Nursing Best Practice Research Centre

Advancing care through knowledge

Other Projects

Evidence-Informed Nursing Service Delivery Models

Aims of Research Program

To examine the emergence of Evidence-informed Nursing Service Delivery Models (ENSDM) and their uptake within the health care system. We define an ENSDM as a transformative model for health services delivery that crosses health care sectors, involves multiple strategies, engages decision-makers (organizational, regional) in supporting implementation and is primarily delivered by or involves the work of nurses. It entails the proactive use of evidence-informed implementation strategies both within and between organizations so as to enhance the rapid uptake of nursing clinical practice guidelines by practitioners and organizations.

Program Objectives

To understand how an evidence-informed change model develops in the health care system; to describe how ENSDMs diffuse across the health care system and what they cost; and to examine factors that support, sustain and impede intra-and inter-organizational systems change. The research platform for this research program is the ongoing RNAO Nursing Best Practice Guidelines (BPG) initiative, which began in Ontario in 1999 and has expanded to several other provinces in Canada and to other countries. The BPG initiative is funded by the Ontario Ministry of Health and Long-term Care (MOHLTC) on a multi-year basis. Change models of national interest are emerging from the RNAO Initiative.

Potential Contribution to Policy and Decision-Making

Decision-makers in health care service delivery organizations, regional health authorities (LIHNs in Ontario) and government must have information on the cost of new service delivery models, the means by which successful models can be more rapidly deployed throughout the health care system, the features of successful models, and variations in these models that better fit the contextual realities of delivering services across sectors (acute, long-term and community care) and in differing geographic environments (e.g. urban versus rural). However, this information is often lacking. This program of research addresses some of these key necessities, by examining a natural “experiment” of a change process.

Guiding Theoretical Framework

An integrated socio-ecological model, informed by three inter-related theories will guide the program of research. While this model provides a framework for generating project-specific propositions, it also addresses a profound gap identified in the literature on evidence-based practice: the need for “whole-system” research that is necessarily multi-level, to increase our understanding of how to improve the implementation and dissemination of evidence-informed best practices.

Co-Principal Investigators

  • Nancy Edwards RN PhD (Researcher), Professor, CHSRF/CIHR Nursing Chair, University of Ottawa School of Nursing, Dept. Of Epidemiology & Community Medicine;
  • Doris Grinspun RN, PhD(c) (Decision-Maker), Executive Director, Registered Nurses Association of Ontario (RNAO)

Researcher Co-Investigators (12)

Angela Downey PhD CMA FCMA, University of Lethbridge; David Sharp ACMA MA (Oxon) PhD, University of Western Ontario; Ali Dastmalchian BA MSc PhD, University of Victoria; Whitney Berta BSc MBA PhD, University of Toronto; Barbara Davies RN PhD, University of Ottawa; Kathy Higuchi RN PhD, University of Ottawa; Jenny Ploeg RN PhD, McMaster University; Jennifer Skelly RN PhD, McMaster University; Ian Graham PhD, University of Ottawa; Ariella Lang RN PhD, University of Ottawa; Patricia Marck RN PhD, University of Alberta; Cecile Michaud RN PhD, Université de Sherbrooke, Campus de Longueuil

Decision-Maker Co-Investigators (7)

Irmajean Banjok RN MScN PhD, RNAO; Sheila Block BA MA(Econ), RNAO; Judith Ritchie RN PhD, McGill University Health Centre; Tazim Virani RN MScN PhD(c), RNAO; Heather McConnell RN BScN MA(Ed), RNAO; Ann Lynch RN BScN MSc(A), McGill University Health Centre; Stephanie Lappan-Gracon, RN MN, RNAO

Incontinence in mid-life women: Developing evidence-based tools to aid in communication and decision

An estimated 1.5 million Canadians experience urinary incontinence, most of who are women. It is difficult to estimate the fecal incontinence as many people are reluctant to admit they have a problem. Early research has shows that women are not well informed or well prepared to discuss incontinence with their physician or other health providers. This may be related to feelings of embarrassment, not knowing enough about incontinence and not having information about the potential treatment options. With funding from Echo: Improving Women's Health in Ontario (an agency of the Ministry of Health and Long-Term Care), a research team led by Dr. Jennifer Skelly and Dr. Tazim Virani, are conducting a two phase study.

Purpose of the study:

To assemble evidence and then use it to create a tool(s) for Ontario women to assist them in discussion and decision-making with their health care providers related to their urogenital health needs and treatment preferences for urinary (stress, urge, and mixed) and fecal incontinence.

Research Questions:

What are the decision-making needs of women experiencing incontinence? What are the perceived benefits/challenges in using the developed decision aid to meet women's communication and decision-making needs? What are the recommendations from key informants on how to support women in their decision support requirements? The research team members are: Principal Investigators: Dr. Jennifer Skelly Dr. Tazim Virani Co-Investigators: Dr. Donna Fedorkow Dr. Dawn Stacey Dr. Irmajean Bajnok Mrs. Rishma Nazarali Two Consumer Members Doctoral Student: Ms. Yasmin Parpio Research Assistant: Ms. Angela Joyce Progress of the study will be posted in this website on a regular basis. Correspondence can be direct to Dr. Tazim Virani at