Volume 37, Issue 1, 2015 In This Issue

Transcription

Volume 37, Issue 1, 2015
In This Issue
Rock with CANN in Newfoundland..........................................................................................................................................................5
Scientific Abstracts—CANN 2015 ............................................................................................................................................................7
Poster presentations....................................................................................................................................................................................21
Présentations par affiche.............................................................................................................................................................................22
An evaluation study of the implementation of stroke
best practice guidelines using a Knowledge Transfer Team approach..............................................................................................24
Award, Bursary or Scholarship Guidelines ............................................................................................................................................34
Websites of interest
Canadian Association of Neuroscience Nurses and
Canadian Journal of Neuroscience Nursing website: www.cann.ca
Check this site often for updates on information.
Reports will be on the website.
Canadian Nurses Association: www.cna-nurses.com
Canadian Congress of Neurological Society: www.ccns.org
Please check out the web page to learn more about the
society to which we belong. CANN is an affiliate of this society.
Canadian Journal of Neurological Sciences: www.CJNS.org
World Federation of Neuroscience Nurses: www.WFNN.org
All CANN members are automatically members of WFNN.
Board of directors, committee chairpersons and associated
organization representatives 2015 / Conseil d’administration,
responsables des comités et représentants des groupes associés 2015
Councillors
British Columbia: Trudy Robertson
Alberta North: Andrew Kwan
Alberta South: Christianne Krassman
Saskatchewan: Jodi Copeland &
Michelle Jaspar
Manitoba: Jodi Dusik-Sharpe
Ontario West: Corbin Lippert
Ontario Central: Janice Williams
Ontario East: Aline Bourgoin
Quebec: Elizabeth Murphy-Lavallee &
Helen Fong
New Brunswick/PEI: Shelley Paul
Nova Scotia: Joan Pacione
Newfoundland: Jessica Dwyer Milley
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Committee Chairs
Scientific Liaison: Nancy Thornton
Program Chairs (St. John’s,
Newfoundland 2015): Viola Finn &
Jessica Dwyer Milley
Scientific Chairs (St. John’s,
Newfoundland 2015): Jessica Milley
Communication & Marketing (Web
Administrator): Christianne Krassman
Communications & Marketing
(subscriptions): Jennifer Purkiss
Editor CJNN: Mina Singh
Co-Editor CJNN: Corbin Lippert
Representatives
WFNN: vacant
Canadian Stroke Nursing Council:
Patti Gallagher
Canadian Alliance of Brain Tumour
Organizations (CABTO): Karen
Waterhouse
Professional Practice & Research:
Nancy Thornton
Program Liaison: Christianne
Krassman
Executive
President: Tara Bergner
Legislation & Bylaws: Cindy Hartley
Vice President/Secretary: Suzanne
Basiuk
Archivist: Betty Ross
Past President: Cindy Hartley
Membership: Janet White
Treasurer: Mark Bonin
Volume 37, Issue 1, 2015 • Canadian Journal of Neuroscience Nursing
Canadian Journal of Neuroscience Nursing
Le Journal canadien des infirmières et infirmiers en neurosciences
Volume 37, Issue 1, 2015
Editor/Rédactrice en chef
Mina D. Singh, Department of Nursing, York University, 4700 Keele
Street, Toronto, ON M3J 1P3; [email protected]
For subscriptions, contact/Pour inscriptions :
Jennifer Purkiss, 820 Fisher Ave., Ottawa, ON K1Z 6P2;
[email protected]
Co-Editor/Co-rédacteur
Corbin Lippert, [email protected]
•
•
•
•
Peer Reviewers/Réviseures
Sharon Bishop, Regina, SK
Jennifer Boyd, Toronto, ON
Andrea Fisher, Ottawa, ON
Sandra Ireland, Hamilton, ON
Lynn Joseph, Nepean, ON
Wilma Koopman, London, ON
Joanna Pierazzo, Ancaster, ON
Cydnee Seneviratne, Calgary, AB
Mina D. Singh, Toronto, ON
Nancy Thornton, Calgary, AB
Carole White, San Antonio, TX
Make cheques payable to: Canadian Association of Neuroscience
Nurses/Les chèques doivent être émis à : L’Association canadienne
des infirmières et infirmiers en neurosciences (ACIIN) : c/o Jennifer
Purkiss, 820 Fisher Ave., Ottawa, ON K1Z 6P2.
Yearly subscriptions are included with a membership in CANN/ACIIN
($75.00 Member, $65.00 Associate) or they may be purchased separately.
L’abonnement annuel à le Journal canadien des infirmières et infirmiers
en neurosciences est inclus dans les frais d’inscription à l’ACIIN (75,00 $
pour les membres actifs et 65,00 $ pour les membres associés).
Canadian Journal of
Neuroscience Nursing
The Canadian Journal of
Neuroscience Nursing is the
p e er-re v ie we d j our nal of
the Canadian Association of
Neuroscience Nurses (CANN)/
Association canadienne des
infirmières et infirmiers en
neurosciences (ACIIN). The journal
is published three times a year. We
welcome the submission of original
manuscripts in the areas of practice,
research, theory, education, and
policy, which are of interest to the
neuroscience nursing community.
The views, statements, and opinions
expressed in the articles, editorials,
and advertisements are those of
the authors or advertisers. They do
not necessarily represent the views
and policies of CANN/ACIIN,
and the editors and publishers
Canada: $65.00 (CAN)
United States: $65.00 (US)
International: $70.00 (US)
Single Copy: $15.00 (CAN)
disclaim any responsibility or
assumption of liability for these
materials. The Canadian Journal of
Neuroscience Nursing is indexed in
the Cumulative Index to Nursing
and Allied Health Literature,
International Nursing Index (INI)
and Nursing Citation Index.
ISSN 1913-7176 (Print)
ISSN 2368-2639 (Online)
Mission statement
The Canadian Association of
Neuroscience Nurses (CANN)
sets standards of practice and
promotes continuing professional
education and research. Members
collaborate with individuals, families, interdisciplinary teams and
communities to prevent illness
and to improve health outcomes
for people with, or at risk for, neurological disorders.
Copyright
No part of this publication can be reproduced, stored in a retrieval system or transmitted, in any form or by any means, without the prior
written consent of the publisher or a licence from the Canadian Copyright Licensing Agency (Access Copyright). For an Access Copyright
licence, visit www.accesscopyright.ca or call toll-free to 1-800-893-5777.
The Canadian Association of Neuroscience Nurses gratefully
acknowledges the funding provided to the Canadian Journal of
Neuroscience Nursing by the Social Sciences and Humanities
Research Council under the Aid to Transfer Journals program, to
support the operation and expansion of the journal.
Le Journal canadien
des infirmières
et infirmiers en
neurosciences
Le Journal canadien des infirmières et infirmiers en neurosciences est le journal de
L’Association canadienne des
infirmières et infirmiers en neurosciences (ACIIN). Cette publication est revisée par ses propres
membres. Le journal est publié
trois fois par année. Nous acceptons les manuscrits originaux se
rapportant à la pratique du nursing, de la recherche, de la théorie, de l’éducation, et de l’éthique
professionnelle, tous des sujets qui
suscitent l’intérêt de l’ensemble du
personnel en neurosciences.
Les opinions, les points de vue,
et les énoncés exprimés dans les
articles, éditoriaux et affiches
publicitaires sont ceux des auteurs
et commerçants. Ils ne reflètent
pas nécessairement les idées et
les politiques de l’ACIIN. L’éditeur
et la maison d’édition n’acceptent
aucune responsabilité reliée au
contenu du matériel publié dans
le journal. Le Journal canadien
des infirmières et infirmiers en
neurosciences est rattachée au
Cumulative Index to Nursing
and Allied Health Literature,
International Nursing Index (INI)
and Nursing Citation Index.
ISSN 1913-7176 (presse)
ISSN 2368-2639 (en ligne)
Énoncé de mission
L’Association canadienne des
infirmières et infirmiers en neurosciences (ACIIN) établit les standards de pratique de la profession
et fait la promotion de l’éducation
permanente et de la recherche. Les
membres collaborent avec les individus, les familles, les équipes multidisciplinaires et la communauté
en général dans le but de prévenir les maladies neurologiques et
d’améliorer la santé des gens qui en
sont atteints ou qui sont à risque
d’en souffrir.
Editorial
It is with great pleasure I introduce Mina D. Singh as the new
Editor of CJNN. It has been my pleasure to serve as editor for
the past several years—a tremendous learning experience and
opportunity to see and celebrate the work being done by neuroscience nurses across the country!
Mina D. Singh is an Associate Professor, School of Nursing,
York University. She has a long career in nursing, having worked
in neurosurgery, mental health, psychotherapy and public
health. She has previously served CJNN from 2005 to spring
2007 as an associate editor. Her expertise is as a research methodologist, statistician and program evaluator.
She won the 2012 National Nursing Research Scholar Award
and the 2014 Accreditation Reviewer Excellence Award granted
by the Canadian Association of Schools of Nursing (CASN).
She is an associate member of the York Institute for Health
Research (YIHR), the Canadian Evaluation Society, the Nursing
Best Practice Unit, and the former coordinator of the Program
Evaluation Unit at the YIHR (2011–2013). She has also served
the Black Creek Community Health Centre several times as
both the president of the board and member of the board. She
served on the Board of the Ontario Society of Psychotherapists
and is on the Board of Guyana Help the Kids, which is an organization to reduce infant mortality in Guyana.
Welcome and thank you, Mina, for taking up the role of editor.
Thank you also to Corbin Lippert, for his help as co-editor for
the past two years—there is great value in ‘sharing the load’
and Corbin has certainly provided considerable expertise in the
process of critical review and editing of submitted manuscripts.
Teri Green
Editor
Note de la rédactrice
C’est avec grand plaisir que je vous demande d’accueillir Mina
D Singh au poste de rédactrice du JCIIN. J’ai été très heureuse
d’occuper ces fonctions au cours des dernières années; ce rôle
m’a procuré de formidables expériences d’apprentissage et m’a
donné la chance de voir et de célébrer le travail des infirmières
et infirmiers en neurosciences partout au pays!
Mina D Singh est professeure agrégée à l’École des sciences
infirmières de l’Université York. Au fil de sa longue carrière
dans les sciences infirmières, elle a travaillé dans le domaine
de la neurochirurgie, de la santé mentale, de la psychothérapie et de la santé publique. Elle a précédemment occupé les
fonctions de rédactrice en chef adjointe du JCIIN de 2005
au printemps 2007. Ses domaines d’expertise regroupent la
méthodologie de la recherche, les statistiques et l’évaluation
de programmes.
En 2012, elle a remporté le prix du National Nursing Research
Scholar, un prix national de recherche en sciences infirmières,
puis en 2014, le Prix d’excellence pour évaluatrices et évaluateurs aux fins de l’agrément, décerné par l’Association canadienne des écoles de sciences infirmières (ACESI). C’est une
membre active de l’Institut York pour la recherche en santé
(YIHR), de la Société canadienne d’évaluation, de l’Unité de
recherche sur les pratiques exemplaires en soins infirmiers et
elle a été coordinatrice de l’Unité d’évaluation des programmes
du YIHR. Mina a aussi siégé plusieurs fois au comité d’administration du Black Creek Community Health Centre en tant que
présidente et membre. Elle a également fait partie du comité de
la Société des psychothérapeutes de l’Ontario et siège au comité
de Guyana Help the Kids, un organisme qui vise à réduire la
mortalité infantile au Guyana.
Mina, je vous souhaite la bienvenue et vous remercie d’avoir
accepté d’endosser le rôle de rédactrice. Un grand merci également à Corbin Lippert pour son aide en tant que corédacteur
au cours des deux dernières années. Il est très avantageux de
pouvoir « partager la charge » et les compétences de Corbin se
sont révélées inestimables pour examiner d’un œil critique et
réviser les manuscrits que l’on nous soumet.
Teri Green
Rédactrice
The Canadian Journal of Neuroscience Nursing is published by Pappin Communications /
La Journal canadienne des infirmières et infirmiers en neurosciences est publié par Pappin Communications
The Victoria Centre, 84 Isabella Street, Unit 2, Pembroke, Ontario K8A 5S5, email: [email protected]
Managing Editor: Heather Coughlin; Layout and Design: Sherri Keller
Advertising space is available/Disponibilité d’espaces pour messages publicitaires : For information, contact Heather Coughlin,
Advertising Manager, Pappin Communications, The Victoria Centre, 84 Isabella Street, Pembroke, Ontario, K8A 5S5; telephone:
613-735-0952; fax: 613-735-7983; email: [email protected] or visit our website at www.pappin.com
4
Rock with CANN in Newfoundland
CANN 46th Annual Meeting and Scientific Sessions
June 23–26, 2015, St. John’s Newfoundland
Program overview
Tuesday June 23, 2015
8:30–4:00
5:00–7:00
Board of Directors’ Meeting
Welcome Reception – Courtyard
Wednesday, June 24, 2015
8:00–10:00
10:00–10:30
Opening Breakfast, Welcome and Introduction
Grace; Greetings, Presidential address;
Mary Glover Lecture—Ballroom
Familial Intracranial Aneurysms in
Newfoundland & Labrador—Dr. Falah Maroun
Break—Posters and Exhibitors
10:30–11:15
11:15–12:00
Plenary P1– Heart & Stroke Foundation’s
New Spin on Stroke Symptoms:
FAST Campaign—Patrice Lindsey, RN, PHD,
and K. Ruth Whelan, RN, MN, CNN(c), CNS
Plenary P2–Creating an In-Patient Stroke
Alert Process at Royal University Hospital—
K. Ruth Whelan, RN, MN, CNN(c), CNS, and
Amy Paiva, RN, BSN
12:00–1:00
Educational Sponsored Lunch:
DUODOPA and AbbVie
Concurrent Sessions
1:00–2:30
A1
Exploring Creative Approaches to Opening
Dialogue about Palliative and End-of-Life
Care: Is There A Role for Performance
and Visual Art—Brenda Sabo, Katie Dorian,
Alexis Milligan and Erna Snelgrove-Clarke
B1
Neurological Assessment: Pediatric and
Adults—Janice Williams, Dawn Tymianski
C1
Immunoglobulin Therapy in Neuromuscular
Diseases: Current Evidence and Future
Prospects—Wilma J. Koopman, RN(EC),
MScN, TCNP, CNN(C)
C2
Parkinson’s Disease: Role of the Nurse in
Disease Management—Lucie Lachance, RN,
MSc, and Jennifer Doran, BN, CNN(C)
2:35–3:00
Break with Posters and Exhibitors
Concurrent Sessions cont’d.
3:00–4:00
A1
Exploring Creative Approaches to Opening
Dialogue about Palliative and End-of-Life
Care: Is There A Role for Performance
and Visual Art—Brenda Sabo, Katie Dorian,
Alexis Milligan and Erna Snelgrove-Clarke
B1
Adults—Janice Williams, Dawn Tymianski
C2
Parkinson’s Disease: Role of the Nurse in
Disease Management—Lucie Lachance, RN, MSc, and Jennifer Doran, BN, CNN(C)
4:00–4:30
8:00
Living Library/Networking
Pub Night: Rally in the Alley with McCarthy’s
Party—meet in the Ballroom
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Thursday, June 25, 2015
8:00–9:30
9:30–10:00
CANN Annual General Meeting—Ballroom
Break and Posters and Exhibitors
10:00–10:30 Plenary 3: Pseudoprogression and Radiation
Necrosis in High Grade Glioma Patients:
Nursing Considerations in the Context of
Uncertainty—Catherine-Anne Miller
10:30–11:15 Plenary 4: Hope, Well-Being, Coping, and
Quality of Life in Adults with Myasthenia
Gravis—Wilma Koopman, Susan Fowler,
Nicole LeBlanc, Denise Hulley, Michael Nicolle
11:15–12:00 Plenary 5: Nursing Management of Posterior
Fossa Syndrome in Pediatric Patients—
Patricia Nikolski and Venus Shyu
12:00–12:30 Educational Sponsored Lunch: DUODOPA
and AbbVie
12:30–1:00
Educational Lunch continues: Inspirational
speaker—Dr. Bill Eaton
Concurrent Sessions
1:00–1:30
A2
Deep Brain Stimulation in
Drug-Resistant Epilepsy—Karen
Waterhouse, RN, BSN, CNN(C)
B2
Rapid Evaluation and Intervention for
Symptomatic Extracranial Carotid
Disease—Aaron Gardner, BSN, CNN(C) and
Michelle Jaspar, BSN
C3
Lessons Learned from Patients and
Families: Reflections from more than 100
Years of Neuroscience Nursing Practice—
Bev Irwin, RN, BN, Nancy Thornton, RN,
MScN, CNN(C), and Pauline Weldon, RN,
CMSN
1:35–
2:00
A3
Motorcycle Helmets and Traumatic
Brain Injuries—Katie Fink
B3
Thalamus Injuries: Hitting Where It Hurts
the Most—Stephanie van Rooy, RN(EC), MN
1:45
C4 Persistent Vegetative State and Early
Pregnancy: An Ethical Dilemma—
Shawna Kelly, RN, BScN, ACN, CNN(C),
Russel Matias, RN, BScN, CNN(C), and Sara
Bevilacqua, RN, BScN, CCN, CNN(C)
3:00
D1
Brain of Zones Session 1—Sue Kadyschuk
and Katie Fink * Break will be provided
in the room
2:35–3:00
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3:00–
3:30
A5
The Hidden Culprit: Ruptured PCA
Aneurysm—Nicole Chenier-Hogan, RN(EC),
BA, MSc, CNN(C)
4:00
B5
Secondary Stroke Prevention—Patrice
Lindsey, RN, PHD, and K. Ruth Whelan, RN,
MN, CNN(c), CNS
3:30
C5
When Your Brain Turns On You: Exploring
Anti-NMDA Encephalitis in the Pediatric
Population—Katanya Fuerst, RN, Rheanna
Radchenko, RN, Sophia Phillips, RN, and
Arbelle Manicat-Emo, RN(EC), NP-Paeds
3:30
C6
Challenging Families: Trials, Tribulations
and Triumphs—Jennifer Boyd, RN,
MHSc, CNN(C)
A6
Brain of Zones Session 2—Sue Kadyschuk }
and Katie Fink *Please note this will be in
room D
4:30pm
Professional Practice: Review of
Standards of Practice
Free Night: Please see suggestions in conference bag
Friday, June 26, 2014
6:15
Run for Research around Quidi Vidi Lake
8:00–8:45
Plenary 6: Educational Sponsored
Breakfast: Pauline Weldon Memorial
Lecture—Dr. Jock Murray and Genzyme
8:45–9:30 Plenary 7: Using the ROSA Robot for
Placement and Securement of Intracranial
Depth Electrodes for Monitoring of
Non-Lesional Epilepsy—Hayley Shephard
9:30-10:00
Plenary 8: A Resource Manual for Individuals
and Families Living with an Adult with TBI—
Courtney Coish, BN, RN, MN
10:00–10:30
10:30–12:30
Plenary 9: Clinical Pathway for the
Assessment of the Deteriorating Patient—
Dawn Tymianski, RN-EC, NP-A, MN,
CNN(C), PhD(c)
12:30
Onward to London, Ontario,
Wrap Up and Door Prizes
Scientific Abstracts—CANN 2015
Plenary 1
Plenary 2
Heart and Stroke Foundation’s New Spin
on Stroke Symptoms: FAST Campaign
Creating an In-Patient Stroke Alert
Process at Royal University Hospital
K. Ruth Whelan, RN, MN, CNN(c), CNS, and Patrice Lindsey,
RN, PHD
Amy Paiva, RN, BSN, and K. Ruth Whelan, RN, MN, CNN(c),
CNS
In Canada, stroke is a leading cause of death, disability, and
health care expenditure, affecting an estimated 62,000 people
per year. Thrombolytic and intra-arterial therapy, if provided in
a timely manner, can greatly optimize a stroke patient’s outcome
by decreasing a person’s disability. The number of individuals
presenting to emergency departments within treatment timeframe is suboptimal, as many Canadians do not recognize the
sign of stroke or know what to do if a stroke is occurring. The
Heart and Stroke Foundation of Canada launched its FAST
campaign in December 2014 in an effort to increase Canadians’
awareness of the signs and symptoms of stroke and improve
patient outcomes. Public awareness campaigns using the FAST
acronym have had great success in many countries around the
world and similar success is expected in Canada. Launching
the campaign is one step in the process of improving stroke
care—linking the FAST approach to Canadian stroke best
practices and monitoring hospital-level stroke readiness and
response are also important elements that will be discussed in
this presentation.
