In Thisue2sVooTisl2sm3l7 In This IssueASSETS/DOCUMENT/CJNN - Spring 2015 web.pdf · 2015-05-19 · et la maison d édition n acceptent aucune responsabilité reliée au contenu du

Volume 37, Issue 1, 2015

In This IssueRock 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

2 Volume 37, Issue 1, 2015 • Canadian Journal of Neuroscience Nursing

Board of directors, committee chairpersons and associated organization representatives 2015 / Conseil d’administration, responsables des comités et représentants des groupes associés 2015CouncillorsBritish Columbia: Trudy RobertsonAlberta North: Andrew KwanAlberta South: Christianne KrassmanSaskatchewan: Jodi Copeland & Michelle JasparManitoba: Jodi Dusik-SharpeOntario West: Corbin LippertOntario Central: Janice WilliamsOntario East: Aline BourgoinQuebec: Elizabeth Murphy-Lavallee & Helen FongNew Brunswick/PEI: Shelley PaulNova Scotia: Joan PacioneNewfoundland: Jessica Dwyer Milley

Committee ChairsScientific Liaison: Nancy ThorntonProgram Chairs (St. John’s, Newfoundland 2015): Viola Finn & Jessica Dwyer MilleyScientific Chairs (St. John’s, Newfoundland 2015): Jessica MilleyCommunication & Marketing (Web Administrator): Christianne KrassmanCommunications & Marketing (subscriptions): Jennifer PurkissEditor CJNN: Mina SinghCo-Editor CJNN: Corbin Lippert

RepresentativesWFNN: vacantCanadian Stroke Nursing Council: Patti Gallagher

Canadian Alliance of Brain Tumour Organizations (CABTO): Karen WaterhouseProfessional Practice & Research: Nancy ThorntonProgram Liaison: Christianne Krassman

ExecutivePresident: Tara BergnerLegislation & Bylaws: Cindy HartleyVice President/Secretary: Suzanne BasiukArchivist: Betty RossPast President: Cindy HartleyMembership: Janet White Treasurer: Mark Bonin

Websites of interestCanadian Association of Neuroscience Nurses and Canadian Journal of Neuroscience Nursing website: www.cann.caCheck 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.orgPlease 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.

CopyrightNo part of this publication can be reproduced, stored in a retrieval sys-tem or transmitted, in any form or by any means, without the prior written consent of the publisher or a licence from the Canadian Copy-right Licensing Agency (Access Copyright). For an Access Copyright licence, visit www.accesscopyright.ca or call toll-free to 1-800-893-5777.

Canadian Journal of Neuroscience NursingLe Journal canadien des infirmières et infirmiers en neurosciences

Volume 37, Issue 1, 2015

Editor/Rédactrice en chefMina D. Singh, Department of Nursing, York University, 4700 Keele Street, Toronto, ON M3J 1P3; [email protected]

Co-Editor/Co-rédacteurCorbin Lippert, [email protected]

Peer Reviewers/RéviseuresSharon Bishop, Regina, SKJennifer Boyd, Toronto, ONAndrea Fisher, Ottawa, ONSandra Ireland, Hamilton, ONLynn Joseph, Nepean, ONWilma Koopman, London, ONJoanna Pierazzo, Ancaster, ONCydnee Seneviratne, Calgary, ABMina D. Singh, Toronto, ONNancy Thornton, Calgary, ABCarole White, San Antonio, TX

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).

For subscriptions, contact/Pour inscriptions : Jennifer Purkiss, 820 Fisher Ave., Ottawa, ON K1Z 6P2; [email protected]

• Canada:$65.00(CAN)• UnitedStates:$65.00(US)• International:$70.00(US)• SingleCopy:$15.00(CAN)

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.

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.

Canadian Journal of Neuroscience NursingThe Canadian Journal of Neuroscience Nursing is the peer-rev iewed journal 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

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 statementThe Canadian Association of Neuroscience Nurses (CANN) sets standards of practice and promotes continuing professional education and research. Members collaborate with individuals, fam-ilies, interdisciplinary teams and communities to prevent illness and to improve health outcomes for people with, or at risk for, neu-rological disorders.

Le Journal canadien des infirmières et infirmiers en neurosciencesLe Journal canadien des infir-mières et infirmiers en neu-rosciences est le journal de L’Association canadienne des infirmières et infirmiers en neu-rosciences (ACIIN). Cette publi-cation est revisée par ses propres membres. Le journal est publié trois fois par année. Nous accep-tons les manuscrits originaux se rapportant à la pratique du nur-sing, de la recherche, de la théo-rie, 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 missionL’Association canadienne des infirmières et infirmiers en neu-rosciences (ACIIN) établit les stan-dards de pratique de la profession et fait la promotion de l’éducation permanente et de la recherche. Les membres collaborent avec les indi-vidus, les familles, les équipes mul-tidisciplinaires et la communauté en général dans le but de préve-nir les maladies neurologiques et d’améliorer la santé des gens qui en sont atteints ou qui sont à risque d’en souffrir.


