Saturday, November 4, 2017Ritz-Carlton Hotel, Toronto

CANIBD: Standards of IBD Nursing PracticeBarbaraCurrieMNRN-NPQEIIHealthSciencesCentreHalifax,NovaScotia

First impressions…

Canyouseeyourpracticereflectedinthesestandards?

Exercise• Divideinto6groups(6-8/table)• Eachgroupwillbeassignedastandardtoreview(informationonyourtable)

• Designateascribe• Writedowneverythingthatcomestomind• Donotspendyourtimecritiquingthestandard…thatwillcomelater

• Onememberwillreportdiscussionpointstogroup

GroupsGroup1– KnowledgeClinicalCare

IBDN

Group2– Knowledge ClinicalCare

APIBDN

Group3– SupportivePatient

CenteredCareIBDN

Group4– SupportivePatient

CenteredCareAPIBDN

Group5– QualityCareAssurance– KeyResponsibilitiesof

IBDN

Group6– EvidenceBasedPractice– Leadership

Next steps…• Standardscommittee

willreviewandcompilefeedbackanddistributealongwiththeSOPdocument(emailtomembership)forfinerreview.

• MemberswillhaveopportunitytoprovidefurtherfeedbackthenstandardswillberevisedandresenttomembershipforanelectronicvoteofapprovalbyendJanuary2018.

Thank-you

Group1: Clinical Care IBDN• Possessesin-depthknowledgeofgastrointestinaltractandetiologyandpathogenesisofIBD

andassociatedconditions• UnderstandsmedicalandsurgicaloptionsinIBDincludingbenefit,riskandmonitoringfor

efficacyandcomplication.• Abilitytouseknowledgetoformulateandnegotiatetreatmentplanswithpatients• Isamemberofamultidisciplinaryteamassuchtheymustestablishacollaborativeapproach

totheprovisionofcareofIBDpatients.• Shouldhaveregularaccess(preferablyweekly)tokeymembersoftheIBDteamtodiscuss

complexpatientneeds(Medical,surgical,nutritional)andindividualizepatientsplan.• Individualpatientsplansofcaremayinclude,butarenotlimitedto:restoringhealth(smoking

cessation/weightmanagement),maintainingandstabilizinghealth(medicaltreatment),preventingillness(immunizationupdates),injuryanddisease(Cancerscreening),alleviatingsuffering,andprovidingsupportivecareforthosewhoaredying.

• Participatesinstrategiestopromotehealthycommunities.• Collectspreliminaryscreeningforpossiblebiologicmedicationuse,suchasTBtesting,viral

diseasescreening,immunizationscreening,andimmunizationrecommendations• Isinformedandcanshareinformationonrisksandbenefitsoftreatment,monitoring

requirementsandsharetimeestimatesfortheattainmentofexpectedoutcomes.• Participatesinthedevelopmentofstandardoperatingprocedurestofacilitatecontinuityof

careandconsistency.• Documentsindividualpatientoutcomesaccordingtoexpectedgoalsinaretrievableformat• Activelyparticipatesinthedevelopmentandcontinuousimprovementofsystemsthat

supporttheplanningprocess• PromotesarelationshipbetweentheIBDN,multidisciplinaryteam,andpatienttoimprove

healthcareoutcomesandadherencetothetreatmentplan• Assistspatientandfamilyinidentifyingandsecuringservicestoaddressneedsacrossthe

healthcarecontinuumfactoringcostindecisionsabouttreatmentandcare

Group2: Clinical Care APIBDN• Initiatesandinterpretsdiagnostictestsandproceduresrelevanttothe

patientscurrentstatus• Systematicallycomparesandcontrastsclinicalfindingswithnormaland

abnormalvariationsinformulatingadifferentialdiagnosis• Identifiesexpectedoutcomesthatincorporatescientificevidence,cost,

clinicaleffectivenessandpatientsatisfaction• UtilizesCanadianAssociationofGastroenterologyconsensusguidelinesto

guidecareplanning• Assumesresponsibilityforsafeandefficientimplementationoftheplan.• Providesleadershipincoordinationofinter-professionalhealthcaresuchas

dietarycounsellingorsocialworkreferral,forintegrateddeliveryofcareservicesforthepatient.

