August 9, 2021
Since 2010, St. Michael’s Hospital together with the Spiritual Care Team has provided patients with prayer shawls. Rev. Pamela Lucas described a prayer shawl as a knitted or crocheted blanket which begins with prayers and blessings for the recipient. Originally the shawls were intended for use in palliative care to bring hope and peace to patients, and their families and caregivers alike. By 2017, the increased demand had spread to other units in the hospital and to patients with different beliefs and religious views. The prayer shawls became so sought after, they had to be sourced from outside the GTA.
In response to the increased demand, in 2019 Rev. Lucas began looking into the impact people reported feeling from using a prayer shawl (either as patients or caregivers), in response to the increased demand for them throughout the hospital. She hoped to understand what specific benefit patients (or their loved ones) were drawing from using the Prayer Shawls in order to provide them with the best quality supports during their time in hospital.
Together with a colleague from the Spiritual Care Team (Rev. Joel Aguirre) and support from IPBR, Rev. Lucas initiated a retrospective chart review to identify patients or caregivers who had received a prayer shawl over a two-year period. She identified that over 120 prayer shawls had been distributed across St. Michael’s alone, and that the great majority were being dispersed within the ICU and General Surgery areas. The three principal themes she identified that patients and families reported feeling when using a prayer shawl were comfort, peace and hope. Further research and analyses are ongoing to examine the data and identify additional themes and benefits reported specifically by patients or their caregivers.
In November of 2020, Rev. Lucas shared a preliminary summary of her findings for presentation at the IPBR-AFP Showcase. In early 2021, Rev. Lucas passed away prior to the completion of this work. To honour her contributions to patient care and in an effort to continue the research she was passionate about, the IPBR team will continue her research together with her research team member Rev. Joel Aguirre. We look forward to sharing those results in future.
April 6, 2021
Name: Sarah Rydahl
Role: St. Joseph’s at Home Coordinator and Vaccine Coordinator at St. Joseph’s Health Centre
Research interests: Independence in older adults, fall reduction, and exercise to improve balance
As COVID-19 made its way through hospitals, and the third wave of the pandemic put a strain on resources, the need for seamless patient flow could not be ignored. During the pandemic, deferred access to medical care and hospital discharge was “viewed as the best option” for patients to avoid risk of infection and make space for acute care treatment (Rydahl & Liao, 2020). Throughout the pandemic, rehabilitation care has remained an important element of the care continuum for patients to regain their functional ability for independent living upon discharge.
Sarah Rydahl and her team have focused their research on evaluating how the Reactivation Care Centre (RCC) compares to other areas of St. Joseph’s Health Centre in terms of patient care, cost per day, length of stay and preventative care strategies for patients. Moreover, they will evaluate this criterion before and after the COVID-19 pandemic. Sarah and her team hypothesized that the RCC will have a shorter length of stay, reduced cost per day with more PSWs employed, greater annual savings, greater number of discharges home with support, and higher score on the Barthel Index when compared to patients in other areas of St. Joseph’s. Their team aims to achieve this goal by conducting a retrospective chart review to identify patients that were admitted between May 2019 and September 2020, and categorized as alternative level care to be included in the study.
In the early stages, their team has found that the average length of stay for patients at the RCC increased from 44.61 days pre-pandemic to 78.38 post-pandemic and with fewer discharges. Due to the enhanced infection prevention and control guidelines to reduce transmission, patients remained at the RCC longer than pre-pandemic records. Moreover, wait times for long term care facilities increased due to the strict guidelines on admission that were implemented to slow the spread of COVID-19 transmission. With the goal to provide enhanced services from the interprofessional team at the RCC, Rydahl explains that COVID-19 heightened the complexity of the transition planning process.
As a physiotherapist, promoting independence in older adults is Sarah’s primary interest. In past research Sarah investigated how exercise classes successfully improved balance and fall incidences in newly discharged patients. These classes provided older adults with the opportunity to develop their independence, and the tools necessary to confidently re-enter the community (Brouwer, Walker, Rydahl et al., 2003). Now, Sarah works on the holistic approach of the RCC with the goal that it will provide a smooth transition for patients back into the community after reaching their ideal mobility, and functional status. She hopes it will benefit the health-care system by better allocating resources to the appropriate patient demographic. Stay tuned for publications on Sarah Rydahl and her team’s study.
You can find out more on this work by accessing their published article here
doi: 10.1046/j.1365-2389.2003.51265.x. PMID: 12757571
March 3, 2020
Name: IPBR Journal Club
Purpose: An opportunity for nurses & health disciplines to connect to discuss and critically analyze current research relating to patient care
Fun trivia: Join us for a fun trivia recap at the end of journal club
Necessity is said to be the mother of invention. In 1875, out of the necessity to read a wider range of articles that would otherwise not have been available to him due to prohibitive cost, Sir William Osler established a formalized journal club in Montreal at McGill University.
That’s right – did you know that this time-enduring tradition has some of its roots in Canada? While Osler’s journal club was not likely the first journal club in the world (some research suggests there may have been some similar organizations in London and Germany), it was likely the first North American journal club. The cost of purchasing periodicals as a sole reader would have been prohibitive at the time to Osler, so he organized for a group of people to come together to defray the cost and share the benefit of access to a larger collection of articles.
Initially journal clubs were held for medical education purposes, and focused on specific topics. Even as periodicals became more readily available, people continued to hold journal clubs to discuss and critically analyze novel research findings. These clubs took place in person and typically occurred on a regularly scheduled basis (i.e., on weekly, bi-weekly or monthly intervals). Expanding beyond the field of medical education, journal clubs were used across various research training disciplines and allied health disciplines to review current literature and stimulate discussion.
So is there a use for a journal club in the modern age where you can quickly Google information and ideas? It turns out there’s still a significant benefit!