Editorial

Note de la 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

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 neu-roscience 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 meth-odologist, 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 orga-nization 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 GreenEditor

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 psychothéra-pie 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 évalua-teurs aux fins de l’agrément, décerné par l’Association cana-dienne 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’adminis-tration 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 égale-ment 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 GreenRédactrice

Volume 37, Issue 1, 2015 • Canadian Journal of Neuroscience Nursing 5

Rock with CANN in NewfoundlandCANN 46th Annual Meeting and Scientific Sessions

June 23–26, 2015, St. John’s Newfoundland

Program overviewTuesday June 23, 2015 8:30–4:00 Board of Directors’ Meeting5:00–7:00 Welcome Reception – Courtyard

Wednesday, June 24, 20158:00–10:00 Opening Breakfast, Welcome and Introduction Grace; Greetings, Presidential address; Mary Glover Lecture—Ballroom Familial Intracranial Aneurysms in Newfoundland & Labrador—Dr. Falah Maroun10:00–10:30 Break—Posters and Exhibitors

10:30–11:15 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), CNS11:15–12:00 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 Sessions1:00–2:30A1 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-ClarkeB1 Neurological Assessment: Pediatric and Adults—Janice Williams, Dawn TymianskiC1 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.3:00–4:00A1 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-ClarkeB1 Neurological Assessment: Pediatric and Adults—Janice Williams, Dawn TymianskiC2 Parkinson’s Disease: Role of the Nurse in Disease Management—Lucie Lachance, RN, MSc, and Jennifer Doran, BN, CNN(C)

4:00–4:30 Living Library/Networking8:00 Pub Night: Rally in the Alley with McCarthy’s Party—meet in the Ballroom


Thursday, June 25, 20158:00–9:30 CANN Annual General Meeting—Ballroom9:30–10:00 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 Miller10:30–11:15 Plenary 4: Hope, Well-Being, Coping, and Quality of Life in Adults with Myasthenia Gravis—Wilma Koopman, Susan Fowler, Nicole LeBlanc, Denise Hulley, Michael Nicolle11:15–12:00 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 AbbVie12:30–1:00 Educational Lunch continues: Inspirational speaker—Dr. Bill Eaton

Concurrent Sessions1:00–1:30A2 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, BSNC3 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, CMSN1:35–2:00A3 Motorcycle Helmets and Traumatic Brain Injuries—Katie FinkB3 Thalamus Injuries: Hitting Where It Hurts the Most—Stephanie van Rooy, RN(EC), MN1:45C4 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)3:00D1 Brain of Zones Session 1—Sue Kadyschuk and Katie Fink * Break will be provided in the room


3:00–3:30A5 The Hidden Culprit: Ruptured PCA Aneurysm—Nicole Chenier-Hogan, RN(EC), BA, MSc, CNN(C)4:00B5 Secondary Stroke Prevention—Patrice Lindsey, RN, PHD, and K. Ruth Whelan, RN, MN, CNN(c), CNS 3:30C5 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-Paeds3:30C6 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, 20146:15 Run for Research around Quidi Vidi Lake8:00–8:45 Plenary 6: Educational Sponsored Breakfast: Pauline Weldon Memorial Lecture—Dr. Jock Murray and Genzyme8:45–9:30 Plenary 7: Using the ROSA Robot for Placement and Securement of Intracranial Depth Electrodes for Monitoring of Non-Lesional Epilepsy—Hayley Shephard9:30-10:00 Plenary 8: A Resource Manual for Individuals and Families Living with an Adult with TBI— Courtney Coish, BN, RN, MN


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

Heart and Stroke Foundation’s New Spin on Stroke Symptoms: FAST CampaignK. Ruth Whelan, RN, MN, CNN(c), CNS, and Patrice Lindsey, RN, PHD

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 time-frame 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.

Un nouveau tournant pour la Fondation des maladies du cœur en matière de symptômes de l’AVC : la campagne FASTK. 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 trait-ements 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 reconnais-sent 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 nom-breux pays et le Canada ne devrait pas faire exception. Le lance-ment 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 abor-derons dans cet exposé.

Plenary 2

Creating an In-Patient Stroke Alert Process at Royal University HospitalAmy Paiva, RN, BSN, and K. Ruth Whelan, RN, MN, CNN(c), CNS

Up to 17% of strokes occur in patients who are already in hos-pital. When delivering appropriate treatment, time is a major factor related to positive outcomes for these individuals. Histor-ically, 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 symp-toms of stroke and bring the stroke alert team rapidly to the bedside. At Royal University Hospital in Saskatoon, Saskatche-wan, 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.

La création d’une alerte AVC pour les patients hospitalisés au Royal University HospitalAmy 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 hos-pitalisés. 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’évalua-tion, le diagnostic et le traitement. La création d’une procédure d’alerte AVC pour les patients hospitalisés peut pousser les pro-fessionnels de la santé à prêter attention aux symptômes dis-crets 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.


