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SYSTEMS LEADERSHIP

A CASE STUDY HIGHLIGHTING SYSTEMS LEADERSHIP: SYSTEMS THINKING IN LONG-TERM CARE

Created by Izabela Kanzana, DNP, RN

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As an Advanced Practice Registered Nurse in a Long Term Care (LTC) facility you provide care to 10 residents on Unit A. Every time you are on that floor during lunch time the majority of residents are sitting in wheelchairs and eating their lunch at tables in the dining room. You have looked at several research studies that point to inactivity of residents as a major risk factor contributing to disability and the relationship between increased walking activity and higher functional performance and quality of life. You are curious whether those residents have severe physical limitations keeping them from walking. Your facility has a Walk to Dine program, led by the facility’s restorative nurses. How many residents are able to walk? Is it safe for them to walk? When do they walk? Who assists them with walking? How far do they walk? You are motivated to engage in a project as you have identified an important practice problem. Because the evidence is strong that physical activity is the solution, you know that a QI project to implement the evidence into the process on your unit is the right way to go. The Medical director agrees with you that walking has potential benefits even in LTC.

QUESTIONS

1.  Who would be on your QI team? Which members will be the most important to interview?You know that restorative nurses are in charge of Walk to Dine program for residents. You interview restorative nurses and they do not know how many residents are enrolled in Walk to Dine program. They do not know how often residents walk to meals and how far residents walk.

2.  What would be helpful baseline data?

3.  What might your goals be for your improvement project?

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