February 17, 2012

Grants & Awards

New Article by Susan Slaughter
Functional Outcomes of Nursing Home Residents in Relation to Features of the Environment: Validity of the Professional Environmental Assessment Protocol.
Slaughter SE, Morgan DG.
Journal of the American Medical Directors Association 2012 Feb 11

OBJECTIVES: The aim of this article was to examine associations between specific dimensions of nursing home environments and the functional ability (walking and eating) of residents with dementia, and to contribute to the ongoing psychometric development of the Professional Environmental Assessment Protocol (PEAP). DESIGN: One-year prospective cohort study. SETTING: Fifteen nursing homes in a western Canadian province. PARTICIPANTS: Convenience sample of 120 nursing home residents with middle-stage dementia. MEASUREMENTS: Every 2 weeks we observed residents’ abilities to walk to the dining room and to feed themselves. At the end of a year of observation and immediately following a brief interview with the unit managers, we used the PEAP to measure the extent to which 9 specific dimensions of nursing home environments support the ability of residents with dementia to walk and to eat. Cox proportional hazards models were used to evaluate the effect of specific environmental features on residents’ walking and eating disability. RESULTS: “Support of functional ability” was associated with a reduced hazard of both walking and eating disability. The environmental dimensions of “maximizing awareness and orientation” and better “quality of stimulation” were associated specifically with reduced hazard of walking disability, whereas the dimensions of the nursing home environment specifically associated with a reduced hazard of eating disability included improved “safety and security,” “opportunities for personal control,” and “regulation of stimulation.” The Cox proportional hazards models using the 13-point PEAP scale were not significantly different from nested models using the 5-point PEAP scale, indicating that the 2 scales did not differ in their ability to discriminate between more and less supportive environments for residents with dementia. CONCLUSIONS: Specific dimensions of the nursing home environment reduced the hazard of walking disability, whereas others reduced the hazard of eating disability. Modifying specific features of nursing home environments may reduce disability in nursing home residents with dementia. The 5-point PEAP scale is able to discriminate between nursing home environments as well as the 13-point scale.

New Article by Greta Cummings
Worklife Improvement and Leadership Development study: A learning experience in leadership development and “planned” organizational change.
Cummings GG, Spiers JA, Sharlow J, Germann P, Yurtseven O, Bhatti A.
Health care management review 2012 Jan 25

BACKGROUND:In response to increasing recognition of the importance of quality health care work environments, the Alberta Cancer Board initiated a province-wide leadership development program to plan for organizational change through a series of stages. In 2004, the Leadership Development Initiative (LDI) was implemented to facilitate organizational learning using a cohort-based leadership intervention based on a communities of practice framework. PURPOSES:: The aim of the Worklife Improvement and Leadership Development study was to examine both the outcomes and experiences of participants of the LDI program to better understand leadership development, implementation, and its impact on worklife quality among 5 cohorts of health care managers and staff at the Alberta Cancer Board. METHODOLOGY/APPROACH:: This study used both structured survey and interview methods, using a pretest-intervention-posttest quasi-experiment without a control group design, to assess the effects of LDI on worklife of leaders and staff. Surveys included the Leadership Practices Inventory and Areas of Worklife Scale, which looked at meaningfulness of work and organizational engagement. Interviews and focus group data provided a more detailed description of the experience of leadership development and perceptions of organizational worklife. FINDINGS:: The study revealed layers of information about the complexity of individual and collective leadership in a cohort-based design, perceptions of leadership initiatives, organizational worklife, and planned organizational change. Our findings suggest that early changes in how leaders reflected on their own skills and practices (Leading Self) were positive; however, growing disengagement as the LDI continued was evident in the focus group data, particularly when change in behavior of others was not perceived to be evident. PRACTICE IMPLICATIONS:: To support the effectiveness and success of a leadership initiative, managers and administrators need to implement strategies designed to help leaders grow and cope with ongoing flux of organizational change and stagnation.

Grants & Awards
CIHR: Partnership Award

The CIHR Partnership Award annually recognizes a partnership that exemplifies excellence. The recipients receive a $25,000 award in the form of a one-year research grant for advancing the research or knowledge translation activities of the partnership.These partnerships involve organizations from the private, voluntary or public sectors. They bring health research communities together:

  • to create innovative approaches to research questions;
  • to develop research agendas that are responsive to the health needs, concerns and priorities of Canadians; and
  • to accelerate the translation of knowledge for the benefit of Canadians.