Plenary 3

Pseudoprogression and Radiation Necrosis in High Grade Glioma Patients: Nursing Considerations in the Context of UncertaintyCatherine-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 treat-ment 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). Pseudopro-gression is the apparent radiographic progression following radiotherapy with subsequent improvement or stabilization through time. Radiation necrosis can also look like progres-sion, 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 phenom-enon of pseudo-progression, radiation necrosis versus real pro-gression, 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-radia-tion 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’incertitudeCatherine-Anne Miller

Le glioblastome multiforme (GBM) est la tumeur maligne pri-maire 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 popula-tion comprennent la pseudoprogression (manifestation pré-coce) et la nécrose de la radiothérapie (manifestation à moyen et long terme). La pseudoprogression est une progression

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’ap-parence 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 sci-ences 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-radio-thérapiques depuis un point de vue infirmier, indiquera les interventions en soins infirmiers possibles et recen-sera les éventuelles possibilités de recherches en sciences infirmières.

Plenary 4

Hope, Well-Being, Coping, and Quality of Life in Adults with Myasthenia GravisWilma 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 myas-thenia 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, Myas-thenia 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 compo-nent. 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 signifi-cant 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 graveWilma 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 mon-trer 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 par-ticipants 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 PatientsPatricia Nikolski and Venus Shyu

Posterior Fossa Syndrome (PFS) is a devastating and com-mon 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 secre-tions, 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 inci-dence 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 complica-tion commune et dévastatrice qui entraine souvent une résec-tion 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 dysar-thrie, la labilité émotionnelle et des changements de comporte-ment neurologique ou de personnalité qui peuvent grandement compliquer la convalescence à la suite de l’intervention chiru-rgicale. Les taux d’incidence du SPF varient à travers la docu-mentation : 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 change-ments 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 Non-Lesional Epilepsy Hayley Shepherd

Case report summary A 27-year-old male presented to the epilepsy program diag-nosed with right focal epilepsy since age 19. Though he under-went a right frontal insular resection two years prior, his seizures recurred one month after surgery at a frequency of


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 moni-toring 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 épi-lepsie 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 élec-trodes 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 sécuri-sation 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.

Plenary 8

A Resource Manual for Individuals and Families Living with an Adult with a Traumatic Brain InjuryCourtney Coish, BN, RN, MN

Traumatic brain injury (TBI) is a complex injury with a broad spectrum of symptoms and disabilities. Living with some-one with a TBI is a life-altering event. The individual diag-nosed 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 infor-mation 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 recov-ery. 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 individu-als 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 cérébralCourtney 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 change-ments 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 per-sonne atteinte de TC à la maison sont rares et difficiles à trou-ver. 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’appli-quent 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 sugges-tions 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 PatientDawn 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 sud-den 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’ objec-tive 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.

Through case presentations and exploration, the goals of this talk are to de-construct deterioration and discuss the ‘absolute must do’.

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 dete-

riorating patient 5. Key neurological “absolute must dos” during assessment.

Un cheminement clinique pour l’évaluation des patients dont l’état de santé se détérioreDawn Tymianski, IA-CS, IP-A, M.Sc.inf., CSN(C), Ph.D.(C)

On définit la détérioration comme la dégradation d’une con-dition 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 con-nues 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 objec-tives « 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’informa-tions 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 ren-forcera 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.


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?Brenda Sabo, Katie Dorian, Alexis Milligan and 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 mem-bers; concern that such a conversation may result in further dis-tress; 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 end-of-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., anx-iety and depression).

Traditional educational models that frequently involve impart-ing knowledge through didactic approaches (e.g., lecture for-mat) do little to convey the more intimate elements of the human experience. Nor do research articles that, not infre-quently, remove the contextual aspects of life. Arts-based knowledge translation legitimizes the agency of tacit knowl-edge (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.

This 2 1/2-hour workshop will highlight the role of art in con-necting, 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 edu-

cation about palliative and end-of-life care2. Highlight the benefits of creative work (e.g., performance

art, visual art) in opening communication3. Challenge existing values, attitudes and beliefs about palli-

ative and end-of-life care

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 et Erna Snelgrove-Clarke

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 compren-nent 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 pour-rait 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).

Les modèles éducatifs traditionnels qui impliquent une trans-mission 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.

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 ques-tions de soins palliatifs et de fin de vie. Nous décrirons deux approches créatives. Premièrement, les participants intervien-dront activement avec les artistes Katie Dorian et Alexis Milli-gan 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 vie2. Souligner les avantages du travail créatif (p.ex., les arts du

spectacle, les arts visuels) afin d’ouvrir le dialogue3. Remettre en question les valeurs, les attitudes et les croy-

ances existantes en matière de soins palliatifs et de fin de vie


A2

Deep Brain Stimulation in Drug-Resistant EpilepsyKaren Waterhouse, RN, BSN, CNN(C)

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).

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-op-erative follow-up care.

La stimulation cérébrale profonde pour le traitement de l’épilepsie résistante aux médicamentsKaren 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’impor-tantes conséquences sur le plan psychosocial pour le patient et sa famille, un risque de blessure pour le patient et la possi-bilité 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 émer-gentes, 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’épi-lepsie résistante aux médicaments au moyen de la SCP. J’abor-derai également les soins infirmiers prodigués à ce patient tout au long du continuum, depuis l’enseignement préopératoire jusqu’aux soins de suivi postopératoires.