• Drawsonknowledgetoaddresscomplexissueswithpatientse.g.sexuality,pregnancy,alteredbodyimage,agerelated,financialandemployment.

• Abletomakecomplexdecisionswherepatientsdonotfollowconventionalapproachestocare

• Considerscosteffectiveness,costbenefitandefficiencyassociatedwithpatientcare.

• Criticallyevaluatesthemannerinwhichhealthissuesarepresentedbythepopularmediaandclarifiesthisinformationforpatientsandtheirfamilies.

Group 3: Supportive Patient Centered Care IBDN• Providescareinamannerthatpreservesandprotectsthepatientsautonomy,dignity,

rights,valuesandbeliefs• Recognizesthepatientandfamilyascoremembersofthehealthcareteam• Usesthenursingprocesstoimplementcareprogrammesbasedonlocalorganisational

objectives,relevantguidelines(provincial,CSGNA,CANIBD)andcurrentevidence.• Providespatientswithinformationdescribingtheclinicalserviceinvolvedintherecare

andhowitcanbeaccessed(phoneore-mailcontactpoint)• Providespatientswithinformationandeducationtoempowerthemtobeactivein

decisionmakingprocess• Sharesexpectation’softimefromcontactwiththeIBDNtothepatientreceiving

informationregardingtheirconcernshouldbeprovided(withinonebusinessday)• Wheretherearealternativeoptions,informationandsupportshouldbeofferedto

patientstoenablethemtoshareindecision-makingregardingtreatment.• Helpspatientsnavigatethehealthcaresystemandrolesofmultidisciplinaryteam;

identifiesandfacilitatescontactwithalliedhealthproviders:dietary,socialwork,stomatherapists,publichealth,pharmacist,biologiccoordinator,

• Provideshealthteachingthataddresseshealthylifestyleandriskreducingbehaviours:smokingcessation,nutritionprograms

• SeeksopportunitiestoassesseffectivenessoftherapeuticstrategiesusedandtopromoteadherencetotreatmentSharesinformationreintendedeffectsandpotentialsideeffectsofmedicaltherapyandliaiseswithappropriatecareproviderifconcernsarisetoaddressconcerns

• Providesinformationonreputablewebsites(Crohn’sColitisCanada),andhowtodistinguishbetweenevidenceandtestimony.

• EducatespatientandmultidisciplinaryteamontheroleoftheIBDNinmanagementdisease.

Group 4: Supportive Patient Centered Care APIBDN• Synthesizesempiricalevidencereriskbehaviours

(ETOH/marijuana/prescriptiondrugmisuse),learningtheories,behaviouralchangetheories,motivationaltheories,andepidemiologywhendesigninghealtheducationinformationandprograms

• Considerscomparativeeffectivenessandriskwhenconductingpersonalizedhealthteachingandcounselling

• Evaluatesandparticipatesinthedevelopmentofhealthinformationresourcesforaccuracy,readability,andcomprehensibility

• Engageswithpatientadvocacygroupsinhealthteaching,healthpromotionandequitablehealthcare/accesstoresources

• Participateswithpatientinshareddecisionmakingwhenappropriateandnegotiatingresponsibilities

• ParticipatesinMDTthataddressethicalrisks,benefits,andoutcomes(patientswithhighrisklifestyleschoices,clinicaltrialparticipation,endoflifediscussions)

• Initiatesreferraltootherhealthcareprofessionalsasrequired.• Participatesinrapidaccessclinicsforpatientswithexacerbation

IBD

Group 5: Quality Care Assurance

• IsinformedofandstrivestoachievequalitycareindicatorsoutlinedbyCrohn’sColitisCanada(indevelopment)

• DemonstratesqualitybydocumentingtheapplicationofthenursingprocessandcommunicatingconcernstoappropriatemembersoftheMDT.

• Usescreativityandinnovationtoenhancenursingcare• Treatmentwithimmunosuppressiveorbiologictherapies

shouldonlybeinitiatedbyclinicianswithexpertiseinthereuseforIBD.Sharedprotocolsshouldbedevelopedtosupportprescribingandmonitoringofthesetreatments.

• ParticipatesinnursingprocesstoworkwithMDTinaddressingpatientsclinicalconcernsandfacilitatingcareinthecommunityoradmissiontohospitalasappropriate.

