An evaluation study of the implementation of stroke best practice guidelines using a Knowledge Transfer Team approach.

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 indicators, as well as identifying effective strategies for system-wide 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.

Leadership profile: HealthAchieve 2013 Nursing Leadership Award Winner, Tiziana Rivera.

Tiziana Rivera, the winner of the 2013 Nursing Leadership Award at the November HealthAchieve conference, is chief nursing executive and chief practice officer at Mackenzie Health. As such, she provides strategic leadership for the development and implementation of a shared vision for professional practice, nursing and all disciplines to promote innovative care and the development of care delivery models that will improve quality of care and population health.Prior to assuming her position at Mackenzie Health, Rivera provided strategic leadership for the Seniors' Health Program at Trillium Health Centre, where her role focused on the development of seniors' health services across the continuum of care. She has published numerous articles in refereed journals, conducted several research studies and presented her papers provincially, nationally and internationally. Rivera has a clinical appointment at the University of Toronto Faculty of Nursing, a faculty adviser position at Ryerson and an adjunct faculty position at the School of Health Sciences, York University and at the School of Health Sciences, Humber Institute of Technology and Advanced Learning.In the following Q and A, Rivera shares her thoughts on leadership in nursing and perspectives on several critical issues.

How do hospital administrators perceive cardiac rehabilitation in a publicly-funded health care system?

BACKGROUND: Patient and provider-related factors affecting access to cardiac rehabilitation (CR) have been extensively studied, but health-system administration factors have not. The objectives of this study were to investigate hospital administrators' (HA) awareness and knowledge of cardiac rehabilitation (CR), perceptions regarding resources for and benefit of CR, and attitudes toward and implementation of inpatient transition planning for outpatient CR. METHODS: A cross-sectional and observational design was used. A survey was administered to 679 HAs through Canadian and Ontario databases. A descriptive examination was performed, and differences in HAs' perceptions by role, institution type and presence of within-institution CR were compared using t-tests. RESULTS: 195 (28.7%) Canadian HAs completed the survey. Respondents reported good knowledge of what CR entails (mean=3.42±1.15/5). Awareness of the closest site was lower among HAs working in community versus academic institutions (3.88±1.24 vs. 4.34±0.90/5 respectively; p=.01). HAs in non-executive roles (4.77±0.46/5) perceived greater CR importance for patients' care than executives (4.52±0.57; p=.001). HAs perceived CR programs should be situated in both hospitals and community settings (n=134, 71.7%). CONCLUSIONS: HAs value CR as part of patients' care, and are supportive of greater CR provision. Those working in community settings and executives may not be as aware of, or less-likely to value, CR services. CR leaders from academic institutions might consider liaising with community hospitals to raise awareness of CR benefits, and advocate for it with the executives in their home institutions.

A narrative review on women and cardiac rehabilitation: program adherence and preferences for alternative models of care.

Despite the preponderance of evidence on the numerous benefits of CR, it remains largely under-utilized in women. The objective of this narrative review was to summarize and synthesize the literature on women and CR with regard to outcomes, adherence, and preferences for alternative models of CR. Studies of the effectiveness of CR have generally revealed no major differences between men and women. However, female-specific data are lacking on the effect of CR on mortality and morbidity. Research suggests that women and men may be equally likely to prefer home-based to hospital-based CR services. Women's preferences for and outcomes in, women-only CR are beginning to be uncovered. Discussing program model options with female cardiac patients and referring to preferred types may be the appropriate approach until further evidence is available.