Nasivvik Centre for Inuit Health and Changing Environments Postdoctoral Fellowship Awards
Deadline March 30, 2012

The Nasivvik Centre for Inuit Health and Changing Environments is a multidisciplinary research and training centre based at Université Laval and Trent University and funded by the Institute of Aboriginal Peoples Health, one of the 13 institutes of the Canadian Institutes of Health Research (IAPH-CIHR). The Nasivvik Centre is focused on building capacity in Inuit health research through trainee support, and promoting research on environmental health topics of importance to Inuit communities. Part of the Nasivvik Centre’s mandate involves providing support for research and training of post-graduate fellows in new, innovative areas of research of importance to Inuit health.

Canadian Association of Nursing Research Awards
Deadline March 9, 2012

The Canadian Association for Nursing Research has established four awards to recognize nurses for their outstanding contribution to nursing and the goals of CANR. The CANR research awards are awarded biennially. The next awards presentation will occur in 2012.
The CANR Nurse Researcher Award is for an established nurse scientist who has contributed significantly to nursing research.

  • The CANR Outstanding New Investigator Award is for an outstanding new researcher.
  • The CANR Award for the Promotion of Research Based Practice is made to an individual or group who has provided leadership in the utilization of research in clinical nursing practice.
  • The CANR Practitioner-Researcher Award is for a clinician or manager engaged in research in a clinical setting.


Health Care Administration and Organization
Health Care Innovation and Quality Assurance
Research Methodology

Is it time to drop the ‘knowledge translation’ metaphor? A critical literature review.
Greenhalgh T, Wieringa S.
Journal of the Royal Society of Medicine 2011 Dec;104(12):501-509

The literature on ‘knowledge translation’ presents challenges for the reviewer because different terms have been used to describe the generation, sharing and application of knowledge and different research approaches embrace different philosophical positions on what knowledge is. We present a narrative review of this literature which deliberately sought to highlight rather than resolve tensions between these different framings. Our findings suggest that while ‘translation’ is a widely used metaphor in medicine, it constrains how we conceptualise and study the link between knowledge and practice. The ‘translation’ metaphor has, arguably, led to particular difficulties in the fields of ‘evidence-based management’ and ‘evidence-based policymaking’ – where it seems that knowledge obstinately refuses to be driven unproblematically into practice. Many non-medical disciplines such as philosophy, sociology and organization science conceptualise knowledge very differently, as being (for example) ‘created’, ‘constructed’, ’embodied’, ‘performed’ and ‘collectively negotiated’ – and also as being value-laden and tending to serve the vested interests of dominant elites. We propose that applying this wider range of metaphors and models would allow us to research the link between knowledge and practice in more creative and critical ways. We conclude that research should move beyond a narrow focus on the ‘know-do gap’ to cover a richer agenda, including: (a) the situation-specific practical wisdom (phronesis) that underpins clinical judgement; (b) the tacit knowledge that is built and shared among practitioners (‘mindlines’); (c) the complex links between power and knowledge; and (d) approaches to facilitating macro-level knowledge partnerships between researchers, practitioners, policymakers and commercial interests.

Following a natural experiment of guideline adaptation and early implementation: a mixed-methods study of facilitation.
Dogherty EJ, Harrison MB, Baker C, Graham ID.
Implementation science : IS 2012 Feb 6;7(1):9

BACKGROUND: Facilitation is emerging as an important strategy in the uptake of evidence. However, it is not entirely clear from a practical perspective how facilitation occurs to help move research evidence into nursing practice. The Canadian Partnership Against Cancer, also known as the ‘Partnership,’ is a Pan-Canadian initiative supporting knowledge translation activity for improved care through guideline use. In this case-series study, five self-identified groups volunteered to use a systematic methodology to adapt existing clinical practice guidelines for Canadian use. With ‘Partnership’ support, local and external facilitators provided assistance for groups to begin the process by adapting the guidelines and planning for implementation. METHODS: To gain a more comprehensive understanding of the nature of facilitation, we conducted a mixed-methods study. Specifically, we examined the role and skills of individuals actively engaged in facilitation as well as the actual facilitation activities occurring within the ‘Partnership.’ The study was driven by and builds upon a focused literature review published in 2010 that examined facilitation as a role and process in achieving evidence-based practice in nursing. An audit tool outlining 46 discrete facilitation activities based on results of this review was used to examine the facilitation noted in the documents (emails, meeting minutes, field notes) of three nursing-related cases participating in the ‘Partnership’ case-series study. To further examine the concept, six facilitators were interviewed about their practical experiences. The case-audit data were analyzed through a simple content analysis and triangulated with participant responses from the focus group interview to understand what occurred as these cases undertook guideline adaptation. RESULTS: The analysis of the three cases revealed that almost all of the 46 discrete, practical facilitation activities from the literature were evidenced. Additionally, case documents exposed five other facilitation-related activities, and a combination of external and local facilitation was apparent. Individuals who were involved in the case or group adapting the guideline(s) also performed facilitation activities, both formally and informally, in conjunction with or in addition to appointed external and local facilitators. CONCLUSIONS: Facilitation of evidence-based practice is a multifaceted process and a team effort. Communication and relationship-building are key components. The practical aspects of facilitation explicated in this study validate what has been previously noted in the literature and expand what is known about facilitation process and activity.

