRU

Executive Summary

In an effort to stem the loss of Ontario’s late career nurses, in 2004 the Ontario Ministry of Health and Long-Term Care (MOHLTC) introduced the Late Career Nurse Initiative (LCNI). This initiative involved providing funding to hospitals and long-term care homes for salary or benefits replacement costs for late career nurses (Registered Nurse, Registered Practical Nurse and Nurse Practitioners who are aged 55 and over) participating in less physically demanding nursing roles for 20% of their working time.

The current study was developed to systematically evaluate the impact of the MOHLTC’s LCNI on the retention of late career nurses in Ontario, as well as explore the degree to which it is impacting nurses’ job satisfaction and feelings of organizational commitment. In addition to these primary objectives, the study explores the secondary benefits of the Initiative, such as capacity building and its impact on patient care.

The specific objectives of the study currently underway at the NHSRU are to:

  1. Determine the extent to which the LCNI has had an impact on retention rates of late career nurses;
  2. Evaluate the MOHLTC’s Retention Performance Target formula for assessing the success of organizations’ efforts to retain nurses;
  3. Determine the extent to which the LCNI has had an impact of the job satisfaction, autonomy, control over the work environment, and burnout of late career nurses;
  4. Describe the secondary impacts of the LCNI on organizations (i.e., secondary benefits and consequences);
  5. Determine which specific characteristics of late career proposals are associated with improved retention rates.

To date, researchers have been in contact with 90 organizations that have participated in the LCNI, 67 of which have agreed to contribute data to the study. Currently in the first phase of the evaluation, the NHSRU has engaged Nurse Leaders throughout Ontario in semi-structured interviews to obtain their impressions of the initiative and assess the perceived success of the LCNI. Interview participants have also been asked to characterize the components of a successful LCNI proposal. The current report reflects the preliminary analyses of these interviews.

Key Messages

Successes. Preliminary analysis of the interview data indicates that organizations support the initiative and are reporting successful retention of Late Career Nurses. Nurses Managers suggested that the programs offering opportunities for mentorship, programs focusing on patient care, or those that were specifically designed for the Late Career Nurse participants resulted in higher levels of job satisfaction and enhanced practice experience of Late Career Nurses. Nurse Managers also identified secondary benefits of participation in the LCNI, including improved clinical outcomes with patients and a range of organizational benefits from improvements in organizational culture (e.g. reputation as a good employer, values-driven organization) to completion of important special projects.

Concerns over time frame. Concern has been expressed about the insufficient time provided to organizations to put their programs in place and utilize the LCNI funding, especially the announcement of funding in late December with a requirement to fulfill program goals by March. Participants reported that the short timeframe allotted for projects was problematic due to scheduling difficulties and insufficient time to roll-out proposed projects in order to use the funds offered. Nurse Managers suggested that the funding period of January through March was further complicated by winter holidays combined with the increased needs of patients during cold and flu season.

Response to Retention Performance Target. Participants conveyed that they had little understanding of the purpose or meaning behind the Retention Performance Target (RPT). Recurrent themes appearing in the interview data included difficulty in completing the form, lack of comprehension of the calculations, and little connection between the Target and the initiative (e.g., retention is not the only relevant outcome to organizations, as other indicators of success, such as capacity building and improved patient outcomes are not captured by the RPT). Nurse Managers also expressed that they would benefit from a greater understanding of the RPT formula, and would also like to receive feedback on whether the form has been completed correctly, as well as feedback related to how the measure is used after the fact or compared with other participating sites.

View Full PDF Report

Research in Action Summary: Linking BPGs Use and HOBIC Outcomes in the Community

Posted on by mkoh

Research Team
Diane Doran
Nancy Lefebre
Peggy White
Carole Estabrooks

This summary presents selected highlights from a research study entitled “Linking Best Practice Guideline Use and Health Outcomes for Better Information and Care (HOBIC) in the Community.”

The full report will be available soon on our website: www.nhsru.com. For more information please contact Jenny Carryer at doran.research@utoronto.ca.