A3

Motorcycle Helmets and Traumatic Brain InjuriesKatie Fink

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 Vehi-cle 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.

Neuroscience nurses frequently care for patients with trau-matic brain injuries secondary to motorcycle crashes. This presentation is meant to provide neuroscience nurses with an opportunity to learn more about different aspects of motor-cycle 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 cérébrauxKatie 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 traumatis-mes 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 souf-frent 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 pro-voqués par un accident de moto. Cet exposé a pour but de


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 depart-ment with reports of sudden onset of headache, nausea, tran-sient left-sided weakness and subjective reports of dysphagia. Neurological assessment is reported as unremarkable. No sig-nificant 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 meningi-tis are identified as the primary diagnosis. This presentation will discuss posterior inferior cerebellar artery (PICA) aneu-rysms, 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 aneu-rysms, which account for 0.5%–3% of all intracranial aneu-rysms. 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 dys-phagie. L’évaluation neurologique ne décèle rien de particulier. Il n’existe pas d’antécédents médicaux significatifs ni d’antécé-dents familiaux de migraines ou d’anévrismes. Une première tomodensitométrie du crâne ne révèle rien d’anormal, à l’excep-tion 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

de cas pour faire ressortir toutes les principales caractéris-tiques 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 anévris-mes 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 intraventric-ulaire et d’hydrocéphalie secondaire. Il est essentiel de repérer tôt et de traiter correctement ces anévrismes rares.

B1

Neurological Assessment: Pediatric and Adults Coming Together Janice Williams, and Dawn Tymianski

This intensive workshop will focus on pediatric and adult neu-rological assessment and discuss the management of common neurological problems that may be encountered by neurosci-ence 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 person-nel 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 trait-ement 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

Rapid Evaluation and Intervention for Symptomatic Extracranial Carotid DiseaseAaron Gardner, BSN, CNN(C) and Michelle Jaspar, BSN

In accordance with Canadian Stroke best practice, patients with transient ischemic attack or stroke with ipsilateral carotid ste-nosis 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 pre-senting 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 symptomatiqueAaron 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 transi-toire 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 exam-inerons 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.

B3

Thalamus Injuries: Hitting Where it Hurts the MostStephanie van Rooy, RN(EC), MN

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 supe-rior cerebellar arteriovenous malformation (AVM). Due to his rare anomalous venous architecture, venous hypertension con-tributed 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.

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 sys-tem 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 malStephanie 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 artério-veineuse (MAV) cérébelleuse supérieure. Du fait de cette archi-tecture 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 tox-ine. Le thalamus constitue une voie d’échange centrale pour les informations qui circulent depuis la périphérie jusqu’au cor-tex cérébral afin d’y être traitées. Les axones de tous les sys-tèmes 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.


Nous examinerons la structure, la fonction et la capacité vas-culaire du thalamus et des noyaux concernés. Nous présenter-ons les symptômes neurologiques qui dépendent de la région touchée par la lésion thalamique ainsi que les indications radiologiques obtenues en comparant des techniques d’imag-erie. 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 polyneurop-athy (CIDP) and Multifocal Motor Neuropathy (MMN). In Guillain Barre Syndrome (GBS) and Myasthenia Gravis (MG), IVIg is commonly used to treat. Recently, subcutane-ous immunoglobulin therapy (SCIg) has been used in immu-nological 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 Ig2. Review clinical case studies to discuss the role of Ig in the

treatment of neuromuscular diseases3. 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 inflam-matoire 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’immu-noglobuline sous-cutanée (IgSC) dans la pratique immu-nologique 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

C2

Parkinson’s Disease: Role of the Nurse in Disease ManagementLucie 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 neurodegen-erative 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 man-agement. 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 symp-toms. Nurses are sources of expert knowledge that can offer guid-ance 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 presen-tation 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 maladieLucie 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 neurodégénéra-tive 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 con-stitue 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

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

Although nurse educators recognize that specialized knowl-edge is needed for professional practice, they also argue that self-consciousness (reflection) and continual self-critique (crit-ical reflection) are key to continued competence. Moreover, those who advocate for reflective and critically reflective prac-tice 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 éduca-trices 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 main-tien 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).

Cet atelier fera office de tribune où les infirmières et infirm-iers 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 par-ticipantes et aux participants de partager leurs histoires et leurs réflexions.

C4

Persistent Vegetative State and Early Pregnancy: An Ethical Dilemma in Neuroscience NursingShawna 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 emer-gent care. On admission, she was pregnant at 17 weeks (G1P0). Imaging revealed a massive thalamic hemorrhage and very high intracranial pressure (ICP) requiring rapid decompres-sion, 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, neuro-logical and respiratory support.

During this critical time, obstetrical ultrasound confirmed nor-mal fetal growth and a stable heart rate. Within two weeks of hospital admission and no evidence or anticipated signs of neu-rological 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.