How to assess the best available evidence when time is limited
and there is lack of sound evidence

European Centre for Disease Prevention and Control, 2011

Evidence-based public health could be defined as integrating the best available evidence with the knowledge and considered judgements from stakeholders and experts to benefit the needs of a population. Data from observational studies, surveillance and modelling play an important role as evidence base in public health in the field of infectious diseases. Since information about outbreaks can only be gathered while an outbreak is ongoing, there is a need to better perform and report outbreak investigations. Uncertainties can arise at all stages of a public health decision-making process, or while producing a risk assessment. It is important to handle uncertainties explicitly and transparently and to communicate them to the policymakers. As time goes by and access to evidence increases, uncertainties can be reduced. A five-stage framework for rapid risk assessments is presented, which includes a preparatory phase and further stages of risk detection/verification, assessment of the risk, development of the advice and implementation and evaluation. Practical tools and templates for each stage are also presented, and the importance of being prepared and having tools at hand when an outbreak occurs is underlined

Translating research into action: WHO evidence-informed guidelines for safe and effective micronutrient interventions.
Pena-Rosas JP, De-Regil LM, Rogers LM, Bopardikar A, Panisset U.
The Journal of nutrition 2012 Jan;142(1):197S-204S

In 2009 WHO adopted a new process by which recommendations for safe and effective micronutrient interventions are developed, ensuring the use of best practices and available evidence. This process includes nine steps ranging from establishing steering and guideline groups and prioritizing needs to planning the implementation and updating the guidelines. Systematic reviews of evidence are used to address critical outcomes for decision making, considering the balance among risks and benefits, values, preferences, and costs. Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology is used to assess the overall evidence quality and establish the strength of the recommendations. Guideline development is underway for interventions covering iron and vitamin A supplementation, home fortification with multiple micronutrient powders, and fortification of staple foods. Global guidelines are disseminated through the WHO electronic Library of Evidence for Nutrition Actions, a resource of the evidence and tools for scaling-up micronutrient interventions. The WHO Department of Nutrition for Health and Development and the Evidence-Informed Policy Network will support countries to scale-up the delivery of micronutrient interventions by adapting these evidence-informed guidelines and policies to make them context specific. This will be accomplished by providing summaries of the best available evidence on micronutrient interventions, evidence on health systems, and effective delivery systems along with capturing the tacit knowledge of the countries’ realities. With a systematic approach that uses the WHO strategy on research for health as the connecting thread, the challenges to successfully implement safe and effective micronutrient programs can be addressed.

Clinical Nurse Specialists’ Role in Selecting & Using Knowledge to Improve Practice & Develop Practice-based Policies Designed to Promote Optimum Patient Outcomes
CHSRF, Profetto-McGrath J, Ehrenberg A, Young S, Hill W, 2012

Clinical Nurse Specialists (CNSs) are advanced practice nurses with expert knowledge and skills in a specific area of practice. The role of the CNS in the field of evidence-based practice has largely been ignored, in spite of the fact that it is pivotal to the facilitation of research into practice in the clinical setting. The published literature is limited in terms of how CNSs access and transfer research knowledge in making clinical decisions. Therefore, the purpose of this study was to identify and develop a preliminary understanding of the approaches utilized by CNSs to select and use research knowledge in their daily practice, with the long-term aim of developing concrete strategies for this group beyond obtaining and disseminating evidence. The study comprised four phases over a two-year period, with final data synthesis ongoing.

The Use of Health Knowledge by Not-for-profit Organizations: Taking a Look at Their Policy-influencing Practices
National Collaborating Centre for Healthy Public Policy, 2012

This document is part of a project exploring issues surrounding relationships between not-for-profit organizations (NFPs) and the public health sector. More specifically, it deals with the way in which NFPs use health knowledge in their practices and the issues that this raises for public health professionals conducting or planning to engage in knowledge exchange processes with these stakeholders. The purpose of the analysis proposed here is to facilitate reflection by public health professionals on certain issues affecting current or future knowledge exchange activities with NFPs.