View PDF Summary

Research in Action: Evaluating the Impact of Ontario’s Late Career Nurse Initiative

Posted on by mkoh

Research Team
Diane Doran, RN, PhD, FCAHS
Dan Laporte, Research Manager, NHSRU
Autumn Chilcote, Research Officer, NHSRU
Paul Rizk, Research Officer, NHSRU
Ping Zou, Research Assistant, NHSRU

This summary presents selected highlights from a research study entitled “Evaluating the Impact of Ontario’s Late Career Nurse Initiative”. An interim report for the research study is also available on our website.

Once the study has been completed, the full report will be available on our website: www.nhsru.com. For more information, please contact Autumn Chilcote at autumn.chilcote@utoronto.ca.

View PDF Summary

Increasing the Utilization of Health Outcomes for Better Information and Care

Posted on by mkoh

Research Team:

Diane M. Doran, RN, PhD, FCAHS
Dorothy Pringle, OC, RN, PhD, FCAHS
Peggy White, RN, MN
Laureen Hayes, RN, EdD
Autumn Chilcote, MEd (c)

Executive Summary

This report presents evidence in published literature about successful outcomes/performance monitoring implementation strategies, as well as recommendations from healthcare managers to provide a process evaluation of the Ministry of Health and Long Term Care (MOHLTC) Health Outcomes for Better Information and Care (HOBIC) implemented between 2006 and 2010.The findings demonstrate implementation and sustainability strategies for healthcare initiatives that have been evaluated and published in academic literature, and interview feedback from healthcare managers in acute and long-term care settings in which HOBIC was implemented. The research design for this project included two key components: a literature review on successful outcomes/performance monitoring implementation strategies and interviews with HOBIC leadership in MOHLTC identified sites to discuss specific implementation and utilization strategies and recommendations for HOBIC going forward. Rogers’ Model of the Innovation-Decision Process (2003) was used as a theoretical model to link the implementation processes, specifically the five sequential stages of the process of innovation decision-making: knowledge, persuasion, decision, implementation, and confirmation. This theoretical model describes how, why, and at what rate new ideas and technology spread through culture, and therefore has particular relevance to HOBIC utilization and uptake. A review of published literature focused on the terms: practice change, practice implementation, practice improvement, implementation strategy, successful implementation, nursing practice change, nursing intervention implementation and nursing implementation adoption. This revealed an initial 2,338 abstracts which were scanned, and 29 studies that were selected (Appendix A) and analysed for key themes, strategies, and sustainability efforts that proved successful. Expert consultation was sought through semi-structured phone interviews with HOBIC leaders from 12 acute care sites and four long-term care sites. Qualitative analysis of interview content focused on motivators and strategies for implementation, utilization and sustainability practices, and recommendations for practice-change going forward.

Key messages

Key messages in relation to the implementation and utilization themes are follows:

Implementation themes:

  • Motivations for adoption of HOBIC included administrative initiatives (ex. gains in funding or other resources) and the need for an improved clinical assessment tool.
  • Leaders were responsible for identifying the opportunities for HOBIC within their organization, communicating with committees, management, and staff, and motivating staff enthusiasm to complete the education.
  • Interview participants indicated the use of project teams or “working groups”, allowing for the development of “superusers” that could then disseminate conversation about HOBIC to front-line staff, as well as provide leadership in education initiatives.
  • Consistent with the literature, engaging front-line participatory input on collaborative teams was often noted as important to engagement of staff.
  • The literature shows that education and training are key activities to disseminate new information, receive staff input, and gain staff support, followed by reinforcement where necessary.
  • An adaptable approach was considered essential, as agencies adapted HOBIC within the style of roll-out, and developed agency-specific innovations related to how HOBIC would be used within the organization.
  • Available resources, respondents felt strongly that without the support of the MOHLTC, the HOBIC initiative would not have been possible in their agencies. Financial support was indicated most often as the motivator for implementation of HOBIC.
  • The most commonly applied quality improvement technique in the reviewed studies was the Plan, Do, Study, Act (PDSA) cycle which promotes appropriate testing, adaptation and retesting of change decisions.

