Interprofessional Collaboration in Ontario’s Family Health Teams: A Review of the Literature

Background: In Ontario, 200 interprofessional Family Health Teams (FHTs) have been established since 2005 to improve primary healthcare access, patient outcomes, and costs. High levels of interprofessional collaboration are important for team success; however, effective team functioning is difficult to achieve. FHTs are in their infancy, and little is known about the determinants that have influenced the quality of team collaboration or the outcomes that FHTs have achieved. The objective of this article is to examine current knowledge regarding FHT team functioning.Methods and Findings: A search of the literature resulted in eleven articles for final analysis, which were primarily qualitative in nature. A narrative synthesis of study findings was completed. A number of common challenges to interprofessional collaboration were identified. Nevertheless, patients and providers described improved healthcare access, greater satisfaction, and enhanced quality of healthcare using a FHT approach. Collaboration was fostered by effective leadership, communication, outcome evaluation, and training for both professionals and patients alike.Conclusions: Ontario FHTs have generated improvements in healthcare access and outcomes. Collaborative team functioning, while present, has not reached its full potential. Supportive public policy, education for patients and providers, and evaluation research is needed to advance FHT functioning

An observational study of associations among maternal fluids during parturition, neonatal output, and breastfed newborn weight loss

<p>Abstract</p> <p>Background</p> <p>Newborn weight measurements are used as a key indicator of breastfeeding adequacy. The purpose of this study was to explore non-feeding factors that might be related to newborn weight loss. The relationship between the intravenous fluids women receive during parturition (the act of giving birth, including time in labour or prior to a caesarean section) and their newborn's weight loss during the first 72 hours postpartum was the primary interest.</p> <p>Methods</p> <p>In this observational cohort study, we collected data about maternal oral and IV fluids during labour or before a caesarean section. Participants (n = 109) weighed their newborns every 12 hours for the first three days then daily to Day 14, and they weighed neonatal output (voids and stools) for three days.</p> <p>Results</p> <p>At 60 hours (nadir), mean newborn weight loss was 6.57% (SD 2.51; n = 96, range 1.83-13.06%). When groups, based on maternal fluids, were compared (≤1200 mls [n = 21] versus > 1200 [n = 53]), newborns lost 5.51% versus 6.93% (p = 0.03), respectively. For the first 24 hours, bivariate analyses show positive relationships between a) neonatal output and percentage of newborn weight lost (r(96) = 0.493, p < 0.001); and b) maternal IV fluids (final 2 hours) and neonatal output (r(42) = 0.383, p = 0.012). At 72 hours, there was a positive correlation between grams of weight lost and all maternal fluids (r(75) = 0.309, p = 0.007).</p> <p>Conclusions</p> <p>Timing and amounts of maternal IV fluids appear correlated to neonatal output and newborn weight loss. Neonates appear to experience diuresis and correct their fluid status in the first 24 hours. We recommend a measurement at 24 hours, instead of birth weight, for baseline when assessing weight change. Because practices can differ between maternity settings, we further suggest that clinicians should collect and analyze data from dyads in their care to determine an optimal baseline measurement.</p

University Competency-based Courses for Internationally Educated Nurses (IENs) in Ontario: A Pilot Education Pathway to Registered Nurse (RN) Licensure