Up to 17% of strokes occur in patients who are already in hospital. When delivering appropriate treatment, time is a major
factor related to positive outcomes for these individuals. Historically, in-hospital stroke patients have experienced significant
delay in symptom discovery, response, assessment, diagnosis
and treatment when compared to their emergency department
counterparts. Creating an in-patient code stroke alert process
can trigger health professionals to watch for the subtle symptoms of stroke and bring the stroke alert team rapidly to the
bedside. At Royal University Hospital in Saskatoon, Saskatchewan, the Stroke Services Program recently initiated an inpatient
stroke alert process in an effort to reduce delays in care for our
in-hospital stroke patients. After gaining buy-in from multiple
departments, challenges faced by this new “code stroke alert”
were addressed and measures taken to ensure roll-out would
be successful.
Un nouveau tournant pour la Fondation
des maladies du cœur en matière de
symptômes de l’AVC : la campagne FAST
K. Ruth Whelan, IA, M.Sc.inf., CSN(C), ICS, et Patrice
Lindsey, IA, Ph.D.
Avec un nombre de victimes estimé à 62 000 personnes chaque
année au Canada, l’AVC constitue l’une des principales causes
de mortalité, de handicap et de dépenses de santé. Les traitements thrombolitique et intra-artériel, s’ils sont prodigués
à temps, peuvent grandement optimiser l’état de santé des
patients ayant subi un AVC en réduisant l’incapacité de ces
derniers. Le nombre d’individus qui se présentent aux urgences
dans les délais nécessaires pour recevoir un traitement est
sous-optimal parce que de nombreux Canadiens ne reconnaissent pas les signes d’un AVC ni ne savent quoi faire lorsqu’il
se produit. En décembre 2014, la Fondation des maladies du
cœur du Canada a lancé une campagne intitulée FAST, dans
le but de mieux faire reconnaitre aux Canadiens les signes et
les symptômes d’un AVC et d’améliorer ainsi l’état de santé du
patient. Les campagnes de sensibilisation du public dotées de
l’acronyme FAST ont remporté un vif succès dans de nombreux pays et le Canada ne devrait pas faire exception. Le lancement de la campagne ne constitue qu’une étape du processus
d’amélioration des soins de l’AVC; relier la démarche FAST aux
pratiques optimales de soins de l’AVC au Canada et surveiller
l’état de préparation et de réaction des hôpitaux en matière
d’AVC sont également d’importants éléments que nous aborderons dans cet exposé.
La création d’une alerte AVC pour les
patients hospitalisés au Royal University
Hospital
Amy Paiva, IA, B.Sc.inf. et K. Ruth Whelan, IA, M.Sc.inf.,
CSN(C), ICS
Près de 17 % des AVC surviennent chez des patients déjà hospitalisés. Respecter le facteur temps est crucial pour prodiguer
un traitement adéquat et obtenir des résultats positifs chez
ces individus. En comparaison avec leurs homologues admis
aux urgences pour un AVC, les patients qui en subissent un à
l’hôpital déplorent habituellement de grands retards en ce qui
concerne la découverte des symptômes, l’intervention, l’évaluation, le diagnostic et le traitement. La création d’une procédure
d’alerte AVC pour les patients hospitalisés peut pousser les professionnels de la santé à prêter attention aux symptômes discrets de l’AVC et à faire venir rapidement l’équipe de soins au
chevet du patient. Au Royal University Hospital de Saskatoon,
en Saskatchewan, le Programme de traitement de l’AVC (Stroke
Services Program) a récemment mis en place une procédure
d’alerte AVC pour patients hospitalisés afin de réduire les
retards dans le traitement de ses patients hospitalisés atteints
d’un AVC. Après avoir obtenu l’accord de plusieurs services,
nous avons résolu les difficultés présentées par cette nouvelle
« alerte AVC » et avons pris les mesures nécessaires afin d’en
réussir la mise en œuvre.
7
Plenary 3
Pseudoprogression and Radiation
Necrosis in High Grade Glioma Patients:
Nursing Considerations in the Context of
Uncertainty
Catherine-Anne Miller
Glioblastoma Multiforme (GBM) is the most common primary
brain malignancy and has a limited prognosis (median of 14
months). There has been significant progress with new treatment modalities. The goal of care remains control through time,
and not ‘cure’. The standard treatment of GBM patients includes
chemotherapy and radiation therapy concomitantly.
Post radiation treatment effects in this population include
pseudoprogression (earlier manifestation) and radiation
necrosis (medium to long-term manifestation). Pseudoprogression is the apparent radiographic progression following
radiotherapy with subsequent improvement or stabilization
through time. Radiation necrosis can also look like progression, but presents itself later in the illness trajectory. Patients
with both of these suspected conditions are told their imaging
shows changes, but time is needed to determine whether it is
progression or not. Uncertainty and fear often characterize
this waiting time.
Although there is significant medical literature on the phenomenon of pseudo-progression, radiation necrosis versus real progression, there lacks nursing research on the lived experience
of patients faced with this uncertain imaging result and how
they cope.
This presentation will be an overview of these post-radiation effects from a nursing perspective highlighting nursing
interventions, but also identifying potential nursing research
possibilities.
La pseudoprogression et
la nécrose de la radiothérapie chez
les patients atteints d’un gliome de
haut grade : quelques facteurs
à prendre en compte dans un
contexte d’incertitude
Catherine-Anne Miller
Le glioblastome multiforme (GBM) est la tumeur maligne primaire la plus répandue et son pronostic est limité (médiane de
14 mois). Les nouvelles formes de traitement constituent des
progrès notables. Le but des soins demeure le contrôle dans
le temps et non pas la « guérison ». Le traitement standard du
GBM comporte simultanément de la chimiothérapie et de la
radiothérapie.
Les effets du traitement radiothérapique pour cette population comprennent la pseudoprogression (manifestation précoce) et la nécrose de la radiothérapie (manifestation à moyen
et long terme). La pseudoprogression est une progression
8
radiographique apparente à la suite de la radiothérapie, qui
conduit à des améliorations ou à une stabilisation au fil du
temps. La nécrose de la radiothérapie peut aussi prendre l’apparence d’une progression, mais apparait plus tard dans la
trajectoire de la maladie. L’imagerie des patients qui semblent
atteints de ces deux affections indique des changements, mais
il est nécessaire d’attendre pour déterminer s’il s’agit bien d’une
progression. Ce temps d’attente est souvent empreint de doute
et de peur.
Bien que les phénomènes de pseudoprogression et de nécrose
de la radiothérapie (à l’inverse d’une réelle progression) fassent
l’objet d’une documentation abondante, les recherches en sciences infirmières sur l’expérience des patients confrontés aux
résultats incertains de cette imagerie et sur la façon dont ils y
font face font encore défaut.
Cet exposé présentera un survol de ces effets post-radiothérapiques depuis un point de vue infirmier, indiquera
les interventions en soins infirmiers possibles et recensera les éventuelles possibilités de recherches en sciences
infirmières.
Plenary 4
Hope, Well-Being, Coping,
and Quality of Life in Adults
with Myasthenia Gravis
Wilma Koopman, Susan Fowler, Nicole LeBlanc, Denise
Hulley, CCT, and Michael Nicolle
The aim of this study was to explore the relationship between
hope, well-being, coping, and quality of life in adults with myasthenia gravis.
Subjects (n = 100) completed six questionnaires, which included
a demographic profile, Myasthenia Gravis Activities of Daily
Living Scale, Herth Hope Index, Jalowiec Coping Scale, Myasthenia Gravis Quality of Life Scale (MG-QOL15), and SF-36v2.
The results revealed a high level of hope (mean 40; range,
29–48). The three most frequently used coping strategies
were optimistic, confrontive and self-reliant. Well-being was
measured using the SF-36v2. Participants in this study scored
above the general population on the mental component, but
well below the general population on the physical component. The MG-QOL15 revealed a mean of 10 indicating that
participants in this study were minimally affected by their
myasthenia gravis. The length of illness showed no significant correlation between levels of hope. However, age and
ability to perform ADLs on their own was significant. Further
analysis revealed moderate correlations between hope and
quality of life.
Nurses caring for adults with myasthenia gravis should use
interventions that continue to support hope, quality of life,
and coping throughout the unpredictable and chronic course
of myasthenia gravis.
Espoir, bien-être, adaptation et qualité
de vie chez les adultes atteints de
myasthénie grave
Wilma Koopman, Susan Fowler, Nicole LeBlanc, Denise
Hulley, CCT et Michael Nicolle
Le but de cette étude est d’explorer la relation entre l’espoir,
le bien-être, l’adaptation et la qualité de vie chez les adultes
atteints de myasthénie grave.
Les sujets (n = 100) ont rempli six questionnaires, dont un profil
démographique, l’échelle de mesure des activités quotidiennes
avec myasthénie grave (Myasthenia Gravis Activities of Daily
Living Scale), l’indice de l’espoir Herth (Herth Hope Index),
l’échelle d’adaptation Jalowiec (Jalowiec Coping Scale), l’échelle
de qualité de vie avec myasthénie grave (Myasthenia Gravis
Quality of Life Scale) (MG-QOL15) et le SF-36v2.
Les résultats ont révélé des niveaux d’espoir élevés, avec une
moyenne de 40 (les résultats variaient de 29 à 48). Les trois
stratégies d’adaptation les plus fréquentes étaient de se montrer optimiste, combattif et autonome. On a mesuré le niveau
de bien-être à l’aide du SF-36v2. Les participants à cette étude
ont obtenu des résultats supérieurs à la population générale
pour la composante mentale mais largement inférieurs à ceux
de la population générale pour la composante physique. La
MG-QOL15 a révélé une moyenne de 10, ce qui indique que la
myasthénie grave entrainait une influence minime sur les participants de cette étude. La durée de la maladie n’a pas permis
d’établir de corrélation significative entre les niveaux d’espoir.
Cependant, l’âge et la capacité à mener seuls des AVQ se sont
révélés particulièrement importants. Une analyse plus poussée
a indiqué des corrélations modérées entre l’espoir et la qualité
de vie.
Les infirmières et infirmiers chargés d’adultes atteints de
myasthénie grave devraient recourir à des interventions qui
continuent à favoriser l’espoir, la qualité de vie et l’adaptation
tout au long de l’évolution imprévisible et chronique de la
myasthénie grave.
Plenary 5
Nursing Management of Posterior Fossa
Syndrome in Pediatric Patients
Patricia Nikolski and Venus Shyu
Posterior Fossa Syndrome (PFS) is a devastating and common complication associated with surgical resections of brain
tumours in the cerebellar region, which account for 60–70% of
all pediatric brain tumours. This syndrome consists of: mutism,
dysphagia, dysarthia, emotional lability, neurobehavioural and/
or personality changes that can greatly impact the recovery
course following surgery. Incidence rates of PFS vary across
the literature, with studies reporting anywhere from 8.5% to
upwards of 30%. Although the symptoms are usually transient,
the occurrence of PFS compounds the emotional stress, anxiety,
and guilt that families may already experience. The theme of this
presentation will centre on the nursing implications of caring
for a child with PFS. Management of this patient population
can include: safe oral or enteral feeding, managing oral secretions, aiding effective communication, encouraging activity,
and supporting parents and families with difficulties coping
with behavioural and personality changes. A case study will be
presented to illustrate the presentation of PFS along with the
challenges and successes associated with it. Given the high incidence rate of pediatric brain tumours and PFS, it is important
for health care providers to be aware of the specific challenges
associated with caring for these patients.
Le rôle des soins infirmiers pour les
enfants atteints du syndrome de la
fosse postérieure
Patricia Nikolski et Venus Shyu
Le syndrome de la fosse postérieure (SFP) est une complication commune et dévastatrice qui entraine souvent une résection chirurgicale de la tumeur dans la région cérébelleuse et
représente 60–70 % des tumeurs cérébrales pédiatriques. Parmi
les syndromes, on compte le mutisme, la dysphagie, la dysarthrie, la labilité émotionnelle et des changements de comportement neurologique ou de personnalité qui peuvent grandement
compliquer la convalescence à la suite de l’intervention chirurgicale. Les taux d’incidence du SPF varient à travers la documentation : en fonction des études, les chiffres vont de 8,5 %
à plus de 30 %. Bien que les symptômes soient habituellement
passagers, la fréquence du SPF aggrave le stress émotionnel,
l’anxiété et le sentiment de culpabilité déjà ressentis par les
familles. Cet exposé traitera des répercussions provoquées par
le traitement d’un enfant atteint du SFP en matière de soins
infirmiers. La prise en charge de cette population de patients
peut nécessiter de les nourrir par voie orale ou entérale, de
gérer leurs sécrétions orales, de favoriser une communication
efficace, d’encourager les activités et d’aider les parents et les
familles qui éprouvent des difficultés à s’adapter aux changements de comportement ou de personnalité. Nous présenterons
une étude de cas pour illustrer les symptômes du SFP ainsi que
les difficultés et les succès qui y sont associés. Compte tenu du
taux d’incidence élevé des tumeurs cérébrales pédiatriques et
du SFP, il est important que les fournisseurs de soins de santé
soient au fait des difficultés particulières rencontrées lors de la
prise en charge de ces patients.
Plenary 7
Using the ROSA Robot for Placement
and Securement of Intracranial Depth
Electrodes for Monitoring of NonLesional Epilepsy
Hayley Shepherd
Case report summary
A 27-year-old male presented to the epilepsy program diagnosed with right focal epilepsy since age 19. Though he underwent a right frontal insular resection two years prior, his
seizures recurred one month after surgery at a frequency of
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five to 10 seizures per month, often in clusters. The patient was
readmitted to the Seizure Monitoring Unit for invasive seizure
monitoring of his non-lesional epilepsy, that is, focal epilepsy
with no detectable abnormalities on MRI. Notably, he was the
first patient at this site to experience insertion and securement
of the depth electrodes by the ROSA robot, a fully frameless
and minimally invasive technique involving 3D MR imaging,
confirmation of positioning with robotics and optical sensors,
and insertion of securement bolts into the skull to maintain
the position of the electrodes for the duration of the invasive
monitoring. This advance in neurosurgery, in combination with
a complex patient and his non-lesional epilepsy, provided a
learning opportunity for the nursing staff involved. The intent
of this case report is to share how advances in invasive monitoring and diagnostics have changed the treatment options for
patients with non-lesional epilepsy.
L’utilisation du robot ROSA
pour l’implantation et la sécurisation
d’électrodes intracrâniennes
profondes dans le cadre du
monitorage de l’épilepsie
non lésionnelle
Hayley Shepherd
Résumé de l’étude de cas
Un homme de 27 ans chez qui on avait diagnostiqué une épilepsie focale dans l’hémisphère droit à l’âge de 19 ans a été
orienté vers le Programme d’épilepsie. Bien qu’il ait subi une
résection insulaire frontale droite deux années auparavant, ses
crises d’épilepsie ont recommencé un mois après l’opération
chirurgicale à une fréquence de cinq à dix crises par mois, de
façon souvent groupée. Le patient a de nouveau été admis dans
l’unité de surveillance des crises épileptiques afin d’entamer un
monitorage invasif de son épilepsie non lésionnelle, c’est-à-dire
une épilepsie focale où on ne peut détecter aucune anormalité à
l’IRM. On notera particulièrement qu’il a été le premier patient
de ce site à subir une insertion et une sécurisation des électrodes profondes à l’aide du robot ROSA, une technique sans
cadre et très peu invasive qui recourt à une imagerie 3D par
résonance magnétique, confirme le positionnement grâce à la
robotique et à des capteurs optiques et insère les vis de sécurisation dans le crâne afin de maintenir la position des électrodes
pendant toute la durée du monitorage invasif. Cette avancée
dans le domaine de la neurochirurgie, associée à un patient
complexe et à son épilepsie non lésionnelle, a constitué une
occasion d’apprentissage pour le personnel infirmier concerné.
Le but de cette étude de cas est de montrer combien les progrès
en matière de monitorage invasif et de diagnostic ont changé les
options de traitement pour les patients atteints d’une épilepsie
non lésionnelle.
10
Plenary 8
A Resource Manual for Individuals and
Families Living with an Adult with a
Traumatic Brain Injury
Courtney Coish, BN, RN, MN
Traumatic brain injury (TBI) is a complex injury with a broad
spectrum of symptoms and disabilities. Living with someone with a TBI is a life-altering event. The individual diagnosed with a TBI may experience many changes within their
cognitive, physical, and emotional states. Learning to adapt,
adjust, and deal with these changes can be difficult for both
the individual with the TBI and their caregivers, families,
and friends. While ample research exists on TBI, resource
manuals specific for individuals and families living with an
adult with a TBI in the home environment are limited and
are difficult to access. I developed a learning guide that will
provide information and support and assist individuals and
families in providing care to an adult with a TBI in the home
environment. Since each brain injury is different, not all information will apply to every situation. It is the hope that this
resource manual will assist families in the journey toward a
new “normal” within the first three to six months in the home
environment, as well as be quite useful during the first year
or two following a TBI.
The developed manual offers suggestions on how to deal with
cognitive, behavioural, and emotional changes in a person with
a TBI. It also offers suggestions for individual and family recovery. This manual provides general information on issues families
may encounter during the establishment of a changed lifestyle
following TBI. It offers suggestions on how to assist individuals with a TBI, as well as suggestions for individuals and family
recovery and ways to make transitions manageable. The manual
is designed to help individuals and families make the transition
from the hospital or rehabilitation facility to their home, and to
assist them in managing the cognitive and behavioural changes
in their family member as a result of head injury.
Un guide de référence pour les
individus et les familles qui vivent avec
un adulte souffrant d’un traumatisme
cérébral
Courtney Coish, B.Sc.inf, IA, M.Sc.inf
Le traumatisme cérébral (TC) est une lésion complexe qui
entraine un vaste éventail de symptômes et d’incapacités. Vivre
avec une personne atteinte d’un TC change radicalement une
vie. Les individus chez qui on a diagnostiqué un TC peuvent
subir de nombreux changements d’état cognitif, physique et
émotif. Apprendre à s’adapter, à s’ajuster et à gérer ces changements peut s’avérer difficile à la fois pour la personne atteinte
du TC et pour ses soignants, sa famille et ses amis. Bien que
le TC ait fait l’objet de nombreuses recherches, les manuels
destinés aux individus et aux familles qui vivent avec une personne atteinte de TC à la maison sont rares et difficiles à trouver. J’ai créé un guide d’apprentissage qui informera et aidera
les individus et les familles à prendre soin d’un adulte atteint
d’un TC dans le contexte du domicile. Puisqu’aucune lésion
cérébrale ne se ressemble, certaines informations ne s’appliquent pas à tous les cas. J’espère cependant que ce guide de
référence aidera les familles dans leur cheminement vers un
nouveau « normal » durant les 3 à 6 premiers mois à la maison,
mais qu’il sera également utile au cours de la première et de la
deuxième année à la suite du TC.
Ce guide propose des suggestions sur la façon de gérer les
changements cognitifs, comportementaux et émotifs d’une
personne atteinte d’un TC. Il propose aussi des suggestions
pour le rétablissement de l’individu et de la famille. Ce guide
procure des informations générales sur les problèmes que peut
rencontrer la famille durant la transition vers un nouveau style
de vie à la suite d’un TC. Il propose des suggestions sur la façon
d’aider les individus souffrant d’un TC ainsi que des suggestions axées sur le rétablissement de l’individu et de la famille
et la manière de gérer au mieux ces transitions. Le guide a
pour objet d’aider les individus et les familles à effectuer la
transition depuis l’hôpital ou le centre de réadaptation vers
la maison et de les aider à gérer les changements cognitifs et
comportementaux du membre de la famille ayant subi une
blessure à la tête.
