Title: Hemiplegic Shoulder Pain Prevention: A Collaborative Approach with Nursing and Occupational Therapy in Acute Care 

Author:
Ebonee V. Cole, OTD, MS, OTR/L, CBIS
Alison Bell, OTD, OTR/L

JACOT Volume 6, Issue 1

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Background
Hemiplegic shoulder pain is a common problem after stroke. Prevention is the ideal management strategy for this type of shoulder pain. However, many healthcare providers are not trained in management techniques for hemiplegic shoulder pain. The nursing staff is the primary care provider in the acute care hospital. Therefore, the Arm in Arm project, a quality improvement initiative, was developed to improve acute care nursing staff’s clinical practice for implementing the recommended positioning and handling techniques into routine care for patients with arm hemiplegia after stroke.
Methods
The 10-week quality improvement project was implemented by an occupational therapist who worked collaboratively with the nurse educator on the neurology unit to change practices among the nursing staff in positioning and handling techniques with patients with arm hemiplegia. The quality improvement project was grounded in the Knowledge-to-Action Process Framework and focused on the action cycle of Knowledge-to-Action for implementation. Knowledge translation strategies such as mini-trainings, knowledge champions, infographics, wristbands, signs, and screensavers were implemented to increase adherence to techniques. A self-developed observation checklist monitored the nursing staff’s adherence to techniques. Observation of routine care was performed to evaluate the adherence to positioning and handling techniques.
Results
After ten weeks, the nursing staff’s adherence to positioning techniques in routine care increased from 12% to 71%, and their adherence to handling techniques increased from 50% to 91%.
Conclusion
This project demonstrates that a quality improvement project supported by knowledge translation strategies can improve the nursing staff’s competency and adherence to positioning and handling techniques for patients with arm hemiplegia after stroke in an acute care hospital. Furthermore, the collaboration between occupational therapy and the nurse educator was vital to enhancing knowledge translation efforts for a program such as the Arm in Arm project.