Health Care Administration & Organization
Do nurse and patient injuries share common antecedents? An analysis of associations with safety climate and working conditions.
Taylor JA, Dominici F, Agnew J, Gerwin D, Morlock L, Miller MR.
BMJ quality & safety 2012 Feb;21(2):101-111

Background Safety climate and nurses’ working conditions may have an impact on both patient outcomes and nurse occupational health, but these outcomes have rarely been examined concurrently. Objective To examine the association of unit-level safety climate and specific nurse working conditions with injury outcomes for both nurses and patients in a single hospital. Research design A cross-sectional study was conducted using nursing-unit level and individual-level data at an urban, level-one trauma centre in the USA. Multilevel logistic regressions were used to examine associations among injury outcomes, safety climate and working conditions on 29 nursing units, including a total of 723 nurses and 28 876 discharges. Measures Safety climate was measured in 2004 using the Safety Attitudes Questionnaire (SAQ). Working conditions included registered nursing hours per patient day (RNHPPD) and unit turnover. Patient injuries included 290 falls, 167 pulmonary embolism/deep vein thrombosis (PE/DVT), and 105 decubitus ulcers. Nurse injury was defined as a reported needle-stick, splash, slip, trip, or fall (n=78). Working conditions and outcomes were measured in 2005. Results The study found a negative association between two SAQ domains, Safety and Teamwork, with the odds of both decubitus ulcers and nurse injury. RNHPPD showed a negative association with patient falls and decubitus ulcers. Unit turnover was positively associated with nurse injury and PE/DVT, but negatively associated with falls and decubitus ulcers. Conclusions Safety climate was associated with both patient and nurse injuries, suggesting that patient and nurse safety may actually be linked outcomes. The findings also indicate that increased unit turnover should be considered a risk factor for nurse and patient injuries.

Communication, training, well-being, and commitment across nurse generations.
Brunetto Y, Farr-Wharton R, Shacklock K.
Nursing outlook 2012 Jan;60(1):7-15

Within a context of global nurse shortages, replacing nurses is difficult; training and retention is a critical concern for healthcare management. Similarities and differences in the impact of supervisor-nurse relationships upon satisfaction with training and development, well-being and affective commitment were examined across 3 different nursing generations in Australia. Nine hundred nurses from 7 private hospitals (small, medium, and large) across Australia responded. Path analysis, using an ordinary least squares approach, and multivariate analysis were used to test the hypotheses. Three factors accounted for almost half the variance of Generation Xs’ and Baby Boomers’ and a third of Generation Ys’ affective commitment. Practical implications for hospital management include differences in generations and the pivotal role of nurse supervisors. For all 3 generations of nurses, supervisor-subordinate communication relationships are important because they contribute to satisfaction with training and development and well-being, but also significantly impact affective commitment.

Impacting Canadian public health nurses’ job satisfaction.
Graham KR, Davies BL, Woodend AK, Simpson J, Mantha SL.
Canadian journal of public health.Revue canadienne de sante publique 2011 Nov-Dec;102(6):427-431

OBJECTIVE: Workforce recruitment and retention challenges are being experienced in public health as in other Canadian health sectors. While there are many nurses working in public health, little research has been done about their job satisfaction. Job satisfaction is linked to recruitment, retention and positive client outcomes. The purpose of this research was to examine the relationships between three modifiable work environment factors (autonomy, control-over-practice, and workload) and Canadian public health nurses’ (PHNs) job satisfaction. METHODS: Data were from the 2005 National Survey of the Work and Health of Nurses (response rate, 79.7%; 18,676 nurses). Bivariate and multivariate logistic regression analyses were used for this secondary analysis. Findings were discussed with practicing PHNs, policy-makers and researchers from across Canada at a knowledge translation (KT) ‘Think-Tank’. RESULTS: Among the 271 PHNs, 53.5% reported being ‘very satisfied’ with their jobs. The interaction between autonomy and workload was a significant predictor of PHNs’ job satisfaction, (OR 0.97, 95% CI 0.96-0.99, p < 0.01) as was the interaction between age and workload (OR 1.01, 95% CI 1.00-1.01, p < 0.01). Think-Tank participants selected priority areas for application to public health practice, management and research. CONCLUSION: Despite being an important practice factor, this is the first study to reveal the negative influence of PHNs’ autonomy when in interaction with an excessive workload. Significant workload findings and the presence of generational differences suggest the need for development of workload measurement tools and public health human resource strategies tailored to a multi-generational workforce.