État végétatif persistant & début de grossesse : un dilemme éthique en matière de soins infirmiers en neurosciencesShawna 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)

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 neuro-chirurgie 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 hémorra-gie 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 rétablisse-ment neurologique, elle a sombré dans un état végétatif per-sistant (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 per-sistant 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 simi-laires ou d’expériences cliniques

C5

When Your Brain Turns on You: Exploring Anti-NMDA Encephalitis in the Pediatric PopulationKatanya Fuerst, RN, Rheanna Radchenko, RN, Sophia Phillips, RN, and Arbelle Manicat-Emo, RN(EC), NP-Paeds

Anti-NMDA receptor encephalitis is a type of antibody-medi-ated 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 inflam-matory 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 popula-tion. This can be a devastating time for patients and their fam-ilies, 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 sur-rounding this type of encephalitis, discuss the common symp-toms, treatment options and how the road to recovery can look for these patients. Furthermore, we will look at the nurs-ing 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 enfantsKatanya 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 mal-adie inflammatoire du cerveau causée par les anticorps et dans laquelle le système immunitaire « attaque » les tissus cérébraux sains, provoquant ainsi une inflammation. Premièrement diag-nostiquée en 2007, c’est une forme d’encéphalite relativement nouvelle, mais aussi la forme de maladie inflammatoire du cer-veau la plus couramment diagnostiquée. Cette maladie touche principalement les jeunes femmes et les enfants, la plupart d’en-tre 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 pos-siblement 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 néces-saires. Dans cet exposé, nous étudierons la pathophysiologie associée à ce type d’encéphalite ainsi que les symptômes cou-rants, les options de traitement et les allures que peut prendre le cheminement vers la guérison. Finalement, nous nous intéresse-rons 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

Challenging Families: Trials, Tribulations and TriumphsJennifer Boyd, RN, MHSc, CNN(C)

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 triomphesJennifer Boyd, IA, M.Sc.S, CSN(C)

Au cours de leur pratique, les infirmières et infirmiers en neu-rosciences pédiatriques travaillent en étroite coopération avec les familles. Ils tentent de construire des partenariats théra-peutiques 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 con-sidéré 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 partici-pants, cet exposé aura pour objet de décrire les caractéristiques des familles considérées comme difficiles, de déterminer les fac-teurs qui contribuent à des rencontres difficiles avec les parents et de faire le point sur les approches permettant de traiter avec ces familles difficiles.

D1 / A6

Brain of ZonesSue Kadyschuk and Katie Fink

Knowledge of neuro anatomy and physiology is essential in understanding neurologic function and dysfunction (Barker, 2008; Hickey, 2009) and, therefore, foundational to neuro-science 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 prac-tice. 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.

Gaming has been identified as an innovative learning strat-egy for nurses and holds advantages such as active partici-pation, 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). Neu-roscience 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 expe-rienced neuroscience nurses will benefit from participating in this presentation by adding new or revising current knowledge of neuro anatomy and physiology.


Un cerveau de zonesSue 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 infirm-iers en neurosciences de l’Association des infirmières et infirm-iers 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 péd-agogique des formateurs (Fitzgerald, 2008; Hamilton & Mor-ris, 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

qu’une participation active, une meilleure rétention des infor-mations, 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 repro-duire 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 opti-maux à leurs patients, mais ils doivent aussi dépendre les uns des autres pour résoudre des problèmes et prendre des déci-sions cliniques rapides.

Cette présentation prendra la forme d’un jeu dirigé qui favori-sera un apprentissage actif et la collaboration. Les participants travailleront en équipe afin de répondre à des questions de neu-roanatomie 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 neuro-anatomie et en physiologie à leur répertoire ou d’en réviser de plus anciennes.


Poster presentationsP1

Diabetes Education in the Stroke of Time: Advancing Best Practices in Stroke and Diabetes CareRussel Matias and Rachel Puriv

Diabetes increases the risk for stroke recurrence twofold and significantly increases post-stroke neurological deficits and functional disability (Sharma & Gubitz, 2013). As Type 2 Dia-betes is a modifiable risk factor for stroke, self-management education for patients and their caregivers is vital for second-ary 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 inpa-tients have a diagnosis of diabetes. To address this gap, a qual-ity improvement project was developed to empower bedside nurses through educational workshops to embed diabetes edu-cation 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 med-ication regimens, co-morbidities, tests and procedures. In my poster presentation, I will discuss the development, implemen-tation and evaluation of this project, as well as lessons learned.

P2

Delirium: A Medical EmergencySandra 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 con-tribute 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 geri-atric 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 delir-ium, including inconsistent use of delirium screening instru-ments 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.

P3

Gastrostomy Decision Making: What is there to Know?Rosa Sourial and Antonietta Vitale

At the Montreal Neurological Hospital, patient and family engage-ment 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 pro-cedure 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 meet-ings that it would be helpful to have time to reflect on this and to be provided with some more tangible information.

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, occupa-tional therapy, interventional radiology, gastroenterology and neurology). The development of a patient/family information brochure on decision making regarding gastrostomy tube inser-tion will be based on the findings of the processes.

