Overview of Knowledge Integration Project


The KI study evolved from three previous studies that incorporated the Transitional Discharge Model of care: Bridges to Discharge Pilot Study (Hamilton), The Transitional Discharge Model pilot study (Scotland), and Therapeutic Relationships: From Hospital to Community (Southern Ontario). The KI study was concerned with integrating evidence-based research into clinical practice. This three-year project examined strategies for the introduction of a best practice related to transitional discharge care into selected psychiatric settings.

According to the literature, translation of research knowledge is essential to the research process (CIHR, 2002). During the course of this project, structures and processes supportive of Knowledge Translation were identified. Knowledge Translation can be defined as "the exchange, synthesis and ethically-sound application of knowledge -- within a complex system of interactions among researchers and users -- to accelerate the capture of the benefits of research for Canadians through improved health, more effective services and products, and a strengthened health care system" (CIHR, 2002). The resulting Knowledge Translation framework was implemented and tested through the implementation of an empirically supported transitional discharge model. The KI study focused on identifying strategies and barriers that influenced the implementation of the Transitional Discharge Model (TDM) on clinical wards whereas the previous studies (Forchuk, 2005; Reynolds et al, 2002, 2004) were determining the cost and effectiveness of using the TDM of care.

The KI study involved a variety of wards from six different hospital sites: At the point of discharge, clients were approached by staff and provided the opportunity to participate in the KI Study. Clients were eligible to participate if they were on an extended LOA or an LOA leading to a later discharge date. Clients were interviewed at the point of discharge and one-month post discharge to determine the degree of implementation of the TDM in current discharge practices.

The primary quantitative outcome was the degree of implementation of the TDM amongst each participating ward. Other Quantitative staff measures included staff quality of work life, client functioning, ward length of stay, and re-admissions. Ethnographic qualitative analysis explored and described the usefulness of each implementation strategy and the evolving process in each ward. Successful strategies were useful across stakeholder groups and in different countries.

A Program Evaluation Model with a Delayed Implementation Design was used to identify the barriers and facilitators to implementing the TDM. This design allowed for both "between ward" and "pre/post intervention" comparisons. Wards were divided into three separate groups: A, B, and C. Focus groups were completed with staff of the intervention wards from the previous Therapeutic Relationship study (Group A). Various challenges were identified such as boundary issues, barriers and tension with professionals (hospital vs. community), lack of resources involving clients, clinicians, peer support volunteers & community based services, support from others in the workplace, and the need to integrate communication and documentation into daily practice.

At the time, there were nine modules in TDM training that the staff completed:
  • Introduction to TDM and Best Practices
  • Therapeutic Relationships
  • Bridging and Peer Support Specialists
  • Therapeutic Boundaries
  • Transitional Discharge Planning
  • Telephone Practice
  • Bridging Safely
  • Bridging and Crisis Intervention
  • Partners and Resources
Based on the feedback from A wards, TDM education was revised for B wards. In training, the B wards identified the usefulness of online modules, case scenarios, and a resource person based out of the hospital. B wards focus groups identified potential barriers for implementation including the need for policy development on the management level, resistiveness from peers, time constraints in workload, and continued uncertainty of roles within the model. Introduction of the TDM on the C wards used strategies outlined by group B wards. After education with C wards, staff agreed with both A and B group findings. In addition, C wards identified barriers such as competing educational demands, "turf" issues across disciplines, and organizational restructuring. Overall, staff from all three groups found the need for more time to evaluate the impact of the TDM approach as well as an understanding of the views of clients, Consumer/Survivor groups, and community agency representatives.

References

Canadian Institutes of Health Research (CIHR). (2002). http://www.cihr-irsc.gc.ca/.

Forchuk,C., Martin, M.L., Chan, Y.L., Jensen, E. (2005). Therapeutic Relationships: from psychiatric hospital to community. Journal of Psychiatric and Mental Health Nursing, 12, 556-564.

Forchuk, C., Hartford, K., Blomqvist, A., Martin, M.L., Chan, Y.L. & Donner, A. (2002). Therapeutic Relationships: From Hospital to Communtiy: First Year Results. Report to the Canadian Health Services Research Foundation, Ottawa.

Reynolds W., Lauder W., Sharkey S., Macivier S., Veitch T. & Cameron D. (2004, 2002). The effect of transitional discharge model for psychiatric patients. Journal of Psychiatric and Mental Health Nursing, 11, 82-88.