Plenary 9
Clinical Pathway for
the Assessment of the
Deteriorating Patient
Dawn Tymianski, RN EC, NP-A, MN, CNNC, PhD(C)
Deterioration is defined as a state of worsening of a medical
condition. For the neuroscience patient, the causes of sudden deterioration are multifactorial, including progression
of neurological or metabolic diseases known to affect level of
consciousness.
Assessment of the deteriorating patient is very challenging,
and the ability to expediently assimilate the ‘available’ objective information can lead to high stress levels for the nurse
completing the assessment. Irrespective of skill set, pertinent
information can become overwhelming and critical information
can become obscured.
Bringing your assessment skills to a new level, the purpose of
this talk is to foster critical thinking and provide a sound, valid
assessment pathway that simplifies deterioration, provides
needed guidance during the assessment phase, and solidifies
the confidence of the nurse.
Strategies for success include a review of:
1. Key anatomical areas responsible for our level of consciousness
2. Client neurological signs and symptoms
3. Determination of metabolic or neurological causes
4. Key anatomical areas of concern when assessing the deteriorating patient
5. Key neurological “absolute must dos” during assessment.
Un cheminement clinique pour
l’évaluation des patients dont l’état de
santé se détériore
Dawn Tymianski, IA-CS, IP-A, M.Sc.inf., CSN(C), Ph.D.(C)
On définit la détérioration comme la dégradation d’une condition médicale. Dans le cas du patient en neuroscience, les
causes d’une détérioration soudaine sont multiples et incluent
la progression de maladies neurologiques ou métaboliques connues pour entrainer des altérations du niveau de conscience.
Il est très difficile d’évaluer un patient dont l’état se détériore, et
la capacité à assimiler rapidement toutes les informations objectives « disponibles » peut entrainer un niveau de stress élevé
chez l’infirmière ou l’infirmier chargé(e) de cette évaluation.
Indépendamment de ses compétences, la quantité d’informations pertinentes peut devenir colossale, au point de masquer
les informations essentielles.
Afin de faire progresser vos compétences évaluatives vers un
tout autre niveau, cet exposé a pour objet de favoriser la pensée
critique et de proposer un cheminement de l’évaluation fiable
et sensé qui simplifiera la détérioration, vous procurera l’aide
dont vous avez besoin au cours de la phase évaluative et renforcera votre confiance.
L’exposé reposera sur la présentation et l’exploration de divers
cas et visera à déconstruire la détérioration et à discuter des
« incontournables absolus ».
Afin d’atteindre ce but, nous aborderons :
1. Les régions anatomiques clés dont dépend notre niveau de
conscience
2. Les signes et symptômes neurologiques des clients
3. La façon dont déterminer les causes métaboliques et
neurologiques
4. Les domaines de préoccupation clés sur le plan anatomique
lors de l’évaluation d’un patient dont l’état se détériore
5. Les « incontournables absolus » en matière de neurologie
durant l’évaluation.
Through case presentations and exploration, the goals of this
talk are to de-construct deterioration and discuss the ‘absolute
must do’.
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CONCURRENT Sessions
A1
Exploring Creative Approaches to
Opening Dialogue about Palliative and
End-of-Life Care: Is there a Role for
Performance and Visual Art?
Des approches créatives à l’étude
afin d’ouvrir le dialogue sur les soins
palliatifs et de fin de vie : les arts du
spectacle et les arts visuels ont-ils un
rôle à jouer?
Brenda Sabo, Katie Dorian, Alexis Milligan and Erna
Snelgrove-Clarke
Brenda Sabo, Katie Dorian, Alexis Milligan et Erna
Snelgrove-Clarke
In a cancer care system that places emphasis on cure, health
care professionals (HCP) have a tendency to avoid or put off the
challenging conversations about palliative and end-of-life care,
which are known to be able to promote a healthy quality of life
until death occurs. This occurs for a variety of reasons including
fear that hope will be destroyed for patients and family members; concern that such a conversation may result in further distress; or feeling unprepared to enter into such discussions and
respond to the emotions that may arise. Failure to acknowledge
the need to transition from curative goals to palliative or endof-life care in a timely way can erode the patient/family/HCP
relationship, decrease quality of life, undermine autonomy and
decision-making control, and heighten levels of distress (e.g., anxiety and depression).
Dans un système de soins contre le cancer axé sur la guérison,
les professionnels de la santé (PS) ont tendance à éviter ou à
repousser les conversations difficiles sur les soins palliatifs et de
fin de vie, connus pour procurer une qualité de vie saine dans
l’attente de la mort. Les causes de ceci sont multiples et comprennent la peur de détruire l’espoir des patients et des membres de
leur famille, l’angoisse qu’une telle conversation puisse aggraver
leur détresse, ou le sentiment de ne pas être préparé à avoir une
telle conversation ni à pouvoir réagir aux émotions qu’elle pourrait provoquer. Ne pas réaliser à temps la nécessité de passer
d’un objectif de guérison à des soins palliatifs et de fin de vie peut
éroder la relation patient/famille/PS, diminuer la qualité de vie,
amoindrir l’autonomie et le pouvoir décisionnel et accroitre les
niveaux de détresse (p.ex., anxiété et dépression).
Traditional educational models that frequently involve imparting knowledge through didactic approaches (e.g., lecture format) do little to convey the more intimate elements of the
human experience. Nor do research articles that, not infrequently, remove the contextual aspects of life. Arts-based
knowledge translation legitimizes the agency of tacit knowledge (i.e., the subjective, contextual) and communicates the
relevance of research through the everyday lived experience.
This is of particular importance when targeting sociocultural
norms, values and beliefs held by HCPs, patients and families.
Les modèles éducatifs traditionnels qui impliquent une transmission des connaissances au moyen d’approches didactiques
(p.ex., les exposés) communiquent peu les aspects intimes de
cette expérience humaine, tout comme les articles de recherche
qui, de temps à autre, négligent les aspects contextuels de la vie.
L’application des connaissances par les arts valide le pouvoir
des connaissances tacites (c.-à-d. celles qui sont subjectives et
contextuelles) et transmet la pertinence des recherches à travers
les expériences de tous les jours. Ceci s’avère particulièrement
important lorsqu’on vise les normes socioculturelles, les valeurs
et les croyances des PS, des patients et des familles.
This 2 1/2-hour workshop will highlight the role of art in connecting, creating meaning and opening communication about
palliative and end-of-life issues. Two creative approaches will
be profiled. First, participants will actively engage with creative
artists Katie Dorian and Alexis Milligan in the play, How Often
do I Dream? Second, a visual-arts based educational initiative
embedded within a fourth-year palliative care nursing course
will be presented. How and in what way the role of creative arts
can enhance open, supportive communication about palliative
and end-of-life care will be provided.
Learning objectives:
1. Introduce attendees to innovative ways for providing education about palliative and end-of-life care
2. Highlight the benefits of creative work (e.g., performance
art, visual art) in opening communication
3. Challenge existing values, attitudes and beliefs about palliative and end-of-life care
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Cet atelier de 2 h 30 montrera le rôle important de l’art pour
établir des liens, créer du sens et ouvrir le dialogue sur les questions de soins palliatifs et de fin de vie. Nous décrirons deux
approches créatives. Premièrement, les participants interviendront activement avec les artistes Katie Dorian et Alexis Milligan dans la pièce de théâtre How Often do I Dream? [À quelle
fréquence est-ce que je rêve?]. Ensuite, nous présenterons une
initiative éducative basée sur les arts et intégrée à un cours de
soins infirmiers de 4e année sur les soins palliatifs. Nous verrons
comment et pourquoi les arts créatifs contribuent à instaurer
un dialogue ouvert et positif concernant les soins palliatifs et
de fin de vie.
Objectifs d’apprentissage :
1. Présenter aux participantes et aux participants des façons
innovantes d’éduquer sur les soins palliatifs et de fin de vie
2. Souligner les avantages du travail créatif (p.ex., les arts du
spectacle, les arts visuels) afin d’ouvrir le dialogue
3. Remettre en question les valeurs, les attitudes et les croyances existantes en matière de soins palliatifs et de fin de vie
A2
A3
Deep Brain Stimulation in DrugResistant Epilepsy
Motorcycle Helmets and
Traumatic Brain Injuries
Karen Waterhouse, RN, BSN, CNN(C)
Katie Fink
According to the literature, approximately 25% of patients with
epilepsy do not have adequate seizure control by anti-epileptic
drugs (AED), and are deemed drug resistant. Surgical resection
of a specific epileptogenic focus is an option for only around
20% of these patients (Valentin et al., 2012).
Motorcyclists are 34 times more likely to die in a motor vehicle
crash than those in other motor vehicles, and the primary cause
of death in these fatalities is traumatic brain injury (National
Highway Traffic Safety Administration [NHTSA], 2011; 2007).
Manufacturers of motorcycle helmets are required to design
helmets to meet standards outlined by the Federal Motor Vehicle Safety Standard No. 218 and the Department of Transport
(NHTSA, 2011). The purpose of these motorcycle helmet
design standards is to protect the head from impact and, if
used properly, motorcycle helmets greatly reduce the risk of
death during a crash (Lin & Kraus, 2009). However, even when
a motorcycle helmet is worn and death prevented during a
crash, traumatic brain injuries still occur. The traumatic brain
injuries of these survivors are often severe with diverse areas
of injury, thus making it difficult to identify the protection, if
any, provided by the motorcycle helmet.
The occurrence of drug-resistant epilepsy can have important
psychosocial implications for the patient and their family, risk of
injury for the patient, and the potential for sudden death in the
patient. In efforts to improve the quality of life in these patients,
epileptologists and neurosurgeons have been turning to new
emerging treatment options such as Deep Brain Stimulation
of the anterior thalamic nucleus.
This presentation will discuss our centre’s inaugural experience
with DBS for epilepsy and will highlight a case of one patient
who received treatment with DBS for drug-resistant epilepsy.
I will also discuss the nursing care involved with this patient
across the continuum from preoperative teaching to post-operative follow-up care.
La stimulation cérébrale profonde pour
le traitement de l’épilepsie résistante
aux médicaments
Karen Waterhouse, IA, B.Sc.inf, CSN(C)
Selon la documentation, environ 25 % des patients atteints
d’épilepsie ne possèdent pas de médicaments antiépileptiques
visant à maitriser les crises épileptiques et sont considérés
comme réfractaires aux médicaments. La résection chirurgicale
d’un foyer épileptogène précis ne constitue une option viable
que pour 20 % de ces patients (Valentin et coll. 2012).
L’épilepsie résistante aux médicaments peut entrainer d’importantes conséquences sur le plan psychosocial pour le patient
et sa famille, un risque de blessure pour le patient et la possibilité de mort subite du patient. Afin d’améliorer la qualité de
vie de ces patients, les épileptologues et les neurochirurgiens
se sont tournés vers de récentes options de traitement émergentes, comme la stimulation cérébrale profonde des noyaux
thalamiques antérieurs.
Cet exposé traitera de l’expérience inaugurale de la SCP dans
notre centre et abordera le cas d’un patient dont on a traité l’épilepsie résistante aux médicaments au moyen de la SCP. J’aborderai également les soins infirmiers prodigués à ce patient tout
au long du continuum, depuis l’enseignement préopératoire
jusqu’aux soins de suivi postopératoires.
Neuroscience nurses frequently care for patients with traumatic brain injuries secondary to motorcycle crashes. This
presentation is meant to provide neuroscience nurses with an
opportunity to learn more about different aspects of motorcycle helmets and the influences of these on traumatic brain
injuries they see in their patients. A demonstration of common
helmet strike points during a motorcycle crash (Otte, 2008) and
associated cranial injuries will be provided, and a case study
of a young motorcyclist involved in a motorcycle crash will be
presented.
Les casques de moto et les
traumatismes cérébraux
Katie Fink
Les motocyclistes sont trente-quatre fois plus susceptibles
de mourir dans un accident de la route que ceux conduisant
d’autres types de véhicules à moteur, et ce sont les traumatismes cérébraux qui constituent la cause principale de ces décès
(National Highway Traffic Safety Administration [NHTSA],
2011; 2007). Les fabricants de casques de moto sont tenus
de concevoir des casques conformes aux prescriptions de la
norme fédérale de sécurité des véhicules automobiles no 218 et
à celles du ministère des Transports (NHTSA, 2011). Les normes
de conception de ces casques ont pour but de protéger la tête lors
de l’impact et, si on les utilise correctement, ces casques peuvent
grandement réduire le risque de mort au cours d’un accident (Lin
& Kraus, 2009). Cependant, même si l’usager porte un casque et
que sa mort est évitée durant l’accident, il peut tout de même subir
un traumatisme cérébral. Les traumatismes cérébraux dont souffrent ces survivants sont souvent graves et touchent différentes
régions, ce qui remet en question le niveau de protection (si
protection il y a réellement) offert par les casques de moto.
Les infirmières et infirmiers en neurosciences doivent souvent
s’occuper de patients atteints de traumatismes cérébraux provoqués par un accident de moto. Cet exposé a pour but de
13
montrer aux infirmières et infirmiers en neurosciences divers
aspects des casques de motos et les effets de ces derniers sur
les traumatismes cérébraux des patients dont ils ont la charge.
Nous ferons la démonstration des points d’impact du casque au
cours d’un accident de moto (Otte, 2008) et des traumatismes
crâniens qui y sont liés, puis nous présenterons le cas d’un jeune
motocycliste impliqué dans un accident de moto.
A5
The Hidden Culprit (Ruptured Posterior
Cerebellar Artery Aneurysm)
Nicole Chenier-Hogan, RN(EC), BA, MSc, CNN(C)
A 28-year-old male presents to an outlying emergency department with reports of sudden onset of headache, nausea, transient left-sided weakness and subjective reports of dysphagia.
Neurological assessment is reported as unremarkable. No significant past medical history or familial history of migraines or
aneurysms. Initial CT head scan is reported as normal, an area
of hypoattenuation is reported as artifact.
Working differential diagnosis of migraine versus meningitis are identified as the primary diagnosis. This presentation
will discuss posterior inferior cerebellar artery (PICA) aneurysms, specifically related to the incidence and prevalence,
clinical presentation, diagnostic imaging, and treatment. A
case study approach will be used to highlight all of these key
features in the detection and management of these rare aneurysms, which account for 0.5%–3% of all intracranial aneurysms. The PICA is the largest and most posterior branch of
the vertebral artery supplying the lower portion of the fourth
ventricle, the medulla oblongata and the inferior aspect of
the cerebellar hemisphere. Predominantly, these aneurysms
occur at the junction of the vertebral artery. Ruptured PICA
aneurysms are found to result in an increased incidence of
intraventricular hemorrhage and secondary hydrocephalus.
The early identification and appropriate treatment of these
rare aneurysms is crucial.
Le coupable caché (la rupture
d’anévrisme de l’artère cérébelleuse
postéro-inférieure)
Nicole Chenier-Hogan, IA(CS), B.A., M.Sc., CSN(C)
Un jeune homme de 28 ans admis à un service d’urgences
périphérique se plaint de soudaines migraines, de nausées, de
faiblesses passagères au côté gauche et déclare souffrir de dysphagie. L’évaluation neurologique ne décèle rien de particulier.
Il n’existe pas d’antécédents médicaux significatifs ni d’antécédents familiaux de migraines ou d’anévrismes. Une première
tomodensitométrie du crâne ne révèle rien d’anormal, à l’exception d’une zone d’hypoatténuation, que l’on considère être un
artefact. Selon le diagnostic différentiel en cours, on détermine
que le diagnostic principal est une migraine ou une méningite.
Cet exposé portera sur les anévrismes de l’artère cérébelleuse
postéro-inférieure (ACPI), et plus particulièrement sur leur
incidence et leur fréquence, leur tableau clinique, l’imagerie
diagnostique et leur traitement. Nous recourrons à une étude
14
de cas pour faire ressortir toutes les principales caractéristiques de la détection et de la prise en charge de ces rares cas
d’anévrisme, qui représentent de 0,5 % à 3 % des cas d’anévrisme
artériel intracérébral. L’ACPI est la branche la plus large et la
plus postérieure de l’artère vertébrale et elle approvisionne la
partie inférieure du quatrième ventricule, le bulbe rachidien et
la partie inférieure de l’hémisphère cérébelleux. Ces anévrismes se déroulent principalement au niveau de la jonction de
l’artère vertébrale. Les ruptures d’anévrisme de l’ACPI ont pour
conséquence une incidence accrue d’hémorragie intraventriculaire et d’hydrocéphalie secondaire. Il est essentiel de repérer
tôt et de traiter correctement ces anévrismes rares.
B1
Adults Coming Together
Janice Williams, and Dawn Tymianski
This intensive workshop will focus on pediatric and adult neurological assessment and discuss the management of common
neurological problems that may be encountered by neuroscience nurses working in primary or acute care. An interactive
and case-based approach will be utilized to review common
neurological presentations with a focus on critical thinking and
clinical reasoning skills. The workshop will focus on preparing
nurses with the knowledge and tools to confidently assess and
consider the treatment plan for pediatric or adult neurological
presentations through exploration of common diagnoses and
relevant pathophysiology, identification of assessment findings,
discussion of common diagnostic approaches, determination of
an initial therapeutic plan of care, and red flags for intervention.
L’évaluation neurologique : les enfants
et les adultes se rencontrent
Janice Williams et Dawn Tymianski
Cet atelier intensif portera sur l’évaluation neurologique
des enfants et des adultes et abordera la prise en charge des
problèmes neurologiques courants rencontrés par le personnel infirmier en neuroscience qui travaille dans les services
de soins primaires ou de courte durée. Nous ferons le point
sur les manifestations de troubles neurologiques communs
à l’aide d’une approche interactive fondée sur des études
de cas, tout en mettant l’accent sur la pensée critique et les
habiletés de raisonnement clinique. L’atelier vise à procurer
aux infirmières et infirmiers les connaissances et les outils
qui leur permettront d’évaluer et d’envisager le plan de traitement correspondant aux signes de troubles neurologiques
que présentent les enfants et les adultes, et ce, en analysant
les diagnostics courants et les pathophysiologies pertinentes,
en identifiant les conclusions des évaluations, en discutant
d’approches diagnostiques communes, en déterminant un plan
de soins thérapeutique initial et en signalant les interventions
nécessaires.
B2
B3
Rapid Evaluation and Intervention
for Symptomatic Extracranial Carotid
Disease
Thalamus Injuries: Hitting Where it
Hurts the Most
Aaron Gardner, BSN, CNN(C) and Michelle Jaspar, BSN
A case study will be shared to explore the role of bi-thalamic
injury in the clinical presentation of a 66-year-old male who
had suffered a posterior fossa hemorrhage secondary to a superior cerebellar arteriovenous malformation (AVM). Due to his
rare anomalous venous architecture, venous hypertension contributed to micro hemorrhages in the thalamus and caudate.
This gentleman was offered possible gamma knife surgery, but
underwent a high-risk urgent embolization of the AVM to
reduce the risk of permanent neurological sequelae.
In accordance with Canadian Stroke best practice, patients with
transient ischemic attack or stroke with ipsilateral carotid stenosis of 50–99% should be assessed and offered treatment, if
appropriate, within 14 days of symptom onset. The process of
referral of patients to our cerebrovascular service and barriers
to timely referral will be reviewed. In addition, the management
of patients with asymptomatic carotid disease and those presenting with low grade stenosis (<50%) will be reviewed. Finally,
we will provide an overview of the surgical and endovascular
management of this patient group.
La rapidité de l’évaluation et de
l’intervention dans le traitement de la
maladie carotidienne extracrânienne
symptomatique
Aaron Gardner, B.Sc.inf., CSN(C) et Michelle Jaspar, B.Sc.inf.