In 2014, a team of nurse educators and champions of internationally educated nurses (IENs) in Ontario, Canada, came together to address the issue of supporting IEN transition to practice as one route to help address nursing shortages. Courses were developed with funding from the Government of Ontario, and policy and coordination support from the Council of Ontario Universities, to pilot an educational bridging pathway for IENs. The faculty team across four Ontario universities used a consortium approach to coalesce province-wide expertise in IEN education. What began as a selection of targeted, competency-based courses has since evolved into a full Competency-Bridging Program of Study for Internationally Educated Nurses in Ontario, aligned with other IEN bridging program offerings across the province. This paper describes the initial process of the group, from 2015 to 2018, to create foundational learning and competency-based courses to meet targeted entry-to-practice (ETP) competencies for Registered Nurse (RN) registration with the College of Nurses of Ontario (CNO). The barriers to IENs in meeting ETP requirements and how the gap in the existing Ontario IEN bridging to a Bachelor of Science in Nursing (BScN) education to meet regulatory requirements are also addressed. This article explores how Ontario may respond to the increasing nursing shortages and the need to engage ethically and retain IENs in practice. Lessons learned from competency-course development add to the growing body of knowledge about IEN program experiences in Canada to enable more IENs to enter the Ontario nursing workforce. Résumé En 2014, une équipe d’infirmières et infirmiers enseignants en Ontario, au Canada, et défenseurs des infirmières et infirmiers formés à l’international, s’est réunie pour aborder la question du soutien à la transition des infirmières et infirmiers formés à l’international vers la pratique, comme une voie pour aider à remédier aux pénuries d’effectifs infirmiers. Des cours ont été élaborés grâce au financement du gouvernement de l’Ontario et au soutien en matière de politique et de coordination du Conseil des universités de l’Ontario, afin de piloter un cheminement éducatif de transition pour les infirmières et infirmiers formés à l’international. L’équipe du corps professoral de quatre universités ontariennes a utilisé une approche de consortium pour regrouper l’expertise provinciale en formation des infirmières et infirmiers formés à l’international. Ce qui a commencé comme une sélection de cours ciblés fondés sur les compétences a depuis évolué pour devenir un programme d’études complet de transition pour le développement des compétences attendues en Ontario, aligné sur d’autres programmes de transition offerts dans la province pour les infirmières et infirmiers formés à l’international. Cet article décrit le processus initial du groupe, de 2015 à 2018, pour créer des cours d’apprentissage essentiel fondés sur les compétences permettant de développer les compétences ciblées pour l’accès à la pratique infirmière par l’inscription au tableau de l’Ordre des infirmières et infirmiers de l’Ontario. Les obstacles qui les empêchent de satisfaire aux exigences de compétences pour accéder à la pratique et la façon dont étaient comblés les écarts existants pour les infirmières et infirmiers formés à l’international vers un baccalauréat en sciences infirmières en Ontario sont également abordés. Cet article explore comment l’Ontario peut répondre aux pénuries croissantes d’effectifs infirmiers et à la nécessité de s’engager de manière éthique et de retenir des infirmières et infirmiers formés à l’international dans la pratique. Les leçons tirées de l’élaboration des cours fondés sur les compétences s’ajoutent à l’ensemble croissant de connaissances sur les expériences des programmes au Canada pour les infirmières et infirmiers formés à l’international afin de permettre à davantage d’entre elles et eux d’intégrer les effectifs infirmiers de l’Ontario

A mixed methods pilot study with a cluster randomized control trial to evaluate the impact of a leadership intervention on guideline implementation in home care nursing

Abstract Background Foot ulcers are a significant problem for people with diabetes. Comprehensive assessments of risk factors associated with diabetic foot ulcer are recommended in clinical guidelines to decrease complications such as prolonged healing, gangrene and amputations, and to promote effective management. However, the translation of clinical guidelines into nursing practice remains fragmented and inconsistent, and a recent homecare chart audit showed less than half the recommended risk factors for diabetic foot ulcers were assessed, and peripheral neuropathy (the most significant predictor of complications) was not assessed at all. Strong leadership is consistently described as significant to successfully transfer guidelines into practice. Limited research exists however regarding which leadership behaviours facilitate and support implementation in nursing. The purpose of this pilot study is to evaluate the impact of a leadership intervention in community nursing on implementing recommendations from a clinical guideline on the nursing assessment and management of diabetic foot ulcers. Methods Two phase mixed methods design is proposed (ISRCTN 12345678). Phase I: Descriptive qualitative to understand barriers to implementing the guideline recommendations, and to inform the intervention. Phase II: Matched pair cluster randomized controlled trial (n = 4 centers) will evaluate differences in outcomes between two implementation strategies. Primary outcome: Nursing assessments of client risk factors, a composite score of 8 items based on Diabetes/Foot Ulcer guideline recommendations. Intervention: In addition to the organization's 'usual' implementation strategy, a 12 week leadership strategy will be offered to managerial and clinical leaders consisting of: a) printed materials, b) one day interactive workshop to develop a leadership action plan tailored to barriers to support implementation; c) three post-workshop teleconferences. Discussion This study will provide vital information on which leadership strategies are well received to facilitate and support guideline implementation. The anticipated outcomes will provide information to assist with effective management of foot ulcers for people with diabetes. By tracking clinical outcomes associated with guideline implementation, health care administrators will be better informed to influence organizational and policy decision-making to support evidence-based quality care. Findings will be useful to inform the design of future multi-centered trials on various clinical topics to enhance knowledge translation for positive outcomes. Trial Registration Current Control Trials ISRCTN0691089

A mixed methods pilot study with a cluster randomized control trial to evaluate the impact of a leadership intervention on guideline implementation in home care nursing

