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Interprofessional Practice Based Research


Names and roles: Cecilia Santiago, manager of Nursing Practice; Heather MacDonald, occupational therapist

Project title: Improving the care of patients who exhibit responsive behaviors; an evaluation of an Interprofessional educational workshop

March 25, 2019

Improving the care of patients with dementia who exhibit responsive behaviours

The hospital can be a confusing and stressful place. This is particularly true for patients with dementia, delirium and other neurological conditions who have cognitive impairments, which can result in confused thinking and reduced awareness. The unfamiliar surroundings or the loss of preferred routines can be a lot for patients to handle. As a result of environmental stressors, some patients may “act out” in what is known as responsive behaviours - which could include yelling, resisting essential care, or trying to leave against medical advice. Demonstrating responsive behaviors can place patients and staff at risk.

Understanding and reacting to responsive behaviours can be challenging for clinicians, who often report feeling a lack of confidence in providing effective care in such situations. Cecilia Santiago, a manager of Nursing Practice, Lori Whelan, a consultant in Leadership and Organizational Development, and Heather MacDonald, an occupational therapist, aimed to address this by developing a tailored interprofessional educational program. This program included introducing clinical tools and processes to aid in the care of patients who exhibit responsive behaviours. They then studied the impact of their program on clinicians’ perceived knowledge, self-efficacy, team collaboration and use of care plans in caring for persons with responsive behaviors."

“Currently, little is known about the efficacy of focused interprofessional education on the ability of clinicians in the acute hospital setting to manage responsive behaviours, or about the sustained impact of interprofessional education on practice change,” said Cecilia. “Interprofessional collaboration is integral to achieve enhanced practice opportunities for clinicians and improved care for patients who exhibit responsive behaviours.”

This education initiative aimed to transform how clinicians viewed these patients; from seeing them with fear and avoidance to seeing them as unique individuals with needs and experiences. The results of this study indicate that this educational program not only improved care, but also equipped clinicians with new knowledge and skills to manage responsive behaviours. Cecilia explained that “learning from the initial rollout of the managing responsive behaviours (MRB) program in general internal medicine, we tailored the program for the trauma neurosurgery and the cardiovascular patient population. So far, 479 clinicians have received the MRB education. Components of the MRB program were also embedded in the subsequent development of the constant care program.  We also launched the MRB rounds to provide a supportive team forum to problem solve care planning of patients with complex and challenging behaviours using a case-based learning approach that integrates the use of MRB tools and processes.

Connecting with IPBR

The Interprofessional Practice Based Research program at St. Michael’s Hospital assists nurses and health disciplines professionals at St. Michael’s Hospital engage in the identification, implementation, and evaluation of best practices through research. Cecilia Santiago and Lori Whelan were recipients of a 2015-17 Interprofessional Practice Based Research Grant. This grant provides research funding and mentorship.

“The IPBR grant provided us seed money to carry out the multiple aspects of our evaluation, and provided an opportunity to make research more accessible to front line clinicians. The IPBR team created the manuscript bootcamp which provided me a quiet space and dedicated time for manuscript writing. The team also provided us valuable feedback in our manuscript.”

  • Cecilia Santiago, nursing practice manager at St. Michael’s Hospital

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