Conformément aux pratiques optimales de soins de l’AVC au
Canada, les patients ayant subi un accident ischémique transitoire ou un AVC avec une sténose carotidienne ipsilatérale de
50-99 % devraient être évalués et traités si besoin est dans un
délai de 14 jours après l’apparition des symptômes. Nous examinerons le processus d’acheminement des patients vers notre
service cérébrovasculaire ainsi que les obstacles empêchant
l’acheminement des patients en temps opportun. En outre, nous
examinerons la prise en charge des patients souffrant d’une
maladie carotidienne asymptomatique et de ceux atteints d’une
sténose légère (<50 %). Pour finir, nous donnerons un aperçu de
la prise en charge chirurgicale et endovasculaire de ce groupe
de patients.
Stephanie van Rooy, RN(EC), MN
Bi-thalamic injuries have a number of potential etiologies,
including ischemic, thrombotic, oncological, metabolic,
infectious or toxin related. The thalamus is a central exchange
pathway for information travelling from the periphery to the
cerebral cortex for processing. Axons from every sensory system except olfaction synapse here, as the last relay point before
entry to the cerebral cortex. Pain complexes are often associated
with thalamic injury.
The structure, function, and vascular supply of the thalamus
and relevant nuclei will be reviewed. Neurological symptoms
corresponding to the area of thalamic injury and radiologic
findings comparing imaging modalities will be presented, and
a review of the outcome in this case will be explored to examine
the role of the thalamus.
Les lésions thalamiques : elles frappent
là où ça fait le plus mal
Stephanie van Rooy, IA(CS), M.Sc.inf.
Nous examinerons une étude de cas afin d’explorer le rôle
d’une lésion thalamique bilatérale dans le tableau clinique d’un
homme de 66 ans ayant précédemment subi une hémorragie
de la fosse postérieure à la suite d’une malformation artérioveineuse (MAV) cérébelleuse supérieure. Du fait de cette architecture veineuse anormale, l’hypertension veineuse a contribué
à provoquer des microhémorragies dans le thalamus et le noyau
caudé. L’homme a subi une chirurgie par gamma knife, mais a
dû avoir recours à une embolisation de la MAV urgente et très
risquée afin de réduire le risque de séquelles neurologiques
permanentes.
L’étiologie potentielle des lésions thalamiques bilatérales est
assez variée et peut être de nature ischémique, thrombotique,
oncologique, métabolique, infectieuse, ou être liée à une toxine. Le thalamus constitue une voie d’échange centrale pour les
informations qui circulent depuis la périphérie jusqu’au cortex cérébral afin d’y être traitées. Les axones de tous les systèmes sensoriels, à l’exception de l’olfaction, convergent vers ce
dernier point de relai avant d’entrer dans le cortex cérébral. De
nombreux ensembles de douleurs sont souvent liés aux lésions
thalamiques.
15
Nous examinerons la structure, la fonction et la capacité vasculaire du thalamus et des noyaux concernés. Nous présenterons les symptômes neurologiques qui dépendent de la région
touchée par la lésion thalamique ainsi que les indications
radiologiques obtenues en comparant des techniques d’imagerie. Nous explorerons également les résultats de ce cas pour
examiner le rôle du thalamus.
C1
Immunoglobulin Therapy in
Neuromuscular Diseases: Current
Evidence and Future Prospects
Wilma J. Koopman, RN(EC), MScN, TCNP, CNN(C)
Intravenous immunoglobulin (IVIg) therapy is of proven
effect in chronic inflammatory demyelinating polyneuropathy (CIDP) and Multifocal Motor Neuropathy (MMN).
In Guillain Barre Syndrome (GBS) and Myasthenia Gravis
(MG), IVIg is commonly used to treat. Recently, subcutaneous immunoglobulin therapy (SCIg) has been used in immunological practice and its use in neuromuscular diseases is
emerging.
The objectives of this presentation include:
1. Discuss the clinical pathophysiology and presentation of
patients with neuromuscular diseases that are treated with Ig
2. Review clinical case studies to discuss the role of Ig in the
treatment of neuromuscular diseases
3. Discuss the current evidence for the use of subcutaneous
delivery of Ig in neuromuscular diseases
La thérapie par immunoglobuline pour
les maladies neuromusculaires : les
preuves actuelles et les perspectives
d’avenir
Wilma J. Koopman, IA(CS), M.Sc.inf., TCNP, CSN(C)
La thérapie par injection intraveineuse d’immunoglobuline
(EVIg) entraine des effets connus sur la polyneuropathie inflammatoire démyélinisante chronique (PIDC) et la neuropathie
motrice multifocale (NMM). On utilise souvent l’IVIg pour
traiter le syndrome de Guillain-Barré (SGB) et la myasthénie
grave (MG). On a récemment recouru à la thérapie d’immunoglobuline sous-cutanée (IgSC) dans la pratique immunologique et on commence à l’utiliser dans les cas de maladies
neuromusculaires.
Les objectifs de cet exposé sont les suivants :
1. Examiner la pathophysiologie clinique et les symptômes des
patients atteints de maladies neuromusculaires et traités
par Ig
2. Étudier des cas cliniques pour discuter du rôle de l’Ig dans
le traitement des maladies neuromusculaires
3. Examiner les preuves actuelles justifiant l’injection
sous-cutanée d’Ig pour le traitement de maladies
neuromusculaires
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C2
Parkinson’s Disease: Role of the Nurse
in Disease Management
Lucie Lachance, RN, MSc, and Jennifer Doran, BN, CNN(C)
Although the nurse’s role varies in different clinics across the
country, most are involved with the assessment, management,
education and support of people with Parkinson’s, their family
and/or caregivers.
Parkinson’s Disease is the second most common neurodegenerative disease with no cure that affects a person’s physical,
emotional and social well-being. The complexity of the disease
warrants an interdisciplinary approach to treatment and management. Nurses are often the health care professionals who have
a great deal of contact with patients and, as such, are in a unique
position to assist patients in managing their Parkinson’s symptoms. Nurses are sources of expert knowledge that can offer guidance on managing medication to get the best results and reduce
the impact of any side effects. This presentation will also focus
on nurse care strategies for all stages of Parkinson’s. The presentation will conclude with a case study that will demonstrate how
the information can be applied to clinical practice and how the
nurse’s role complements the interdisciplinary care team.
La maladie de Parkinson : le rôle du
personnel infirmier dans la prise en
charge de la maladie
Lucie Lachance, IA, M.Sc. et Jennifer Doran, B.Sc.inf., CSN(C)
Bien que le rôle des infirmières et infirmiers varie en fonction
des cliniques à travers le pays, la plupart d’entre eux participent
à l’évaluation, à la prise en charge, à l’éducation et au soutien
des personnes atteintes de la maladie de Parkinson, de leurs
familles et de leurs soignants.
La maladie de Parkinson est la seconde maladie neurodégénérative la plus commune, elle est incurable et touche le bien-être
physique, émotionnel et social de la personne. La complexité
de cette maladie nécessite une approche interdisciplinaire en
matière de traitement et de prise en charge. Les infirmières et
infirmiers sont souvent les professionnels de la santé à passer
le plus de temps au contact des patients et par conséquent,
ils occupent une place unique pour aider les patients à gérer
leurs symptômes de Parkinson. Le personnel infirmier constitue une source de connaissances de premier plan, capable de
prodiguer des conseils en matière de gestion de la médication
afin d’obtenir des résultats optimaux et de réduire l’impact des
effets secondaires. Cet exposé traitera des stratégies de soins
infirmiers à toutes les étapes de la maladie de Parkinson. Il se
conclura par une étude de cas qui démontrera comment ces
informations peuvent s’appliquer à la pratique clinique et en
quoi le rôle du personnel infirmier complète celui de l’équipe
de soins interdisciplinaires.
C3
C4
Lessons Learned from Patients and
Families: Reflections from More Than
100 Years of Neuroscience Nursing
Practice
Persistent Vegetative State and Early
Pregnancy: An Ethical Dilemma in
Bev Irwin, RN, BN, Nancy Thornton, RN, MScN, CNN(C), and
Pauline Weldon, RN, CMSN
Although nurse educators recognize that specialized knowledge is needed for professional practice, they also argue that
self-consciousness (reflection) and continual self-critique (critical reflection) are key to continued competence. Moreover,
those who advocate for reflective and critically reflective practice suggest that the development of these abilities must be
woven through one’s professional development and developed
through repeated practice (Williams, 2001).
This workshop will provide a forum for neuroscience nursing
colleagues to hear about some key lessons learned through
more than 100 years of combined neuroscience nursing practice
and how these lessons have shaped both these nurses’ individual
practices and world views. This will be followed by a facilitated
group discussion with opportunity for participants to share
their stories and reflections.
Les leçons tirées des patients et de
leurs familles : des réflexions issues de
plus de 100 années de soins infirmiers
en neurosciences
Bev Irwin, IA, B.Sc.inf.; Nancy Thornton, IA, M.Sc.inf.,
CSN(C) et Pauline Weldon, IA, ICMC
Bien que les infirmiers éducateurs et les infirmières éducatrices admettent la nécessité des connaissances spécialisées
dans la pratique professionnelle, ils soutiennent aussi que
la gêne du regard des autres (réflexion) et une autocritique
constante (réflexion critique) sont essentielles au bon maintien des compétences. De plus, les partisans de la pratique
réflexive et de la pratique réflexive critique avancent que le
développement de ces capacités doit être indissociable du
perfectionnement professionnel et provenir d’une mise en
pratique répétée (Williams, 2001).
Shawna Kelly, RN, BScN, ACN, CNN(C), Russel Matias,
RN, BScN, CNN(C), and Sara Bevilacqua, RN, BScN, CCN,
CNN(C)
On the first day of school, a 28-year-old married school teacher
suffered a grand mal seizure. Her Glasgow Coma Score (GCS)
on presentation was 3/15, requiring immediate intubation and
transfer to a local quaternary neurosurgical centre for emergent care. On admission, she was pregnant at 17 weeks (G1P0).
Imaging revealed a massive thalamic hemorrhage and very
high intracranial pressure (ICP) requiring rapid decompression, including the placement of bilateral external ventricular
drains (EVDs). Her critical illness led to the use of maximum
doses of life-sustaining medications for cardiovascular, neurological and respiratory support.
During this critical time, obstetrical ultrasound confirmed normal fetal growth and a stable heart rate. Within two weeks of
hospital admission and no evidence or anticipated signs of neurological recovery, she progressed into a persistent vegetative
state (PVS) at 21 weeks gestation. The goal of care moved from
the life-sustaining treatment of the mother to that of protecting
the unborn fetus, which was too early to be delivered.
This case presents significant challenges in the area of ethics,
intensive care, and obstetrics. During this presentation and
interactive discussion, the presenter/attendee will:
• Be able to differentiate disorders of consciousness including
brain death, coma, PVS, and minimally conscious state
• Review the known literature on life-sustaining medications
and pregnancy
• Have the opportunity to examine other cases of maternal
brain injury during pregnancy and neonatal outcomes
• Appreciate the ethical considerations faced by the hospital’s
inter-professional team and the patient’s family
• Explore the international dilemmas related to health care
options in other countries
• Be invited to openly discuss similar circumstances or clinical
experiences.
Cet atelier fera office de tribune où les infirmières et infirmiers en neurosciences pourront profiter de certaines leçons
clés issues de plus de 100 années de soins infirmiers en
neurosciences et de la façon dont ces apprentissages ont
façonné à la fois les pratiques individuelles de ces infirmières
et infirmiers et les visions du monde. Ceci sera suivi d’une
discussion de groupe dirigée qui donnera l’occasion aux participantes et aux participants de partager leurs histoires et
leurs réflexions.
17
État végétatif persistant & début
de grossesse : un dilemme éthique
en matière de soins infirmiers en
neurosciences
C5
Shawna Kelly, IA, B.Sc.inf., ACN, CSN(C), Russel Matias,
IA, B.Sc.inf., CSN(C) et Sara Bevilacqua, IA, B.Sc.inf., CSIC,
CSN(C)
Katanya Fuerst, RN, Rheanna Radchenko, RN, Sophia
Phillips, RN, and Arbelle Manicat-Emo, RN(EC), NP-Paeds
When Your Brain Turns on You: Exploring
Anti-NMDA Encephalitis in the Pediatric
Population
Le jour de la rentrée des classes, une jeune enseignante mariée
de 28 ans a subi une crise de type grand mal. Elle a obtenu
un résultat de 3/15 sur l’échelle de Glasgow, nécessitant d’être
immédiatement intubée et acheminée à un centre de neurochirurgie quaternaire afin de recevoir des soins d’urgence.
Lors de son admission, il s’est avéré qu’elle était enceinte de 17
semaines (G1P0). L’imagerie a révélé une importante hémorragie thalamique et une pression intracrânienne (PI) très élevée
nécessitant une décompression rapide et la pose de dérivations
ventriculaires externes (DVE) bilatérales. Cette grave maladie
a mené à l’utilisation de doses maximales de médicaments afin
de lui procurer une assistance cardiovasculaire, neurologique
et respiratoire et de la maintenir en vie.
Durant cette période critique, les échographies obstétricales
ont confirmé la croissance normale du fœtus et un rythme
cardiaque stable. Deux semaines après son entrée à l’hôpital
et toujours sans aucun indice ou signe anticipé de rétablissement neurologique, elle a sombré dans un état végétatif persistant (EVP), à 21 semaines de gestation. Les soins n’ont alors
plus eu pour but de maintenir la mère en vie mais de protéger
le fœtus, dont l’âge était trop peu avancé pour provoquer un
accouchement.
Ce cas présente des défis de taille dans les domaines de l’éthique,
des soins intensifs et de l’obstétrique. Au cours de l’exposé et
de la discussion interactive, les présentatrices et participants
pourront :
• Être capables de différencier les troubles de la conscience,
notamment la mort cérébrale, le coma, l’état végétatif persistant et l’état de conscience minimale
• Examiner la documentation connue sur les médicaments
essentiels au maintien de la vie et sur la grossesse
• Étudier d’autres cas de lésions cérébrales survenues chez des
mères durant leur grossesse, ainsi que les résultats néonataux
• Apprécier les considérations éthiques auxquelles font face
l’équipe interprofessionnelle et la famille de la patiente
• Explorer les dilemmes internationaux liés aux options de
soins de santé dans d’autres pays
• Être invités à discuter ouvertement de circonstances similaires ou d’expériences cliniques
18
Anti-NMDA receptor encephalitis is a type of antibody-mediated inflammatory brain disease whereby the body’s immune
system ‘attacks’ healthy brain tissue resulting in inflammation.
This is a relatively new form of encephalitis, first diagnosed in
2007, yet is now the most commonly diagnosed form of inflammatory brain disease. This disease predominantly affects young
women and children, most of whom were previously healthy
before symptoms began. Symptoms vary widely in presentation,
from seizures in younger children to psychiatric symptoms such
as hallucinations, paranoia and aggression in the older population. This can be a devastating time for patients and their families, as the road to a full recovery is often lengthy and difficult,
requiring many treatments and therapies.
In this presentation we will examine the pathophysiology surrounding this type of encephalitis, discuss the common symptoms, treatment options and how the road to recovery can
look for these patients. Furthermore, we will look at the nursing implications during the various stages of the patient’s and
family’s journey, and how we can provide support during the
recovery process.
Lorsque votre cerveau se retourne contre
vous : une exploration de l’encéphalite
anti-NMDA chez les enfants
Katanya Fuerst, IA, Rheanna Radchenko, IA, Sophia Phillips,
IA et Arbelle Manicat-Emo, IA(CS), IP-Péd.
L’encéphalite à anticorps anti-récepteurs NMDA est une maladie inflammatoire du cerveau causée par les anticorps et dans
laquelle le système immunitaire « attaque » les tissus cérébraux
sains, provoquant ainsi une inflammation. Premièrement diagnostiquée en 2007, c’est une forme d’encéphalite relativement
nouvelle, mais aussi la forme de maladie inflammatoire du cerveau la plus couramment diagnostiquée. Cette maladie touche
principalement les jeunes femmes et les enfants, la plupart d’entre eux étant en bonne santé avant le début des symptômes. La
présentation de ces symptômes varie grandement et va de la
crise épileptique chez les plus jeunes enfants à des syndromes
psychiatriques comme des hallucinations, de la paranoïa et de
l’agression chez les plus âgés. C’est une période de temps possiblement dévastatrice pour les patients et leurs familles, car le
cheminement vers une guérison complète est souvent long et
difficile en raison des nombreux traitements et thérapies nécessaires. Dans cet exposé, nous étudierons la pathophysiologie
associée à ce type d’encéphalite ainsi que les symptômes courants, les options de traitement et les allures que peut prendre le
cheminement vers la guérison. Finalement, nous nous intéresserons aux conséquences en matière de soins infirmiers pour les
diverses étapes du cheminement du patient et de sa famille ainsi
qu’au soutien à leur apporter durant le processus de guérison.
C6
D1 / A6
Challenging Families: Trials, Tribulations
and Triumphs
Brain of Zones
Jennifer Boyd, RN, MHSc, CNN(C)
Knowledge of neuro anatomy and physiology is essential in
understanding neurologic function and dysfunction (Barker,
2008; Hickey, 2009) and, therefore, foundational to neuroscience nursing. Neuro anatomy and physiology is a key
component of orientation to neuroscience nursing units, as
well as a competency for the Canadian Nurses Association’s
(CNA) Neuroscience Nursing Certification exam (CNA,
2014). Neuro anatomy and physiology is a complex subject
with a myriad of concepts and neuroscience educators are
challenged to stimulate nurses’ retention of neuro anatomy
and physiology knowledge and the transfer of it into practice. However, lecture, the primary teaching approach used
by nurse educators (Fitzgerald, 2008; Hamilton & Morris,
2012; Ridley, 2007) may not be the best teaching method to
achieve these goals.
Pediatric neuroscience nurses work closely with families in their
daily practice and strive to develop collaborative, therapeutic
relationships with parents to promote optimal health outcomes
for the child with a neurological condition. When dealing with
a parent who is perceived as “difficult”, nurses may struggle with
achieving this goal. Challenging families can try our patience,
increase our stress, reduce our confidence, test our personal
beliefs, ignite strong emotions and even hinder the provision
of an ideal plan of care.
Through a review of the literature, case examples and audience
participation, the objectives of this presentation are to highlight
the characteristics of families perceived as difficult, identify
factors that contribute to difficult encounters with parents, and
review approaches to dealing with challenging families.
Les familles difficiles : tracas,
tribulations et triomphes
Jennifer Boyd, IA, M.Sc.S, CSN(C)
Au cours de leur pratique, les infirmières et infirmiers en neurosciences pédiatriques travaillent en étroite coopération avec
les familles. Ils tentent de construire des partenariats thérapeutiques et une relation de collaboration avec les parents
afin que les enfants dont ils ont la responsabilité et qui sont
atteints de troubles neurologiques obtiennent des résultats de
santé optimaux. Lorsqu’ils sont confrontés à un parent considéré comme « difficile », les infirmières et infirmiers peuvent
avoir du mal à atteindre ce but. Les familles difficiles peuvent
tester notre patience, augmenter notre stress, déclencher de
fortes émotions et même entraver l’exécution d’un plan de
soins idéal.
Au moyen d’un compte-rendu de la documentation, d’exemples
de cas et de la participation des participantes et des participants, cet exposé aura pour objet de décrire les caractéristiques
des familles considérées comme difficiles, de déterminer les facteurs qui contribuent à des rencontres difficiles avec les parents
et de faire le point sur les approches permettant de traiter avec
ces familles difficiles.