Originally created to foster an environment for teaching research and clinical epidemiology, the application of statistical procedures, and fostering discussion and critical thought, these purposes still hold true today. Presenting a summary of the research helps to make information more memorable and allows it to be more readily called up in one’s mind in future. Actively discussing statistical procedures, identifying steps one took to analyze and assess findings, and noting whether the correct tests were applied allows participants to think of creative ways to analyze their own research and devise new questions. An open forum for critical analysis and thought allows for the generation of new ideas, sharing of different views, and identification of gaps in knowledge.
Today a range of journal club styles exist. The traditional journal club where articles are selected and presented for discussion, including a summary of the hypotheses, methods, results, and discussion is still used. However, where members once used to come together in one room at the same time to have such a discussion, new formats exist for virtual journal clubs where people from multiple sites can partake by video conference, or even at different times on twitter. Twitter journal clubs have become a popular way for having a discussion, where questions related to the article are tweeted out, and multiple respondents can answer during a period of time both to the original question and to the comments made by other participants.
This format has proven especially beneficial as it also automatically generates a history of comments and thoughts people have shared that can later be referred back to. Live tweeting of in-person journal clubs brings together traditional journal clubs and shares the discussion with others following along remotely, and allows their comments to be shared back in the room. This type of format can still allow a traditional presentation of the article to occur, alongside a virtual discussion. People who may not be able to join in person due to various constraints can still partake and share their thoughts, creating the possibility of a more varied discussion than may have happened solely in person.
So now that you’ve learned a bit about the history and benefit of a journal club, you might like to partake in one … but how? The Interprofessional Practice Based Research program (IPBR) has a monthly journal club for our nurses and health disciplines at St. Michael’s Hospital and across Unity Health Toronto who would like to partake in person. Our journal club focuses on a range of issues relating to the provision of care by nurses and health disciplines. A quick Google search can find existing journal clubs that you might find interesting and that will be open access for new members. As mentioned above, Twitter-based journal clubs also exist where people can have a twitter discussion at a set time, often to pre-generated sets of questions. Or perhaps you’re looking for a discipline-specific journal club within the hospital? Check with your department to see if they host a journal club. And if they don’t have one? Perhaps you’ll take a page from Sir William Osler’s book and out of necessity you’ll consider starting one yourself – and yes, you can count on IPBR to help you with that, it would be our pleasure!
Connecting with IPBR
The Interprofessional Practice Based Research program at St. Michael’s Hospital assists nurses and health disciplines professionals at St. Michael’s Hospital engage in the identification, implementation, and evaluation of best practices through research.
The IPBR Journal Club helps me to stay up to date on current evidence that impacts clinical practice, and provides a venue to critically appraise recent articles on point of care questions. – Cecilia Santiago, RN, Nursing Practice Manager
Jan. 22, 2020
Name: Research Month 2019 recap for IPBR
Role: Reviewing the past events hosted by IPBR for the 2019 Research Month at Unity Health
Trivia: IPBR hosted five separate events!
As many of you know, November was Research Month across Unity Health. Originally started at St. Michael’s Hospital, Research Month events now take place across all three hospital sites. This is a great opportunity to celebrate the impact that research makes on policy, practice, patients and families. This year, IPBR held a range of networking sessions, lectures, and our annual showcase as an opportunity for nurses and health disciplines to connect and engage on research, learn research skills, and share the wonderful studies they conduct.
In the past few years, the Research Month committee has organized various lunches with leadership, where staff can come together to connect in an informal setting and have a discussion with various members of the hospital’s leadership team. This year, the IPBR department hosted a Lunch with Leadership session with Sonya Canzian for nurses and health disciplines. Sonya has consistently been a strong supporter of practice based research among our nurses and health disciplines, and we were glad to provide an opportunity for staff to connect with her and have a discussion on research.
We also hosted lectures at Providence Healthcare and St. Joseph’s Health Centre entitled, How to Find Evidence for Evidence Based Practice. We had a great turnout at both sites, and were pleased to see how interested clinicians are in learning the skills to conduct practice based research. These two sessions gave us the opportunity to connect with colleagues across the network, and learn about new research interests that are brewing.
In our IPBR Journal Club, we discussed information that individuals may wish to have in order to give informed consent. We had a lively discussion on study design, considered differences between information patients and family members require versus what they might like to have, and identified ways such an international study could be rerun in the Canadian health care setting.
Last but not least, we held our annual showcase at the end of the month, and while this was our third showcase, it was the first time we partnered with the Alternate Funding Plan. We had 18 posters, and five oral presentations. Thank you to everyone who came to share their amazing research projects – it was remarkable to learn about so many impactful projects. The feedback we received indicated our presenters and attendees enjoyed the opportunity to connect with colleagues and learn about the innovative research being carried out. We have already begun planning for our 2020 IPBR-AFP showcase, and look forward to seeing learning about the new research conducted in the coming year.
Is there an event you’d like to see us host during Research Month next year? Please drop us a line and let us know – we’re always open to new suggestions for opportunities we can create for our clinicians.
Connecting with IPBR
The Interprofessional Practice Based Research program at St. Michael’s Hospital assists nurses and health disciplines professionals at St. Michael’s Hospital engage in the identification, implementation, and evaluation of best practices through research. During Research Month, we aimed to create opportunities for our clinicians to engage and learn new research skills, and showcase the amazing work they are doing. If there is a suggestion for a program you would like to see hosted during a future Research Month, please let us know.
“We are so fortunate for this opportunity to collaborate, inspire, lead and evolve in this research community. Thank you for the hard work and dedication of the organizers.”
– Mirjana Tusha (Respiratory Therapist) & Lucia Lorenzatti (Speech Language Pathologist) (IPBR-AFP Showcase Poster Presenters)
Dec. 19, 2019
Names: Karen Carlyle, Nurse Practitioner; Amanda Hignell, Social Worker
Trivia: A team of dedicated infant cuddlers was established as a result of this research.
