Leveraging an Educational Intervention to Support Full Scope of Nursing Practice and Enhance Integrated Primary Healthcare at a Canadian Mental Health Hospital
Author(s): Cristina de Lasa, Elnathan Mesfin, Eleanor Lam, Sherida Chambers, Alfredo Ramirez, Tania Tajirian
Description:
Individuals with severe mental illness experience premature mortality from physical health challenges1. At the Centre for Addiction and Mental Health, patients are cared for by an interdisciplinary team (IDT), with psychiatrists as the main responsible physicians and hospitalists addressing their physical health. Collaboration between nurses and physicians is vital as they play an essential role in inpatient care delivery2.
Hospitalist feedback revealed a high number of declined referrals led to frustration, ineffective workflows, and delayed patient care; highlighting the need to review the hospitalist referral process with nurses. An IDT where nurses are encouraged to use expertise, clinical knowledge and skills provides high job satisfaction and fosters excellence in nursing care3,4.
We aimed to advance integrated IDT care, empower full scope nursing practice, and reduce the number of declined hospitalist referrals by 25% on pilot units by October 2023. Nurse educators delivered training on reviewing hospitalist notes, utilizing nursing medical directives, performing focused physical nursing assessments, checking for duplicate referrals, and requesting allied health service referrals. Administration of anonymous pre- and post-training surveys assessed knowledge change regarding topics covered and identified learning gaps. A retrospective chart review was conducted to evaluate the number of total and declined hospitalist referrals.
Surveys showed increase in knowledge and comfort in topics covered, while 3-month post-intervention analysis revealed a 38% and 12% reduction in total and declined hospitalist referrals respectively. 6-month post-intervention analysis is ongoing to assess sustainability and guide organizational scaling, including planned IDT qualitative surveys and thematic analysis of declined hospitalist referrals.