Sue Kadyschuk and Katie Fink
Gaming has been identified as an innovative learning strategy for nurses and holds advantages such as active participation, increased information retention, and promotion of
teamwork and problem solving (Fitzgerald, 2008; Henry,
1997; Ridley, 2007; Royse & Newton, 2007). Games may
also make learning more enjoyable and less stressful, and
be used to replicate real-life situations or processes, which
facilitates clinical decision making (Royse & Newton). Neuroscience nurses require knowledge of neuro anatomy and
physiology to effectively care for their patients, but they also
rely on each other to problem solve and make rapid clinical
decisions.
This presentation is a facilitated game that will encourage active
learning and collaboration. Participants will work in teams to
correctly answer neuro anatomy and physiology questions that
will assist them in solving a final puzzle. Both new and experienced neuroscience nurses will benefit from participating in
this presentation by adding new or revising current knowledge
of neuro anatomy and physiology.
19
Un cerveau de zones
Sue Kadyschuk et Katie Fink
Une bonne connaissance de la neuroanatomie et la physiologie
est essentielle pour bien comprendre le fonctionnement et le
dysfonctionnement neurologique (Barker, 2008; Hickey 2009) et
constitue donc la base des soins infirmiers en neuroscience. La
neuroanatomie et la physiologie sont des composantes clés de
l’orientation des unités infirmières en neurosciences ainsi que
des compétences pour l’examen de certification en soins infirmiers en neurosciences de l’Association des infirmières et infirmiers du Canada (AIIC, 2014). La neuroanatomie et la physiologie
constituent des sujets complexes qui regroupent une multitude
de concepts. Ainsi, les formateurs en neurosciences doivent
trouver des moyens d’aider les infirmières et infirmiers à retenir
ces connaissances en neuroanatomie et en physiologie et à les
appliquer. Cependant, l’exposé, soit la principale méthode pédagogique des formateurs (Fitzgerald, 2008; Hamilton & Morris, 2012; Ridley, 2007), ne constitue peut-être pas la meilleure
démarche pédagogique pour atteindre ces objectifs.
Le jeu s’avère être une stratégie d’apprentissage innovante pour
les infirmières et les infirmiers car il présente des avantages tels
20
qu’une participation active, une meilleure rétention des informations, la promotion du travail en équipe et la résolution de
problèmes (Fitzgerald, 2008; Henry, 1997; Ridley, 2007; Royse &
Newton, 2007). Les jeux rendent également l’apprentissage plus
plaisant et moins stressant et on peut y recourir pour reproduire des situations réelles ou des processus, ce qui facilite la
prise de décision clinique (Royse & Newton). Les infirmières
et infirmiers en neuroscience doivent certes bien connaitre la
neuroanatomie et la physiologie pour prodiguer des soins optimaux à leurs patients, mais ils doivent aussi dépendre les uns
des autres pour résoudre des problèmes et prendre des décisions cliniques rapides.
Cette présentation prendra la forme d’un jeu dirigé qui favorisera un apprentissage actif et la collaboration. Les participants
travailleront en équipe afin de répondre à des questions de neuroanatomie et de physiologie qui les aideront à résoudre un
casse-tête final. Les nouveaux membres du personnel infirmier
tout comme les plus chevronnés bénéficieront de cet exposé,
qui permettra d’ajouter de nouvelles connaissances en neuroanatomie et en physiologie à leur répertoire ou d’en réviser de
plus anciennes.
Poster presentations
P1
P3
Diabetes Education in the Stroke of
Time: Advancing Best Practices in Stroke
and Diabetes Care
Gastrostomy Decision Making: What is
there to Know?
Russel Matias and Rachel Puriv
At the Montreal Neurological Hospital, patient and family engagement is an essential part of the care delivery. This vision influences
the way clinicians, patients and families collaborate in decision
making. An example of such an engagement is the discussion
regarding the decision of a gastrostomy tube insertion. This procedure is often confronted in the population of stroke and ALS,
as they are known to suffer from dysphagia. The interdisciplinary
team engages in discussions with patients and family on the need
of such a procedure. However, families express during these meetings that it would be helpful to have time to reflect on this and to
be provided with some more tangible information.
Diabetes increases the risk for stroke recurrence twofold and
significantly increases post-stroke neurological deficits and
functional disability (Sharma & Gubitz, 2013). As Type 2 Diabetes is a modifiable risk factor for stroke, self-management
education for patients and their caregivers is vital for secondary stroke prevention. Patients admitted to the neurovascular
inpatient unit, within a regional stroke centre were lacking a
consistent approach to diabetes education. This represented
a significant gap given that approximately 50% of our inpatients have a diagnosis of diabetes. To address this gap, a quality improvement project was developed to empower bedside
nurses through educational workshops to embed diabetes education into their practice and discharge planning according to
the Canadian Diabetes Association (CDA) Clinical Practice
Guidelines (CDA, 2013). The project includes the development
of an educational tool kit, a needs assessment, inter-professional
workshops, and patient educational material. The workshops
will provide nurses with the knowledge on how to teach patients
diabetes survival skills and more advanced topics such as caring
for stroke patients with altered nutritional intake, complex medication regimens, co-morbidities, tests and procedures. In my
poster presentation, I will discuss the development, implementation and evaluation of this project, as well as lessons learned.
P2
Delirium: A Medical Emergency
Sandra Tulley, Rebecca Sinyi and Aideen Carroll
The literature indicates that delirium is increasing in incidence
in the acute medically ill patient. The prevalence of delirium
ranges from 6% to 56% in hospital settings and costs upwards
of $17 million/year. There are many risk factors known to contribute to delirium resulting in the complexity of identifying,
assessing and managing a patient who develops delirium.
Hospital-acquired delirium is a growing concern for our geriatric population. The evidence is clear that the development
of delirium influences a patient’s hospital course, increasing
length of stay, and is associated with poor long-term physical
functional and cognitive outcomes. Moreover, psychological
distress to family and caregivers is significant.
Several studies have shown gaps in health care professional’s
knowledge, skills and comfort regarding management of delirium, including inconsistent use of delirium screening instruments and poor adherence to delirium management protocols.
The management of delirium can be complex, requiring the
collective expertise and approach of the interprofessional team.
To address these issues this poster was created to educate the
IP team to improve understanding of various types of delirium
and to highlight prevention and management strategies.
Rosa Sourial and Antonietta Vitale
The goal of this presentation/poster is to summarize the process
taken to develop information material in order to empower
patients and families. Some of the processes are a review of the
literature, a survey of patient and family needs, and a summary
of stakeholders’ discussions (interviews with dietitian, occupational therapy, interventional radiology, gastroenterology and
neurology). The development of a patient/family information
brochure on decision making regarding gastrostomy tube insertion will be based on the findings of the processes.
P4
Neuro-Connect: An inter-site synapse
Claire Nehmé, MScN, Lucy Wardell, N, MSc(A), and Lucia
Fabijan, N, MSc(A)
Objective: To improve the communication between providers at patient discharge from the emergency department (ED).
Background: Timely communication between health care providers is essential to ensure safe and effective patient care. This
is particularly relevant at key transition points such as at patient
discharge from the emergency room. Due to the construction
of a new McGill University Health Centre (MUHC) super-hospital, patients cared for at the Montreal Neurological Hospital
(MNH) will no longer have access to an on-site ED. Hence, now
more than ever, there is a need to develop a more structured
system to ensure seamless communication between providers.
Methods: A quality improvement project was undertaken,
using LEAN Six Sigma methodology, to examine current communication practices between ED staff and MNH specialty
teams and to enhance information transfer upon discharge
from the ED. Quality improvement indicators were identified
and measured pre and post implementation of a new communication system.
Results: Data will be provided on the volume of calls, delay
to notification of and follow-up by specialist teams, as well as
patient and staff satisfaction. The lessons learned will be discussed as well as the implications of instituting standardized
communication handoff systems to enhance patient safety and
care quality at other centres.
21
P5
Promoting Rest using a Quiet Time
Innovation in an Adult Neuroscience
Step-Down Unit
Tara Bergner
Sleep and rest are fundamental for the restoration of energy
needed to recuperate from illness, trauma and surgery. At present, hospitals are too noisy to promote rest for patients. A literature search produced research that described how quiet time
interventions addressing noise levels have met with positive
patient and staff satisfaction, as well as creating a more peaceful and healing environment. In this paper, a description of the
importance of quiet time and how a small, but feasible innovation was carried out in an adult neuroscience step-down unit
in a large tertiary health care facility in Canada is provided.
Anecdotal evidence from patients, families, and staff suggest
that quiet time may have positive effects for patients, their families, and the adult neuroscience step-down unit staff. Future
research examining the effect of quiet time on patient, family
and staff satisfaction and patient healing is necessary.
Key words: noise, hospital, quiet time, rest, patient satisfaction
Présentations
par affiche
Affiche 1
Affiche 2
Des connaissances sur le diabète à point
nommé : la promotion de pratiques
exemplaires en matière de soins de
l’AVC et du diabète
Le délire : une urgence médicale
Russel Matias et Rachel Puriv
Le diabète accroit par deux le risque de récurrence de l’AVC et
augmente de façon significative les déficiences neurologiques
et l’incapacité fonctionnelle après un AVC (Sharma & Gubitz, 2013). Parce que le diabète de type 2 constitue un facteur
modifiable de risque d’AVC, l’éducation des patients et de leurs
soignants en matière d’autogestion constitue un élément vital
de la prévention de l’AVC secondaire. Les patients admis dans
l’unité neurovasculaire pour patients hospitalisés d’un centre
de l’AVC régional ne jouissaient pas d’une approche constante
en matière d’éducation sur le diabète. Cela représentait une
sérieuse lacune, étant donné qu’environ 50 % de nos patients
hospitalisés sont diabétiques. Afin de combler cette lacune,
nous avons mené un projet d’amélioration de la qualité au cours
duquel les infirmières et infirmiers au chevet des patients ont
suivi des ateliers de formation afin qu’ils intègrent cette éducation sur le diabète dans leur pratique et leur planification
des congés des patients, conformément aux Lignes directrices
pour la pratique clinique de l’Association canadienne du diabète
(ACD, 2013). Le projet comprend la création d’une trousse à
outils pédagogique, une évaluation des besoins, des ateliers
interprofessionnels et du matériel pédagogique destiné aux
patients. Les ateliers procureront au personnel infirmier des
connaissances sur la façon dont enseigner des compétences de
survie aux patients diabétiques, mais également sur des thèmes
plus avancés tels que les soins pour les victimes d’AVC souffrant
d’apports nutritionnels altérés, les régimes médicamenteux
complexes, les comorbidités, les examens et les procédures.
Lors de la présentation de mon affiche, je parlerai de la création,
de la mise en œuvre et de l’évaluation de ce projet, ainsi que des
leçons qui en ont été tirées.
22
Sandra Tulley, Rebecca Sinyi et Aideen Carroll
La documentation indique une augmentation de l’incidence
du délire chez les patients atteints d’une affection médicale
et hospitalisés en soins de courte durée. Dans les hôpitaux, la
fréquence des délires va de 6 à 56 % et coûte plus de 17 millions
de dollars par année. On sait que de nombreux facteurs de risque contribuent au délire, ce qui fait qu’un patient sombrant
dans le délire est difficile à identifier, à évaluer et à prendre en
charge.
Le délire nosocomial constitue un sujet de préoccupation grandissant pour notre population gériatrique. Il est clair que l’apparition du délire influe sur le séjour hospitalier du patient, du
fait qu’elle en augmente la durée, et qu’elle entraine de piètres
résultats physiques, fonctionnels et cognitifs à long terme. En
outre, la famille et les personnes soignantes font l’objet d’une
importante détresse psychologique.
De nombreuses études ont indiqué des lacunes dans les connaissances, les aptitudes et le niveau de confort des professionnels de la santé en matière de gestion du délire, notamment
par l’utilisation inconstante des instruments de dépistage du
délire et un faible respect pour les protocoles de gestion du
délire. La prise en charge du délire peut s’avérer complexe et
requérir l’approche et les compétences collectives d’une équipe
interprofessionnelle.
C’est pour aborder ces questions que cette affiche renseignera
l’équipe IP sur les divers types de délire et décrira des stratégies
de prévention et de prise en charge.
Affiche 3
La prise de décision concernant la
gastrostomie : que doit-on savoir?
Rosa Sourial et Antonietta Vitale
À l’Hôpital neurologique de Montréal, la participation des
patients et des familles constitue une partie essentielle des
prestations de soins. Cette vision influe sur la façon dont les
cliniciens, les patients et les familles collaborent pour prendre
une décision. Parmi les exemples d’une telle participation, on
pourrait citer les discussions concernant la décision d’insérer
un tube de gastrostomie. La population atteinte d’un AVC ou
d’une SLA est souvent confrontée à cette procédure car elle
souffre fréquemment de dysphagie. L’équipe interdisciplinaire
doit ainsi discuter de la nécessité d’une telle procédure avec les
patients et leurs familles. Cependant, au cours de ces rencontres, les familles font savoir qu’elles aimeraient avoir le temps
de réfléchir et recevoir des informations plus tangibles.
L’objectif de cette présentation/affiche est de résumer les
procédés auxquels nous avons recouru pour créer des documents d’information devant aider les patients et les familles
à prendre une décision. Ces procédés comprennent une analyse documentaire, un sondage sur les besoins des patients et
des familles et un résumé des discussions avec les intervenants
(entretiens avec le diététicien, ergothérapie, radiologie d’intervention, gastroentérologie et neurologie). La brochure d’information destinée aux patients et aux familles concernant les
décisions à prendre au sujet de l’insertion d’un tube de gastrostomie reposera sur les résultats de ces procédés.
Affiche 4
Neuro-Connect : une synapse intersite
Claire Nehmé, M.Sc.inf., Lucy Wardell, inf., M.Sc.(A), et Lucia
Fabijan, inf., M.Sc.(A)
Objectif : Améliorer la communication entre les fournisseurs
de soin lorsque le patient sort du service des urgences (SU).
Contexte : Une communication rapide entre les fournisseurs
de soins de santé est essentielle pour garantir des soins sûrs et
efficaces aux patients. C’est tout particulièrement le cas lors de
points de transition clés tels que la sortie des urgences. Du fait
de la construction du nouveau super-hôpital du Centre universitaire de santé McGill (CUSM), les patients traités à l’Hôpital
neurologique de Montréal (HNM) n’auront plus accès à un SU
sur place. Ainsi, plus que jamais, un système plus structuré est
nécessaire pour garantir une communication sans faille entre
les fournisseurs de soins.
Méthodes : Nous avons entrepris un projet d’amélioration de
la qualité à l’aide de la méthodologie LEAN Six Sigma pour
examiner les pratiques actuelles de communication entre le personnel du SU et les équipes spécialisées de l’HNM et améliorer
le transfert d’informations lors de la sortie du SU. Nous avons
déterminé les indicateurs d’amélioration de la qualité, que nous
avons mesurés avant et après la mise en œuvre du nouveau
système de communication.
Résultats : Nous communiquerons les données relatives au
volume des appels, aux retards dans la notification et dans le
suivi des équipes spécialisées, et concernant la satisfaction des
patients et du personnel. Nous parlerons des apprentissages qui
en sont ressortis, ainsi que des conséquences de la mise en place
de systèmes de communication normalisés visant au transfert
des informations dans le but d’améliorer la sécurité du patient
et la qualité des soins prodigués dans d’autres centres.
Affiche 5
Une innovation au sein d’une unité de
soins courants en neurosciences pour
adultes : favoriser le repos à l’aide de
moments de calmes
Tara Bergner
Il est essentiel de dormir et de se reposer afin de récupérer
l’énergie nécessaire à se remettre d’une maladie, d’un traumatisme ou d’une intervention chirurgicale. À l’heure actuelle,
les hôpitaux sont trop bruyants pour permettre aux patients
de se reposer. Une étude documentaire a mis en évidence des
recherches décrivant à quel point les interventions qui favorisent les moments de calme en réduisant le niveau de bruit ont
reçu un accueil positif auprès des patients et du personnel et
ont donné lieu à un environnement plus paisible et propice
à la guérison. Dans cet article, nous décrirons l’importance
des moments de calme, ainsi que la façon dont cette innovation modeste mais réalisable a été mise en place dans l’unité
de soins courants en neurosciences pour adultes d’un important établissement de soins de santé tertiaires. Les témoignages
des patients, des familles et du personnel indiquent que les
moments de calme ont eu des effets positifs sur les patients,
leurs familles et le personnel de l’unité de soins courants. Il est
nécessaire de mener de plus amples recherches sur les effets
des moments de calme sur les patients et leurs familles, ainsi
que sur la satisfaction du personnel et la guérison des patients.
Mots clés : bruit, hôpital, moment de calme, repos, satisfaction
des patients
23
An evaluation study of the implementation
of stroke best practice guidelines using a
Knowledge Transfer Team approach
By Mina Singh, RN, PhD, Michaela Hynie, PhD, Tiziana Rivera, RN, MSc, GNC(C), Laura MacIsaac, RN, MSc, CNN(C), Annie
Gladman, RN, BScN(c), and Abel Cheng, BSc, MEd
Abstract
Introduction: Strokes will become an increasing burden on
the Canadian health care and social systems in coming years.
Caring for people who have experienced a stroke is a challenging
issue. The Registered Nurses Association of Ontario (RNAO)
developed Stroke Assessment Across the Continuum Best
Practice Guidelines (BPGs) to support the best possible care for
this population. This article reports the findings of an evaluation
of the implementation of recommendations from the stroke BPGs
using a Knowledge Transfer Team (KTT) at Mackenzie Health’s
Integrated Stroke Unit in Richmond Hill, Ontario.
Methods: Over a 12-month period, an evaluation of the
implementation activities using structure, process, and outcome
Une étude évaluative de la mise en
œuvre des lignes directrices sur les
pratiques optimales de soins de l’AVC
au moyen d’une approche fondée
sur une équipe de transfert des
connaissances
Résumé
Introduction : Au cours des prochaines années, l’AVC va
progressivement devenir un fardeau pour les soins de santé
et les services sociaux canadiens. Prodiguer des soins aux
personnes atteintes d’un AVC est un grand défi à relever.
L’Association des infirmières et infirmiers autorisés de
l’Ontario (RNAO) a élaboré des lignes directrices sur les
meilleures pratiques (LDMP) en matière d’évaluation de
l’AVC à travers le continuum afin d’encourager la meilleure
qualité de soins possible pour cette population. Cet article
présente les résultats d’une évaluation effectuée dans
l’unité de soins intégrés de l’AVC du Mackenzie Health de
Richmond Hill, en Ontario, et portant sur la mise en œuvre
des recommandations des LDPE au moyen d’une équipe de
transfert des connaissances (ETC).
Background
Stroke is the third leading cause of death in Canada, and the
leading cause of neurological disability (Canadian Stroke Network, 2011). A stroke occurs when there is a lack of blood supply to a part of the brain, as a result of blockage or rupture of
a blood vessel. Within the time span of three minutes, brain
cells in that part of the brain will start to die. More than 50,000
24
indicators, as well as identifying effective strategies for systemwide dissemination of BPG implementation and outcomes was
completed. Data were collected from the staff, KTT members,
and patients and their providers.
Results: The results clearly illustrate that all of the health care
professionals involved in the study felt the KT approach was
an effective method of implementing and disseminating the
stroke BPGs. The main limitations perceived by staff and KTT
members were time constraints, difficulty recruiting a larger
sample size, competing priorities, lack of compliance, changes to
charting, staff attrition, and a lack of financial support.
Conclusion: The KTT approach resulted in improved patient care
and outcomes, as illustrated by the high patient satisfaction levels.
Méthodes : Au cours d’une période de 12 mois, nous avons
procédé à une évaluation des activités de mise en œuvre au
moyen d’indicateurs de résultats, de structure et de processus,
ainsi qu’en déterminant les stratégies efficaces permettant la
propagation de la mise en œuvre des LDPE et de leurs résultats
à l’échelle de tout le système. Nous avons recueilli des données
de la part du personnel, des membres de l’ETC, des patients
et de leurs fournisseurs de soins.