Project title: The Infant Cuddler Study: Evaluating the effectiveness of volunteer cuddling in infants with neonatal abstinence syndrome
When expectant mothers are exposed to opioids, their babies may suffer from withdrawal or Neonatal Abstinence Syndrome (NAS). Withdrawal symptoms can include vomiting, diarrhea, poor feeding, irritability, fever, sweating, and nasal congestion – these are tough symptoms for anyone. All newborns are adapting to a “new normal” in their first few days outside the womb, and experiencing the additional symptoms of withdrawal can make your first days in the world a bit more challenging. These infants need significant extra care.
“The discomfort babies with NAS experience is palpable. It becomes easy to recognize the cry of a baby going through withdrawal,” says Karen Carlyle, a Nurse Practitioner at St. Michael’s Hospital.
Non-pharmacological approaches for withdrawal care, known as supportive therapies, are often provided alongside medication. These therapies are believed to minimize the physiological effects of the withdrawal and can include cuddling – simply, the idea of holding a baby close and or gently rocking the baby. In 2015, the St. Michael’s Hospital Neonatal Intensive Care Unit (NICU) launched a Volunteer Cuddler program to help provide care for babies suffering from withdrawal. This program, which is exactly as cute as it sounds, brings in and trains volunteers to cuddle these vulnerable infants when the family is unable to. This is an important service in this inner-city hospital. St. Michael’s Hospital provides obstetrical care to many women struggling with opioid use. Before its introduction, little was known about whether or how this program was making a difference.
Carlyle and Amanda Hignell, a social worker at St. Michael’s Hospital, were part of the team that brought the Volunteer Cuddler Program into the NICU. They mentioned that “over the years [they saw] how infants with NAS settle while being held but nurses are often busy providing acute care to other patients, and parents are not always present in the NICU to hold their child. In the United States, there were a growing number of hospitals utilizing volunteers as cuddlers and [they] thought we could easily replicate a similar program, while also studying the impact of volunteer cuddlers as evidence is missing in this area of the literature.”
To measure the impact of this program, they used a multi-pronged, mixed methods approach. On the quantitative side, they measured the length of stay of the infants in the NICU. They also held focus groups with bedside nurses and program volunteers to get their perspectives on the impact of the program.
Carlyle and Hignell’s preliminary findings indicated that cuddling is therapeutic for babies suffering from withdrawal. Babies who are cuddled spend less time in the hospital than those who were not a part of the volunteer cuddler program. Furthermore, both bedside nurses and program volunteers are enthusiastic about the positive effects this program is having on care.
“The response that we’ve had both internally, from families, volunteers and staff, as well as externally, has been tremendous,” says Amanda. “Hospitals across the country have been reaching out to us asking how to start cuddling programs of [their] own. It is so gratifying to know that this program is not only helping infants at St. Michael’s, but across Canada”.
The findings from this pilot study are now published in the journal of Pediatrics and Child Health. Stay tuned for further details as this program continues to make positive impacts on the lives of newborns facing symptoms of withdrawal.
Connecting with IPBR
The Interprofessional Practice Based Research program at St. Michael’s Hospital assists nurses and health disciplines professionals at St. Michael’s Hospital engage in the identification, implementation, and evaluation of best practices through research. Amanda Hignell and Karen Carlyle are recipients of a 2018-2020 Interprofessional Practice Based Research Grant. This grant provides research funding and mentorship.
“This study would not have been possible without the support of the IPBR program. This was the first time either of us have led a research study; the advice from our research, library and REB mentors was invaluable throughout the process.”
– Karen Carlyle and Amanda Hignell
Oct. 18, 2019
Names: Kathy Popovski, Elizabeth Logan
Role: Nurse Practitioners
Project title: Navigating opioid therapy for acute pain: the experience of pain management nurse practitioners
Research interests: Opioids, acute pain, education, controlled substances
If you search ‘opioid crisis’ in Google news, you will find over 13 million results. It should come as no surprise to learn that Canada is in the midst of an opioid epidemic. Over the past 10 years, there has been an unprecedented increase in overdoses and deaths associated with the use of opioid pain relievers. This has caused the medical community to examine opioid prescribing practices.
Although opioids are the cornerstone of acute pain management, they are highly addictive, must be carefully managed, and are not always the right choice for everyone. In 2017, new Canadian guidelines for opioids for non-cancer pain were released to help reduce the overprescribing of opioids.
At the same time that these guidelines were being written, nurse practitioners (NPs) were granted the authority to prescribe controlled substances. Nurse practitioners are highly educated and experienced nurses who are able to diagnose illnesses and prescribe medications. Before this change in their role, NPs were able to prescribe a number of different medications, but this did not include opioids. Now, after completing the education requirements, it is part of their role to carefully and safely prescribe opioids to patients.
“Our NP colleagues advised us they required ongoing education for continued competence and confidence in opioid prescribing, as well as for sustainability of this extended scope of practice,” said Kathy Popovski, an NP on the acute pain service at St. Michael’s Hospital.
NPs Kathy Popovski and Elizabeth Logan heard the need from their colleagues and took on this challenge.
“As experts in pain management, we have the knowledge and expertise in non-pharmacological and pharmacological pain management strategies, including opioid therapy,” Popovski said. “As opioids remain the cornerstone of managing acute pain, our extensive experience with opioid therapy provided the perfect fit to lead the educational initiatives to support safe and effective prescribing of controlled drugs and substances for NPs at St Michaels.”
They started by sending out a survey to their colleagues to assess their educational needs. Based on the responses, they developed a number of resources and workshops to support safe and effective prescribing of controlled drugs and substances.
These initiatives included:
1. Hosting an educational lecture series on the guidelines for prescribing
2. Providing a consultation service
3. Creating discharge instructions to provide education and instructions for patients
Popovski and Logan are currently evaluating the effectiveness of these initiatives for supporting NP learning and following up with their NP colleagues to determine future educational needs. This training is offered to NP students throughout all their rotations, and has been a very successful and well received initiative.
