Case studies
Social Movement Action Framework
Promoting healthy public policy through mobilized collective actions
Queen’s Park on the Road and Queen’s Park Day are two events in which RNAO members meet with members of provincial parliament (MPPs) from all of the political parties to promote healthy public policy and nursing services. through individual and collective actions. Learn more in this case study.
Through two annual initiatives – Queen’s Park on the Road and Queen’s Park Day – RNAO members meet with members of provincial parliament (MPPs) from all of the political parties to promote healthy public policy and nursing services. Through direct engagement and advocacy with MPPs, RNAO has mobilized collective action for policy initiatives addressing areas such as poverty reduction, the use of pesticides for cosmetic use, promoting refugee health and protecting the safety and security of residents in long-term care (Grinspun et al., 2018a).
Mobilizing community engagement to sustain a childhood obesity prevention initiative
Multiple communities mobilized to sustain a childhood obesity prevention program through targeted individual and collective action. Read more in this case study.
A community initiative called Sustainable Childhood Obesity Prevention through Community Engagement (SCOPE) provides an example of collective action in the context of public health.
In the SCOPE public health initiative, the community formed a coalition with local partners such as libraries and primary care offices to take collective action for the prevention of childhood obesity. Together, they participated in a range of collective action activities, including: presentations and events promoting healthy eating choices, stakeholder engagement, resource development and policy and practice change (Kennedy et al., 2019a).
Building a global collective identity to advance knowledge uptake and sustainability - the RNAO Best Practice Spotlight Organization (BPSO) Program
RNAO's Best Practice Spotlight Organization (BPSO) program has integrated a collective identity of knowledge champions to advance evidence uptake and sustainability.
|
The Best Practice Spotlight Organization® (BPSO®) Program (https://rnao.ca/bpg/bpso) has global reach and impact that is sustained by many factors, including the development of collective identity that promotes an evidence-based culture. The BPSO logo, as a tangible representation of a collective identity, is displayed in individual sites to indicate they are BPSO units. This visibility motivates and inspires nurses and other staff to use best practice guidelines (BPG) to support the health and well-being of staff, patients/persons and their families. Participation and membership in the international BPSO network further the ties and pride of BPSO and builds the collective identity (Grinspun & Bajnok, 2018).
Within organizations, individual BPSOs nurture Best Practice (BP) Champions (https://rnao.ca/bpg/get-involved/champions) who take on leadership roles to support the planning, implementation, evaluation and sustainability of BPGs. Nurses and other staff members develop a collective identity based on a culture of integrating evidence-based practice to achieve excellence in care. The visibility of BP Champions is seen when staff where BPSO-branded clothing items, and pins that are awarded at the completion of the Best Practice Champions’ training workshop (see the examples below of social media posts of BPSO-branded t-shirts and a pinning ceremony of new champions by RNAO CEO, Dr. Doris Grinspun) (Grinspun & Bajnok, 2018). |
Knowledge-to-Action Framework
Overcoming barriers to evidence-based practice – Lessons learned from DongZhiMen Hospital and Beijing University of Chinese Medicine (BUCM) School of Nursing
DongZhiMen Hospital and Beijing University of Chinese Medicine (BUCM) School of Nursing are international BPSOs in Beijing, China. Staff at the sites identified barriers to the use of evidence in practice including heavy workloads, cultural differences and reluctant attitudes about using evidence to inform practice.
DongZhiMen Hospital and Beijing University of Chinese Medicine (BUCM) School of Nursing are international BPSOs in Beijing, China. They identified barriers to the use of evidence in practice including heavy workloads, cultural differences and reluctant attitudes about using evidence to inform practice. The assessment and identification of barriers allowed change teams to develop effective strategies for implementation with the input of stakeholders.
For example, for the implementation of the RNAO best practice guideline Assessment and management of foot ulcers for people with diabetes, barriers included
- nursing shortages across China,
- a lack of training to support the development of knowledge and skills in evidence-based nursing practice,
- the costs of guideline implementation. and
- practice recommendations that exceeded local nursing scope.
SOURCE: Transforming Nursing Through Knowledge, 2018.
Evaluating the impact of implementing the Person- and Family-Centred Care Best Practice Guideline at Spectrum Health Care
Spectrum Health Care, a Best Practice Spotlight Organization® (BPSO®) and home health organization, evaluated care outcomes after implementing the Person- and Family-Centred best practice guideline (BPG).
Spectrum Health Care (Spectrum), an RNAO Best Practice Spotlight Organization® (BPSO®), is a home health organization with more than 200 nursing staff across three locations in the province of Ontario, Canada.
Spectrum chose to implement the 2015 Person- and Family-Centred Care (PFCC) Best Practice Guideline (BPG) to enhance person- and family-centred care and to reduce complaints regarding care. Members of the senior leadership team at Spectrum Health Care led implementation together with Spectrum’s Patient and Family Advisory Council.
To support the practice change, Spectrum used the following implementation interventions:
- Conducting a gap analysis to determine the knowledge/practice gap;
- Holding education sessions for staff on person- and family-centred care best practices;
- Revising their care processes to include review of care plans with the person and/or members of their family
- Surveying staff members on their attitudes about person- and family-centred care via surveys
- Developing staff education on communication strategies to support the assessment of a person’s care needs and care plans.
After implementing these interventions, Spectrum assessed the number of complaints received from persons receiving care per 1,000 care visits and compared that to their baseline.
They found a decrease of 42 per cent of complaints from persons received over an 18-month time period at one of the sites that was implementing the PFCC BPG at Spectrum Health Care.
At another site, an 80 per cent reduction in complaints was found following the staff education intervention.
Data analyses overall indicated that the implementation of the PFCC BPG was highly successful in reducing persons' complaints regarding care.
Read more about Spectrum Health care’s results of implementing the PFCC BPG here: Slide 2 (rnao.ca)
Sustaining the Assessment and Management of Pain Best Practice Guideline across a multi-site long-term care home
The Region of Peel, a Best Practice Spotlight Organization® (BPSO®), has sustained the implementation of the Assessment and Management of Pain best practice guideline (BPG) for almost a decade.
The Region of Peel, an RNAO Best Practice Spotlight Organization® (BPSO®) started implementing the RNAO Assessment and Management of Pain best practice guideline (BPG) in 2014 and has sustained its use since then. For example, in their 2019 BPSO annual report, they cited a continuous downward trend in the number of clients who reported a worsening of their pain. Pain experienced by the residents was better controlled, and the staff was found to assess, identify, and manage pain better by using the BPG.
Their keys to success include:
- building on what works (for example, existing practices and policies)
- empowering champions and growing their champion network
- involving residents and families
- gaining support from leaders and partners including RNAO, Peel of Region Leadership, Health Quality Ontario).
- collaborating with an interdisciplinary team
- conducting a formal sustainability evaluation
To learn more about The Region of Peel’s journey in sustaining the use of the Assessing and Managing Pain BPG, along with other BPGs, check out this webinar.
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.
|
Topics prioritized by content experts |
Topics prioritized by patient partners |
|
|