P4

Neuro-Connect: An inter-site synapseClaire Nehmé, MScN, Lucy Wardell, N, MSc(A), and Lucia Fabijan, N, MSc(A)

Objective: To improve the communication between provid-ers at patient discharge from the emergency department (ED).

Background: Timely communication between health care pro-viders 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-hos-pital, 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 com-munication 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 commu-nication 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 dis-cussed as well as the implications of instituting standardized communication handoff systems to enhance patient safety and care quality at other centres.


P5

Promoting Rest using a Quiet Time Innovation in an Adult Neuroscience Step-Down UnitTara Bergner

Sleep and rest are fundamental for the restoration of energy needed to recuperate from illness, trauma and surgery. At pres-ent, hospitals are too noisy to promote rest for patients. A liter-ature 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 peace-ful and healing environment. In this paper, a description of the importance of quiet time and how a small, but feasible innova-tion 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 fam-ilies, 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 afficheAffiche 1

Des connaissances sur le diabète à point nommé : la promotion de pratiques exemplaires en matière de soins de l’AVC et du diabèteRussel 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 & Gub-itz, 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 édu-cation 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.

Affiche 2

Le délire : une urgence médicaleSandra 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 ris-que 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 gran-dissant pour notre population gériatrique. Il est clair que l’ap-parition 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 con-naissances, les aptitudes et le niveau de confort des profession-nels 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 rencon-tres, 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 docu-ments d’information devant aider les patients et les familles à prendre une décision. Ces procédés comprennent une anal-yse 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’inter-vention, gastroentérologie et neurologie). La brochure d’in-formation destinée aux patients et aux familles concernant les décisions à prendre au sujet de l’insertion d’un tube de gas-trostomie reposera sur les résultats de ces procédés.

Affiche 4

Neuro-Connect : une synapse intersiteClaire 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 univer-sitaire 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 per-sonnel 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 calmesTara Bergner

Il est essentiel de dormir et de se reposer afin de récupérer l’énergie nécessaire à se remettre d’une maladie, d’un trauma-tisme 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 favoris-ent 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 innova-tion modeste mais réalisable a été mise en place dans l’unité de soins courants en neurosciences pour adultes d’un import-ant 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


BackgroundStroke is the third leading cause of death in Canada, and the leading cause of neurological disability (Canadian Stroke Net-work, 2011). A stroke occurs when there is a lack of blood sup-ply 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

Canadians experience a stroke each year, or one every ten min-utes, 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

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

AbstractIntroduction: 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.

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

RésuméIntroduction : 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).

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.


Ontario and Registered Nurses’ Association of Ontario, 2005). This burden on the economy will continue to grow, as the num-ber 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 eas-ily 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 prac-tice. 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 reviewResearch 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 chal-lenge 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 out-comes (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 GuidelinesThe 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 Organ-ization (BPSO) candidacy process (RNAO, 2004). BPSOs are health care organizations that have committed to the imple-mentation 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 know-ledge, 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 exam-ining 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 prac-tice 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 communica-tion 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 finan-cial 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 imple-menting 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


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 imple-menting 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 TeamsThe 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 trans-fer” 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 suc-cessfully facilitate the understanding between individuals and groups. In health care settings, knowledge transfer is very com-mon. 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-pro-fessional health care providers are specifically trained to utilize KT strategies at the point of care to support the dis-semination, saturation and adoption of the respective RNAO BPGs. KTTs rely on best practice champions to communi-cate 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 guide-lines that, although not described as KTTs, reflect the KTT approach. These are: network cultures; development of out-reach; inreach models; and the use of stars, champions and

experts (Perry, 2006). Similar to KTTs, the network education described in the evaluation included staff sharing expertise, and maintaining relationships between the academic and clin-ical staff where they outlined problem solving approaches in diverse circumstances (Perry, 2006). Consistent with the research on effective implementation strategies by Rycroft-Malone 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 combina-tions of these approaches.

In the successful stroke best practices implementation described by Summers and Soper (1998), the hospital devel-oped a “collaborative care” approach supported by a team sim-ilar 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 clin-ical pathways for patients (Summers & Soper, 1998).

This evaluation contributes to the understanding of the effec-tiveness of a KTT program to implement BPGs, and the con-sequences 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.

PurposeThe purpose of this study was to evaluate and determine effi-cacy 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.

EthicsEthics 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 GuidelinesThe Knowledge Transfer Team (KTT) approach had several ele-ments 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.


MarketingThe marketing component of the implementation began in August 2010. The project lead updated staff on the progress of the implementation using posted announcements, staff meet-ings 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.

EducationThe 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 physiother-apist (PT), a unit manager, a nurse educator, an advanced prac-tice nurse and a patient care coordinator (PCC). The CNSS is a validated stroke assessment tool used to perform stroke assess-ments. 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 incom-plete or incorrect documentation of the stroke scale were provided with realtime one-to-one reviews. Ongoing staff chal-lenges 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.