Abstract Background Foot ulcers are a significant problem for people with diabetes. Comprehensive assessments of risk factors associated with diabetic foot ulcer are recommended in clinical guidelines to decrease complications such as prolonged healing, gangrene and amputations, and to promote effective management. However, the translation of clinical guidelines into nursing practice remains fragmented and inconsistent, and a recent homecare chart audit showed less than half the recommended risk factors for diabetic foot ulcers were assessed, and peripheral neuropathy (the most significant predictor of complications) was not assessed at all. Strong leadership is consistently described as significant to successfully transfer guidelines into practice. Limited research exists however regarding which leadership behaviours facilitate and support implementation in nursing. The purpose of this pilot study is to evaluate the impact of a leadership intervention in community nursing on implementing recommendations from a clinical guideline on the nursing assessment and management of diabetic foot ulcers. Methods Two phase mixed methods design is proposed (ISRCTN 12345678). Phase I: Descriptive qualitative to understand barriers to implementing the guideline recommendations, and to inform the intervention. Phase II: Matched pair cluster randomized controlled trial (n = 4 centers) will evaluate differences in outcomes between two implementation strategies. Primary outcome: Nursing assessments of client risk factors, a composite score of 8 items based on Diabetes/Foot Ulcer guideline recommendations. Intervention: In addition to the organization's 'usual' implementation strategy, a 12 week leadership strategy will be offered to managerial and clinical leaders consisting of: a) printed materials, b) one day interactive workshop to develop a leadership action plan tailored to barriers to support implementation; c) three post-workshop teleconferences. Discussion This study will provide vital information on which leadership strategies are well received to facilitate and support guideline implementation. The anticipated outcomes will provide information to assist with effective management of foot ulcers for people with diabetes. By tracking clinical outcomes associated with guideline implementation, health care administrators will be better informed to influence organizational and policy decision-making to support evidence-based quality care. Findings will be useful to inform the design of future multi-centered trials on various clinical topics to enhance knowledge translation for positive outcomes. Trial Registration Current Control Trials ISRCTN06910890</p

University Competency-based Courses for Internationally Educated Nurses (IENs) in Ontario: A Pilot Education Pathway to Registered Nurse (RN) Licensure

In 2014, a team of nurse educators and champions of internationally educated nurses (IENs) in Ontario, Canada, came together to address the issue of supporting IEN transition to practice as one route to help address nursing shortages. Courses were developed with funding from the Government of Ontario, and policy and coordination support from the Council of Ontario Universities, to pilot an educational bridging pathway for IENs. The faculty team across four Ontario universities used a consortium approach to coalesce province-wide expertise in IEN education. What began as a selection of targeted, competency-based courses has since evolved into a full Competency-Bridging Program of Study for Internationally Educated Nurses in Ontario, aligned with other IEN bridging program offerings across the province. This paper describes the initial process of the group, from 2015 to 2018, to create foundational learning and competency-based courses to meet targeted entry-to-practice (ETP) competencies for Registered Nurse (RN) registration with the College of Nurses of Ontario (CNO). The barriers to IENs in meeting ETP requirements and how the gap in the existing Ontario IEN bridging to a Bachelor of Science in Nursing (BScN) education to meet regulatory requirements are also addressed. This article explores how Ontario may respond to the increasing nursing shortages and the need to engage ethically and retain IENs in practice. Lessons learned from competency-course development add to the growing body of knowledge about IEN program experiences in Canada to enable more IENs to enter the Ontario nursing workforce. Résumé En 2014, une équipe d’infirmières et infirmiers enseignants en Ontario, au Canada, et défenseurs des infirmières et infirmiers formés à l’international, s’est réunie pour aborder la question du soutien à la transition des infirmières et infirmiers formés à l’international vers la pratique, comme une voie pour aider à remédier aux pénuries d’effectifs infirmiers. Des cours ont été élaborés grâce au financement du gouvernement de l’Ontario et au soutien en matière de politique et de coordination du Conseil des universités de l’Ontario, afin de piloter un cheminement éducatif de transition pour les infirmières et infirmiers formés à l’international. L’équipe du corps professoral de quatre universités ontariennes a utilisé une approche de consortium pour regrouper l’expertise provinciale en formation des infirmières et infirmiers formés à l’international. Ce qui a commencé comme une sélection de cours ciblés fondés sur les compétences a depuis évolué pour devenir un programme d’études complet de transition pour le développement des compétences attendues en Ontario, aligné sur d’autres programmes de transition offerts dans la province pour les infirmières et infirmiers formés à l’international. Cet article décrit le processus initial du groupe, de 2015 à 2018, pour créer des cours d’apprentissage essentiel fondés sur les compétences permettant de développer les compétences ciblées pour l’accès à la pratique infirmière par l’inscription au tableau de l’Ordre des infirmières et infirmiers de l’Ontario. Les obstacles qui les empêchent de satisfaire aux exigences de compétences pour accéder à la pratique et la façon dont étaient comblés les écarts existants pour les infirmières et infirmiers formés à l’international vers un baccalauréat en sciences infirmières en Ontario sont également abordés. Cet article explore comment l’Ontario peut répondre aux pénuries croissantes d’effectifs infirmiers et à la nécessité de s’engager de manière éthique et de retenir des infirmières et infirmiers formés à l’international dans la pratique. Les leçons tirées de l’élaboration des cours fondés sur les compétences s’ajoutent à l’ensemble croissant de connaissances sur les expériences des programmes au Canada pour les infirmières et infirmiers formés à l’international afin de permettre à davantage d’entre elles et eux d’intégrer les effectifs infirmiers de l’Ontario