Utilization themes:

  • For sustained utilization of HOBIC, leadership provided a conduit for providing feedback to- and receiving feedback from- organizational and clinical staff, coordinating educational opportunities, and adapting HOBIC use to the priorities and current practices within the agency.
  • Audit and feedback involved use of HOBIC reports to review compliance with use and exchange knowledge in the integration of HOBIC into clinical care and organizational management.
  • Ongoing education of staff, as an important element of HOBIC utilization and practice change, involved diverse ways, including internal and external opportunities, as well as educational collaboration between agencies.
  • Continual adaptation involved diverse ways in working toward sustainable practice change based on the needs of their organization, resources available, and feedback from stakeholders.
  • Consistent with the literature findings, several barriers were noted:
  • Lack of knowledge of the utility of HOBIC measures and reports.
  • Daily work tasks that were not directly related to HOBIC.
  • Admission wait-times that were outside of the HOBIC window, transfer of patients to units that were not using the HOBIC tool, and difficulty communicating HOBIC-related questions to patients.
  • Agencies also noted the lack of sustained funding and resources as a barrier to utilization, including loss of internal and external HOBIC Coordinators, and little perceived advantage in ongoing measurement without complete agency compliance.

Recommendations

Outcomes for this project included the importance of effective leadership before, during and after implementation, education, adaptability, the availability and use of resources, framework for change being embedded in a conceptual model, and the availability and use of audit and feedback mechanisms.

Agency recommendations arising from the study are grouped into the key themes emerging from this research, with an additional category below specifying recommendations and feedback for the MOHLTC.

Leadership

  1. Demonstrate strong support and commitment for evidence-based practice and HOBIC outcomes among senior leadership within the organization.
  2. Identify HOBIC leaders, including specific job functions and responsibilities related to implementation and sustainability (e.g., using report information, giving feedback to staff, reporting to committees).
  3. Anchor HOBIC in other practice initiatives such as evidence based practice, quality improvement, patient centred care, and patient safety.
  4. Provide opportunities for regular communication between staff, project team, and administration related specifically to HOBIC.
  5. Identify individuals within the agency that will provide support or back-up for leadership in the case of staffing changes, or in the case of need for additional support.
  6. Provide a recognition and reward system for leadership initiatives taken by staff.
  7. Evaluate the feasibility of a new staff position, including skills and experience in leadership roles, with job duties including implementation, evaluation, leading quality improvement or practice development related to HOBIC outcomes, and sustainability of HOBIC.
  8. Update current job descriptions and performance evaluations to clearly define staff roles and responsibilities related to use of HOBIC and evidence based practice.
  9. Allocate budgetary funds for the management of sustainability of HOBIC.
  10. Integrate HOBIC language into agency and unit policy manuals, mission, and value statements.

Project team

  1. Consider the development of team leadership related to HOBIC utilization and sustainability, including rationale for selection of team members, representation from multiple areas within the organization, clarification of responsibilities for the team, measurable goals, and a feedback system in place to monitor practice change.
  2. Provide team training in quality improvement, PDSA, and evidence-based practice. Allow development of working plans integrating training and assessment needs for the agency.

Education

  1. Outline clear and measurable rationale for educational initiatives, including goals related to learning and practice change.
  2. Anchor training in practice initiatives such as evidence-based practice, enabling adaptation to local priorities.
  3. The change process needs to begin by identifying the priorities and needs of frontline staff and then demonstrating how HOBIC can support practice initiatives designed to address these priorities and needs.
  4. Provide education that addresses the use of new technologies that may be required to complete HOBIC (e.g., first-time computer use, part-time and casual staff that are not familiar with tools). Offer education in different modes and formats
  5. Identify broad educational opportunities, both formal and informal, in which to integrate HOBIC as a talking point and for practical uses.
  6. Provide a feedback mechanism through which HOBIC users can evaluate educational offerings, and pre- and post- education evaluation systems.
  7. Develop methods to evaluate completed education for HOBIC users, including accountability through job descriptions, compliance audits, and feedback to users.
  8. Provide visible reminders and easy-access reference materials (e.g., chart-side laminated guides, hints for success).
  9. Provide ‘bedside’ assistance to facilitate uptake during the implementation stage, with a support person to work with client needs while the assessment tool is practiced. The support person/trained facilitator needs to model the integration of HOBIC review and feedback into clinical care planning, practice reflection, and continuous improvement.
  10. Provide opportunities for group experiential learning (e.g., patient care rounds), to facilitate implementation and utilization of HOBIC within workflow.
  11. Provide a forum for questions and answers; post FAQs in an area that is easy to see and easy to access for HOBIC users.
  12. Identify experts that can be accessed for questions relating to HOBIC use, including different ways of reaching experts; cross-train experts.
  13. Develop education that includes the use of actual patient scenarios, anticipating questions that are agency-specific.
  14. Integrate HOBIC into new-hire orientation, with opportunities for additional education ongoing.