Nurse Practitioners like Popovski and Logan use experiential and scientific knowledge to provide comprehensive pain management to patients. This includes opioid dose reduction, providing alternative therapeutic options, patient education, and follow up. Nurse practitioners at St. Michael’s are in a unique position to provide leadership in providing safe and effective pain control in the era of opioid misuse.
Connecting with IPBR
The Interprofessional Practice Based Research program (IPBR) at St. Michael’s Hospital assists nurses and health disciplines professionals engage in the identification, implementation, and evaluation of best practices through research. Popovski and Logan have had consultations with the IPBR team to refine their research questions and develop knowledge translation tools to share their educational resources. Their work has been published in Canadian Nurse.
Sept. 30, 2019
Fun trivia: This set of tips is almost like the equivalent of having a fairy godmother step in and help with your application!
You have an awesome and impactful idea for research project, leadership has indicated their support for your project, and key members of your research team have been identified. You also found a call for grant applications that can help fund the project – now if only you had a fairy godmother to write a strong grant application for you…
The IPBR team has created a set of tips for preparing a successful grant application … you might even say the IPBR team is like your fairy godmother!
1. Start early and set timelines
Grants typically have several components and requirements. In addition to various written sections, there are often additional requirements such as departmental approvals or letters of support required to complete the submission. Reach out to the individuals whose approval or support you are seeking early on to also allow them enough time to complete the tasks you may be asking of them. Once you have identified all the application requirements, create a realistic schedule for completing various portions of a grant in order to ensure you have left yourself enough time to complete each section. Consider setting yourself an earlier deadline to complete the grant than the actual submission deadline. This will provide you a buffer should any hiccups arise.
2. Look at what was funded before
Grant agencies often provide lists of previous award recipients. In some cases, agencies post abstracts of past and ongoing research, which can help you to identify what critical project elements have helped to make an applications successful. Use these pieces of information to get an idea of the types of projects the granting agency is interested in funding. See if there is a common theme among these projects, and whether you could highlight this similar concept in your own grant application.
3. Ensure your methods and aims are well matched
While this may seem straightforward, a common flaw in many grant applications is the inclusion of additional methods that do not match the study’s aims, or the listing of aims that are not addressed in the methods. Ensure that each aim is clearly matched to a method. Avoid providing a vague methodology outline that attempts to provide a blanket explanation on how to address multiple aims. Having a well-focused study methodology directly linked with each specific study aim will demonstrate to reviewers that the study is well thought out and organized.
4. Ensure you can clearly articulate the impact or benefit of this proposed work
While you may see the relevance in your study, and the impact may seem large to you, the benefit of this study may not immediately stand out for reviewers. Remember that your grant application is not the only one a reviewer is looking over – they will likely review several interesting projects. Clearly outline the impact or benefit of your proposed work. This reduces any guesswork needed on behalf of the reviewer, and will immediately show that there is a clear purpose to conducting this study.
5. Polish your prose, dot your i’s and cross your t’s
You have spent so much time refining your idea and preparing your application – do not let typos and improper prose tarnish the quality of your grant application. An application riddled with grammatical errors will not be as easy for a reviewer to read compared to one without such errors. Poor prose can obscure your project goal for the reader. Have someone review your application – consider asking an individual who you trust, perhaps a person who works in health care but not in your specific field. Remember to ask this person early on so they can make time in their schedule. This person can help you identify areas where clarification or revision are necessary, as well as point out more minor errors that you may have missed.
Connecting with IPBR
The Interprofessional Practice Based Research program at St. Michael’s Hospital assists nurses and health disciplines professionals at St. Michael’s engage in the identification, implementation, and evaluation of best practices through research. The program also offers a Small Grant Application, which includes $5,000 in funding over two years, project mentorship, and a community of practice. The grant application is open to nurses and health disciplines clinicians at St. Michael’s Hospital. Additional details on the grant are available on the intranet. The current call for applications closes at 11:59pm October 24th, 2019.
September 10, 2019
Name: Reem Haj, Elizabeth Leung
Project title: Optimizing antimicrobials: Using “CHART” data to identify patients eligible to be transitioned from intravenous to oral antimicrobial therapy
Fun trivia: This project has become part of a corporate objective!
You are in the hospital because your small cut became badly infected and you need antibiotics – stat! In the past this likely would have meant an intravenous (IV) drip. Now there are a number of antibiotics that can be given in pill form. That’s right – no needle, no being tethered to a pole, and no being stuck in bed until someone can help you get the lines all sorted out. Add to that the benefit of reduced risk of line infection and often a shorter length of stay in the hospital.
In fact, for many antibiotics, the oral formulations are just as effective as the intravenous medications.
What’s the catch? Despite the fact that many oral formulations are equally effective to IV medication, IV antibiotics are still more commonly used in hospitals, and at times are over-prescribed. One of the biggest challenges facing clinicians in converting patients to oral medications is efficiently identifying patients who are ready to be converted, which can result in overuse of IV medications. Historical practices of prescribing IV antibiotics and ingrained standard protocols contribute to the difficulty in shifting this practice. Furthermore, there are cases when there are good reasons for patients to remain on IV antibiotics. The key is to identify who should and who should not be on IV antibiotics.
Elizabeth Leung and Reem Haj, clinical pharmacists at St. Michael’s Hospital, are tackling this problem in a big way. Through a fellowship with IPBR and the Li Ka Shing Centre for Healthcare Analytics Research & Training (LKS-CHART), they are using big data to develop a computerized surveillance tool. The tool they are working on will sift through all of the patients in the hospital each day, identify those who are on specific IV antibiotics, and run information about their current medical status through an algorithm to determine who is and is not eligible for conversion from IV to oral antibiotics.
They are working together with a diverse team including physicians, pharmacists and a nutritionist, to ensure that the algorithm aligns with clinical judgement. By co-developing this tool, prescribing physicians will find it useful because they know they agree with the eligibility criteria the tool is using to identify these patients.
