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stroke rehabilitation

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181. Reducing Foot Complications for People with Diabetes

Nurse Integrated Cancer Program London Health Sciences Centre London, Ontario Sharon Brez, RN, BScN, MA(Ed), CDE Advanced Practice Nurse The Ottawa Hospital Ottawa, Ontario Lillian Delmas, RN, BScN, CRRN Nurse Clinician The Rehabilitation Centre Ottawa, Ontario Penny Fredrick, RN, CDE Diabetes Nurse Educator Peterborough Regional Health Centre Peterborough, Ontario Robin Hokstad, RN, CDE Diabetes Nurse Educator Nipissing Diabetes Resource Centre North Bay, Ontario Margaret Hume, RN, MScN, CDE (...) of Toronto Toronto, Ontario Sandi Dennison, RN Diabetes Nurse Educator Diabetes Wellness Centre Windsor, Ontario Paula Doering, RN, BScN, MBA Director Medicine – Mental Health The Ottawa Hospital Ottawa, Ontario 4 Reducing Foot Complications for People with DiabetesNicola Dorosh, RN Public Health Nurse North York, Ontario Maureen Dowling, RPN Clinical Nurse The Rehabilitation Centre Ottawa, Ontario Marilyn Elliot, RN, CRRN Clinical Nurse The Rehabilitation Centre Ottawa, Ontario Richard Gauthier, RN

2004 Registered Nurses' Association of Ontario

182. Promoting Continence Using Prompted Voiding

, nature and consistency of bowel movements. ¦ Any relevant medical or surgical history which may be related to the incontinence problem, such as but not limited to diabetes, stroke, Parkinson’s disease, heart failure, recurrent urinary tract infections or previous bladder surgery. 3.0 Review the client’s medications to identify those which may have an impact IV on the incontinence. 4.0 Identify the client’s functional and cognitive ability. III 5.0 Identify attitudinal and environmental barriers (...) , but does not include briefs. Toileting is for the purpose of voiding and not for just changing of briefs. Urinary incontinence is the involuntary loss of urine that is sufficient to be a problem, and may present as any of the following types: Transient incontinence is urine loss resulting from causes outside of or affecting the urinary system such as acute confusion, infection, atrophic urethritis or vaginitis, medications, psychological conditions, restricted mobility or stool impaction. Urge

2002 Registered Nurses' Association of Ontario

183. Care and Maintenance to Reduce Vascular Access Complications

of the vascular access site; ¦ Facilitate delivery of prescribed therapy; and ¦ Prevent dislodgement, migration, or catheter damage. Patency/Flushing/ 7.0 Nurses will maintain catheter patency using flushing and IV Locking locking techniques. 8.0 Nurses will know what client factors, device characteristics and infusate factors IV can contribute to catheter occlusion in order to ensure catheter patency for the duration of the therapy. Occlusion 9.0 Nurses will assess and evaluate vascular access devices (...) for occlusion in order to IV facilitate treatment and improve client outcomes. Blood Withdrawal 10.0 Nurses will minimize accessing the central venous access device (CVAD) in IV order to reduce the risk of infection and nosocomial blood loss. Add-Ons 11.0 Nurses will change all add-on devices a minimum of every 72 hours IV Documentation 12.0 Nurses will document the condition of vascular access devices including: III ¦ The insertion process; ¦ Site assessment; and ¦ Functionality. Client Education 13.0

2005 Registered Nurses' Association of Ontario

184. Assessment and Management of Venous Leg Ulcers

fracture or other major leg injury, previous vein surgery, varicose veins, or prior history of ulceration with/without use of compression stockings. History of episodes of chest pain, hemoptysis, or history of a pulmonary embolus. Lifestyle factors (e.g., sedentary lifestyle, chair-bound), obesity, poor nutrition. An assessment for signs indicative of Non-Venous Disease also includes: Family history of non-venous etiology. Heart disease, stroke, transient ischemic attack. Diabetes mellitus (...) . Peripheral vascular disease (PVD)/intermittent claudication. Smoking. Rheumatoid arthritis. Ischemic rest pain. A combination of the features described above may be indicative of mixed arterial/venous disease (RCN, 1998). Discussion of Evidence: Several clinical studies show strong support for the need for thorough history taking for assessment of venous insufficiency (NZGG, 1999; RCN, 1998). The New Zealand Guidelines Group (1999) further suggests assessing the history of the ulcer, the mechanism

