A video-recorded, actor simulation aimed at developing Advanced Practice Nursing (APN) competencies for quality and safety in care transitions for stroke patients. The simulation focuses on the role of the APN in the context of an interprofessional integrated stroke care team coordinating the care of an older adult living with stroke and other comorbidities. The scenario evolves through two scenes which will include two care transitions: 1) acute care hospital to rehab hospital; and 2) rehab hospital back to home in the community.

Learning Outcomes 

1. Describe the importance of having a specialized interprofessional stroke care team to ensure safety and quality of care through hospital to home care transitions  
2. Apply knowledge of best practices to optimize patient safety in clinical practice 
3. Demonstrate behaviours supportive of a patient safety culture, safety risk, teamwork, communication, and quality improvement  

APN Practice Competencies

• Leadership
• Quality and Safety
• Optimizing health system competencies
• Interprofessional consultation and collaboration

Simulation Characters

• CNS
• PT
• OT
• SW
• Patient 

Setting

Scene 1: Takes place in an inpatient stroke unit in an acute care hospital 

Scene 2: Takes place in an inpatient rehabilitation unit of a rehab hospital

Theoretical Perspective

This simulation considers several frameworks and best practices which inform interprofessional integrated stroke care and the role of the Advanced Practice Nurse within the stroke care team. Key underlying principles include the following:

• Integrated stroke care includes both acute and rehabilitation care to patients with stroke. Stroke units provide patients with access to stroke expertise to support patients through all phases of their stroke journey from acute care in hospital to rehabilitation and reintegration back into the community. Strong evidence and best practices for stroke care in Canada indicate that a stroke unit should have a dedicated interprofessional team with expertise in stroke care. Team members should include: physicians, nurses, occupational therapists, physiotherapists, speech-language pathologists, social workers, dietitians, patients and family members (Heran et al. 2022). Additional team members may also include APNS such as Clinical Nurse Specialists (CNS), pharmacists, psychologists, spiritual care providers, recreation and peer and caregiver support groups.
• Stroke Care Transitions across health sectors require partnerships between acute care and rehabilitation facilities, community-based stroke rehabilitation and community services. Safe care transitions across sectors require ongoing, effective interprofessional communication and collaboration between healthcare teams. (Markle-Reid et al. 2020; Bookey-Bassett, 2023, in press)
• Quality and Safety of stroke care includes ongoing collecting and analysis of process and outcome data (locally, regionally, and nationally) and strategies to support ongoing quality improvement to address gaps in service delivery. There is no one single definition of quality – however, the Institute of Medicine (2001) describes quality in healthcare as “being safe, effective, patient centred, timely, efficient and equitable.” Quality improvement refers to the systematic use of various tools and techniques to improve patient care and associate healthcare processes (Adams, 2018).
• Healthcare Excellence Canada’s Safety Competencies Framework (Canadian Patient Safety Institute, 2020) can be used to guide quality improvement and safe stroke care transitions. The 6 competency domains include:
  • Patient Safety Culture
  • Teamwork
  • Communication
  • Safety Risk, and Quality Improvement
  • Optimize Human and System Factors
  • Recognize, Respond to and Disclose Patient Safety Incidents
• Within the Advanced Practice Nursing Pan-Canadian Framework (2019), APNs (e.g.,  Clinical Nurse Specialists, Nurse Practitioners) require competencies for direct comprehensive care, optimizing health systems, education, research, leadership, consultation and collaboration. APNs contribute to health system optimization through advocacy, promoting innovative client care and facilitating equitable, client-centred health care. APNs implement improvements in health care, including delivery structures and processes. APNs also identify gaps in the health system and develop strategies to facilitate and manage change. See Appendix A, Sample CNS Role Description.