Adaptability

  1. Conduct regular scheduled reviews of the utility of assessment tools. Evaluate the feasibility of re-invention of an improved assessment tool, with a patient-centred rationale for assessment devices.
  2. Initiate a reward and recognition system for HOBIC users to suggest innovations to sustainability of HOBIC.
  3. Develop an ongoing evaluation system to determine the rationale and utility of HOBIC related to agency culture and values. Communicate with staff.

Material or written resources

  1. Develop a range of site-specific materials that are available and accessible. Clarify job duties related to update and placement of material or written resources.
  2. Evaluate staffing models and job responsibilities, considering the possibility of staffing changes in order to support HOBIC sustainability.

Theoretical model

  1. Identify strategies that would integrate HOBIC measurement into current quality initiatives, Quality Committee priorities, or accreditation strategies.
  2. HOBIC indicators could be incorporated into PDSA cycles to support quality improvement
  3. Integrate HOBIC data collection into evidence based practice initiatives, demonstrating the relationship between evidence based practice and outcomes measurement.

Audit and feedback

  1. Schedule regular meetings to review clinical reports and discuss strategies on incorporating information into clinical practice and organizational management.
  2. Conduct scheduled chart audits for compliance or patient outcomes improvement.
  3. Link HOBIC outcome feedback with audit and feedback about clinical practice, nursing process, and evidence-based practice. The relationship between outcomes measurement, nursing process, and client outcome achievement needs to be continually reinforced.
  4. Communicate results to staff, with a reward or recognition system in place to identify areas of practice change and use of evidence-based outcomes.
  5. Conduct regularly scheduled compliance reviews with clinical and organizational users, with feedback related to practice change.
  6. Combine audit feedback with educational opportunities to develop and expand capabilities of HOBIC users.
  7. Provide opportunities for ongoing process review, encouraging input from clinical and organizational users; evaluate and implement recommendations for adaptation, with a recognition system in place to acknowledge staff innovations.
  8. Maintain evaluation of HOBIC as a priority item for staff and committee meetings.

MOHLTC Recommendations

  1. Offer leadership training and networking opportunities for staff involved in HOBIC implementation and utilization, especially related to developing confidence, communication skills, change management, and responding to negative feedback.
  2. Provide on-site support staff during the implementation process, including expertise in guiding in-house ‘bedside’ coaches, in order to provide support for practice change during the implementation phase.
  3. Allocate budgetary funds for sustainability measures related to HOBIC.
  4. Offer training related to teamwork, project management, quality improvement initiatives, and evidence-based practice.
  5. Facilitate participation for MOHLTC HOBIC experts on agency project teams.
  6. Provide referral information for connection with other agency experts, software vendors, or IT support experts for agency project teams.
  7. Encourage agencies to adapt MOHLTC education materials for site-specific needs; provide encouragement and feedback for improvements.
  8. Sponsor educational forums for HOBIC users where new research, training and education, and feedback are encouraged.
  9. Provide FAQ updates to managers and HOBIC users on a regular basis.
  10. Provide an external resource person that is available after implementation to respond to questions and assist with trouble-shooting post-implementation.
  11. Offer ongoing education encouraging use of reports in care-planning and organizational management.
  12. When reviewing requests for funding for implementation of HOBIC, encourage agencies to indicate rationale related to mission and values of the organization.
  13. Tie HOBIC compliance post-implementation to availability of resources, such as opportunities to conduct research or provision of education.
  14. Offer email or listserv reminder updates to agency users, including an educational component, new research, recommendations from other HOBIC users, and information on how to fully utilize reports.
  15. Offer post-implementation review (e.g., multi-agency project groups, phone calls). Address and/or implement recommendations of users.