2004 Registered Nurses' Association of Ontario

185. Practice Education in Nursing

BACKGROUND Practice Education in Nursing S. Alloy-Kommusaar, RN Registered Nurse, Supervisor Extendicare Van Daele Sault Ste. Marie, Ontario Marilyn Ballantyne, BScN, MHSc, PhD Chief Nurse Executive/Clinician Investigator Holland Bloorview Kids Rehabilitation Hospital Toronto, Ontario Marika Bellerose, NP Nursing Practice Consultant First Nations & Inuit Health Branch - Ontario Region Sioux Lookout, Ontario Debbie Bruder, BA, RN, MHS Clinical Informatics Specialist Grand River Hospital Kitchener, Ontario (...) & Transformation Specialist Bluewater Health Sarnia, Ontario Mary Anne Krahn, RN, BScN, MScN, EdD(c) Programs Chair, School of Nursing Fanshawe College London, Ontario Lisa Lallion, RN, BScN, MN, CNS, CMSN(c) Clinical Nurse Specialist The Scarborough Stroke Clinic Scarborough, Ontario Jinhee (Jin) Lee, BScN, RN Registered Nurse and Former RNAO student rep from McMaster University Kelowna General Hospital Kelowna, British Columbia Newton Leong, RN, BScN Staff Nurse St. Michael’s Hospital Toronto, Ontario Vikky

2016 Registered Nurses' Association of Ontario

186. Risk Assessment and Prevention of Pressure Ulcers

of Canada, London, Ontario Dr. Marisa Zorzitto Regional Geriatric Service, West Park Healthcare Centre, Toronto, Ontario RNAO also wishes to acknowledge the following organizations in Ottawa, Ontario, for their role in pilot testing the original guideline: SCO Health Services The Rehabilitation Centre of the Royal Ottawa Health Care Group St Patrick’s Nursing Home Perley Rideau Centre of the Royal Ottawa Health Care Group Hôpital Montfort Saint Elizabeth Health Care VHA Home Healthcare RNAO sincerely (...) should be considered. – Level Ib 3.12 Institute a rehabilitation program, if consistent with the overall goals of care and IV the potential exists for improving the individual’s mobility and activity status. Consult the care team regarding a rehabilitation program. Discharge/Transfer 4.1 Advance notice should be given when transferring a client between settings IV of Care Arrangements (e.g., hospital to home/long-term care facility/hospice/residential care) if pressure reducing/relieving equipment

2002 Registered Nurses' Association of Ontario

187. Delirium, Dementia, and Depression in Older Adults: Assessment and Care, Second Edition

) Regional Clinical Nurse Specialist, Rehabilitation & Geriatrics Programme, Winnipeg Health Region Adjunct Professor, College of Nursing, Faculty of Health Sciences, University of Manitoba Research Associate, Manitoba Centre for Nursing and Health Research Winnipeg, Manitoba Registered Nurses’ Association of Ontario Expert PanelBACKGROUND Delirium, Dementia, and Depression in Older Adults: Assessment and Care, Second Edition Registered Nurses’ Association of Ontario Expert Panel ...con’t Philippe Voyer (...) London, Ontario Lisa Janisse, RN, BScN, MScN Nursing Professional Scholarly Practice/Manager London Health Science Centre London, Ontario Stacey Jonhson, RN, MN Quality Lead Health Quality Ontario Toronto, Ontario Lisa Lallion, RN, BScN, MN, CNS, CMSN(c) Clinical Nurse Specialist The Scarborough Stroke Clinic Toronto, Ontario24 REGISTERED NURSES’ ASSOCIATION OF ONTARIO BACKGROUND Delirium, Dementia, and Depression in Older Adults: Assessment and Care, Second Edition Jeannette Lindenbach, RN, MScN

