Presenter: Ruta Valaitis (co-PI)

Building Community Health Capacity through the Development of an Online Community of Practice for Street/Outreach Nurses in Ontario Presenter: Ruta Valaitis (co-PI) Research Team: Dyanne Semogas (co-PI), Noori Akhtar-Danesh, Fiona Brooks, Anne Childs, Cathy Crowe, Wendy Muckle, Patricia Austin, and Sally Binks CPHA Annual Conference Halifax June 1-4th,2008

Supported by:

Objective • To describe the use of a participatory design approach to the development of an online (virtual) community of practice for street and outreach nurses in Ontario.

Communities of Practice “…those communities that are formed by people who engage in a process of collective learning in a shared domain of human endeavour.” (Wenger, 2004)

A Community of Practice: The Elements • Domain: the issue that unites people and drives their learning • Community: the people involved in the domain • Practice: the activities that the community shares Wenger, McDermott, & Snyder, 2002

Community of Practice Domain: The nursing care of homeless and underhoused clients Community: Street and outreach nurses in Ontario Practice: Solving practice problems, implementing best practice, sharing experiences, advocating for access to care and social justice

Participatory Design • An offshoot of Action Research (AR) • The aim of AR is to integrate theory, research, and practice • End users collaborate with researchers in the design of tools that they will use in real-life work contexts. • Is an iterative process Clemensen, Larsen, Kyng, & Kirkevold, 2007

Scenarios in Participatory Design • Scenarios: “Stories about people and their activities” (Carroll, 2000) • Inform the design and refinement of tools that people use in their activities: makes use explicit

Scenario Exercise in VCoP Project • Think tanks held with street and outreach nurses in Toronto, Hamilton, Ottawa, and Sudbury • Participants were asked to create a persona and several scenarios

Persona & Scenarios Persona: typology of a street nurse • Characteristics • Work context • Activities over a typical day Scenarios: situations that brought the persona to the VCoP, how he/she used the VCoP in his/her work

Findings What are the characteristics of street nurses? • Flexibility • Knowledge • Physical strength • Tolerance • Commitment to social justice

Findings What is the context of street nursing? • Initial contact with health care system for homeless, underhoused persons: advocacy, facilitation • Strong focus on primary health care (mental health, substance use, infectious and chronic disease management) • Peer engagement, knowledge exchange, support

Findings What do street nurses want in a VCoP? A safe place to share : • Information on clinical trends and best practice • Narratives/ stories • Critical alerts

Findings What do street nurses want in a VCoP? • Reduce isolation • Validation of practice • Image sharing • Learning from other regions • Sharing resources and information

Validation of practice “ finding out that you’re not a bad nurse. So that idea that common things are common, other people feel the same thing”. Support for nurses new to role “I wanna just say, I think this is really, really, really awesome and very exciting, because I’m a new grad basically, I was a new grad, and I’m just recognizing more and more, especially now I have my degree, in that nurses don’t talk to each other, they don’t … they help each other but being so short staffed, and being so overworked, and being so stressed out, there’s no time for all this communication – how was your day? They don’t even talk about hey I had this client and I really kind of screwed up when I did this thing, just so you know don’t do that. There’s no communication with nurses and this could be like getting really big”.

Scenario: Learning from other regions “The response came really quickly from several health units, just one day it took. And one health unit in fact forwarded all their policy materials for their reference and Gloria and Ben liked it so much that they adapted it with permission. So they were able to start their program … this health unit had done all the footwork and had done a large literature review and all that stuff. So they adapted it just to suit their northern needs a little bit. And then the health unit also invited Ben to shadow with their mobile needle exchange unit for a few days. So that was the outcome of that scenario”.

Alert System “Or even just people, like warning the people, almost like an alert system about some things might be important too. Like if there is an outbreak in a certain place and the local hospital may need to know that some of the people that would be referred they might need to have policy or protocol in place, stuff like that, right”? Resources “It would be great to have like a quick way to get information… Because often times what ends up happening is you spend an hour yourself researching whatever everybody else has already researched only nobody else knows that everybody has researched it. So if there was like something to click on … {Participant affirmation} that was about bedbugs and you could just pop up all the things that you would need to know …”

Scenarios Future versions Initial build Beta version Live site

sno.mcmaster.ca Features • Information on clinical trends and best practice • Critical alerts • Reduce isolation • Validation of practice • Learning from other regions • Sharing resources and information • Narratives/ stories

Next Steps • Launch Site May 20th, 2008 • Steering committee continues to provide direction to the site development • Continue recruitment of “champions” • Evaluation of the site begins • Site expected to evolve as the community grows

Questions?

References Carroll, J. (2000). Five reasons for scenario-based design. Interacting with Computers, 13(1), 43-60 Clemensen, J. Larsen, S., Kyng, M., & Kirkevold, M. (2007). Participatory design in health sciences: Using cooperative experimental methods in developing health services and computer technology. Qualitative Health Research, 17(1), 122-130 Wenger, E. (2004). Communities of practice: A brief introduction. Retrieved May 6, 2008 from http://www.ewenger.com/theory/index.htm Wenger, E., McDermott, R., & Snyder, W. (2002). Cultivating communities of practice: A guide to managing knowledge. Boston: Harvard Business School Press

Presenter: Ruta Valaitis (co-PI)