Registed Nurses' Association of Ontario

Promoting Continence using Prompted Voiding Best Practice Guideline

Deborah Lappen

I have been working as a staff nurse on a high tolerance rehabilitation unit at Baycrest for the last five years. Having recently graduated with a Master’s degree in Nursing, I was looking for an experience in which I could advance my new skill set while simultaneously having a mentored and supported learning experience. The Advanced Clinical Practice Fellowship (ACPF) was the perfect program to launch me into the world of the Advanced Practice Nurse and offer me the opportunity to create an individualized learning experience designed to build my skills and knowledge.

Baycrest has been involved in achieving its Best Practice Spotlight Organization (BPSO®) Candidacy since 2012, and in doing so, has been implementing six best practice guidelines across the organization. I was curious to learn more about what “implementation” really is, and therefor decided to focus my ACPF on deepening my understanding of the implementation process. I chose to focus my implementation learning activities around one of the Best Practice Guidelines (BPGs) being implemented: Prompting Continence Through Prompted Voiding.

To steer the course of my five-month fellowship experience, I created a detailed learning plan with identified strategies, outcomes and evaluation criteria to meet my learning objectives. Some of these strategies included completing literature reviews, meeting with experts in the field within and beyond my organization, having observational opportunities, and facilitating focus groups, team huddles, and continence discussions at various staff and working group meetings. The implementation process was arduous, as it involved a lot of preparation, a large number of activities and ongoing education and follow up with staff and management. However, there were many moments along the way which demonstrated that the implementation work was having an impact and making a difference in patient care. One of the most rewarding experiences was to watch staff (including nurses and interdisciplinary team members) become knowledgeable and confident about their role in continence care for their patients, and to witness new practice champions emerge and take on lead roles in bringing the best practice guideline to life on the unit.

To sustain what I have gained at conclusion of this fellowship, I will continue my involvement with the BPSO® Working Groups, which will allow me to advance my knowledge and skills regarding guideline implementation. Additionally, I will be utilizing what I have gained from this experience in my everyday nursing care, and will seek opportunities to share what I have learned with my colleagues. My continued involvement in the implementation process will reinforce what I have gained through the fellowship and also allow me to expand my expertise in this area. To sustain staff capacity (in utilizing the continence guideline and promoting best practice), on-going education has been integrated into orientation for new staff, in presentations at clinical skills days, and will continue to be emphasized in other future programs and initiatives related to best practices in urinary health. Patient and family education materials related to urinary health will also foster sustainability of the guideline. My primary mentor (who is the BPSO® lead and continence guideline lead) has worked sustainability outcomes into the guideline (i.e. electronic documentation tools, auditing, post-implementation follow-up, quality indicators, etc.). This will contribute to supporting the changes made on the implementation unit to promote ongoing integration of the guideline. The organization will help promote sustainability by providing time for these initiatives to take place, as well as providing opportunities (such as workshops and conferences) for the on-going development of staffs’ skills and knowledge.

I am deeply grateful to the RNAO and the support that I have received from my mentor and mentoring team, as well as others within my organization for this incredible learning opportunity. I feel very fortunate to have been chosen for this fellowship, and have gained knowledge and skills that I know will last me a lifetime, and I look forward to sharing my experience with others.

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