Engaging patients, families and professionals at the bedside using whiteboards.

Health-care systems around the world are striving to be patient-centered, and there is growing evidence that engaging patients and families in their care, as well as in efforts to redesign services, contributes to improved outcomes and experiences for patients and providers. This patient-oriented care movement includes efforts to improve the quality of information and communication between health-care professionals and patients as well as families and caregivers. Whiteboards have emerged as a best practice in hospitals to promote engagement and improve information and communication, yet with limited empirical evidence regarding their value to patients, families, or interprofessional teams. We introduced whiteboards on an acute medical unit at a community hospital and conducted an evaluation using a pre-post design collecting both qualitative and quantitative data. Baseline and post-implementation data were collected via qualitative interviews with patients/family and providers and using the Canadian Patient Experience Survey; focus groups were held with staff and members of the care team. Qualitative results highlighted improvements in communication between the care team and patients as well as family members. Implications for practice include attention to patient/family empowerment and safety, adherence to guidance for good communication, and support for regular training and education in the use of communication tools for members of the interprofessional team.

BiVADs: a bridge to the future for patients and their families: the art and science of nursing combined in the face of technology.

Approximately 500,000 Canadians live with heart failure (Ross et al., 2006). These numbers continue to rise due to advancing technology and successes in treating cardiac conditions and potentially fatal events such as myocardial infarctions. According to Carrier (2005), individuals with damaged hearts are living longer, and lives are being successfully saved with the surge of cardiovascular assist devices developed in recent years, which are increasingly used as a bridge to transplant. Despite the lifesaving capabilities of ventricular-assist devices, these innovations pose risks and complications that can be debilitating for patients and their families (Carrier, 2005). As this complex trajectory is navigated, nurses provide care and support to the patient and family while playing a unique role in the assessment and monitoring of these devices. A family-centred nursing model provides a framework for practice when nursing patients and families are in crisis. The foundations of the McGill Model of Nursing are focused on a strengths-based approach, revolving around collaboration between patients, family resources, and tailored interventions (Gottlieb & Feeley, 2005). As students placed in a critical care setting, we began to realize the complexity of care required to nurse these patients and their families. In this paper, a case study is used to describe and share our learning experiences of caring for a patient with a biventricular assist device, as well as the principles that guided our interventions.

The intensive care unit as an untapped learning resource: a student perspective.

The nursing student's clinical experience serves to form a bridge between the theoretical knowledge of the classroom and its application to patient care. The intensive care unit (ICU) has not traditionally been considered an ideal placement for undergraduate nursing students (Ballard & Trowbridge, 2004). However, in the fall of 2008, with a rise in enrolment, the school was faced with finding more clinical sites to accommodate our placement needs. Twelve of our students in the first semester of their second year of the baccalaureate program were challenged with meeting the objectives of our curriculum in four of the ICUs located in our partnering hospitals at the McGill University Health Centre. The successful outcome of this rotation, from both a student and a faculty perspective, was that this critical care experience facilitated a strong clinical foundation, a comprehensive view of health and illness, and a direct link between theory and practice (Hoffman, 2001). The purpose of this article is to share the personal experiences of the student nurses who completed their first medical-surgical rotation in a critical care setting. We will also discuss how this setting can contribute to the enrichment of future nursing education and practice.

Full disclosure of adverse events to patients and families in the ICU: wouldn't you want to know?

In the past several years, there has been an increasing focus in our Canadian health care system related to patient safety. The Canadian Disclosure Guidelines, which were released in May 2008, discuss various patient safety initiatives underway across Canada. They emphasize the importance of a clear and consistent approach to disclosure, regardless of the variability in the definitions and interpretations across health care institutions. In addition, they highlight that all patients have the right to be informed about all aspects of their care, and all harm must be communicated to patients regardless of the reason (Disclosure Working Group, 2008). In this article, the authors describe and share our learning experiences, as nurses and students, while working in critical care settings when these guidelines were needed to communicate a harmful incident. Often, health care practitioners only become aware of specific guidelines regarding the disclosure of an adverse event once the incident has occurred. A case study will be discussed to illustrate the benefits of having a policy and a systematic framework in place to support a critical care environment in disclosing errors and adverse events to affected patients and their families.