The tool to help identify patients that are eligible for conversion from IV to oral antibiotics has now been developed and is currently in its pilot implementation stage in the general medicine wards. The goal is to continue to roll out this initiative in the hospital and explore expanding the tool’s range to other IV medications which have appropriate oral options available.
Connecting with IPBR
The Interprofessional Practice Based Research program at St. Michael’s Hospital assists nurses and health disciplines professionals at St. Michael’s Hospital engage in the identification, implementation, and evaluation of best practices through research. Reem Haj and Elizabeth Leung are recipients of a CHART-IPBR fellowship. This fellowship provides mentorship, partnership with a data scientist, and funding for protected time to conduct the project. Elizabeth notes that “this fellowship has really allowed us to explore how big data can be used to support and inform system changes that improve patient care.”
June 26, 2019
Name: Manuscript Writing Boot Camp
Role: Provide space for focused writing
Research interest: Publications, knowledge dissemination, creative writing, framing a research message
Fun trivia: This initiative is often described as a tall, dark, drink of knowledge
Two nurses, four dietitians, and three social workers walk into a room. They listen to a presentation, participate in a creative activity, and get to work writing.
I bet you were thinking that I was going to tell you a great joke, but no, instead I just described a great program. The IPBR Manuscript Writing Boot Camp.
I’ll tell you more. Every three weeks (starting again in the fall) the IPBR team hosts a Manuscript Writing Boot Camp. The purpose of this program is to provide a dedicated time and space to write up scholarly activities for publication. The Boot Camp starts with a 40-minute didactic presentation that describes the components of a manuscript. Clinicians are encouraged to ask questions and together we discuss tips and tricks for writing. After the presentation, participants are given time to relax. They are able to bring a snack and undertake a creative activity. The goal of the activity is to get their minds off of the stress and pressures of writing, and get the creative juices flowing. Then it is time to get to work. The rest of the three-hour session is dedicated quiet time to write. The IPBR team provides support and offers guidance as needed.
We are thrilled with the popularity of this program. Every session clinicians come and take time out of their busy days to work on their manuscripts. Some clinicians are committed to making this a regular part of their schedule. Those who can’t make the full session are welcome to join us for the dedicated time to continue their work in a quiet and supportive environment.
Feedback from the sessions has been overwhelmingly positive. One clinician stated that, “I extremely enjoyed the session, and look forward to attending more. Not only did I get tips that I immediately got to apply to my working cover letter, but I now have more ideas to use as I re-review my manuscript and abstract. …I think that it should be stressed that many of us in that session appreciate having the time and quiet space to work on our paper submissions.”
Another added, “I left with a renewed sense of hope that I will take this paper across the finish line. Thank you both for your time. I will use the intervals between our meetings to work on the paper.”
We welcome all nurses and health disciplines clinicians at St. Michael’s Hospital to join us. Stop in, check it out, and get some work done. Writing can be stressful and putting it off is sometimes too easy. Here is an opportunity to get help, be supported, and make progress! We publish our Manuscript Writing Boot Camp schedule in our monthly newsletter and also send out email reminders – keep an eye out for updates about new dates for Fall 2019! Contact us at any time if you would like more information at IPBR@smh.ca.
March 25, 2019
Names and roles: Cecilia Santiago, manager of Nursing Practice; Heather MacDonald, occupational therapist
Project title: Improving the care of patients who exhibit responsive behaviors; an evaluation of an Interprofessional educational workshop
The hospital can be a confusing and stressful place. This is particularly true for patients with dementia, delirium and other neurological conditions who have cognitive impairments, which can result in confused thinking and reduced awareness. The unfamiliar surroundings or the loss of preferred routines can be a lot for patients to handle. As a result of environmental stressors, some patients may “act out” in what is known as responsive behaviours – which could include yelling, resisting essential care, or trying to leave against medical advice. Demonstrating responsive behaviors can place patients and staff at risk.
Understanding and reacting to responsive behaviours can be challenging for clinicians, who often report feeling a lack of confidence in providing effective care in such situations. Cecilia Santiago, a manager of Nursing Practice, Lori Whelan, a consultant in Leadership and Organizational Development, and Heather MacDonald, an occupational therapist, aimed to address this by developing a tailored interprofessional educational program. This program included introducing clinical tools and processes to aid in the care of patients who exhibit responsive behaviours. They then studied the impact of their program on clinicians’ perceived knowledge, self-efficacy, team collaboration and use of care plans in caring for persons with responsive behaviors.”
“Currently, little is known about the efficacy of focused interprofessional education on the ability of clinicians in the acute hospital setting to manage responsive behaviours, or about the sustained impact of interprofessional education on practice change,” said Cecilia. “Interprofessional collaboration is integral to achieve enhanced practice opportunities for clinicians and improved care for patients who exhibit responsive behaviours.”
This education initiative aimed to transform how clinicians viewed these patients; from seeing them with fear and avoidance to seeing them as unique individuals with needs and experiences. The results of this study indicate that this educational program not only improved care, but also equipped clinicians with new knowledge and skills to manage responsive behaviours. Cecilia explained that “learning from the initial rollout of the managing responsive behaviours (MRB) program in general internal medicine, we tailored the program for the trauma neurosurgery and the cardiovascular patient population. So far, 479 clinicians have received the MRB education. Components of the MRB program were also embedded in the subsequent development of the constant care program. We also launched the MRB rounds to provide a supportive team forum to problem solve care planning of patients with complex and challenging behaviours using a case-based learning approach that integrates the use of MRB tools and processes.
Connecting with IPBR
The Interprofessional Practice Based Research program at St. Michael’s Hospital assists nurses and health disciplines professionals at St. Michael’s Hospital engage in the identification, implementation, and evaluation of best practices through research. Cecilia Santiago and Lori Whelan were recipients of a 2015-17 Interprofessional Practice Based Research Grant. This grant provides research funding and mentorship.