View Full PDF Report

Toward A National Report Card in Nursing: A Knowledge Synthesis

Posted on by mkoh

Prepared for the Planning Committee for a Think Tank entitled “Toward a National Report Card for Nursing” held in Montreal on February 13, 2011.

Research Team

Diane Doran, RN, PhD, FCAHS
Barbara Mildon, RN, PhD, CHE
Sean Clarke, RN, PhD, FAAN

Executive Summary:

This knowledge synthesis has been compiled on behalf of the planning committee for a Think Tank entitled “Toward a National Report Card for Nursing.” The objectives of the Think Tank are to create a shared vision and critical path for a national report card on nursing, to generate support for the work, and to outline the steps to achieve the national report card. The report card for nursing is envisioned as a selected minimum set of data on input, process and output indicators that can be collected nationally (initially using pilot sites) and benchmarked. In the future, such report card data will be used to formulate relationships between the levels of indicators, and will consequently reveal the contribution of nursing care to nursing sensitive outcomes and influence policy direction for nursing.

This knowledge synthesis identifies what is known about outcomes/performance monitoring initiatives in nursing, including specific indicators and reporting systems and what is known about the development, implementation and utilization of nursing report cards. This information supports the Think Tank objectives by providing participants with current and relevant knowledge to enable and advance their dialogue and decision-making related to a national report card for nursing.

The utilization of data in order to identify nursing’s contribution to quality care and to conduct research into patient outcomes dates back to Florence Nightingale. However, it was not until the late 1970s that efforts to systematically collect data to assess outcomes gained widespread attention. At that time concerns about quality of care prompted the development of datasets such as the “Universal Minimum Health Data Set” and the “Uniform Hospital Discharge Data Set,” now known as the “DAD” (Discharge Abstract Database). These datasets facilitated consistency in data collection amongst health care organizations by prescribing the data elements to be gathered. The aggregated data then informed the assessment of quality of care in hospitals and provided information on patients discharged from hospitals. However, these datasets did not include specific information about nursing care delivered to patients in the hospital, thereby rendering nurses’ contribution to patient, organizational and system outcomes invisible. To address that information gap, initiatives were undertaken in Canada and around the world to develop nursing minimum data sets (NMDS). These initiatives included Canada’s development of the Health Information: Nursing Components (HI:NC) system.

Building on experience with the various NMDS, nursing outcome databases were created to house clinical outcomes found to be sensitive to nursing care. Nursing sensitive outcomes were first identified for patient safety outcomes such as mortality, adverse events and complications during hospitalization. However, over time indicators reflective of improved client outcomes were identified including patients’ engagement in health care, their functional status and social and mental well-being. Initiatives to develop nursing sensitive outcomes, indicators and databases include the Health Outcomes for Better Information and Care project in Ontario (HOBIC); Canada-HOBIC (involving Saskatchewan and Manitoba); the National Database of Nursing Quality Indicators (NDNQI); the Collaborative Alliance for Nursing Outcomes California (CALNOC); the Military Nursing Outcomes Database (MilNOD); and the Veterans Affairs Nursing Outcomes Database (VANOD). These initiatives generate evidence in the form of data by which to identify a relationship between nursing care and outcomes for patients, clients and residents. Report cards were developed as a mechanism to share the results. In 2001 a Knowledge Synthesis: Toward a National Report Card in Nursing 4 Prepared for the Planning Committee – Toward a National Report Card for Nursing team of experienced nurse researchers in Ontario developed a nursing report which was the first step in the development of a balanced scorecard for nursing services. It provided recommendations and supporting evidence for the inclusion of nursing data in each of the four quadrants of the balanced scorecard (system integration and change; clinical utilization and outcomes; patient satisfaction; and financial performance and condition). The indicators were selected based on outcomes of care and included those experienced by the patient, nurses, informal caregivers (e.g. family and friends) and hospital. As the availability of outcomes data has increased over time, it has been used to improve the quality of care and for research examining the relationship between nursing inputs and outcomes.

