Registed Nurses' Association of Ontario

Evaluation of the Implementation of the Promoting Continence Using Prompted Voiding Best Practice Guideline in Geriatric Setting

Monika Virk

I have been working in long-term care, in the area of cognitive support, at Baycrest Centre for Geriatric Care (herein referred to as Baycrest) for 2½ years, since commencing my career as a registered nurse. Throughout the duration of my career, I have been fortunate enough to participate in many educational and professional development opportunities. None, however, have been as unique as the RNAO Advanced Clinical Practice Fellowship, which I applied to in 2013, with the hopes of focusing my attention on evaluation efforts for the continence Best Practice Guideline. Towards the end of September, I was fortunate enough to be selected by the RNAO to complete a fellowship to be completed from October 2013 to February 2014.

My experience was filled with many learning opportunities, interactions and activities that played a part in achieving objectives detailed in my learning plan. Prior to, and during the start of the fellowship time, I completed an extensive literature search on evaluation of prompted voiding, nursing programs, guidelines and facilitation strategies. I learned the importance of critically analyzing research findings and maintaining a sense of perspective while reading articles. I was invited to attend meetings of the Baycrest evaluation team, whose members are involved in organization-wide program evaluation. Not only was I able to network with different disciplines, but I learned about their processes on a broader scale. During a site visit, I spent the day networking with experts in continence and practice development at West Park Health Centre, and drew on the organization’s experience as part of my learning. Along the way, I learned a great deal from the numerous individuals I worked with, all from varying areas of practice.

Based on the data gathered I had a foundation for formulating an evaluation strategy for the continence guideline on the pilot unit. I identified strategies that would determine if objectives were met. This entailed formal and informal feedback, chart reviews, and use of organization-specific measures meant to track resident outcomes. This process posed challenges in the sense that it was quite dependent on feedback provided from staff and families. My greatest challenge was capturing staff at a time when they were unoccupied and able to engage in evaluation activities. Ultimately flexibility and persistence were integral in finding a mutually agreeable time for all involved parties in order to obtain feedback. I gained valuable data from the staff about their experience with the program, both positive and negative, consistent with the literature reviewed. Evaluation of quantitative data provided valuable information about the program. These measures were obtained via MDS assessments, resident care plans and QI indicators tracked by the organization. Based on the evaluation findings, it appeared that while there were areas for improvement, the program was effective when executed appropriately in the improvement of continence status in a cognitively impaired population

As per my learning plan, observation of facilitation by several members of the mentoring team was carried out to learn more about the various styles of facilitation and identify strategies of effective and ineffective facilitations. I took the opportunity to discuss my observations with members of the mentoring team, so that I was able to reflect on the process. Whenever I had the chance to facilitate educational sessions or discussions with staff I would have the opportunity to reflect on the experience once it had occurred. This was valuable to me as a growing leader as it enabled me to learn more about the experiences nurse leaders within the organization have, and the various strategies that they use in 2 order to deal with challenges they are faced with. It was also helpful to get into the practice of reflecting on certain encounters and sharing findings with colleagues in order to receive feedback from varying perspectives. Overall, I feel as if I have developed increased confidence and insight when it comes to my facilitation capabilities.

Towards the close of my fellowship, the opportunity arose for me to participate in the evaluation of a pilot project being implemented within the long-term care home. It was a natural bowel care trial focusing on the effects of administering ground flax seeds in lieu of pharmacological interventions. Utilizing my evaluation skills, I was able to gather pre-implementation and post-implementation data on resident’s bowel routine and functioning and participate in some of the preliminary analysis in conjunction with the implementation team. This helped consolidate my evaluation skills that were developed throughout the course of the fellowship and validate my role as a valued member of the evaluation team.

The last component of my fellowship was, and continues to be, knowledge sharing to sustain findings from my experience. To help promote sustainability of the work completed during the fellowship, I created a presentation for the continence working group through which I presented my experience. This information was also shared with other Baycrest staff, through a presentation on the ACPF experience that was open to all staff. My mentoring team supported me in abstract submission to have a poster presentation at the Ontario Long-Term Care Association Applied Research day, which we were accepted for. This allowed me to work extensively on the process of poster creation, something that I had not yet experienced. Furthermore, Baycrest has recently entered into a partnership with West Park Healthcare Centre. Nadine Janes, the director of practice development, is the lead in organizing the international conference Enhancing Practice 2014, to take place in Toronto later this year. Baycrest has been selected to represent Canada in the café component of the event, at which I will speak to my experiences with practice development in the context of my fellowship. Though my fellowship has come to a close, I believe that the learning from it will continue to be disseminating through varied formal and informal formats, and am excited to share my learning experience with others.

Nursing is a profession in which one must be continuously learning, adapting, developing and persevering. Through completion of the RNAO Advanced Clinical Practice Fellowship, and immeasurable support and guidance that was provided to me every step of the way from my mentoring team, I have had the opportunity to grow as a professional nurse. I encountered challenges in a way that I have not previously seen, and had the opportunity to work with individuals with varying levels of expertise. These experiences have fueled my desire to continue to pursue educational opportunities so that I can continue to enhance myself as a registered nurse. I am extremely grateful to the RNAO for allowing the possibility of this experience, my organization, and especially my mentoring team for their enduring support throughout the application and fellowship process. I look forward to returning to the unit with increased confidence, knowledge and perspective on nursing.

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