“The IPBR grant provided us seed money to carry out the multiple aspects of our evaluation, and provided an opportunity to make research more accessible to front line clinicians. The IPBR team created the manuscript bootcamp which provided me a quiet space and dedicated time for manuscript writing. The team also provided us valuable feedback in our manuscript.”
- Cecilia Santiago, nursing practice manager at St. Michael’s Hospital
February 20, 2019
Names: St. Michael’s Nutrition Screening Implementation Team
Roles: Nursing management, registered dietitians, nurses, portering, patient food services, volunteers, volunteers management, directors and others
Project goal: early identification of patients at risk for malnutrition
Interesting fact: 71 per cent of patients of the 936 patients diagnosed and managed as malnourished were over the age of 55 years.
Healing takes a lot of energy. Good nutrition is really important to enable the body to have the energy it needs to fight off infection and heal wounds. If you are malnourished, your body is less equipped to fight off illness and this can lead to negative health outcomes. Therefore, treating patients for malnutrition is an important part of holistic care.
March is National Nutrition month. At St. Michael’s Hospital we have a strong focus on assessing, and addressing the nutrition needs of each patient that walks through our doors. Quite literally. We have implemented a hospital-wide protocol in which every patient on almost every inpatient unit is screened for their risk of malnutrition. Patients that screen positive are followed up by a registered dietitian that can determine a plan of care to address their nutritional needs. In 2018 more than 10,000 patients were screened at St. Michael’s, almost 1,500 were assessed for malnutrition by an RD and almost 1,000 patients managed as malnourished. This initiative is a team effort that includes managers, nurses, dietitians, food services, portering, volunteer services, patients and others.
The key to the success of this initiative is having a quick and easy screening tool that sensitively detects patients at risk for malnutrition. However, screening tools have not been validated for use in every patient population or setting.
Our dedicated group of dietitians have taken on this challenge. They are conducting studies to assess which screening tools are the most sensitive and reliable to identify malnutrition risk in different populations. For example, Arti Sharma-Parpia, a dietitian in the Hemodialysis unit, is conducting a study to determine the best malnutrition screener for patients with end-stage renal disease, a population who is at high risk of malnutrition. Similarly, dietitian Sabrina Janes is currently evaluating the effectiveness of screening tools in identifying malnutrition risk in the mental health population. Both projects involve testing out several different screeners and comparing the accuracy and sensitivity of the screeners to the gold standard malnutrition diagnostic assessment tool.
The results of these projects will inform which screener is best for identifying malnutrition risk. “Patient access to expert nutrition support, oral nutritional supplements, dysphagia management, community-based nutrition programs, and food security counseling starts with the reliable and valid identification that a patient is malnourished”, said Kim Bradley, practice manager for the Dietitian group. “When this can happen in an acute care context it can guide all players, including the patient, in managing nutrition as an important part of healing and mental wellness.”
January 14, 2019
Name: Alyson Martinez
Role: Registered dietitian
Research interests: premature babies, oral feeding, parent education
Project title: An exploration of feeding skill development in the parent-premature infant dyad in the Neonatal Intensive Care Unit (NICU)
Fun trivia: Hidden talent – making handmade pasta
As adults, we don’t put a lot of thought into how we eat. We open our mouths and in it goes. We forget that eating is a learned behaviour. Babies have to learn how to eat, and this learning requires many complex processes (ex. motor control and coordination.)
For infants born prematurely, these processes can be compromised. Many premature babies start off being fed through a tube. The transition to eating by mouth can be difficult for many reasons (ex. inability to suckle.) Difficulty establishing oral feeding can lead to extra health challenges and increase the length of stay in hospital. While in the neonatal intensive care unit (NICU), trained nurses feed the babies. At home this responsibility falls to the parents. This can be a daunting task for many parents, even when provided with education and resource supports.
“We hope to design educational interventions and parental support programs to help facilitate safe and effective feeding practices, and in turn reduce the incidence of feeding-related comorbidities, said Alyson Martinez, a registered dietitian at St. Michael’s Hospital and principal investigator of the Interprofessional Practice Based Research Grant. Martinez and her team are trying to understand the parent perspective on feeding their infants. What anxieties do they have? What challenges do they face? How confident do they feel about translating the skills they learned in the NICU to their home?
When premature babies are being treated in the NICU, there are many different health disciplines that see to their care. Interprofessional care allows for holistic patient-centered care; according to Martinez, “every role on our team informs the others. She notes that “feeding encompasses not just nursing, but includes the medical team and other health disciplines as well, such as dietitians, lactation consultants, and occupational therapists.” Therefore, identifying factors that promote or prevent healthy feeding practices would benefit from having an interprofessional lens.
Through her research, Alyson aims to develop resources that support parents and help them engage in effective feeding practices at home. Starting oral feeding might not be effortless, but it can be made easier.
Connecting with IPBR
The Interprofessional Practice Based Research program at St. Michael’s Hospital assists nurses and health disciplines professionals at St. Michael’s Hospital engage in the identification, implementation, and evaluation of best practices through research. Alyson Martinez is a recipient of a 2018-20 Interprofessional Practice Based Research Grant. This grant provides research funding and mentorship.
“What I really appreciate about the IPBR program is that it gave me an entry point into research. I had a research question in mind, but didn’t know how to surpass the challenges of getting the project started. IPBR supported me in guiding me through the research process- it allowed me to access funding to make the project possible, but also linked me with the IPBR team, who help with my study design. The team supported me in learning new skills, such as learning to use NVivo software as I am completing a qualitative study. They also helped me build capacity to present to not only IPBR program but also in a larger audience.”