DesignA 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 com-pared outcomes before the implementation and at six and nine months after implementation. The evaluation included both formative (improving the quality of the program) and summa-tive (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 questionsThe 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 implemen-tation 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 comple-tion 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?

EvaluationBoth 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 ques-tions were directed to elicit information about the strategies used, as well as perceived factors that facilitated or created bar-riers to implementation.

SampleThere 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 Mack-enzie 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 collectionThere 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.


Knowledge Transfer Teams and point-of-care staffThe 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 follow-ing the workshop, and at nine months following the work-shop. 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-effi-cacy 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).

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 opin-ions 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.

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 implemen-tation 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.

Finally, an interview lasting one hour by telephone was con-ducted with the project lead regarding the successes of the KTT strategy, barriers and limitations and general impressions.

Patients and familiesThree tools were utilized for patients and their families. The Client and Caregiver Readiness to Learn, the Patient Educa-tion 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 point-of-care staff. This aided staff in identifying patients’ and

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 com-pleted by point-of-care staff and/or any member of the team. The worksheet personalized the information pro-vided 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 ques-tionnaire in November and December 2011. The question-naire, created by the research team, assessed patient and caregivers’ satisfaction regarding the care and education they received.

Chart auditsCompliance 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.

Respondent Measure Date and Sample Size

KTT Staff Knowledge and Self-Efficacy

Sept 2010 (pre- and post-workshop), n=7

Nov 2011 (post-implementation), n=4

KTT Barrier Focus Group

July 2011, n=6

BPG Feedback Survey

Dec 2011, n=1

Point-of-Care Staff

Knowledge and Self-Efficacy

Oct-Dec 2010 (pre-implementation), n=9

July 2011 (refresher), n=6

Nov 2011 (post-implementation), n=8

Patient and Families

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

Chart Audits 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 docu-mentation 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.

AnalysisAll qualitative data were transcribed verbatim, and interpre-tive, 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-effi-cacy) were analyzed using t-tests.

FindingsThe findings presented below are organized by the broad eval-uation questions.

Process questionsWas 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 com-pletion 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 constraintsKTT members encountered difficulty in arranging meet-ings 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 mem-bers 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 implemen-tation, further constraining the time they had to devote to this initiative.

NoncomplianceThe 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 con-sent 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 barri-ers 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 reluc-tance to take on new responsibilities. KTT members mentioned that some staff members felt their compliance and participa-tion 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 sum-mer 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 bar-riers 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 implemen-tation of the BPGs.

How could the implementation be improved?The areas for improvement of the KTT approach mainly cen-tred 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 transi-tioned 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 Neurolog-ical 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.


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 iden-tified that more information was required from KTT mem-bers 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 Prac-tice Spotlight Organization (BPSO) project coordinators, posed a challenge in implementation.

Finally, there was a lack of financial support and budget restric-tions to fully support the stroke educators. Nevertheless, the project lead, members of KTT and point-of-care staff were suc-cessful 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 pro-fessions 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-learn-ing 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 mod-ules. 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.

Outcome questionsKTT 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 ano-nymity, 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-imple-mentation score on self-efficacy was 3.5 (SD = 0.20), suggesting a very high level of self-efficacy. All point-of-care staff (includ-ing the stroke KTT) was again asked to complete the self-effi-cacy 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 post-BPG implementation was 2.9 (SD = 0.77). This reflects a mod-erate 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 ano-nymity 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 satisfactionOf 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 trans-ferred 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 tele-phone 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 approxi-mately 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 ques-tions regarding strokes were answered. Overall, the majority of the respondents indicated that the information and educa-tion they received on stroke during their stay on the Integrated Stroke Unit at Mackenzie Health met their needs.

Clinical outcomesClinical 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 Assess-ment 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 doc-umented once or twice during the patient’s stay on the Inte-grated Stroke Unit, this information (e.g., CNS scores) was not assessed as often as it should be according to BPGs. Addition-ally, 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 addi-tional 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 documen-tation of CNS scores was sporadic. There was improvement in the nursing documentation in the second Wave, includ-ing 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 sam-ple size (n=2).

Of the 18 participants, only three (n=3) had documented tem-peratures 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. Documenta-tion 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 dia-betic 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 outcomeAs a result of implementing the BPGs in the ISU, a number of organizational outcomes were achieved. The following out-comes 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;


• 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 expe-riencing stroke.

DiscussionCreating 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 inter-professional health care team, and management. Colleagues discussed the recommendations, shared tips and challenges and taught each other skills required to complete stroke assess-ments. 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 knowl-edge of the BPGs on their part and knowledge transfer among colleagues.

The results clearly illustrate that all of the health care pro-fessionals 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 satis-faction 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 facil-itate 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.

Implications for KTT UtilizationAs the study results illustrated, the KTT approach was an effec-tive method of utilizing KTTs to implement and disseminate BPGs into clinical practice. Developing KTTs comprising mem-bers 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 prac-tice: 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 pro-vided 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 com-pensated. 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 exam-ple, to explore the benefits of utilizing KTTs to train and social-ize 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 long-term 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 authorsMina 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

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]

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Award, Bursary or Scholarship Guidelines Codman Award$1,500.00 from Codman

The Codman Award will be presented to the author or authors of a written paper, which demonstrates the achievement of excel-lence in the area of neuroscience nursing research. It is expected that the money will be used for professional development.

