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Best practice guidelines, although a recent phenomenon, have become a global movement in nursing. Scholars, practitioners, healthcare organizations, governments and the nursing associations have a unique opportunity to enhance quality and demonstrate joint accountability to patients, the healthcare system and the public as a whole. This article offers insight into the Registered Nurses Association of Ontario (RNAO) Nursing Best Practice Guidelines Project. Funded as a multi-year project by the Ministry of Health and Long-Term Care in 1999, the RNAO project is leading nursing's best practice guideline movement in Canada and reaching others abroad.

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This study identified informational needs of stroke survivors and their family members as perceived by themselves and by health professionals. The source of information, and the desired source for future information were also explored. Green's Precede-Proceed model was used as a theoretical framework. In the study 35 stroke survivors, 39 family members and 43 health professionals participated. The results show that stroke survivors and family members indicated to desire the most information regarding reducing the chance of a new stroke. Stroke survivors rated as the major gaps of information: reducing the chance of a new stroke and coping with stress. Family members rated as the major gaps of information: sources to apply for help; strategies to perform activities of daily living, and reducing the chance of a new stroke. Stroke survivors and their family members expressed as the most desired source of information the doctor in the hospital. Health professionals expressed a high level of concern about the amount of information stroke survivors and family members receive; they expressed a substantial need for information about all topics for both groups, which should be provided by several sources. Some needs are recognized, but in most cases not met. Family members of stroke survivors who suffered more than one stroke seem to have received more information--and to desire less. Both highly educated stroke survivors and family members indicate to have received less information and desire more information than lower educated respondents.

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Rehabilitation for persons with head injuries is a multifaceted process that requires structure, consistency, and predictability. This article discusses the process followed by nurses on one rehabilitation unit to revise a standard nursing workload measurement tool to reflect the physical, cognitive, behavioral, and psychosocial needs of patients with traumatic brain injury (TBI). Family education and support, a critical component of care, was also addressed. The flexibility of the tool, known as GRASP, allowed the incorporation of neurobehavioral items based on the Rancho Los Amigos cognitive functioning scale and the inclusion of important therapeutic nursing interventions. The revised tool reflects the time required to deliver comprehensive nursing care to TBI patients and, thus, promotes the desired rehabilitation outcomes for patients and their families.

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This paper presents a model of professional nursing in organizations that provides cohesive direction to the development of patterns that shape how nursing is structured in an organization. Such cohesive direction can foster integration between the practice and the discipline components of nursing. The model can influence the structure of nursing on a macro level within the organization and on a micro level by influencing patterns of nursing care delivery. A set of values, assumptions, dimensions, constructs, principles and propositions have been identified and brought together in this model. As a framework, it can be used to shape the structures and processes that contribute to professional nursing excellence in practice settings.

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Cerebrovascular accident is a major cause of morbidity and mortality in adults, and occurs more frequently in persons with diabetes. The numerous resulting cognitive, perceptual, communicative, and motor disturbances present a challenge to the individual's ability to learn and carry out aspects of diabetes care and other personal care activities. Different educational strategies can be used depending on the impairments that are present and the needs of the individual. The major goal of these interventions is to help the individual achieve an optimal level of independence, emotional well-being, and overall quality of life. After a thorough assessment to identify the remaining abilities, the educator should collaborate with clients and their families to plan and implement ability enhancing and ability compensating strategies.

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Urinary incontinence is a common issue in the treatment of adults with head injuries, but it is frequently neglected by healthcare professionals. Because the problem is treatable, early intervention is recommended. This article presents a systematic and comprehensive approach to bladder management. This management program includes three main interventions: fluid management, establishment of a micturition schedule, and use of a behavioral approach based on positive reinforcement. These interventions can be used independently or simultaneously, depending on the nursing assessment.

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