-Alyson Martinez, registered dietitian
Name: IPBR Showcase recap
Role: Celebrates practice based research at St. Michael’s Hospital
Research interests: cool clinicians, exciting research, fun photo booths, good food, compelling presentations
Fun trivia: No cacti were harmed in the making of this event
What do you get when you put together a room full of hungry yet happy clinicians, a culture of innovation and enquiry, a Polaroid camera and some streamers? The 2018 IPBR Showcase!
On Thursday, Nov. 8 the IPBR team hosted nearly 80 guests from across St. Michael’s for our second annual IPBR Showcase. The aim of this inspiring afternoon was to celebrate the amazing research initiatives being carried out by our nursing and health disciplines clinicians across the hospital, share a bit about what the IPBR program has to offer and announce something new and exciting for our clinicians.
The event, held in the Upper Marketeria started with networking and fun antics at our photo booth. Interprofessional teams shared their best poses and bunny ears. We also had a chance to visit with and learn about the work from the 2015-2017 IPBR Small Grant teams who displayed their research posters all around the room. On the big screen rotated a series of practice based researcher spotlights and a fun quiz on who published what.
The formal component of the Showcase was launched by Dr. Tim Rutledge, our President and CEO who shared his congratulations for all of the excellent practice based research being showcased at the event.
“I am completely inspired by what you are doing with what is essentially seed funding…when we reflect and refine our practice we give better care…there is nothing like reflective practice and doing evaluation on our practice to support excellence,” he commented.
Our director, IPBR, Jane Topolovec-Vranic described some of the initiatives underway and premiered our new IPBR video:
She also spoke to some of the metrics of IPBR over the past year including over 150 consultations with more than 60 clinicians on a variety of research projects.
Next, each of the two current IPBR Small Grant teams shared the aims of their respective research projects:
- Alyson Martinez and Natalie Puccio – Exploring how parents of premature infants learn to independently feed their babies once they leave the hospital for home;
- Marjorie Hammond and Vivian Law – Studying the barriers and enablers to performing peripheral nerve blocks for pain management in hip fracture patients.
Finally, Sonya Canzian, our vice-president Clinical Programs and Chief Nursing and Health Disciplines Executive announced a new opportunity for our clinicians! Nurses and health disciplines clinicians who are actively engaged in research will be able to apply for a practice-based researcher (status-only) appointment with the Li Ka Shing Knowledge Institute. This new category of appointment will;
- Enable our nurses and health disciplines to lead their own research projects, and
- Provide a means for us to recognize those clinicians who go above and beyond the excellent care they provide to patients and help contribute new knowledge in their field through research.
Stay tuned for more information about the appointment process which will launch network-wide on Jan. 1, 2019.
After inspiring closing remarks by Sonya, the form presentations concluded and attendees continued networking, snacking and selfie-ing. Some even took the opportunity to get their work holiday photo done.
Thank you to all those who took the time to attend, to our speaker and to our researchers who shared their ongoing and completed research projects. We look forward to an even bigger showcase next year with more practice-based researchers, projects and impacts across the hospital.
October 15, 2018
Marjorie Hammond, Registered Nurse
Vivian Law, Pharmacist
Research interests: Hip fractures, opioids, peripheral nerve blocks, elderly patients
Project title: Improving care of hip fracture patients by identifying factors influencing the implementation of peripheral nerve blocks as an evidenced-based treatment in the perioperative setting
– Marjorie is trained in medical and traditional Chinese medicine and acupuncture.
– Vivian has a great topographic memory
“She was doing so well until she fell,” or “he was in great health until he broke his hip.” These are common stories that you might hear about an elderly loved one. The sad truth is, as we get older our bones increase in frailty and are more likely to break. Hip fractures are particularly common in the elderly. They can lead to loss of independence, health complications and death. Sustaining a hip fracture in addition to being a sentinel event for the patient it is often a life-changing event for their loved ones particularly if the patient was the primary care giver for their partner. Hip fractures can be very painful and managing the pain with opioids, the most conventional treatment is well known to be associated with undesirable adverse events.
“Suboptimal pain management and opioid related adverse events can negatively impact patient recovery, and cause unnecessary emotional distress for the patient and their loved ones”, said Marjorie Hammond, a clinical nurse specialist in Geriatrics at St. Michael’s Hospital.
Clinicians are looking for other ways to manage acute pain in hip fracture patients. One other pain management method is the use of a peripheral nerve block. A peripheral nerve block involves an ultrasound guided injection of local anesthetic into an area in upper thigh near the groin. The injection solution spreads to the nerves, effectively shutting down fractured hip pain. The technique is similar to “freezing” needles that the dentist might use before pulling out a tooth. Nerve blocks are safe, inexpensive, effectively reduce pain and decrease the need for opioids. This helps the patient get on their feet faster and reduces the length of stay in the hospital.
Nerve blocks sound like a great strategy for managing hip fracture pain; so why aren’t they being used as routinely as a standard of care? Marjorie and her colleague, pharmacist Vivian Law, are trying to find out the answer to this question. Her team is talking to clinicians and using implementation science based research methods to figure out factors that promote or prevent the use of nerve blocks. Her team hopes in the future to design and test strategies to increase the use of nerve blocks for hip fracture pain management as a first step toward providing this pain management intervention as a routine standard of practice.
When asked why she is interested in this research question, Marjorie stated that “older adults 65 years and older comprise 88 per cent of hip fractures in Canada. We are facing an opioid crisis in the country, and importantly older adults are at significant risk for adverse events associated with the use of opioids. The reduction of potential adverse events and provision of more optimal pain relief can be achieved by fascia iliac blocks.”
Connecting with IPBR
The Interprofessional Practice Based Research program at St. Michael’s Hospital assists nurses and health disciplines professionals at St. Michael’s Hospital engage in the identification, implementation, and evaluation of best practices through research. Marjorie Hammond and Vivian Law are recipients of a 2018-2020 Interprofessional Practice Based Research Grant. This grant provides research funding and mentorship.
“The IPBR program has not only funded this study but provided additional mentorship with respect to the complexities of moving a research proposal forward to actually conducting the study.”