2016 Registered Nurses' Association of Ontario

188. Assessment and Management of Pressure Injuries for the Interprofessional Team, Third Edition

to the resources listed in Appendix D. Th is Guideline is designed to help interprofessional teams become more comfortable, confi dent, and competent when caring for people with existing pressure injuries. It is intended for use in all domains of health care (including clinical, administration, and education) across health-care settings (including acute care, rehabilitation, long-term care, out-patient clinics, community care, and home care). It focuses on the core competencies and the evidence-based (...) to and after every wound care intervention, using the same valid and reliable tool consistent with the person’s cognitive ability. V ? Recommendation 1.7: Perform a vascular assessment (i.e., medical history, physical exam) of all persons with pressure injuries in the lower extremities on initial examination. V ? Recommendation 1.8: Conduct a mobility and support surface assessment on initial examination and whenever there is a signi? cant change in the person’s medical condition, weight, equipment

2016 Registered Nurses' Association of Ontario

189. Assessment and Management of Pain (Third Edition)

were interprofessional, made up of people who held clinical, administrative and academic roles in a variety of health-care organizations. They work with clients of all ages in different types of care – acute, long-term and home health care, mental health and addictions G , rehabilitation and community services. The participants of the focus groups outlined outstanding resources including books, guidelines, position papers, and care pathways developed to meet the needs of specific populations (...) Darlene Davis, RN, MN Health Services Manager, Pain Services Capital District Health Authority Halifax, Nova Scotia Céline Gélinas, RN, PhD Assistant Professor Ingram School of Nursing McGill University Researcher and Nurse Scientist Centre for Nursing Research and Lady Davis Institute Jewish General Hospital Montreal, Quebec Nicholas Joachimides, RN, BScN, CRN(c), MCISC Clinical Educator Holland Bloorview Kids Rehabilitation Hospital T oronto, Ontario Salima S. J. Ladak, RN(EC), MN Nurse Practitioner

2013 Registered Nurses' Association of Ontario

190. Professionalism in Nursing

(Registered Practical Nurse) Stroke Data & Evaluation Specialist Hamilton Health Sciences Hamilton , Ontario Susan Grant, RN, BScN Professional Practice Leader Ross Memorial Hospital Lindsay, Ontario Julie Gregg, RN, BScN, MAd Ed Coordinator Member Relations and Development College of Registered Nurses of Nova Soctia Halifax, Nova Scotia Lucie Grenier, RN, BAA, MAP Directrice Générale Adjoinite-affaires cliniques Centre hospitalier affilie Universitaries de Quebéc Québec City, Québec Debbie Hanna-Bull, RN (...) Health Surrey, British Columbia Carmen Millar, MScN, MAP Director of Nursing Hopital Charles LeMoyne Greenfield Park, Québec Toba Miller, RN, MScN, MHA, GNC(C) Advanced Practice Nurse The Ottawa Hospital – Rehabilitation Centre Ottawa, Ontario Deborah Mings, RN, MHSc, ACNP, GCN(C) Clinical Nurse Specialist St. Peter's Hospital Hamilton, Ontario Gail Mitchell, RN, BScN, MScN, PhD Associate Professor York University Toronto, Ontario Mitzi Grace Mitchell, RN, GNC(C), PhD(c) Lecturer York University

2007 Registered Nurses' Association of Ontario

191. Establishing Therapeutic Relationships

and the nurse is observed in this phase (Sundeen et al., 1989). Vignette: A 72-year-old male client is being discharged from a stroke rehabilitation in-patient program. The nurse has worked with the client and his family over the past couple of months. A pressing concern is planning for in-house supports and discussing community resources that have now been accessed. The final meeting is planned between the nurse and client to review the progress that has been made and the future plans. Both use (...) be biological, psychological and/or socio-contextual; Symptoms; Standard interventions and issues of rehabilitation; Pharmacology-in order to administer, monitor, and instruct; and Knowledge of best practices. 6. Knowledge of the broad influences on health care and health care policy. The nurse needs to have knowledge of the forces that may influence the context of the client’ s care: Social and political forces; The client’s expectations of the health care system; How the health care professional

