title: A journey to patient-centered care in Ontario, Canada: implementation of a best-practice guideline.
abstract: OBJECTIVE
  This article describes the process undertaken to implement the Best-Practice Guideline on Client (patient)-centered care. Curriculum development, the application of theoretical frameworks, and the use of a variety of models for care and learning are described. Clinical nurse specialists demonstrated successful curriculum development, facilitation, and research uptake by participants.
  
  
  BACKGROUND
  As a Canadian teaching hospital, we are committed to promoting a variety of evidence-based practice guidelines that are systematically developed and framed around a core set of values consistent with our ethical frameworks and based on current research and theories. Many guidelines are prescriptive; however, this particular guideline posed challenges because of its conceptual and philosophical nature.
  
  
  METHODS
  Challenges of curriculum development were resolved using the "know-do-be" framework and "proximity" as the element of the caring component of patient-centered care. Elements of narrative theory and inclusion of nursing and other experiential learning models were utilized. Competing corporate initiatives that linked with client-centered care were included.
  
  
  RESULTS
  The process resulted in the development of a 12-week course entitled "The Telling Stories of our Practice-Client-Centered Care." Evidence of sustainability and spread of this best-practice guideline to other corporate initiatives through research, patient safety workshops, nursing staff orientation, and other educational activities focusing on professionalism, quality of work life, and falls prevention is described.
  
  
  CONCLUSIONS
  Clinical nurses specialists and other advanced practice nurses demonstrated clinical competencies in initiating changes that resulted in increased use of evidence-based practice.
authors.affiliation: McMaster University, St Joseph's Healthcare Hamilton, 50 Charlton Ave. E, Hamilton, Ontario, Canada. pford@stjoes.ca
authors.forename: Patricia Elizabeth Ann
authors.initials: PE
authors.lastname: Ford
authors.forename: Steven
authors.initials: S
authors.lastname: Rolfe
authors.forename: Helen
authors.initials: H
authors.lastname: Kirkpatrck
mesh_terms: D003479:Curriculum; D019317:Evidence-Based Medicine / Q000458:organization & administration*; D006784:Hospitals, Teaching / Q000458:organization & administration*; D006801:Humans; D016294:Models, Nursing; D009720:Nurse Clinicians; D009864:Ontario; D018802:Patient-Centered Care / Q000458:organization & administration*; D017410:Practice Guidelines as Topic