- Marjorie Hammond
October 10, 2018
Name: Courtney Sas
Role: Social worker
Research interests: Dialysis, renal disease, goals of care
Project title: Deciding to stop: considerations for fully informed decision-making in end-stage renal disease
Fun trivia: Hidden talent – Irish dancing
In this age of medical advancement and technological strides, people are living longer than they have previously. Even for conditions where cures are not yet possible, there may be life-sustaining treatment options. Take for example patients with end-stage kidney disease who can go on dialysis. Dialysis machines do the job of our kidneys by filtering the blood and removing toxic waste from the body. This can prolong life potentially for many years. For patients who are unable to get a kidney transplant, dialysis is the only viable option. However, it comes at a cost. Dialysis requires patients to visit clinics up to five times a week for four to five hours per visit. This can be extremely burdensome and onerous. For some patients, specifically those with multiple health concerns, dialysis may not actually extend their life expectancy.
For patients with end-stage renal disease, it comes down to a choice. To pursue dialysis or to consider palliative options that focus on maximizing their quality of life until death. As you can imagine, end of life conversations about the patient’s goals, and values, and preferences around their treatment are really difficult to have. But these conversations are crucial if patients are going to be given a choice. “Patients should feel empowered and in control of their disease as much as possible. It is important that we listen to patients, hear what they have to say, and not project our own values on to them,“ said Courtney Sas, a social worker at St. Michael’s Hospital, Nephrology unit.
Courtney has developed educational resources to facilitate these goals of care conversations. She works with the clinical team to ensure that each patient has an opportunity to make choices around their treatment; to know their options, understand the potential risks and rewards, and weigh the pros and cons against their values and preferences. She aims to ensure that patients can set their own goals of care and share these goals with their medical team and their caregivers/ families.
According to Courtney, there is still a lot to know in terms of how to implement these educational initiatives. She indicates that “anecdotally we think that what we are doing is important and serves a need but we are very curious to know if research supports our theory.” To address these questions, Courtney is collaborating with Alison Thomas, a nurse practitioner on the hemodialysis unit, to understand whether these educational resources and goals of care conversations are effective from the perspective of the patient and clinician. They also aim to determine whether these educational resources result in improved communication and long term care for these patients according to their care goals.
Connecting with IPBR
The Interprofessional Practice Based Research program at St. Michael’s Hospital assists nurses and health disciplines professionals at St. Michael’s Hospital engage in the identification, implementation, and evaluation of best practices through research. Both Courtney and Alison have had consultations with the IPBR team to refine their research questions and develop a research protocol.
“As a clinician, I am not trained to conduct research. I have found the support of IPBR to be tremendously valuable. Our different backgrounds complement each other which allows us to do valuable research.”
-Courtney Sas, social worker at St. Michael’s Hospital, Nephrology Unit
October 1, 2018
St. Michael’s Hospital has long supported academic research and fostered a culture of discovery across the organization. We take great pride in the fact that our clinicians seek to deliver excellent patient care using the best available evidence. With its roots in nursing research, the Interprofessional Practice Based Research Program (IPBR) helps to equip our nursing and health disciplines professionals to improve patient care through research and education. We aim to empower clinicians to critically appraise and question their practice and then take those questions to create and translate new knowledge at the bedside.
Take for example one of our registered dietitians, Alyson Martinez. As a practitioner in the Neonatal Intensive Care Unit (NICU), she noted that many parents of premature infants seem distressed about the transition to feeding their new baby once they went home. Alyson wondered how these parents felt about their experiences of learning to feed their premature infant, and how they were able to translate these skills to independently caring for and feeding their infant upon discharge home. The findings from Alyson’s ongoing study will help to inform new educational resources for parents and staff in the NICU.
Each month here on the IPBR Blog you’ll learn about inspiring clinicians such as Alyson, who go above and beyond the excellent care they provide to the patients to also contribute to establishing best practices in health care.
Why support practice-based research?
At St. Michael’s we have more than 1600 nurses and 940 health disciplines clinicians who, at the bedside, are optimally positioned to identify gaps in our clinical practice and identify research questions with significant potential impact. Moreover, the opportunity to engage in research has significant impacts upon an individual’s sense of personal and professional development. Participating in a research project may spark an interest which could lead to changes in how one approaches and provides clinical care, as well as a new career path in academia, leadership, or clinical practice. Being involved in interprofessional practice-based research also provides:
- an opportunity to answer a question the clinician may have wondered about at the bedside;
- a chance to network and meet like-minded colleagues both internally and externally (i.e. conferences);
- a means to develop many practical skills from critical thinking, written and oral communication, project management, leading a team, collaboration, problem solving and more;
- new career advancement opportunities.
What does the IPBR Program offer?
We established the IPBR Program in order to provide research support, tools, opportunities and mentorship for our nursing and health disciplines clinicians as St. Michael’s. Through multifaceted approaches including one-on-one mentorship, workshops, seminars, and online self-paced resources, we aim to make participating in and leading a research project accessible, feasible and enjoyable for our busy clinicians.
Ways in which you can support practice-based research at St. Michael’s
- encourage your staff and colleagues to engage and connect with the IPBR team if they have an interest in research
- celebrate the achievements of those presenting and publishing their work
- financial donations to help establish new opportunities for clinicians to engage in practice-based research
What you’ll find on the IPBR blog
Each month we’ll be profiling the latest and greatest in practice-based research at St. Michael’s. This includes spotlighting the innovative and driven clinicians who are contributing to the development of new knowledge and ideas to improve patient care. We’ll also be showcasing IPBR initiatives, metrics and new developments. Let us know if there is anything else you would like to see us provide and connect with us if you’re engaged in practice-based research!
VP of Clinical Programs at St. Joseph’s (interim) and at St. Michael’s and chief nursing and health disciplines officer (interim)
Last updated October 26, 2021