ELIGIBILITY1. 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.

CONTENT1. The paper is written according to the manuscript guidelines

for publication2. 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 prac-

tice, education, administration or research;5. The paper is relevant to current trends in neuroscience

nursing;6. Demonstrates comprehensive knowledge of the topic.

STYLE1. The paper is written according to the manuscript guidelines

for publication as established by the Canadian Journal of Neuroscience Nursing

SELECTION1. 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.

PRESENTATION1. A representative of the Codman Company presents the

award at the Annual Meeting.

PUBLICATION1. The completed paper must be submitted to the editor of

CJNN, or designee (e.g., peer reviewer) at the Annual Meet-ing for publication;

2. The monetary portion of the award will be withheld until publication in CJNN.

Medtronic Award$1,000.00 Travel Grant from Medtronic

The Medtronic Award will be presented to the author or authors of a written paper that demonstrates the achievement of excel-lence 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.

ELIGIBILITY1. 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.

CONTENT1. 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.

STYLE1. The paper is written according to the manuscript guidelines

for publication as established by the Canadian Journal of Neuroscience Nursing.

SELECTION1. 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 with-hold the award if no paper meets the specifications;

3. The Scientific Program Committee must receive papers for consideration by February 15.

PRESENTATION1. A representative of the Medtronic Ltd. will be on hand at the

Annual Meeting to present the award.


CJNN, or designee (e.g. Peer reviewer) at the Annual Meet-ing 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 Cana-dian Association of Neuroscience Nurses (CANN) who demon-strates 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 Foun-dation of Canada, the award includes the publication of the win-ner’s paper in the Canadian Journal of Neuroscience Nursing.

ELIGIBILITY1. At least one of the author(s) is a general/honorary mem-

ber of the Canadian Association of Neuroscience Nurses (CANN) and was a general/honorary member in the pre-ceding year.

2. The author 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 in the year the award is being presented.

4. The paper contains original work by the author(s). 5. The paper may be an adaptation from a previous work by

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.

CONTENT1. The paper is approached from a nursing perspective.2. The paper is relevant to care of patients with brain tumour.3. The author(s) presents a logical development of ideas based

on scientific evidence.4. The author(s) demonstrates creativity and originality.5. The paper has implications for neuroscience nursing prac-

tice, education, administration or research.6. The paper is relevant to current trends in neuroscience nurs-

ing with brain tumour patients.7. The paper demonstrates comprehensive knowledge of the

topic.

STYLE1. The paper is written according to established guidelines for

the writing of a manuscript as per Canadian Journal of Neu-roscience Nursing (CJNN) guidelines.

2. The paper shall not exceed 20 double-spaced typed pages.

SELECTION1. 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.

PRESENTATION1. A representative of the Brain Tumour Foundation of Can-

ada will present the award at the Annual Meeting and Sci-entific Sessions. Complimentary Conference registration is provided to the Brain Tumour Foundation of Canada representative if the award is being presented in that par-ticular year.


CJNN, or designate (e.g., peer reviewer) at the Annual Meet-ing for publication.


Jessie Young Certification BursaryThe Jessie Young Certification Bursary was established to pro-mote 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.

ELIGIBILITY1. 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 pub-lished 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 DEADLINE1. The closing date for receipt of applications for the Jessie

Young Certification Bursary is May 31 each year.

Marlene Reimer Research AwardThe Marlene Reimer Research Award was established to pro-mote 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 deter-mined yearly. The award may be awarded to one or more indi-viduals depending on available funds.


1. Research funds will be allocated yearly based on numbers of requests;

2. Application deadline is November 1 annually3. The total Marlene Reimer Research Award will be $2,000

plus the net profit from the Run for Research of the previ-ous 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 elec-tronically 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 insti-

tution/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 find-

ings 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 deci-sion is made and official recognition will be given at the annual meeting luncheon;

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 AwardThe 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 Sci-entific Sessions. This award provides funding for one confer-ence 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 Foun-dation of Canada Award for Excellence in Neuroscience Nursing) are eligible for the New Authors’ Award or Gen-eral 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 gen-eral 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 addi-tional sheet). _________________________________________________________________________________________________

_____________________________________________________________________________________________________________

Are you applying or have you received monies from other sources of funding? No Yes If yes, name sources and amounts received:_______________________________________________________

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: ____________________________

Canadian Journal of Neuroscience Nursing

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.

Le journal canadien des infirmiers et infirmières

en neurosciencesRéglements de publication

dans le JCIIN1. Le Journal canadien des infirmiers et infirmières en neu-

rosciences 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 con-sulter 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 révi-seurs 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 impli-cations 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 cérébrovascu-laire (ACV)

■■ Les médicaments sont nommés utilisant le terme générique écrit en lettres minuscules et le nom commer-cial écrit entre parenthèses.

Documents

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