Registed Nurses' Association of Ontario

Implementation of the Best Practice Guideline: Assessment and Management of Foot Ulcers for People with Diabetes in a Clinic Setting

Jenny St. Jean
Bayshore Healthcare

My journey began right after the completion of my Masters in Clinical Science with a focus in Wound Healing. A month had past in the late summer and I along with two other nurses was contacted by our organization to see who would like the opportunity to apply for the fellowship. All that came to mind was exhaustion from the masters program, lots of work, but the opportunity to develop knowledge and skills professionally along side other mentors who were already professionally developed and experienced in providing evidence based care and knowledge translation. I knew after my masters I wanted to use what I had learned by becoming a mentor to other nursing staff along with improving practice in my agency to provide our community with the evidence based practice care. The application process was just as stressful and complex as I had anticipated, however looking back now I believe it was to assist the fellowship applicant in specifying and organizing as much as possible their learning goals, objectives and outcomes in a timely manner so time was not wasted once the fellowship began. Even after having a learning plan to follow; completing the learning objectives, activities and outcomes within the given 450 hours was still very challenging due to competing priorities, time and availability of mentors and management due to unexpected events. Once the application process was finished all that was left to do was to wait for acceptance into the program.

Once I was accepted into the RNAO Fellowship I remember the feelings of excitement, happiness, anxiety but determination to grow professionally and intellectually. Having the opportunity to participate in the RNAO fellowship has allowed me to do just that; grow professionally and intellectually in terms of having a better understanding of how to creating positive practice change in my agency and as a result positive outcomes for the people in my community. In my past experience, time and resources have been the biggest competing factors when wanting to learn and develop skills and most of the time organizations don’t have the time or money to mentor you into a specific role; you have to “learn as you go.” Fortunately the fellowship was able to give me the time and support financially to be able to improve my skills professionally and to learn how to change practice in the community so that I can represent my new role as Wound Care Resource nurse with confidence.

During the fellowship I learned a few key principles when it comes to creating practice change and developing professional skills: There will always be competing priorities that will post-pone certain objective(s). However, if you have the ability to overcome this delay and are able to move forward once the priority has resolved then you have still succeeded in completing your objective(s).

Time is of essence for many healthcare professionals; the ability to utilize technology like teleconferencing and Webex allows for better communication as a group, saves time and resources. This method is more impersonal and as a result may be more difficult to engage other healthcare professionals in understanding the need for the practice change possibly due to the presenter having poor electronic presenting skills or due to other distractions occurring in the different environments.

A gap analysis is a great way to truly identify current best practices in an organization, identify recommendations from the BPG that are not met, partially met and met, and lastly to answer where when why and how. I have also learned how to utilize different gap analysis tools to assist me when doing future gap analysis in my organization.
Stakeholders are everywhere; internally: staff, management, clinic resource nurse, cleaning staff, area director, personal support workers, administration etc. Externally: physicians, hospital staff and administration, clinic staff and administration and clients. I have learned through this fellowship to engage stakeholders early in practice change, building credibility and relationships with stakeholders is important to build trust, sharing the same or similar values, knowledge and positive success will increase trust and using multiple methods to disseminate information will better engage stakeholders. Offering opportunities for clarification and participation will also engage stakeholders in the practice change. Providing brief and easy to understand information prior to meeting with mentors allows them the time to review information and prepare questions after meeting. Lastly, new stakeholders can emerge overtime, at any time.

Resources are one of the most important influences in being able to create and sustain practice change. Researching and being able to show statistically that a practice change is required is the most influential information to prove and support why there is a need for practice change and to obtain resource support.

Using tools and questionnaires to identify facilitators and barriers is very helpful when planning to implement practice change. It assists in creating strategies to overcome the barriers and how to best utilize the facilitators to successfully implement and sustain a practice change.

Research and education is important to determine which implementation strategies will best suit an environment. Since there is no black and white answer to what strategies work best for which environment, taking the time to learn and understand education theories along with researching article from experts in knowledge translation will help healthcare providers create a successful implementation plan.

Researching expert opinions and experience along with utilizing the RNAO Toolkit to develop strategies to monitor knowledge use and evaluate outcomes helps healthcare providers identify strategies that will best suit their specific environment.

The last key principle I have learned during this fellowship is to be able to sustain practice change, understanding which sustainability factors are strong and weak in the environment will help the healthcare provider understand what areas to focus on first. Utilizing self assessment tools to help identify 2-3 sustainability factors that have a high potential for improvement will better support sustainability of a practice change. Using strategies like positivity, joint-decision making, and leadership will amplify sustainability of practice change and creating an operational framework template that is specific to your environment will help sustain future processes for implementing practice change.

I am very thankful to have had the opportunity to participate in the RNAO fellowship and hope to get the opportunity another time in the near future.

Learn more about Advanced Clinical/Practice Fellowships now.