ArticleBMJ open quality2026
Building capacity for integrated health care-nursing education initiatives in a Canadian mental health setting.
Article in BMJ open quality, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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6 authors.
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Abstract
backgroundIndividuals with serious mental illness at a Toronto mental health hospital receive interdisciplinary team (IDT) care through a reverse integration model supporting both mental and physical health. Nurses play a central role in this model, yet face barriers including unclear role definitions, limited resources and workflow constraints. Enhancing nursing autonomy and IDT collaboration may improve patient outcomes and workforce retention.
methodsThis quality improvement study aimed to reduce nursing-initiated hospitalist requests by 25% across four pilot units by October 2023. From February to May 2023, 99 nurses completed 1 hour refresher training sessions to strengthen clinical decision-making, clarify scope within the IDT, and improve workflow efficiency. Pre-training and post-training surveys assessed nurses' self-reported knowledge and comfort, and an implementation survey assessed perceived impacts on practice and collaboration. A retrospective electronic health record (EHR) chart review (September 2022-June 2024) evaluated total and declined hospitalist requests (outcome measures), focused nursing assessments (FNAs; process measures) and direct allied health requests (AHRs; balancing measures).
resultsPre-training and post-training surveys were completed by 69 and 72 nurses, respectively. Mean composite self-reported knowledge scores increased from 3.56 (SD 0.88) pre-training to 4.57 (SD 0.57) post-training (mean difference 1.02; 95% CI 0.77 to 1.26; p<0.001). Implementation surveys indicated improved clinical practice, enhanced IDT collaboration, and strong endorsement of the training. However, nursing-initiated hospitalist requests (monthly mean=339.4) and declined requests (monthly mean=30.6; 9% decline rate) showed no sustained reduction. Common reasons for declined requests included completed assessments (18.8%), duplicate requests (18.8%), and redirected AHRs (13.0%). FNAs (monthly mean=91.77) and AHRs (monthly mean=14.3) remained stable.
conclusionTargeted nursing education improved nurses' self-reported knowledge and IDT perceived collaboration but did not reduce hospitalist requests. Sustained impact may require ongoing education, integrated onboarding, EHR workflow enhancements, and clearer role definitions.
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