The World Health Organization defines the quality of care as “the extent to which health care services provided to individuals and patient populations improve desired health outcomes.”
Nurses Specialized in Wound, Ostomy and Continence Canada has evolved substantially since the first set of standards of practice were published in 1997 in what was formerly the Canadian Association of Enterostomal Therapy. In this case study, we explore aspects of these revised standards’ development and publication and highlight five lessons to take to the next project.
Elevating standards
The Standards of Practice aim to support clinical practice based on informed evidence to improve the care and management of people living with wound, ostomy and continence challenges.
“Revision of the NSWOC Standards of Practice every five years enables the organization to reflect the evolving health care environments, patient and caregiver needs, and educational achievements of the NSWOC. Regular revision is also a requirement of the Canadian Nurses Association (CNA) for ongoing nursing specialty certification,” described committee chair Debra Johnston. “These practice standards demonstrate why the CNA has recognized the Wound, Ostomy and Continence Institute with the 2020 Employer Recognition Award for exemplary support of CNA-certified nurses and the CNA Certification Program.”
Download the NSWOC Standards 3rd edition here
16 Standards
These 16 new standards of practice are a poignant reminder of how the role and organization of nurses in Canada has evolved. The pandemic in 2020 forced many established practices to be re-examined, adapted, and refined. Each of the 16 standards begins with an introductory statement to provide context to the content within.
The Quadruple Aim was introduced to the committee by Wajma Attayi and this became a foundational part of the document. Originally developed by the Institute for Health Improvement the Quadruple Aim framework applies interventions and care provided by an NSWOC to improve measurable health care outcomes, including:
- decreased number of patient visits;
- improved patient health and well-being;
- fewer emergency department visits and readmissions;
- decreased health care costs; and
- in turn, improved experiences of the provider and significant others.
The graphic of the 16 standards at the beginning of the document provides a visual representation. It also helped highlight in orange the four new standards that were developed for this 3rd edition. The four new standards are:
- collaboration;
- patient safety/quality improvement;
- professional accountability; and
- Indigenous cultural safety.
Patient-centred care is fundamental to the care provided by an NSWOC, and as such, patient-centred care is embodied as an essential component of each standard. Other standards concerning privacy and technology could be researched and considered for the 4th edition.
Standards dissemination
Overall, 95% of the reviewers stated that they would recommend these standards to NSWOC colleagues in Canada.
NSWOCC CEO Cathy Harley has a comprehensive implementation strategy. Work has also begun to translate the standards into French. The standards were launch in February 2021. There will be a presentation on the standards at the NSWOCC national conference on May 14, 2021.
To register for the NSWOCC conference here
5 lessons from the development of these standards
There should always be lessons learned in every project. Things that you would do differently next time around. There is usually a next time and it is worthwhile to take the time as a project concludes to write these down.
- Replicate fostering the personal connection between the committee members or task force.
- Double check each email send to the committee to ensure that changes in email addresses or inclusion of new members are current.
- Seek broader representation on the committee and among peer-reviewers so that all parts of Canada and health settings where applicable are included.
- Assign work through small sub-groups with a designated team lead.
- Implement a six-month post launch to assess the success of the implementation.
Standards of Practice are critical for all health care disciplines as they support clinical practice based on informed evidence to improve the care and management of patients. Revision of the NSWOC Standards of Practice every 5 years enables the organization to reflect the evolving health care environments, patient and caregiver needs, and educational achievements of the NSWOC. Regular revision is also a requirement of the CNA for ongoing nursing specialty certification. As a testimony to John’s adaptability and relatability to our project, although not a nurse himself, he was able to appreciate and articulate the provincial nursing practice nuances and scopes of practice within our profession to help direct and shape our revised Standards. With his leadership, we were able to complete this project 3 months in advance of the deadline.
Debra Johnston, MN, BScN, RN, NSWOC, WOCC(C)
Download the NSWOC Standards 3rd edition here
It was a pleasure working with this dynamic standards committee. The work began just before the committee members were overwhelmed with the first wave of COVID in Canada. Debra brought a connection to the group over Zoom by recognizing the member’s personal triumphs, including two baby boys, a wedding and Canadian citizenship. We also had a final celebratory call with the committee to thank them for their commitment. Thank you to the whole committee, Debra for her leadership, and Wajma Attayi who synthesized the research and guided us to the Quadruple Aim. Natasha Wilson once again produced some beautiful artwork.
Work has now begun on a urinary diversion position statement, which is a collaboration between the Canadian Urological Association, Urology Nurses of Canada and NSWOCC. In parallel, Opencity Inc is also project managing the production of the Operating Room Nurses Association of Canada (ORNAC) Standards, Guideline and Position Statements for Perioperative Registered Nurses.
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