Résultats : Les résultats indiquent clairement que tous les
professionnels de la santé ayant participé à l’étude ont eu le
sentiment que la démarche de transfert des connaissances
constituait une méthode efficace pour mettre en œuvre et
propager les LDPE de l’AVC. Selon le personnel et l’ETC, les
principales limites étaient marquées par des contraintes de
temps, des difficultés à recruter un échantillon plus large,
des priorités concurrentes, le manque de conformité, les
changements dans la consignation des renseignements, le
départ du personnel et le manque d’aide financière.
Conclusion : La démarche reposant sur une ETC a entrainé
une amélioration des soins prodigués aux patients et de
l’état de santé de ces derniers, tel que l’indique le niveau de
satisfaction élevé des patients.
Canadians experience a stroke each year, or one every ten minutes, and there are more than 300,000 people living with the
effects of stroke today (Lindsay Bayley, McDonald, Graham,
Warner, & Phillips, 2008).
Persons affected by a stroke cost the Canadian economy $2.7
billion a year in physician services, hospital costs, lost wages,
and decreased productivity (Heart and Stroke Foundation of
Ontario and Registered Nurses’ Association of Ontario, 2005).
This burden on the economy will continue to grow, as the number of strokes is expected to rise exponentially with the aging
Canadian population (Cross, 2008). Although lost brain cells
cannot be recovered, with long and intense periods of active
rehabilitation, patients with stroke can rehabilitate more easily back into everyday activities (Caplan, 2011). Appropriate
care is, therefore, essential for individual patients, and for the
system overall.
Mackenzie Health in Richmond Hill, Ontario, is designated as
a District Stroke Centre, and receives about 900 patients who
have suffered a stroke each year. Of these, approximately 270
patients are admitted for care at the Integrated Stroke Unit, 200
are referred to the Stroke Prevention Clinic and the remainder
are redirected to their home hospital, or discharged home. In
order to address the increasingly complex needs of patients with
stroke and align with best practice recommendations, nursing
education in regard to performing the Canadian Neurological
Stroke assessment was increased at Mackenzie Health in 2009.
Delivering efficient and high-quality nursing care requires
research evidence to guide decision-making in clinical practice. One method Mackenzie Health used to ensure efficient
and high-quality care for these patients was participation in the
implementation of recommendations from the RNAO Stroke
Assessment Across the Continuum Best Practice Guidelines
(BPGs) (RNAO, 2005; 2011). The dissemination of stroke BPGs
on the Integrated Stroke Unit (ISU) was aimed to improve the
patient care experience leading to enhanced clinical outcomes,
as well as increased knowledge of health care providers on the
ISU. The stroke BPG recommendations were implemented
using a Knowledge Transfer Team (KTT) approach. The KTT
was responsible for facilitating the transfer of knowledge
of BPGs to point-of-care staff on each unit. The knowledge
transfer mobilization included the identification of Knowledge
Champions; an emphasis on inter-professional learning and
engagement; and the incorporation of e-learning strategies.
The overall goal of this evaluation was to determine the efficacy
of utilizing unit-based KTTs to implement and disseminate
the RNAO BPGs for stroke care. The evaluation of the KTT
approach included both formative (improving the quality of
the KTT approach) and summative (determining the effects
of the KTT approach) components. The design, delivery and
outcomes of the KTT approach were examined.
Literature review
Research in disease, treatment and care delivery has exploded
with new findings published at an increasingly rapid rate.
Increased patient acuity, staffing issues and budget cuts challenge nurses in keeping current of new findings (DiPietro
Doran, & McArthur, 2010). To ensure appropriate and efficient
decision making, nursing organizations and leaders must find
effective methods of transferring knowledge to point-of-care
staff (DiPietro et al., 2010; Virani & Grinspun, 2007). Academic
literature suggests that when research evidence is applied in
clinical practice, such as making care processes compliant with
best practice recommendations, there are improved patient outcomes (Reker et al., 2002; Stroke Unit Trialists’ Collaboration
2009). These benefits are captured in a report by Summers and
Soper (1998) who report that “physician practice guidelines,
and a standardized education program resulted in a decreased
length of stay, decreased complications, increased patient
compliance with medications, and an increased percentage of
patients dismissed to home” (Summers & Soper, 1998, p. 1).
Best Practice Guidelines
The RNAO introduced the International Affairs and Best
Practice Guidelines (iaBPG) program in 1999 in order to
develop, disseminate, implement and evaluate healthy work
environments and clinical best practice guidelines (Virani &
Grinspun, 2007). BPGs have been developed in a number of
practice areas, including stroke care, that provide nurses with
evidence-based information and tools. These BPGs facilitate
health care personnel in providing clients with the best care
possible. The RNAO supports organizations to systematically
implement BPGs through the Best Practice Spotlight Organization (BPSO) candidacy process (RNAO, 2004). BPSOs are
health care organizations that have committed to the implementation and evaluation of RNAO BPGs. These organizations,
through a partnership with RNAO, evaluate outcomes of BPG
implementation on the patient, organization and system. Best
Practice Spotlight Organizations assist in building capacity
amongst new candidate organizations through sharing knowledge, resources and experience.
Implementation of stroke best practice guidelines has been
applied into clinical practice all over the world and has been
found to be effective in improving patient care. A study examining compliance with stroke care guidelines at 11 Veterans
Affairs medical centres in the U.S. found patients were most
satisfied when their care was provided in accordance with
post stroke rehabilitation care guidelines (Reker et al., 2002).
A detailed examination of the impact of the implementation
of best practice guidelines at a hospital in the United States
showed that applying best practice guidelines in clinical practice can result in numerous positive outcomes that may account
for the increased patient satisfaction noted above (Summers &
Soper 1998). The opportunity for staff to meet to review clinical
paths and outcomes resulted in increased awareness of areas
where changes could be made to streamline and improve care
processes. Staff increased their knowledge of, and communication around, patients’ treatment needs (e.g., with home health
care coordinator; around nutrition and feeding). The hospital
also implemented a rapid response system in other units for
cases where staff observed stroke symptoms in their patients,
in order to facilitate early intervention. Since implementing the
best practices guidelines, the hospital also documented financial benefits because of shorter hospital stays, better resource
allocation, and the development of a more comprehensive home
health care program.
At the same time, there are also reports of challenges in implementing best practices (Rycroft-Malone et al., 2004). A review
of strategies for implementation of best practices in stroke care
across multiple centres in Australia found that some staff were
ambivalent about the relevance, inclusiveness and quality of
research underpinning the practice recommendations, and
that staff members were often unclear about how exactly to
25
implement best practices in their own settings (Perry, 2006).
The support of key individuals in the health centres was critical
to implementation success, as was the provision of education to
clinical staff, access to a range of resources, including databases
of information, information technology, and the presence of
individuals on staff who could develop local guidelines. Further
barriers to implementing evidence-based practices have been
found to include challenges in finding, identifying, and implementing relevant evidence and lack of resources to support
changes. Elements that facilitate success include ensuring that
suggested practices fit existing organizational structures and
procedures, good inter-professional relationships, and having
a dedicated project lead to coordinate efforts (Rycroft-Malone,
2004).
Knowledge Transfer Teams
The delivery of efficient and high-quality nursing care requires
health care personnel to utilize research evidence to guide their
decision-making in clinical practice. Sustainable Best Practice
Guidelines have the potential to improve the quality of care
and patient outcomes. However, there are few, if any, reports
on the sustainability of BPG outcomes for patient care in the
literature (Summers & Soper, 1998). In fact, there have been
relatively few empirical nursing studies examining outcomes of
BPG implementation related to quality of care in general; most
have focused on the attitudes of staff towards implementation
efforts (Rycroft-Malone et al., 2004).
As suggested by the literature reviewed above, ensuring the
implementation of best practices requires effective methods
for transferring evidence-based knowledge. “Knowledge transfer” refers to a process where both cognitive and interpersonal
factors are engaged in the sharing of knowledge. Knowledge
transfer has been used in a variety of different settings to successfully facilitate the understanding between individuals and
groups. In health care settings, knowledge transfer is very common. Research findings are transferred into clinical practice
to improve patient care, as well as into practice settings where
more experienced personnel work directly with those with less
experience (Aita, Richer, & Heon, 2007; Giroux, 2008; Smith
& Davies, 2006).
In health care environments, unit-based KTTs have been
shown to create an inter-professional learning environment
that can effectively implement and disseminate knowledge
through innovation (Greenhalgh, Robert, MacFarlane, Bate,
& Kyriakidou, 2004). These unit-based teams of inter-professional health care providers are specifically trained to
utilize KT strategies at the point of care to support the dissemination, saturation and adoption of the respective RNAO
BPGs. KTTs rely on best practice champions to communicate information to staff within units, support discussion of
best practices, and model best practice behaviour. Previous
research supports the value of implementing best practice
guidelines using KTT approaches. An Australian evaluation
of the implementation of best practice guidelines found four
different approaches to implementing best practice guidelines that, although not described as KTTs, reflect the KTT
approach. These are: network cultures; development of outreach; inreach models; and the use of stars, champions and
26
experts (Perry, 2006). Similar to KTTs, the network education
described in the evaluation included staff sharing expertise,
and maintaining relationships between the academic and clinical staff where they outlined problem solving approaches
in diverse circumstances (Perry, 2006). Consistent with the
research on effective implementation strategies by RycroftMalone et al. (2004), Perry found that many programs also
used stars, champions and experts. “Recommendations from
these individuals were accepted because of their reputation
for ‘expert practice’ ” (Perry, 2006, p. 36). The evaluators
noted that most health centres they studied used combinations of these approaches.
In the successful stroke best practices implementation
described by Summers and Soper (1998), the hospital developed a “collaborative care” approach supported by a team similar to KTTs, an inter-professional collaborative practice team,
whose members included a neurologist, clinical nurses, the
unit nurse manager, the clinical nurse educator, the department
administrator, physical, speech, and occupational therapists,
a nutritionist, a social worker, a pharmacist, and a chaplain.
The collaborative practice team members committed to work
together for two years to review data collected on patients,
observe variations from expected practices, and improve clinical pathways for patients (Summers & Soper, 1998).
This evaluation contributes to the understanding of the effectiveness of a KTT program to implement BPGs, and the consequences for quality of care delivered by nurses for patients
with stroke. The evaluation of Mackenzie Health’s multifaceted
implementation program provides data on the effectiveness
of a KTT approach to support the sustainability of BPGs and
outcomes for client care, as well as contributing to the research
on the quality of patient care.
Purpose
The purpose of this study was to evaluate and determine efficacy of utilizing unit-based KTTs to implement and disseminate
the RNAO BPG for stroke assessment on the ISU at a specific
health centre in Ontario.
Ethics
Ethics applications were submitted to the Research Ethics
Boards (REBs) at both York University and Mackenzie Health
for approval of the study. Both REBs declared this project to
be ethically sound and granted their approval for the study to
progress.
Implementation of
Best Practice Guidelines
The Knowledge Transfer Team (KTT) approach had several elements for implementation of the BPGs. The first was marketing
to raise general awareness. The second was in-person education
sessions. KTT staff received education through workshops and
ongoing one-to-one education. KTT staff then provided small
group and one-to-one education to other staff at the unit level.
The third was the use of e-learning strategies for all staff, with
encouragement and support by the KTT members.
Marketing
The marketing component of the implementation began in
August 2010. The project lead updated staff on the progress of
the implementation using posted announcements, staff meetings and one-to-one staff engagement. Information about stroke
and the BPG recommendations was posted on the best practice
bulletin board in the staff conference room. These methods of
marketing information were continued for the duration of the
project. Additionally, the stroke project lead utilized this method
of communication to remind staff to complete the required items.
Education
The launch of the Stroke BPG occurred via a full-day workshop.
The stroke KTT members attended a session to learn about
knowledge transfer and the Canadian Neurological Stroke Scale
(CNSS). The KTT members attending the workshop included
registered nurses, an occupational therapist (OT), a physiotherapist (PT), a unit manager, a nurse educator, an advanced practice nurse and a patient care coordinator (PCC). The CNSS is a
validated stroke assessment tool used to perform stroke assessments. Assessments were completed on admission, at regular
frequencies ordered by the physician and with any change in
the patient’s physical or neurological status (Heart and Stroke
Foundation of Ontario and RNAO, 2005; 2011).
The stroke project lead and the patient care coordinator (PCC)
audited two to four electronic stroke assessments five days a
week. The audits occurred while the staff member was still
on shift. Staff members who completed and documented the
assessments correctly were congratulated. Nurses with incomplete or incorrect documentation of the stroke scale were
provided with realtime one-to-one reviews. Ongoing staff challenges in accurate documentation of the stroke scale and KTT
attrition led to the planning of a KTT refresher workshop. In
July 2011, approximately seven months after the stroke BPGs
were implemented, the stroke project lead facilitated a refresher
workshop with the stroke KTT.
Design
A 12-month time series design was utilized to determine the
efficacy of a knowledge transfer model in implementing and
disseminating the BPG recommendations. The time series compared outcomes before the implementation and at six and nine
months after implementation. The evaluation included both
formative (improving the quality of the program) and summative (determining the effects of the program) components. It
examined the design and delivery (process) of the knowledge
transfer program, as well as its outcomes.
Evaluation questions
The following questions guided this evaluation:
Process:
4. To what extent were the components of the KTT approach
implemented as planned?
a. What strengths and weaknesses were identified with
the approach?
b. What were the perceived barriers and limitations to the
implementation of the BPG?
c. In what way could implementation of the KTT approach
be improved?
5. To what extent did the environment support the implementation of the KTT approach?
6. How was inter-professional education utilized to implement
the BPG?
7. To what extent was e-learning utilized?
Outcome:
1. Is there a difference in staff self-efficacy and satisfaction
with client care as a result of the implementation of the
guidelines?
2. What is the impact on client satisfaction following completion of the program?
3. Which clinical outcomes were impacted as a result of the
implementation of the guidelines?
4. Which organizational outcomes were impacted as a result
of the implementation of guidelines?
5. What outcomes, individual, staff, and organizational, were
sustained over time?
Evaluation
Both qualitative and quantitative methodologies were used
to collect data on the implementation and outcome aspects
of the KTT approach. Using data and method triangulation
provided richness to the database that maximized the results
of this evaluation study. These methods included document
reviews, interviews, and surveys (at the end of the workshops,
for web components). Patients were interviewed in person and
via telephone about their nursing care related to the BPGs at six
and nine months. The interview schedules were taken from the
Registered Nurse Association of Ontario (RNAO) Best Practice
Guide (BPG) Toolkits. Data collection via surveys was done
with staff before and at six months after education sessions to
evaluate the sustainability of these sessions. Evaluation questions were directed to elicit information about the strategies
used, as well as perceived factors that facilitated or created barriers to implementation.
Sample
There were two target populations. The first was patients who
were diagnosed as having had a stroke and were admitted to
the Integrated Stroke Unit (ISU) point of care from the Mackenzie Health emergency department, and their families. The
second target population was the ISU point-of-care staff and
members of the KTT.
Once patients were admitted to the ISU and identified, the
stroke project lead approached the patients and their families
to determine whether they would like to participate in the
study. If they were agreeable, the project lead briefed them on
the study and obtained their consent to participate by having
them sign and date a consent form. Similarly, point-of-care
staff and members of the KTT were also asked to complete
a consent form indicating their willingness to participate in
the study.
Data collection
There are several measures for the patients and their families,
and the members of the KTT and ISU point-of-care staff. All
participants, both staff and clients/family members, completed
an informed consent form prior to completing any measure.
The measures are described below.
27
Knowledge Transfer Teams and point-of-care staff
The measures of the KTT and ISU point-of-care staff were
completed in a time series with three points of evaluation:
after the first workshop (0 to 3 months, depending on whether
they were KTT or point-of-care staff ), at six months following the workshop, and at nine months following the workshop. There were four strategies used to collect data on the
effectiveness of the strategy (see Table 1). The first was a
measure called the Knowledge and Self-Efficacy survey. In
this self-administered questionnaire, participants rated their
self-efficacy and assessed their knowledge of stroke. Self-efficacy denotes an individual’s belief that performing a specific
action or behaviour will result in an expected outcome and
that the individual possesses the ability to perform the action
required. “The stronger self-efficacy a person has, the more
resilience that person has under stress, and the more effort
he or she will put forth to accomplish goals” (RNAO, 2004,
p. 20). Self-efficacy questionnaires were completed by KTT
staff and by point-of-care staff before and after the BPGs had
been implemented on each of the units to determine whether
implementing these guidelines on the units increased mean
self-efficacy scores, thus illustrating increased resilience and
ability to accomplish goals. Questions were scored from 1 (not
at all true) to 4 (exactly true).
families’ learning needs, preferences and their readiness for
information. Patients and their family members were provided
with education and resources based on their unique needs
and preferences.
The education provided to patients was documented using
the Patient Education Worksheet. The document was completed by point-of-care staff and/or any member of the
team. The worksheet personalized the information provided and incorporated patient and family learning needs
and preferences.
After being discharged from the ISU, patients were contacted
via telephone to complete the Stroke Patient Follow-Up questionnaire in November and December 2011. The questionnaire, created by the research team, assessed patient and
caregivers’ satisfaction regarding the care and education they
received.
Chart audits
Compliance with stroke BPGs was evaluated with chart audits
at approximately four-month increments beginning three
months after the stroke BPGs were initiated on the Integrated
Stroke Unit. The stroke project lead and the patient care
Table 1: Data collection for KTT evaluation.
The second means of collecting information was a one-hour
focus group discussion at the hospital on KTT Barriers in
which KTT members discussed their attitudes and opinions on dissemination and implementation of the BPGs
on the unit following the refresher workshop. Discussion
focused on what limitations and barriers KTT members had
encountered in implementing the BPGs on the unit. The
group brainstormed and developed a list of suggestions to
overcome the challenges and barriers they had encountered.
The identified barriers and actions were collated and then
circulated to the KTT.
Respondent
Measure
Date and Sample Size
KTT Staff
Knowledge and
Self-Efficacy
Sept 2010 (pre- and
post-workshop), n=7
The third method of collecting information was with the BPG
Feedback Survey. This short open-ended questionnaire was sent
to KTT members to provide more feedback on the implementation of the BPG. It was administered electronically in late
November and December of 2011. All of these measures were
self-administered and no identifying data were collected from
KTT members or point-of-care staff, thus ensuring anonymity
of responses.
Point-of-Care
Staff
Finally, an interview lasting one hour by telephone was conducted with the project lead regarding the successes of the KTT
strategy, barriers and limitations and general impressions.
Patients and families
Three tools were utilized for patients and their families. The
Client and Caregiver Readiness to Learn, the Patient Education Worksheet and the Stroke Patient Follow-Up questionnaire
were all developed by the project team for the purposes of this
project.
The Client and Caregiver Readiness to Learn questions were
administered to patients upon admission to the ISU by pointof-care staff. This aided staff in identifying patients’ and
28
Nov 2011 (postimplementation), n=4
KTT Barrier
Focus Group
July 2011, n=6
BPG Feedback
Survey
Dec 2011, n=1
Knowledge and
Self-Efficacy
Oct-Dec 2010 (preimplementation), n=9
July 2011 (refresher),
n=6
Nov 2011 (postimplementation), n=8
Patient and
Families
Chart Audits
Client and
Caregiver
Readiness to
Learn
Jul 2010-Nov 2011,
n=12
Patient Education
Worksheet
Jul 2010-Nov 2011,
n=12
Patient Follow Up
Nov 2011-Dec 2011,
n=8
Wave 1
Mar 2011, n=10
Wave 2
July 2011, n=6
Wave 3
Nov 2011, n=2
coordinator (PCC) also performed frequent chart audits to
ensure staff members were correctly assessing patients using
the Canadian Neurological Stroke Scale (CNSS). Audits were
completed in real time, which allowed them to provide the
unit nursing staff with immediate feedback regarding documentation compliance. Chart audits were completed in March
(Wave 1, n=10), July (Wave 2, n=6), and November 2011 (Wave
3, n=2). This sample is only for the audits completed by the
research team, not the checks completed by the Stroke Project
Lead and the PCC.
