Providing continuing education to support a change in practice for a busy Emergency Department poses a challenge. Factors such as shift work, high patient acuity, and unpredictable patient flow create barriers to traditional methods of delivery of a comprehensive educational experience. This article describes an experience with introducing a change in practice using an innovative Web-based delivery plan. Specific strategies were employed to address presentation of content, application of knowledge, establishment of a shared understanding, and enhancement of communication opportunities. The Web-based learning environment proved to be a successful means of providing nurses with a collaborative learning experience around a new practice issue. This experience also highlighted the need for a new skill set for learners and educators using online learning technologies.
Background
The COVID-19 pandemic has presented a unique opportunity to explore how health systems adapt under rapid and constant change and develop a better understanding of health system transformation. Learning health systems (LHS) have been proposed as an ideal structure to inform a data-driven response to a public health emergency like COVID-19. The aim of this study was to use a LHS framework to identify assets and gaps in health system pandemic planning and response during the initial stages of the COVID-19 pandemic at a single Canadian Health Centre.
Methods
This paper reports the data triangulation stage of a concurrent triangulation mixed methods study which aims to map study findings onto the LHS framework. We used a triangulation matrix to map quantitative (textual and administrative sources) and qualitative (semi-structured interviews) data onto the seven characteristics of a LHS and identify assets and gaps related to health-system receptors and research-system supports.
Results
We identified several health system assets within the LHS characteristics, including appropriate decision supports and aligned governance. Gaps were identified in the LHS characteristics of engaged patients and timely production and use of research evidence.
Conclusion
The LHS provided a useful framework to examine COVID-19 pandemic response measures. We highlighted opportunities to strengthen the LHS infrastructure for rapid integration of evidence and patient experience data into future practice and policy changes.
Background:
As the level of acuity of pediatric hospital admissions continues to increase, additional pressure is being placed on hospital resources and the nursing workforce.
Local Problem:
Currently, there is no formalized approach to care for high-acuity patients on our pediatric inpatient unit.
Methods:
We used a qualitative descriptive design, guided by the Theoretical Domains Framework and Capability, Opportunity, Motivation-Behaviour (COM-B) model, to conduct focus groups and interviews with clinicians and administrators to identify potential barriers and enablers to implementing a high-dependency care (HDC) model. An HDC model focuses on the relationship between adequate nursing staff resources and patient acuity to improve patient health outcomes.
Results:
Participants identified the need for clear guidelines and supportive physical structures to facilitate HDC implementation. Anticipated benefits included enhanced nursing confidence and family-centered care.
Conclusions:
Study findings highlight multilevel factors to consider prior to implementing an HDC model on a pediatric inpatient unit.
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