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Could patients with spinal cord injuries (SCI) progress faster, if they incorporate more therapy into time spent on their units?
That's the question Gillian Johnston, a physiotherapist (PT) at Toronto Rehab's Lyndhurst Centre, asked when she looked at the disconnect between what patients were working on in physiotherapy – such as learning how to transfer themselves from a wheelchair to a bed – versus what they were incorporating into day-to-day practice on their units.
"I felt like we could be providing more opportunity for therapy throughout the day, and that patients would progress faster if we did," says Gillian.
This extension of therapy was ideal for Jana Lazor, a patient who was motivated to maximize her rehab journey.
"I wanted to practise transfers as much as possible, but I had only developed that sense of trust with Gillian," Jana says.
That all changed when her unit piloted patient-specific transfer training – a formal process of teaching nurses, at the bedside, how to support a patient's individual transfer training.
Now back at home, Jana says the additional practice accelerated results, eased anxiety, and increased her confidence.
"Going home is a scary transition, and the ability to transfer in and out of bed on my own is huge," she says.
"Having had as much opportunity as possible to improve my transfers helped me say, 'I can do this.'"
Traditionally, staff use a mechanical lift or basic transfer to help patients in and out of bed. It's not until a patient is more independent – often toward the end of their stay – that individualized, more therapeutic transfers are practiced on the unit.
The problem with basic transfers is that they don't necessarily offer therapeutic benefits.
"There's a difference between putting someone in bed and making it significant to their rehab goals," says Gillian.
For example, setting up a transfer that encourages use of the right leg versus the left, supports a patient's goal of strengthening their right leg.
While an initial survey of staff showed support of providing transfer training earlier on the unit, it also revealed that some staff lacked confidence in their ability to do it safely.
So Gillian formed a multidisciplinary committee of PTs, occupational therapists, nursing professional practice leaders, and educators, to address challenges and standardize a training process.
Empowering patients and TeamUHN
The process they developed is now kick-started each day in morning huddle, when the question, "are there any opportunities for transfer training or retraining," is raised.
If the answer is yes, members of the care team meet at the patient's bedside, to practice in a collaborative environment.
They repeat this training until everyone – including the patient – is comfortable adding their names to the "Transfer Champion" list above the bed.
"Once your name is on the list, the next staff member to come along can approach that team member for training, without having to rely solely on the PT." explains Gillian.
Patients and staff both report an increase in confidence around transfers.
"The worst fear we have as patients is that we'll fall – and we've worked too hard to get here, to injure ourselves again," says Jana.
"But collaborating with my team made me feel safe."
According to a survey gathered post-implementation, staff comfort in performing transfers has grown from 18 per cent to 63 per cent.
"Nurses generally like to get involved in helping patients progress to the next step," says Michael Pollard, a registered nurse.
"Training and support from our interprofessional team has definitely helped increase our confidence to do so."
Enhancing the rehab experience and realizing results sooner
Patient-specific transfer training will have been implemented on all units at Lyndhurst by year end.
While evidence continues to be collected, to help quantify the impact of this early intervention, staff and patients agree that it enhances the rehab experience.
According to Jana, her transfers really took off, as soon as she started practising on the unit.
"When I arrived at Lyndhurst, I was completely dependent on a mechanical lift to get in and out of bed," she says.
"But less than two weeks after starting in the gym, I was incorporating it into my daily practice with my nurses, and getting faster every day."
Gillian says that in the absence of earlier transfer training on the unit, it would have been incorporated much later in her 12-week stay.
The ability to enhance a patients' rehab experience is what's most rewarding for Gillian.
"When you identify a gap and think, 'we're not helping this person as much as we could,' and then figure out a way to make it happen, it reminds us why we're all here."