Case studies
Social Movement Action Framework
Valuing the need for hospice and palliative care services
Advocacy for humane death and dying care practices led to the valuing and realization of hospice and palliative care services in South Australia.
Advocacy for humane death and dying care practices led to the valuing and realization of hospice and palliative care services in South Australia in the 1990s (Elsey, 1998). Early hospice and palliative care advocates pressed for comprehensive community services provided by knowledgeable, humane and compassionate care providers who understood and supported the need for an alternative to medical practices in this area.
Advocates also recognized the need for funding, legislation, support of relevant volunteer organizations, and capacity-building in health professionals to ensure effective delivery of hospice and palliative care services.
Rooting the Kahnawake Schools Diabetes Prevention Project in Indigenous values
A diabetes prevention project in a First Nations community in Quebec was effectively implemented through multiple strategies including the integration of Indigenous values and beliefs.
The Kahnawake Schools Diabetes Prevention Project (ksdpp.org) in the First Nations reserve of the Mohawks of the Kahnawake in Quebec, Canada aims to prevent type 2 diabetes in Kahnawake by empowering community members to care for their health. Project leaders were informed at the outset by evidence that demonstrated a two-fold higher risk of diabetes and diabetes-related complications in adults (Tremblay et al., 2018).
To be meaningful for community members, the change was rooted in the values and traditions of Kanien’kehá:ka beliefs, incorporating a holistic approach of spiritual, emotional, physical and mental dimensions that reflect wellbeing. The project’s focus aligned with the value of protecting and promoting the health of future generations. By linking the change in values, families and other community members were more invested in the cause.
Mobilizing communities for HIV prevention
Social movement strategies have been effectively applied to advance and advocate for HIV prevention. Read more in this case study.
Social movement strategies to engage and mobilize communities have been effective at reducing HIV transmission. Community-based interventions have made significant advancements in HIV prevention, including:
- decreasing discrimination against those who are HIV positive;
- raising the levels of HIV testing and counseling amongst young adults;
- improving access to program and service quality; and
- increasing the uptake of antiretroviral treatment to prevent transmission to non-infected partners.
Engaging and mobilizing communities – including members of stakeholder groups and civil society agencies – has been critical in taking collective action towards the goal of preventing HIV transmission. To be effective, communities were found to need the following three key components:
- empowerment through elements, such as leadership, resources, program management and the support of external partners
- development of having a collective or shared identity as a community
- capacity in health promotion, including the development of knowledge and skills, available resources, civic engagement, values for change and a learning culture
Knowledge-to-Action Framework
Adapting BPG recommendations to a public health context – Insights from Toronto Public Health
Toronto Public Health – a Best Practice Spotlight Organization® (BPSO®) - has adapted several RNAO best practice guidelines (BPGs) to align with a population health approach.
Toronto Public Health – a Best Practice Spotlight Organization® (BPSO®) in Toronto, Canada – has implemented several RNAO best practice guidelines (BPGs), including Woman Abuse: Screening, Identification and Initial Response (2005) and Preventing and Addressing Abuse and Neglect of Older Adults (2014). Because some practice recommendations in these guidelines focus on the individual person or patient level, they didn’t always align with Toronto Public Health’s population health approach.
To adapt recommendations to the public health context, the change team completed a literature review to explore definitions and adapt strategies to align with the model of care delivery and health promotion philosophy.
Another approach that was taken by Toronto Public Health: piloting BPG recommendations within one small program team. The team would then evaluate the implementation until successful, consistent with the Plan-Do-Study-Act approach). Once successful, the intervention was scaled up within the organization to other programs and teams (Timmings et al., 2018).
Adapting BPG recommendations to a Chinese acute care context to reform care delivery– lessons learned from DongZhiMen Hospital
Care practices were revised using adapted evidence-based best practice guidelines in an acute care facility in Beijing, China.
DongZhiMen Hospital – a BPSO in Beijing China – was motivated to reform care delivery through the use of RNAO BPGs. While best practice recommendations provided general guidance, DongZhimen Hospital identified the need to translate these statements into detailed instructions and parameters tailored to their specific hospital context.
To adapt statements to their context, they translated the guideline into Chinese. A multidisciplinary team then worked through the initial steps of the Knowledge-to-Action Framework. This involved:
- reviewing carefully the evidence to thoroughly understand the intent of the recommendations
- conducting a comprehensive gap analysis
- interviewing staff members and others to identify facilitators and barriers to the use of the BPG.
Using this information, the team was able to create specific, clinical nursing practice standards derived from the recommendations and relevant to their context (Hailing and Runxi, 2018).
Facilitating an evidence-based culture at Unity Health Toronto - St. Michael’s Hospital
Unity Health Toronto - St. Michael’s Hospital, a Best Practice Spotlight Organization® (BPSO®) has embedded evidence-based practices into its culture and daily work processes as part of its corporate strategy.
Unity Health Toronto - St. Michael’s Hospital, a Best Practice Spotlight Organization® (BPSO®) in Toronto, Canada, has embedded evidence-based practices into its culture and daily work processes. Evidence-based practice is part of the hospital’s corporate strategy. It has invested resources to build a critical mass (over 30 per cent) of staff members who are best practice champions.
The hospital also provides multiple capacity-building opportunities, including a community of practice, boot camps, booster sessions and mentorship. The annual Nursing Week Gallery Walk, depicted in the image above, is just one way that St. Michael’s Hospital profiles the work of champions and others dedicated to using evidence to inform change initiatives.
SOURCE: Transforming Nursing Through Knowledge, 2018.
Engaging Persons with Lived Experiences
Integrating patient partners in change – Lessons learned from Kidney Health Australia
Kidnney Health Australia case study
In early 2018, Kidney Health Australia (KHA) developed a guideline for managing percutaneous renal biopsies for individuals with chronic kidney disease (Scholes-Robertson et al., 2019). KHA included 40 persons from across Australia with lived experience of chronic kidney disease and their caregivers – “patient partners”. KHA asked patient partners to prioritize which topics were most important to them during a percutaneous renal biopsy.
Patient partners valued: minimizing discomfort and disruption, protecting their kidneys, enabling self-management, and making sure that support for families and caregivers would be available. They indicated that all of this would help alleviate anxiety and avoid undue stress. Their voices were heard, and KHA effectively incorporated these suggestions in guideline development.
Notably, there were marked differences between the priorities identified by the content experts on the guideline development working group, versus what the patient partners perceived to be important to their health and wellbeing, as shown in the table below.
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Topics prioritized by content experts |
Topics prioritized by patient partners |
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