• ParticipateswithMDTintransitioningpatientsbacktothecommunityfromhospitalcareandensuringtimelyfollow-upwithappropriatemembersofMDT.

• Arrangementsshouldalwaysbemadeindiscussionwiththepatient.

Group 5: Review key responsibilities of the IBDN• Toassessthegastrointestinalstatusofpatientsintheoutpatientclinicandinitiateand

monitorinvestigationsandtreatmentwhereappropriate.Standardoperatingproceduresareexpectedtobedevelopedatalocalleveltosupportthispracticewithinthefullscopeofpracticeofthenurse.

• TheIBDNwillworkcloselywithallmembersofthemulti-disciplinaryhealthcareteam–referringpatientstotheappropriatedisciplineastheirindividualneedsdictate.

• TheIBDNwilloftenbeworkingcloselywithpatientsdischargedfromhospitaltothecommunityandequallywillbethelinkwithcommunitystaffwhenanIBDpatientisadmittedtohospital.

• TheIBDnursewillactasaresourceforothermembersofthehealthcareteam,advisingonappropriatecareandconductingnursingeducationsessionstoincreaseawarenessofthecondition.

• ItisimportantthattheIBDnursetakestheleadonthesettingofstandardsofcareforpatientswithinflammatoryboweldisease.

• TheIBDnursewillneedtobeaccessibletobothpatientsandotherstaffmembers.• TheIBDnurseshouldbeinvolvedinco-ordinatingthesharedbiologicscreening

programme betweenhospitalandcommunityforallpatientsonimmunosuppressive/biologictreatments.

• TheIBDnurseshoulddeveloppatienteducationsessionstoempowerpatientswithaccurateknowledgeandcopingstrategies.

• TheIBDnursewillworkverycloselywithnursesinboththehospitalandthecommunityinhelpingtoassess,planandevaluatenursingcareforpatientssufferingfrominflammatoryboweldisease.

Group 6: Evidence Based Practice

TheIBDN• TheIBDNshouldbeexpectedandenabledtoparticipateinlocal

andnationalprofessionaleducationtoensureandmaintaincompetencyandknowledgeinthisfastdevelopingsubspecialty.

• Participatesinand/orundertakesownresearch• Patientsshouldbegiventheopportunitytoparticipatein

clinicaltrialsandpatientledresearch,toprovidesamplesforethicallyapprovedresearch,andindevelopmentofpatientidentifiededucationtools.

TheAPIBDN• Shouldhaveaccesstomedicalsupportandnursingsupervision• Publishesbestpracticefindings

Group 6: LeadershipTheIBDN• Supportsthedevelopmentandimplementationofanationalstrategyforthedevelopmentof

IBDservices.• PromotestheimplementationofIBDstandardstoregionalandnationalhealthorganisations.• Ensuresimplementationofaformaltransitionprogrambetweenpaediatricandadultcare• SupportspilotprojectsforadultambulatoryIBDservicesinruralareas• Ensuresthedevelopmentofclinicalandpatientreportedoutcomemeasuresthatwillsupport

quality,safetyandcosteffectivenessofIBDservices.• Participatesinthedevelopmentandpresentationofnursingandpatienteducational

programs• HasaclearvisionofhowanIBDserviceshouldfunctionwithinthelocalhealthcarepolitical

structure• Identifiesserviceneedsandactivelyparticipatesininfluencingservicedevelopment• Assumesresponsibilityfornurseledclinicsandtelephonehelplines.• Engagesinteamworkandteam-buildingprocess

TheAPIBDN• Worksasanautonomouspractitionermanagingworkloadefficiently• Identifieslimitationswhichmayaffectservicecapacity• ParticipatedinthedevelopmentofregionalandnationalIBDstandardsandqualitycare• Invitesthecontributionofpatients,familyandmultidisciplinaryteamtoachieveoptimal

outcomes• Promotesadvancedpracticenursingandroledevelopmentbyinterpretingroleforpatients,

familiesandothers• Mentorscolleaguesintheacquisitionofclinicalknowledge,skills,abilitiesandjudgement.• ServesasapreceptorforadvancepracticestudentsinIBD