2002 Registered Nurses' Association of Ontario

192. Supporting and Strengthening Families Through Expected and Unexpected Life Events

, and death, while unexpected life events may include trauma/accidents, chronic illness, developmental delay and disability . The guideline also includes recommendations for connecting nurses with families, in order to be able to assist families during these events. Lastly, this guideline includes recommendations for nurses and other health care providers to advocate for changes in the health care system. The nursing best practice guideline focuses its recommendations on: Practice Recommendations directed (...) ” process. The guideline was further refined taking into consideration the pilot site feedback and evaluation results. 14 Supporting and Strengthening Families Through Expected and Unexpected Life Events15 Nursing Best Practice Guideline Definition of Terms Acute Care Setting: An institution providing services to clients with acute needs (physical and psychological). Rehabilitation and palliative care can be a part of the acute care setting. Clinical Practice Guidelines or Best Practice Guidelines

2002 Registered Nurses' Association of Ontario

193. Integrating Tobacco Interventions into Daily Practice

(Reid et al., 2015). Based on current tobacco use rates, the 21st century will see one billion tobacco-related deaths globally (World Lung Foundation, 2015). The impact of tobacco use on public health remains extremely high. Furthermore, there are direct and indirect health-care costs as the use of tobacco is also a risk factor for serious acute and chronic illnesses, including cancer, stroke, and heart and lung diseases. In Canada, the health and economic costs associated with tobacco use (...) Edition Figure 1: Brief Intervention Flow Chart ^ These interventions should be done in addition to providing support relevant to context (in-patient vs. community). * In-patient setting refers to all settings where clients are admitted (including hospital, long-term care home, psychiatric, or rehabilitation facilities). ** Community setting refers to health promotion settings that are outside of hospital (clients are not admitted). ~ In-patient behavioural interventions (such as counselling support

2017 Registered Nurses' Association of Ontario

194. Pelvic Girdle Pain in the Antepartum Population: Physical Therapy Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability, and Health From the Section on Women's Health and the Orthopaedic Section of the American Full Text available with Trip Pro

. The organization and classification of the document can guide research to address the paucity of evidence especially in the interventions with this population. 1 Embody Physiotherapy & Wellness, LLC, Sewickley, Pennsylvania ; Department of Physical Therapy , University of Pittsburgh, Pittsburgh, Pennsylvania; and Department of Physical Therapy , Chatham University, Pittsburgh, Pennsylvania. 2 Oncology Rehab, Centennial, Colorado. 3 Department of Physical Therapy , Chatham University, Pittsburgh, Pennsylvania (...) course of PGP, impairments are failing to normalize, and the symptoms are worsening with increased disability. This should include the presence of transient osteoporosis and diastasis rectus abdominis (DRA) as possible comorbidities in this population, as well as the presence of pelvic floor muscle, hip, and lumbar spine dysfunctions. (Recommendations are based on strong evidence.) | Imaging Studies: F In the absence of good evidence, expert opinion and foundation science may be used to guide

2017 American Physical Therapy Association

196. Preventing Falls and Reducing Injury from Falls, Fourth Edition

, & Lemaire, 2013). Further research is needed regarding the feasibility of these technologies in daily life settings (Ejupi et al., 2014; Howcroft et al., 2013). Step Test Setting: rehabilitation Population: patients in post-stroke rehabilitation A clinical test of balance that requires stepping one foot on and off a 7.5-cm step as quickly as possible for 15 seconds and recording the number of completed steps (testing both legs and recording the lowest score). May be used in conjunction with clinical (...) adults with balance and gait impairments or frailty, living in the community and in institutional settings, but not necessarily to people with certain conditions such as Parkinson’s disease, stroke, dementia, and other cognitive impairments (Okubo et al., 2016).107 BEST PRACTICE GUIDELINES • www.RNAO.ca APPENDICES Preventing Falls and Reducing Injury from Falls — Fourth Edition TYPE OF TRAINING OR EXERCISE INTERVENTION DEFINITION POTENTIAL BENEFITS Tai chi (alternate names: taiji, tai chi chuan