Table 1 shows the timing and sample size of the data collection
across the different sources and by type of measure.
Analysis
All qualitative data were transcribed verbatim, and interpretive, narrative, and exploratory/descriptive approaches were
used to analyze the text. Direct quotations and stories from
all stakeholders about their experiences, attitudes, beliefs, and
thoughts were analyzed and included in the evaluation report,
with a particular emphasis on changes in practice related to
stroke care. Responses on the quantitative measures (self-efficacy) were analyzed using t-tests.
Findings
The findings presented below are organized by the broad evaluation questions.
Process questions
Was KTT implemented as planned?
As planned, there was a full-day training workshop for the KTT,
followed by a refresher workshop six months later; notices on
message boards were posted to inform staff about the initiative;
and completion of the e-learning components by all of the staff.
Interprofessional team members were paid for their time at the
workshops and were replaced on the unit. In her interview,
the project lead reported sending out several reminders to her
staff to ensure that they completed the educational materials,
reinforcing that some effort is required in order to ensure completion in an environment with many other demands.
What were the perceived barriers and limitations to
implementation?
A number of challenges were reported by KTT members in the
focus group discussion, and in the interview with the project
lead. These could be organized in terms of three main themes:
time constraints, lack of compliance, and language barriers.
Time constraints
KTT members encountered difficulty in arranging meetings with staff members who work only nights, part-time or
casual shifts. This led to a lack of consistency in meetings
during the first year of implementing the BPGs. KTT members also reported it took extra time to document the BPGs,
which impacted the time nurses could dedicate to patient
care and other duties. The staff faced competing priorities,
as there were a number of other projects and new processes
being implemented at the same time as the BPG implementation, further constraining the time they had to devote to
this initiative.
Noncompliance
The study faced a non-compliance issue because several of the
point-of-care staff failed to return completed consent forms
at the beginning of the study. It was necessary to obtain consent from staff in order to obtain their feedback. Staff played a
critical role in implementing the BPGs, so their feedback was
required to measure the success of the study. In the KTT barriers discussion, several suggestions were made for why there may
be noncompliance, including negative attitudes regarding the
benefits, the likelihood of success, the sustainability of changes
and/or the value of the knowledge being transferred and a reluctance to take on new responsibilities. KTT members mentioned
that some staff members felt their compliance and participation in implementing the BPGs was not necessary despite the
availability of information and support of the KTT members.
Data collected from the chart audits done throughout the summer months (Wave 2 of data collection) showed a decrease in
compliance in terms of charting the required measurements.
This could have been due to an increase in use of agency staff to
cover staff vacations; one of the KTT members mentioned that
agency staff often completely disregarded BPG strategies that
were in place. This challenge is discussed in more detail below.
There was also a challenge in enrolling a larger sample of
patients in the implementation largely due to the language barriers between patients and staff. This is a result of Mackenzie
Health’s multicultural diverse patient population and was not
specific to the approach taken in encouraging the implementation of the BPGs.
How could the implementation be improved?
The areas for improvement of the KTT approach mainly centred around the challenges in implementing the program. For
example, KTT staff noted that the KTT approach was focused
on implementing recommendations that, in some instances,
proved to be difficult to audit. This suggests that there could
be more reflection on how success in implementing the KTT
approach is operationalized. The timing of KTT initiatives
should also perhaps be reflected on. There were a number of
other changes happening on the unit at the same time (see
below), which made it more challenging to implement the KTT
strategies. In terms of improving the strategies themselves,
however, no specific suggestions were made.
Did the environment support the implementation?
A number of challenges were faced by the KTT as a result
of changes in the environment. It does not appear that any
other approach to knowledge transfer would have managed
these challenges with more ease. A main challenge was that
in February 2011, one month after the stroke BPGs had been
implemented, charting on the Integrated Stroke Unit transitioned from paper charting to electronic charting. This caused
numerous problems for staff, especially since one of the key
components tracked in the chart audits, Canadian Neurological Stroke Scale (CNSS) scores, was not immediately visible
in the electronic charting for the staff. In order to chart these
data the nurses were required to access additional charting
options by clicking on the menu. With this being part of a
new system nurses were learning, this extra step was often
overlooked.
29
The stroke project lead and the PCC invested a great deal of
time coaching the staff and assisting them with the charting
challenges. They also completed random chart audits (on all
patients’ charts, not just study participants’ charts) to ensure
that staff were documenting consistently and correctly.
A very short questionnaire was developed when it was identified that more information was required from KTT members and it was administered by e-mail in December 2011.
The project leads were asked to email this questionnaire
to their KTT members and it was hoped that four or five
members from each KTT would return their completed
questionnaires to the academic principal investigator, thus
ensuring confidentiality. Only one completed questionnaire
was returned.
Another KTT staff identified challenge was staff turnover
because of maternity leave, job changes, and vacations. This
posed a barrier as it required finding the time and resources
to educate new staff members. The project lead noted that the
changes in leadership at many levels, including two Best Practice Spotlight Organization (BPSO) project coordinators, posed
a challenge in implementation.
Finally, there was a lack of financial support and budget restrictions to fully support the stroke educators. Nevertheless, the
project lead, members of KTT and point-of-care staff were successful in getting CNSS into Best Practice care on the Integrated
Stroke Care.
How was interprofessional education utilized?
The KTT team comprised staff from a number of different professions including registered nurses, an occupational Therapist,
and a physiotherapist. As well there was a blend of leadership
including the unit manager, the clinical educator, the patient
care coordinator and point-of-care staff. The interprofessional
team members participated in the workshops, group education
sessions and one-to-one discussions. They completed e-learning
modules and actively participated in sharing information and
education with their colleagues.
To what extent was e-learning utilized?
The project lead utilized e-learning strategies to support the
consistency of information being disseminated. Five e-learning modules and videos were developed and posted for staff
to access. The content of the modules included brain anatomy
and physiology, stroke anatomy and physiology, assessment of
the patient with stroke, treatments for patients with stroke, and
managing complications of stroke. A poster utilizing ISU staff
photographs was developed to demonstrate how to complete
the CNSS. A video portraying four different patient scenarios
was used to test nurses’ comprehension of the education modules. Staff members were asked to view the video and score
the patient scenarios using the CNSS. Staff were reminded in
person, through posters and, finally, through letters to complete
this learning module. They were encouraged to view the video
and complete the patient scenarios individually or in groups.
With the support of the unit manager, a member of the KTT,
the unit was able to achieve 100% compliance in completing
the exercise.
30
Outcome questions
KTT and staff self-efficacy
KTT self-efficacy scores were collected three times during the
course of the study. Seven (n=7) out of the eight KTT members
attended the training workshop in September 2010 and then
completed the pre- and post-workshop measures of self-efficacy
(NB: the eighth member of the KTT was the project lead and
led the workshop and, thus, did not complete the survey). Staff
submitted their surveys on coded forms that maintained anonymity, but allowed linking individuals’ pre- and post-workshop
scores. KTT staff provided exactly the same values pre- and
post-workshop on the self-efficacy measure, however, with a
mean of 2.8 (SD = 0.35) on a 4-point scale, indicating moderate
self-efficacy.
Point-of-care staff also completed a self-efficacy questionnaire
and a consent form before the stroke BPGs were initiated on the
Integrated Stroke Unit. Nine staff members (n=9) completed
the survey prior to the implementation. The mean pre-implementation score on self-efficacy was 3.5 (SD = 0.20), suggesting
a very high level of self-efficacy. All point-of-care staff (including the stroke KTT) was again asked to complete the self-efficacy questionnaire approximately 11 months after the stroke
BPGs were implemented. Eight staff members (n=8) completed
the post-implementation survey. The mean score for the postBPG implementation was 2.9 (SD = 0.77). This reflects a moderate level of self-efficacy.
An independent samples t-test was conducted to compare
whether there was a statistically significant change in mean
self-efficacy scores between the pre-BPG implementation
and post-BPG implementation questionnaires. Repeated
measures tests could not be used because these surveys were
separated from consent forms in order to protect the anonymity of participants, and the two groups did not include
all of the same participants. The means for the pre- and
post-implementation scores were not significantly different
from one another, t < 1.
Client satisfaction
Of the 18 original study participants, 12 were identified as
appropriate to follow up using a telephone interview. The
remaining six were unable to participate in the follow-up study
due to attrition (patient expired, n=1), or they had been transferred to a long-term care facility (n=2), or they were currently
still inpatients (n=3). Of the 12 patients who were identified
as appropriate to participate in the telephone interview, eight
(8) could be reached by telephone for follow-up purposes. The
remaining four could not be contacted due to incorrect telephone numbers (n=2) or no answer at the telephone number
provided despite making three attempts to reach the person
(n=2).
Of the eight completed interviews, the interviewer spoke to four
patients. The remaining four interviews the patient’s spouse
answered the interview questions. The spouse was interviewed
in those cases where the patient was not able to speak to the
interviewer due to aphasia or weakness/fatigue. Half of the
patients were male (50%) and the average age was approximately 60 years.
Of these 12 patient/family members, 87.5% of the respondents
indicated that they were satisfied with the care received on the
Integrated Stroke Unit at Mackenzie Health, as is illustrated by
the following quotes:
“The care was excellent” (mentioned by two respondents)
“All of the nurses on the stroke unit were very good.”
Three-quarters of respondents (75%) indicated that they
received education regarding stroke risk factors, complications
that can occur as a result of stroke and how to prevent another
stroke from occurring. They also received the Let’s Talk About
Stroke booklet and/or brochures on stroke. Three-quarters
(75%) of respondents attended the Patient/Family Education
series on Wednesday mornings and felt that all of their questions regarding strokes were answered. Overall, the majority
of the respondents indicated that the information and education they received on stroke during their stay on the Integrated
Stroke Unit at Mackenzie Health met their needs.
Clinical outcomes
Clinical outcomes were evaluated through data captured from
the chart audits, which included reviewing charting on specific
measurements. There were 10 charts audited in the first wave
(March 2011), six in the second wave (July 2011), and two in
the third and final audit (November 2011). The Stroke Assessment Across the Continuum BPG (RNAO, 2005) states that:
“Nurses in all practice settings should conduct an assessment
on admission using a validated tool (i.e., CNSS or GCS) and
continue to monitor the client’s ISU status on an ongoing basis
for any changes in: level of consciousness; orientation; motor
(strength, pronator drift, balance and coordination); pupils;
speech/language; vital signs (temperature, pulse, respiration,
blood pressure, and oxygen saturation); and blood glucose”
(p. 7). Specific measurements that were reviewed therefore
included the CNS measurement, the patient’s temperature and
their blood glucose.
For each wave of the study, charts were audited to determine
whether the CNS was completed and whether any changes in
scores were noted. A negative change of greater than one in the
scoring could be indicative of neurological deterioration and
the physician was to be notified. The RNAO (2005, 2011) stroke
guidelines state that temperature should be assessed frequently
after admission because studies have shown that an increase in
temperature within the first 72 hours post stroke is associated
with increased morbidity and mortality. Even a mild increase in
temperature of two degrees can exacerbate ischemic neuronal
injury and physiological dysfunction (RNAO, 2005).
In many of the audits in which the information had been documented once or twice during the patient’s stay on the Integrated Stroke Unit, this information (e.g., CNS scores) was not
assessed as often as it should be according to BPGs. Additionally, in regard to the patient’s temperature, which was assessed
during each shift, in most of the respondent’s cases it did
not exceed 37.5°C. For the few patients who did register an
increased temperature, it was not noted in the charting whether
Tylenol had been administered.
The RNAO (2005) estimates that one-third of patients who have
had an acute stroke are diabetic. However, a large proportion
of patients with stroke, even those who are not diabetic, can
develop stress hyperglycemia, which may be indicative of additional complications (RNAO, 2005). Hyperglycemia has been
associated with poor patient outcomes. Thus, according to
the BPGs, a baseline blood glucose should be taken from each
patient on admission. This was difficult to determine in some
cases because the baseline glucose may have been drawn while
the patient was in the Emergency Department (ED) and did not
show up in the electronic documentation section where the
blood glucose levels were taken on the units.
Almost two-thirds (60%) of the staff had correctly charted the
CNS during the first Wave, while 20% had charted the CNS
scores sporadically. In Wave 2, half of the charts had CNS
scores calculated (n=3) and in two of these charts documentation of CNS scores was sporadic. There was improvement
in the nursing documentation in the second Wave, including progress notes indicating that the physician had been
informed of deterioration in the CNS score in two of the three
charts. Just less than one-third (30%) of the charts in Wave 1
had decreased CNS scores, yet there were no notes made in
any of these charts regarding the deterioration. Thus, there
was an improvement in notations indicating the physician had
been informed of the decrease in CNS score between Wave
1 and Wave 2, but it was impossible to determine whether
improvements had occurred in Wave 3 due to the small sample size (n=2).
Of the 18 participants, only three (n=3) had documented temperatures above 37.5°C (2 in Wave 1 and 1 in Wave 2). As noted
above, no notations were made in the charting as to whether
Tylenol had been administered to those participants. Diabetic
charting was fairly consistent across all three data collection
waves. For the most part, the only discrepancies noted were for
those patients with a history of diabetes. This was not always
caught on admission and noted in the charting. Documentation of previous diabetes was charted correctly during Wave
2. Half (50%) of the patients had documentation of previous
diabetes and one patient (16.7%) was a newly diagnosed diabetic who also had a charted blood glucose result higher than
10.1 mmol/L. However, no consult had been noted in the chart
for the dietician to see this patient. In Wave 3, neither of the
two patients were documented as diabetic on admission and
neither had a blood glucose result of more than 10.1 mmol/L.
However, one patient had documentation of previous diabetes
and had a consultation for the dietician. This illustrates some
inconsistencies in the charting in regard to diabetic history and
some confusion, because only newly diagnosed diabetics were
to receive a consultation for the dietician.
Organizational outcome
As a result of implementing the BPGs in the ISU, a number of
organizational outcomes were achieved. The following outcomes occurred as a result of implementing the stroke BPGs
on the ISU:
• implementation of an evidence-based assessment tool (CNS)
for patients with stroke, allowing nursing staff to objectively
manage and assess patients with stroke;
• implementation of an interprofessional education worksheet
for patients with stroke and their family members;
31
• ability to quickly and consistently assess patients, thereby
potentially improving patient outcomes;
• increased patient awareness of stroke risk factors, signs and
symptoms, and secondary prevention; and
• a policy for diagnosing and treating patients in hospital experiencing stroke.
Discussion
Creating KTTs proved to be effective in the implementation
of stroke BPGs on the ISU. KTTs were composed of nursing
staff, educators, advanced practice nurse, members of the interprofessional health care team, and management. Colleagues
discussed the recommendations, shared tips and challenges
and taught each other skills required to complete stroke assessments. This ownership was a great benefit to the successful
integration of BPGs into clinical practice. As the BPGs were
being implemented on the nursing units, staff began helping
and teaching each other, which facilitated increased knowledge of the BPGs on their part and knowledge transfer among
colleagues.
The results clearly illustrate that all of the health care professionals involved in the study felt the KT approach was
an effective method of implementing and disseminating the
stroke BPGs. The KT approach resulted in improved patient
care and outcomes demonstrated by the high patient satisfaction levels.
Challenges that were encountered during the study were
expected, as the research demonstrated that the lack of time,
lack of authority, lack of support from managers and ward staff
can prevent implementation of BPGs to proceed as expected
(Perry, 2006). However, there were further challenges with the
chart audit data. These data were difficult to interpret since
there were some measurements of compliance that clearly
decreased from Wave 1 to Wave 2. Also, because the last
wave of the study only had two patient participants, it was
difficult to determine whether any improvements had been
made in the charting from Wave 2 to Wave 3. It is unfortunate
that the sample size in Wave 3 was so small because verbatim
reports from the staff, the KTT and the project lead, along
with all the extra effort the project lead and PCC made in
coaching the nursing staff with their charting, suggested that
improvements were, indeed, made over the course of the BPG
implementation.
Caution must be used in interpreting the data due to the small
sample sizes, both for staff data and patient data. These small
sample sizes are due to a number of challenges discussed above,
including high staff attrition and language barriers. However,
despite the challenges, this study of a KTT approach to facilitate the implementation, dissemination and uptake of BPGs
in a clinical setting contributes to the understanding of what
nurses can do to increase the quality of care, as related to the
sustainability of BPGs. Implementation of the BPGs using a
KTT approach also promoted a sense of pride in providing
top-quality care to patients and their families and generated
interprofessional and inter-departmental collaboration and
support.
32
Implications for KTT Utilization
As the study results illustrated, the KTT approach was an effective method of utilizing KTTs to implement and disseminate
BPGs into clinical practice. Developing KTTs comprising members of the interprofessional health care team to facilitate the
knowledge transfer of the unit specific BPGs to point-of-care
staff was an effective method of teaching and implementing
new skills into practice.
Carrying out any research in an acute care environment is a
challenging undertaking. This study was no exception and the
research team met with a number of challenges and subsequent
delays, some of which were listed among the study limitations.
Based on the challenges the project lead and the KTT team
faced, there are several recommended implications for practice: further defined roles for each KTT members, scheduling
of more frequent meetings, and higher financial compensation
for KTT members.
One of the KTT members suggested that it would have been
helpful if each of the KTT members had specific roles or duties
assigned to them. There was a great deal of information provided on what their role was as a unit, but there was some
confusion as to specific roles within the team.
The scheduling of frequent meetings where the KTT can share
strategies, evaluate what they have done, and problem solve
any barriers encountered in translating knowledge to the staff
would improve future implementations. A meeting schedule
could be developed by the KT champions and agreed on by
the entire KTT. These measures would ensure the viability and
sustainability of the KTTs for future BPG initiatives.
The project lead reported that the KTT was required to perform
a great deal of additional work for which they were not compensated. Sustainable funding to allow for additional persons
to facilitate the implementation of BPGs into clinical practice
would enhance the KT program. Additional resources would
alleviate the pressure put on the KTTs and allow for smoother
integration of BPGs into practice.
Future studies could explore further use of the KTTs, for example, to explore the benefits of utilizing KTTs to train and socialize new staff in health care or other environments. It would also
be beneficial if membership of the KTT was more stable with
less staff turnover. This could provide more evidence for longterm effects of BPG implementation. It would be necessary for
future initiatives and studies to take the challenges listed into
consideration in order to ensure their success.
About the authors
Mina Singh, RN, PhD, York University, Faculty of Health,
Toronto, ON
Michaela Hynie, PhD, York University, Faculty of Health,
Toronto, ON
Tiziana Rivera, RN, MSc, GNC(C), Mackenzie Health, 10
Trench Street, Richmond Hill, ON
Laura MacIsaac, RN, MSc, CNN(C), Mackenzie Health, 10
Trench Street, Richmond Hill, ON
Annie Gladman, RN, BScN(c), Mackenzie Health, 10 Trench
Street, Richmond Hill, ON
Abel Cheng, BSc, Med, Mackenzie Health, 10 Trench Street,
Richmond Hill, ON
REFERENCES
Aita, M., Richer, M.C., & Heon, M. (2007). Illuminating the
process of knowledge transfer in nursing. Worldviews on EvidenceBased Nursing, 4(3), 146–155.
Canadian Stroke Network. (2011). Stroke 101. Retrieved from
http://www.canadianstrokenetwork.ca/index.php/about/about-stroke/
stroke-101/
Caplan, L.R. (2011). Etiology and classification of stroke.
Retrieved from UpToDate Inc.: http://www.uptodate.com/contents/
etiology-and-classification-of-stroke
Cross, S.(2008). Stroke care: A nursing perspective. Nursing
Standard, 22(23), 47–56.
DiPietro, T., Doran, D., & McArthur, G. (2010). Supportive
decision making at the point-of-care. Computers, Informatics, Nursing,
28(4), 235–240.
Giroux, J. (2008). Passing the torch. Urologic Nursing, 28(2), 94.
