Safety on a Complex
Continuing Care Hospital Unit

by Denise Dodman, RN, BScN, GNC
Advance Practice Leader
Chatham-Kent Health Alliance ~ Chatham, ON

Chatham-Kent Health Alliance’s Rehab/Complex Continuing Care program is dedicated to an elder friendly approach to care. Best practice research clearly indicates indwelling urinary catheters increase the risk of urinary tract infection and possible delirium.  As a safety measure, Rehab/Complex Continuing Care is committed to a reduction in the numbers of catheters used, the length of time they are used and in assisting people to become continent of urine.  In spite of joining a provincial collaborative, acquiring all the needed tools and offering formal experiential learning session, some nurses were reluctant to use the new assessment tools and embrace prompted voiding strategies.

Working from a shared staff list, the champions met with each of their co-workers on a casual basis, using the documents to take a humourous look at past practices, successes and the future vision for care.  Nurses asked pointed questions and misunderstandings were clarified.  Nurses then applied the new information completing the assessment triage tool with their champion, creating an opportunity for case- based dialogue and real-time feedback. Two Best Practice Champions at the Sydenham campus, who attended a Best Practice Champion workshop through the Registered Nurses Association of Ontario, were selected to coach and mentor their fellow nurses in using the best practice tools.  Working with an Advanced Practice Leader, they created two newsletter documents, one highlighting all the nurses’ and program accomplishments in reducing catheters and moving toward prompted voiding and another highlighting the new triage and assessment tools.  Working from a shared staff list, the champions met with each of their co-workers on a casual basis, using the documents to take a humourous look at past practices, successes and the future vision for care.  Nurses asked pointed questions and misunderstandings were clarified.  Nurses then applied the new information completing the assessment triage tool with their champion, creating an opportunity for case based dialogue and real time feedback. Working from a shared staff list, the champions met with each of their co-workers on a casual basis, using the documents to take a humourous look at past practices, successes and the future vision for care.  Nurses asked pointed questions and misunderstandings were clarified.  Nurses then applied the new information completing the assessment triage tool with their champion, creating an opportunity for case-based dialogue and real-time feedback. 

The results were a welcomed change from traditional education.  Questions could be asked one-on-one that may not have occurred during traditional education.  The learning was valid to the nurse’s practice.  Each nurse at the Sydenham unit had an opportunity to use the tools with the support of their champion.  Dialogue Education was cost effective; there was no need for a meeting room, cost of an expert or paid time away from the patient.  Individual sessions took approximately ten minutes for each dialogue encounter and three to four weeks for each staff member to be approached.  There were clear expectations for nurses from the handouts, dialogue and application. Nurses liked this method of learning about a project.  Dialogue Education allowed the Best Practice Champions to be viewed as experts on this nursing unit and created an atmosphere for more dialogue with the Best Practice Champions in the future. 

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