2017 Registered Nurses' Association of Ontario

197. Knee Pain and Mobility Impairments: Meniscal and Articular Cartilage Lesions Full Text available with Trip Pro

to return to activities; and monitor changes in the patient's status throughout the course of treatment. Examination — Physical Impairment Measures 2018 Recommendation Clinicians should administer appropriate physical impairment assessments of body structure and function, at least at baseline and at discharge or 1 other follow-up point, for all patients with meniscus tears to support standardization for quality improvement in clinical care and research, including the modified stroke test for effusion (...) improvement in clinical care and research, including the modified stroke test for effusion assessment, assessment of knee active range of motion, maximum voluntary isometric or isokinetic quadriceps strength testing, and palpation for joint-line tenderness. Interventions — Progressive Knee Motion 2018 Recommendation Clinicians may use early progressive active and passive knee motion with patients after knee meniscal and articular cartilage surgery. Interventions — Progressive Weight Bearing 2018

2018 American Physical Therapy Association

198. Core Set of Outcome Measures for Patients with Neurologic Conditions Full Text available with Trip Pro

of 243 standardized measures in clinical practice, education, and research. Each task force developed recommendations for specific patient subgroups (eg, acute, subacute, and chronic stroke) and across a variety of health care settings. This work may have enhanced the quality of rehabilitation by providing clinicians with a substantial amount of summarized information for each OM for the target patient population. However, due to the large number of OMs reviewed and recommended, it is unlikely (...) adult neurologic rehabilitation . Collaboratively, clinicians and patients should decide how the results should guide the plan of care. | METHODS The steps outlining the process of review and determination of the core set are shown in . The GDG consisted of 3 PTs (J.M., K.P., and J.S.) with expertise in outcome measurement. Two of the team leaders (J.S. and K.P.) served as Chair of the ANPT's EDGE task forces for stroke and multiple sclerosis, respectively. The third (J.M.) led the development

2018 American Physical Therapy Association

199. Delirium in Older People

or the inability to lift both arms. Cardioembolic stroke (OR 5.58) and total anterior circulation infarcts (OR 3.42) were more likely to develop delirium. Post-stroke delirium is associated with greater 6 and 12 month mortality, and reduced functional status and higher institutionalisation at 12 months. The usual predisposing factors contributing to delirium apply to surgical patients however some specific risk factors need consideration. Trauma or unplanned surgery such as fractured neck of femur carries (...) effectiveness established in one randomised controlled trial. 57 Atypical antipsychotics have been shown to be comparable to haloperidol in terms of efficacy. 58, 59 There is no significant difference in efficacy within the class of atypical antipsychotic medications. 60 Atypical antipsychotics have less extrapyramidal side effects and should be considered for delirious patients with an extrapyramidal syndrome. However, there is evidence of harm from antipsychotics including ischaemic stroke 61 and evidence

2012 Australian and New Zealand Society for Geriatric Medicine

200. Management of chronic pain

risk of myocardial infarction and coronary heart disease death whereas this has not been observed with naproxen. In the same meta-analysis, all NSAIDs were associated with an increased risk of heart failure, but there was no evidence of an increased risk of stroke. 62 B NSAIDs should be considered in the treatment of patients with chronic non-specific low back pain. B Cardiovascular and gastrointestinal risk needs to be taken into account when prescribing any non-steroidal anti-inflammatory drug (...) , diarrhoea, oedema, dry mouth, rash, dizziness, headache, and tiredness. 58-60 COX-2 selective NSAIDs had fewer side effects than traditional NSAIDs (RR 0.83, 95% CI 0.70 to 0.99). 58 Gastrointestinal (GI) adverse effects are well-established risks of long-term regular NSAID treatment. This has been compounded by emerging evidence showing an increased risk of cardiovascular disease, stroke and heart failure. The risk of serious upper GI events differs significantly between NSAIDs. 61 The greatest risk

2013 SIGN

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