Canada has many advantages that other countries do not have because of our national data sets housed at the Canadian Institute of Health Information, including the DAD, the Management Information System (MIS) and the Resident Assessment Instrument (RAI) suite of instruments. A nursing minimum data set could be linked to data within those datasets which contain the types of information about patients and facilities that are essential for risk adjustment.

The majority of NMDS focus on a core set of patient safety outcomes, such as pressure ulcers, falls, and nosocomial infections. HOBIC and C-HOBIC have taken a broader perspective to include outcomes such as functional status, symptoms, and therapeutic self-care. Several NMDS have also included a work environment survey which enables an examination of the impact of work environment change on nurse and patient outcomes. Collectively, these data elements are generally categorized according to Donabedian’s well recognized “structure, process and outcome framework.” Accordingly, selection of nursing sensitive outcomes for a Canadian nursing report card should encompass data from each of the three categories and should include both quality and safety indicators. Selection of report card data needs to be guided by appropriate research methods. Additionally three primary questions to guide indicator selection have been identified: 1) is the indicator meaningful, 2) feasible, and 3) actionable?

As Think Tank participants identify the next steps in advancing NMDS work in Canada the findings of this knowledge synthesis support the recommendation that the following questions be considered: 1) What data elements would constitute the minimum data set? 2) How can the data be captured in valid and reliable ways? 3) How can such data be linked to other data sets that contain information about patient and hospital characteristics? 4) How can data on nursing interventions be collected? And finally, 5) How can these data be analyzed and repackaged, not only to enable quality improvement and support for patient care decisions organization-wide, but also for application at the unit level by unit/service managers, front line nurses and other care providers at the point of service? It is also recommended that data related to nursing work environment be collected as part of the core dataset.

This knowledge synthesis provides evidence of a solid foundation of knowledge and achievements in the field of nursing outcomes measurement and reporting. The existence of reliable and valid nursing sensitive indicators and outcomes has been identified for both safety and quality outcomes for patients. Moreover, the feasibility of collecting and reporting such data has been affirmed. Data gathered in a national nursing report card could inform dialogue and planning regarding current nursing issues in Canada. The Think Tank represents a welcome and strategic opportunity to advance efforts to realize a national nursing report card.

View PDF Report (English)

View PDF Report (French)

The Emerging Role of PDAs in Information Use and Clinical Decision Making

Posted on by rkhan

Author(s): Doran, D. M.

Publication: Evidence Based Nursing, 2009;12:35-38.

Abstract: One of the great challenges facing healthcare professionals today is the effective and efficient management of an ever-increasing amount of clinically related health information. An important dimension of this challenge is the accessibility of information at times of decision making. Mobile information terminals, such as personal digital assistants (PDAs), have the potential to address this challenge by bringing the most relevant information directly to the point of care. Providing information through convenient electronic sources may address some of the barriers that inhibit access and clinical use of new and relevant research by nurses. The purpose of this Notebook is to explore the use of PDAs to increase nurses’ access to and use of evidence-based resources in practice. It will explore how information and communication technologies, such as PDAs, can support evidence-based practice and will examine the role of information and communication technologies within the context of established knowledge-translation approaches. Recognising that information technologies alone will not change evidence-based practice, the limitations of current technologies will be discussed, drawing on research evidence to argue the importance of considering technological innovation within the context of other knowledge-translation strategies. New or enhanced competencies that will be needed to ensure quality health care were outlined in the publication Crossing the quality chasm.1 They included expertise in evidence-based practice, quality improvement, informatics, and patient-centred care. Each of the skills identified represents a key component of evidence-informed decision making, and they all come together where nurses and patients meet—at the point of care. Nurses must be engaged in continuous learning to acquire patient-centred and treatment-focused information in new and more rewarding ways. Our team has been studying the effectiveness of PDAs and mobile tablet personal computers (tablet PCs) for improving nurses’ access to evidence-based resources at the point of care. Point of care in this context is where nurses and patients interact and could include the bedside, an ambulatory clinic, the home, or even an electronic communication.