Green, T.L., & Kelloway, L. (2009). 18 Best practice nursing care
across the stroke continuum: Recommendations for assessment and
management. European Journal of Cardiovascular Nursing, 8(Suppl.
1), S2–S2.
Greenhalgh, T., Robert, G., MacFarlane, F., Bate, P., &
Kyriakidou, O. (2004). Diffusions of innovations in service
organizations: Systematic review and recommendations. Millbank
Quarterly, 82(4), 581–629.
Heart and Stroke Foundation of Ontario & Registered Nurses
Association of Ontario. (2005). Stroke assessment across the continuum
of care. Toronto, Canada: Heart and Stroke Foundation of Ontario,
Registered Nurses Association of Ontario. Retrieved from http://rnao.
ca/bpg/guidelines/stroke-assessment-across-continuum-care
Joint Evaluation in Standards for Educational Evaluation.
(1994). The program evaluation standards: How to assess evaluations
of educational programs. (2nd ed.). Thousand Oaks, CA: Sage.
Lindsay, P., Bayley, M., McDonald, A., Graham, I., Warner,
G., & Phillips, S. (2008). Toward a more effective approach to stroke:
Canadian best practice recommendations for stroke. Canadian Medical
Association Journal, 178(11), 1418–1425.
Address for correspondence: Mina Singh, Department of
Nursing, York University, 4700 Keele Street, Toronto, ON,
M3J 1P3, (416) 736-2100, ext. 66439; Email:
[email protected]
Lin, P. (2006). Promoting evidence-based practice in stroke care
in Australia. Nursing Standard, 20(34), 35–42.
Molnar-Szakács, H., & Carew, M. (2000, November). Stroke in
Canada: The Need for a New Approach (Editorial). Retrieved from
Canadian journal of public health: journal.cpha.ca/index.php/cjph/
article/download/19/19
Perry, L. (2006). Promoting evidence-based practice in stroke
care in Australia. Nurs Stand, 30(24), 35–42.
Registered Nurses Association of Ontario [RNAO]. (2004). A
phenomenal journey: The dissemination and uptake of the nursing best
practice guidelines across Canada, final report. Retrieved from http://
www.rnao.org/Storage/11/522_BPG_national_wkshop_final_report.pdf
Registered Nurses Association of Ontario [RNAO]. (2005).
Stroke Assessment Across the Continuum of Care. Retrieved from: http://
rnao.ca/bpg/guidelines/stroke-assessment-across-continuum-care
Registered Nurses Association of Ontario [RNAO].
(2011). Stroke Assessment Across the Continuum of Care
Supplement. Retrieved from: http://rnao.ca/bpg/guidelines/
stroke-assessment-across-continuum-care
Reker, D.M., Duncan, P.W., Horner, R.D., et al. (2002). Postacute
stroke guideline compliance is associated with greater patient
satisfaction. Archives of Physical Medicine and Rehabilitation, 83(6),
750–756
Rycroft-Malone, J. (2004). The PARIHS Framework: A
framework for guiding the implementation of evidence-based practice.
Journal of Nursing Care Quality, 19(4), 297–304.
Smith, D., & Davies, B. (2006). Creating a new dynamic in
aboriginal health. The Canadian Nurse, 102(4), 36–39.
Stroke Unit Trialists’ Collaboration. (2009). Organised inpatient
(stroke unit) care for stroke Cochrane Database of Systematic Reviews, 4.
Summers, D., & Soper, P.A. (1998). Implementation and
evaluation of stroke clinical pathways and the impact on cost of stroke
care. The Journal of Cardiovascular Nursing, 13(1), 69–87.
Virani, T., & Grinspun, D. (2007). RNAO’s best practice
guidelines program: Progress report on a phenomenal journey.
Advances in Skin and Wound Care, 20(10), 528–535.
33
Award, Bursary or Scholarship Guidelines
Codman Award
Medtronic Award
$1,500.00 from Codman
$1,000.00 Travel Grant from Medtronic
The Codman Award will be presented to the author or authors of
a written paper, which demonstrates the achievement of excellence in the area of neuroscience nursing research. It is expected
that the money will be used for professional development.
The Medtronic Award will be presented to the author or authors
of a written paper that demonstrates the achievement of excellence in the area of neuromodulation or neuroscience nursing
clinical practice. It is expected that the money will be used to
assist the recipient with travel expenses to attend the annual
meeting to present their paper.
ELIGIBILITY
1. At least one of the author(s) is a general/honorary member of
the Canadian Association of Neuroscience Nurses (CANN)
and was a general/honorary member in the preceding year;
2. The author(s) stipulates in writing the intention to seek
the award by the call for abstracts deadline; the deadline is
November 1 each year.
3. The author(s) is prepared to present the paper at the CANN
Annual Meeting;
4. The paper contains original work by the author(s);
5. The paper may be an adaptation from a previous work by
author(s); this must be stated;
6. The award may not be presented to the same author(s) two
consecutive years.
CONTENT
1. The paper is written according to the manuscript guidelines
for publication
2. The author(s) presents a logical development of ideas based
on scientific evidence;
3. The author(s) demonstrate creativity and originality;
4. The paper has implications for neuroscience nursing practice, education, administration or research;
5. The paper is relevant to current trends in neuroscience
nursing;
6. Demonstrates comprehensive knowledge of the topic.
STYLE
for publication as established by the Canadian Journal of
SELECTION
1. The paper is selected by the Scientific Program Committee
through consultation with the scientific liaison and editor
of CJNN;
2. The Scientific Program Committee reserves the right to
withhold the award if no paper meets the specifications;
3. The Scientific Program Committee must receive papers for
consideration by February 15.
PRESENTATION
1. A representative of the Codman Company presents the
award at the Annual Meeting.
PUBLICATION
1. The completed paper must be submitted to the editor of
CJNN, or designee (e.g., peer reviewer) at the Annual Meeting for publication;
2. The monetary portion of the award will be withheld until
publication in CJNN.
34
ELIGIBILITY
1. At least one of the author(s) is a general/honorary member of
the Canadian Association of Neuroscience Nurses (CANN)
and was a general/honorary member in the preceding year;
2. The author(s) stipulates in writing the intention to seek
the award by the call for abstracts deadline; the deadline is
Annual Meeting;
4. The paper contains original work by the author(s);
author(s); this must be stated;
6. The award may not be presented to the same author(s) two
consecutive years.
CONTENT
for publication;
on scientific evidence;
3. The author(s) demonstrate creativity and originality;
4. The paper has implications for neuroscience nursing practice,
education, administration or research;
5. The paper is relevant to current trends in neuroscience nursing;
6. Demonstrates comprehensive knowledge of the topic.
STYLE
for publication as established by the Canadian Journal of
Neuroscience Nursing.
SELECTION
1. The paper is selected by the Scientific Program Committee
through consultation with the scientific liaison and editor
of CJNN;
2. The Scientific Program Committee reserves the right to withhold the award if no paper meets the specifications;
3. The Scientific Program Committee must receive papers for
consideration by February 15.
PRESENTATION
1. A representative of the Medtronic Ltd. will be on hand at the
Annual Meeting to present the award.
PUBLICATION
CJNN, or designee (e.g. Peer reviewer) at the Annual Meeting for publication;
Brain Tumour Foundation of Canada for
Excellence in Neuroscience Nursing
$1,500.00 from BTF of Canada
This annual award is presented to a member(s) of the Canadian Association of Neuroscience Nurses (CANN) who demonstrates excellence in neuroscience nursing related to brain
tumours. Established in honour of Pamela Del Maestro, RN,
BSc, CANN member and a co-founder of Brain Tumour Foundation of Canada, the award includes the publication of the winner’s paper in the Canadian Journal of Neuroscience Nursing.
ELIGIBILITY
1. At least one of the author(s) is a general/honorary member of the Canadian Association of Neuroscience Nurses
(CANN) and was a general/honorary member in the preceding year.
2. The author stipulates in writing the intention to seek the
award by the call for abstracts deadline; the deadline is
Annual Meeting in the year the award is being presented.
4. The paper contains original work by the author(s).
the authors(s); this must be stated.
6. The award may not be presented to the same author(s) in
two consecutive years.
7. The author may not be the recipient of any other CANN
award in the same given year.
8. The successful recipient(s) will write a letter of appreciation
to the Brain Tumour Foundation of Canada and outline how
the award has been utilized to improve their practice.
CONTENT
1. The paper is approached from a nursing perspective.
2. The paper is relevant to care of patients with brain tumour.
on scientific evidence.
4. The author(s) demonstrates creativity and originality.
5. The paper has implications for neuroscience nursing practice, education, administration or research.
6. The paper is relevant to current trends in neuroscience nursing with brain tumour patients.
7. The paper demonstrates comprehensive knowledge of the
topic.
STYLE
1. The paper is written according to established guidelines for
the writing of a manuscript as per Canadian Journal of Neuroscience Nursing (CJNN) guidelines.
2. The paper shall not exceed 20 double-spaced typed pages.
SELECTION
1. The Scientific Program Committee selects the paper in
collaboration with the editor of CJNN and the Scientific
Liaison.
2. The Scientific Program Committee reserves the right to
withhold the award if no paper meets the specifications.
3. Papers for consideration must be received by the Scientific
Program Committee by February 15 of each year.
PRESENTATION
1. A representative of the Brain Tumour Foundation of Canada will present the award at the Annual Meeting and Scientific Sessions. Complimentary Conference registration
is provided to the Brain Tumour Foundation of Canada
representative if the award is being presented in that particular year.
PUBLICATION
CJNN, or designate (e.g., peer reviewer) at the Annual Meeting for publication.
Jessie Young Certification Bursary
The Jessie Young Certification Bursary was established to promote continuing professional education in line with the mission
and vision of CANN. This bursary provides financial support
to qualified CANN members to pursue CNA Certification in
neuroscience nursing.
ELIGIBILITY
1. This bursary is open to registered nurses who have worked in
neurosciences and are members of CANN in good standing
for at least two years.
2. Successful candidate(s) must agree to write a letter to be published in the CJNN describing how completion of the course
will advance neuroscience nursing.
A complete application consists of:
1. A completed application form.
2. Proof of registration to write the certification exam, or proof
of certification renewal .
3. Evidence of amount of registration and or renewal fees.
4. Proof of current registration with provincial nursing
association.
5. One letter of reference from a person who has had the
opportunity to assess your work.
• Acceptable referees include:
• Another member of CANN
• Manager
• Educator (institution or hospital)
APPLICATION DEADLINE
1. The closing date for receipt of applications for the Jessie
Young Certification Bursary is May 31 each year.
Marlene Reimer Research Award
The Marlene Reimer Research Award was established to promote neuroscience nursing research in line with the mission
and vision of CANN. This award provides financial support to
qualified nurses to pursue a research project focusing directly
on neuroscience patient care issues relevant to the scope of
nursing practice in Canada. The amount of the award is determined yearly. The award may be awarded to one or more individuals depending on available funds.
35
1. Research funds will be allocated yearly based on numbers
of requests;
2. Application deadline is November 1 annually
3. The total Marlene Reimer Research Award will be $2,000
plus the net profit from the Run for Research of the previous year; to be reviewed annually at the midyear meeting
by the BOD;
4. Fundable projects will focus directly on neuroscience patient
care issues;
5. Projects will focus on issues within the scope of nursing
practice in Canada;
6. The primary investigator must be a nurse and an active
member of CANN. in the preceding year;
7. A letter of request plus the proposal shall be sent to the
chairperson of the research committee (may be sent
electronically);
8. An additional two copies of the proposal will be mailed electronically to the research chairperson; one copy includes
identifying information (research team members, health
care setting) and the second copy does not include this
information.
9. A letter or support from management/clinical supervisor
describing the contribution of this neuroscience nursing
research study proposal should accompany the application;
10. The research proposal shall include the following:
• Title of project
• Names and qualifications of the principal and
co-investigators
• Purpose of the project
• Methodology (including sample, procedures and data
analysis plan)
• Evidence of consent by the Ethics Committee of the institution/agency from which the research subjects will be
selected, if applicable
• Budget and timeframe
• Amount of money requested from CANN.
11. The proposed budget should include the following headings:
• Professional services
• Supplies
• Services
• Travel (does not include funding for travel to present findings at annual CANN meeting)
• Equipment
12. Proposal should also include details about other funding
sources; including those confirmed and those pending;
13. The Research Committee will review proposals and notify
the Board of Directors on decisions about funding awards;
14. The award will be given to the recipient at the time the decision is made and official recognition will be given at the
annual meeting luncheon;
36
15. Those who receive funding shall provide progress reports
to the Research Committee upon request;
16. The deadline for applications for research funds will be
November 1st and will be published in CJNN;
17. Researchers are expected to publish their results in CJNN
and present them at the Annual Meeting ;
18. Researchers must submit a report of their research to the
Research Committee.
CANN Abstract Award
The Canadian Association of Neuroscience Nurses established
the CANN Abstract
Award to promote continuing professional education in line
with the mission and vision of CANN and to help facilitate the
attendance of CANN members at the Annual Meeting and Scientific Sessions. This award provides funding for one conference registration from the accepted abstracts for the Annual
Meeting and Scientific Sessions. The successful applicant will
be reimbursed for their conference registration (Early Bird
Member Rate Only) following their oral or poster presentation
at the Annual Meeting and Scientific Sessions.
CJNN Authors’ Awards
$200.00 from CJNN
1. All authors who submit a paper that is published in CJNN,
who are not receiving another CANN award (such as the
Codman Award, Medtronic Award, or Brain Tumour Foundation of Canada Award for Excellence in Neuroscience
Nursing) are eligible for the New Authors’ Award or General Author’s Award;
2. A new author is defined as an author who publishes in CJNN
for the first time;
3. Eligible authors’ names will be entered into the separate
draws that will be held at the June meeting;
4. Cheques for $200.00 will be presented to the winners of each
of the two authors awards at the Annual General Meeting
in June;
5. The successful authors do not need to be CANN members;
6. Successful authors who are not present at the time of
announcement of the awards will have their award(s) mailed
to them;
7. If there are no new authors in any given year, a second general author award will be drawn from the eligible authors of
the same year;
8. The award will be presented by the editor of CJNN or
designate.
Application for the Jessie Young Certification Bursary
NAME:_______________________________________________________________________________________________________
(Ms, Mrs. Miss, Mr., Sir) (Surname)
(First Name)
(Middle Name)
ADDRESS: ___________________________________________________________________________________________________
PHONE: (Business): _________________________ (Home):_________________________ (Other): _________________________
EMAIL:_____________________________________
CANN Membership number:____________________________
Educational Preparation (attach CV as desired): ____________________________________________________________________
_____________________________________________________________________________________________________________
Employment History (attach CV as desired):________________________________________________________________________
_____________________________________________________________________________________________________________
What are your plans upon obtaining Neuroscience Certification or Certification renewal? Please describe how certification or
certification renewal will contribute to your future plans. (may attach one additional sheet)________________________________
_____________________________________________________________________________________________________________
Please describe how Certification in Neuroscience Nursing will advance the field of neuroscience nursing (may attach one additional sheet).__________________________________________________________________________________________________
_____________________________________________________________________________________________________________
Are you applying or have you received monies from other sources of funding?
received:_______________________________________________________
No
Yes If yes, name sources and amounts
Declaration by Applicant:
To the best of my knowledge, the information provided above is accurate and truthful. If successful, I agree to write a letter to the
editor for the next edition of CJNN regarding receipt of this bursary.
Signed: ____________________________ Date: ____________________________
CANN Abstract Award application
NAME:_______________________________________________________________________________________________________
(Ms, Mrs. Miss, Mr., Sir) (Surname)
(First Name)
(Middle Name)
ADDRESS: ___________________________________________________________________________________________________
PHONE: (Business): _________________________ (Home):_________________________ (Other): _________________________
EMAIL:_____________________________________
CANN Membership number:____________________________
NAME OF ABSTRACT:________________________________________________________________________________________
Please send the completed application form by mail, fax, or e-mail to:
Signed: ____________________________ Date: ____________________________
37
Canadian Journal of
Manuscript Guidelines
for Publication
1. The Canadian Journal of Neuroscience Nursing (CJNN) is
a peer-reviewed journal.
2. APA formatting is used for both the body of the paper
and the references. For further information, please refer to
the latest edition of: American Psychological Association
(2010). Publication Manual of the American Psychological
Association (6th ed.). Washington, DC: American
Psychological Association.
3. Papers must be word processed and submitted in Word
format. A hard copy and disk may be sent by mail or the
paper may be submitted by e-mail attachment to Theresa
Green, RN, PhD, Assistant Professor, University of Calgary,
Faculty of Nursing, Room 2210, Professional Faculties
Building, University of Calgary, 2500 University Dr. NW
Calgary, AB T2N 1N4, Canada or [email protected].
4. Two peer reviewers review all papers received for content.
The Editor appraises the paper for formatting, style,
grammatical accuracy, and appropriateness for publication.
This process usually takes five to eight weeks. Papers may
be: a) accepted as submitted, b) returned for revisions, or
c) rejected and returned with feedback.
5. Manuscript guidelines
Maximum length is 6,000 words or 20 pages
Margins 1", double spaced, Times New Roman, 12-point
font size
Title page with full title, name, and institutional affiliation
Abstract of fewer than 200 words
Left justified, paragraphs indented 5 spaces
Headings typically include: Introduction; Review of
the literature (conceptual and data based); Research
question/Objectives/Hypotheses/Clinical concern;
Methodology and method; Analysis/Findings;
Discussion including specific Clinical implications/
recommendations; Summary/Conclusions; and
References. (Please note, not all of these headings are
needed or may apply to all papers).
Abbreviations should always be preceded by the full term.
An example would be Traumatic Brain Injury (TBI).
Drug citations include the generic name in lowercase
letters and brand names in parentheses.
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Le journal canadien
des infirmiers et infirmières
en neurosciences
Réglements de publication
dans le JCIIN
1. Le Journal canadien des infirmiers et infirmières en neurosciences est une publication révisée par ses propres
membres.
2. APA est utilisé pour la rédaction du journal et pour les
références. Pour de plus amples informations, veuillez consulter la publication suivante : The American Psychological
Association. (2009) Publication Manual of the American
Psychological Association (6e éd.) Washington, DC.
3. Les manuscrits doivent être transcrits par traitement de
texte utilisant Word 6.0 ou Word Perfect. Une copie, sur
papier et disquette, peut être envoyée par la poste ou le
manuscrit peut être envoyé par courriel à Theresa Green,
rédactrice en chef, 1468 Northmount Dr. N.W., Calgary,
Alberta T2L 0G6 ou [email protected]
4. Le contenu de tous les manuscrits reçus est révisé par réviseurs puis adapté pour fins de publication par la rédactrice
en chef. Ce processus nécessite environ 5 à 8 semaines.
Les articles pourraient être acceptés tels quels, retournés
pour révision ou retournés accompagnés de commentaires.
5. Spécifications se rapportant à la rédaction du manuscrit :
Longueur maximale du manuscrit : 6 000 mots ou 20
pages.
Marges de 1 pouce, double interligne, « Times New
Roman », 12 lettres au pouce
Page titre avec titre complet, le nom et le lieu d’emploi
de l’auteur
Un résumé de moins de 200 mots doit être inclu.
Marge de gauche, laisser 5 espaces pour les nouveaux
paragraphes
Les entêtes peuvent inclure : introduction, revue de la
litérature, (concept et données), but de la recherche,
objectifs, hypothèses, aspect clinique, méthodologie et
méthodes, analyses et résultats, discussions avec implications d’ordre clinique, recommendations, résumé et
conclusion, références. Veuillez prendre note que toutes
ces entêtes ne s’appliquent pas nécessairement à tous les
manuscrits présentés au comité
Les abréviations doivent toujours être précédées du
terme complet, par exemple : Accident cérébrovasculaire (ACV)
Les médicaments sont nommés utilisant le terme
générique écrit en lettres minuscules et le nom commercial écrit entre parenthèses.
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Volume 37, Issue 1, 2015 In This Issue

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