Case studies
Social Movement Action Framework
Building a collective identity to foster an anti-bullying culture
As part of a school anti-bullying campaign for children of military families in the United States, social movement participants used collective identity to promote anti-bullying messages. Read more in this case study.
As part of a grassroots anti-bullying campaign for children of military families in schools in the United States, social movement participants used collective identity to promote anti-bullying messages. Collective identity activities taken by school staff, parents and community members to promote the message "Because Nice Matters" included:
- designing and using posters, artwork and t-shirts to publicize their communication messages
- selecting and using the colours black and purple to unify their campaign
- engaging staff and students in the initiative
- having local businesses wear t-shirts with anti-bullying messaging as a sign of community support (de Pedro et al., 2017).
Guiding best practice guidelines (BPG) implementation with BPSO implementation teams
To support the effective implementation of BPGs, Best Practice Spotlight Organizations® (BPSOs®) create change teams that operate as core leadership structures to support evidence uptake and sustainability. Learn more in this case study.
To support the effective implementation of BPGs, Best Practice Spotlight Organizations® (BPSOs®) create change teams that operate as core leadership structures to support evidence uptake and sustainability. Their roles in the core leadership structure can include:
- selecting recommendations
- developing an action plan
- mobilizing implementation strategies
- supporting adherence to a practice change
- engaging in monitoring and evaluation activities
- taking active steps to support sustainability
As champions, one role of BPSOs is to compare their current practice to the guideline recommendations to see how the current practice can be maintained, strengthened or changed. Taking a “can do” attitude, they actively collaborate with their peers throughout the change process, and value and welcome their input and ideas. They take on leadership roles to support evidence-based practice change in collaboration with nurses, other staff and others (Bajnok et al., 2018a).
Engaging an interprofessional change team to lead implementation: West Park Healthcare Centre
West Park Healthcare Centre applied a call to action to implement best practice guidelines with the support and guidance of their senior leadership and implementation teams. Learn more about the role of core leadership structures in this case study.
West Park Healthcare Centre, an RNAO BPSO, is a rehabilitation and complex care centre in Toronto, Canada. They applied a compelling call to action to implement these RNAO BPGs: Assessment and Management of Pain, Client Centred Care and Prevention of Falls and Fall Injuries in the Older Adult.
With support from senior leadership, interprofessional change teams – including nurse leaders, such as advanced practice nurses and nurse practitioners – were responsible for leading the implementation strategies, which included taking collective action. Implementation efforts focused on engaging in quality improvement measures, promoting the culture and values of evidence-based practice and aligning their implementation efforts to the organization’s culture and values.
As members of the implementation teams, the nurse leaders were influencers who aimed to build collaborative and committed relationships amongst the interprofessional team and create a work environment that empowered staff to take evidence-based action. The team embraced diverse perspectives and knowledge to allow for adaptations to the local context.
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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