An Evaluation of Communication Practices in Ontario Family Health Teams (FHT)

Posted on by rkhan

Executive Summary:

The Family Health Team (FHT) initiative is providing care to more than 1.7 million Ontarians, including 180,000 patients who did not previously have a family physician Furthermore, early Ministry estimates suggest that physicians in these new settings will be able to see “up to 52%” more patients a day than physicians working in traditional practice settings.

The Ministry of Health and Long Term Care (MOHLTC) has set a target of implementing an additional 50 family health teams and 25 nurse practitioner-led health care clinics, over the next four years. This will bring the total FHTs to 200 with the hopes of facilitating around-the-clock care for Ontarians and reducing the strain on the already over burdened Emergency departments around the province.

This study is preliminary in nature, and will investigate participant’s experiences working in FHTs, as well as investigate collaboration, role conflict and ambiguity. Although this study is largely exploratory the researchers hope to examine the data for trends linking collaborative practices to wait times, job satisfaction and stress.

Nurses interviewees were asked to provide recommendations to improve the overall efficiency of the Family Health Team initiative. The full list of suggestions included:

1. Improve collaboration and communication within the FHT to enhance inter –disciplinary practice (e.g., teach skills and strategies to implement).

2. Ensure healthcare professionals are working to their full professional capacity

3. Encourage physicians to put forward referrals to other healthcare professionals (e.g., nurse practitioners, dietician etc) to collaboratively manage complex patients, as it is not always necessary for them to see a physician.

4. Implement clinical meetings with all FHT providers to enable conversation about patient care.

5. Encourage physicians to advise patients that they don’t always need to be seen by the physician.

6. Both hire and speed up the hiring process of more RNs, NPs, Pharmacists and Psychiatrists.

7. Develop chronic disease self management programs. 8. Educate the community to what a FHT does and advertise the concept to increase awareness (e.g., community newsletter).

View PDF Full Report

Research Team

Diane Doran
Linda O’Brien-Pallas

Sector Specific Components that Contribute to Positive Work Environments and Job Satisfaction For Nurses/ Issues in Long-Term Care and Community Care

Posted on by rkhan

Executive Summary:

Most data examining the correlation between work environment conditions and job satisfaction for nurses is derived from studies conducted in the acute care/hospital sector. There are fewer studies examining the relationship between work environment and nurse job satisfaction in other employment sectors. In November 2007, the Ontario Ministry of Health and Long-Term Care (MOHLTC) asked the Nursing Health Services Research Unit (University of Toronto site) to conduct a study to explore factors that contribute to job satisfaction for nurses working outside of the acute care (hospital) sector.

This study explored sector specific components that contribute to positive work environments and job satisfaction for nurses working outside of the acute care sector. Specifically, this study examined the recruitment and retention initiatives being implemented by nursing employers in the community, public health and long-term care sectors in various geographic areas of Ontario. The study sought to elicit the perceptions of nurse leaders and front-line staff nurses. The following are the research questions of the study.

1. What recruitment and retention initiatives/Healthy Work Environment (HWE) strategies are nursing employers currently implementing?
2. What are the perceptions of nurse leaders and front line staff regarding the effectiveness of the retention initiatives? What is working and what isn’t?
3. What are the specific recruitment and retention challenges being experienced by nursing employers?
4. What are the main work environment concerns as perceived by nurse leaders and staff nurses? 5. What keeps nurses in their current jobs?
6. Are there generational differences regarding nurses’ job satisfaction?

In a second phase of the study, completed over the winter and spring of 2009, the following questions were also posed to the community care nurses:

1. How are your case loads and working hours decided?
2. How would you characterize or describe the role of the CCACs?
3. What would you describe as some of the positive aspects of working with the CCACs? How about negative aspects?
4. What unique challenges do nurses in your sector face when trying to provide care?
5. How efficient do you feel the current system for administering care in the community is? What recommendations do you have for improving the current system?
6. What are your thoughts on the current model for managing community services (i.e., competitive bidding)? Does it have any impact on your feelings of job security or job satisfaction? Does it have any impact on your ability to provide quality care? Probe: If yes, please describe.

View PDF Full Report

Research Team

Linda O’Brien-Pallas
Diane Doran, RN, PhD