The effects of ownership, staffing level and organisational justice on nurse commitment, involvement, and satisfaction: a questionnaire study.
Heponiemi T, Elovainio M, Kouvonen A, Kuusio H, Noro A, Finne-Soveri H, et al.
International journal of nursing studies 2011 Dec;48(12):1551-1561

BACKGROUND: Elderly care systems have undergone a lot of changes in many European countries, including Finland. Most notably, the number of private for-profit firms has increased. Previous studies suggest that employee well-being and the quality of care might differ according to the ownership type. OBJECTIVE: The present study examined whether the ownership type and the staffing level were associated with organisational commitment, job involvement, and job satisfaction. In addition, we examined the potential moderating effect of organisational justice on these associations. DESIGN: Cross-sectional questionnaire study. PARTICIPANTS AND SETTING: 1047 Finnish female staff members aged 18-69 years working in sheltered housing or nursing homes (units n=179). METHODS: The relationships were studied with analyses of covariance (ANCOVA), adjusting for the effects of age and case-mix. RESULTS: Organisational commitment and job satisfaction levels were low in for-profit sheltered homes when justice levels were low, but when justice levels were high, for-profit sheltered homes did not differ from other ownership types. Similarly, organisational justice acted as a buffer against low commitment resulting from low staffing levels. Staffing levels were lowest in public sheltered homes and highest in not-for-profit sheltered homes. CONCLUSION: The results show that organisational justice can act as a buffer against low organisational commitment that results from low staffing levels and working in for-profit sheltered homes. Increasing justice in regard to the management, outcomes, and procedures in the organisation would thus be important.

Effects of nurse staffing and nurse education on patient deaths in hospitals with different nurse work environments.
Aiken LH, Cimiotti JP, Sloane DM, Smith HL, Flynn L, Neff DF.
Medical care 2011 Dec;49(12):1047-1053

CONTEXT: Better hospital nurse staffing, more educated nurses, and improved nurse work environments have been shown to be associated with lower hospital mortality. Little is known about whether and under what conditions each type of investment works better to improve outcomes. OBJECTIVE: To determine the conditions under which the impact of hospital nurse staffing, nurse education, and work environment are associated with patient outcomes. DESIGN, SETTING, AND PARTICIPANTS: Outcomes of 665 hospitals in 4 large states were studied through linked data from hospital discharge abstracts for 1,262,120 general, orthopedic, and vascular surgery patients, a random sample of 39,038 hospital staff nurses, and American Hospital Association data. MAIN OUTCOME MEASURES: A 30-day inpatient mortality and failure-to-rescue. RESULTS: The effect of decreasing workloads by 1 patient/nurse on deaths and failure-to-rescue is virtually nil in hospitals with poor work environments, but decreases the odds on both deaths and failures in hospitals with average environments by 4%, and in hospitals with the best environments by 9% and 10%, respectively. The effect of 10% more Bachelors of Science in Nursing Degree nurses decreases the odds on both outcomes in all hospitals, regardless of their work environment, by roughly 4%. CONCLUSIONS: Although the positive effect of increasing percentages of Bachelors of Science in Nursing Degree nurses is consistent across all hospitals, lowering the patient-to-nurse ratios markedly improves patient outcomes in hospitals with good work environments, slightly improves them in hospitals with average environments, and has no effect in hospitals with poor environments.

Health Care Innovation & Quality Assurance
‘The ABC of Handover’: impact on shift handover in the emergency department.
Farhan M, Brown R, Vincent C, Woloshynowych M.
Emergency medicine journal : EMJ 2011 Dec 28

Introduction A study was undertaken to test the impact of a new tool for shift handover, ‘The ABC of Handover’, in the emergency department (ED). The impact on shift handover following implementation of this structured tool, the effect on clinical and organisational aspects of the subsequent shift and the opinions of users of this new tool are reported.MethodsA prospective observational before and after study was performed to explore the effect of implementing ‘The ABC of Handover’ on clinical and organisational practice using a questionnaire.Results41 handovers were observed before implementation of ‘The ABC of Handover’ and 42 were observed after. The new tool was successfully implemented and resulted in a change of practice which led to a significant increase in the operational issues mentioned at handover from a mean of 34% to a mean of 86% of essential items with the ABC method. Over the study period, middle-grade staff demonstrated improved situational awareness as they adopted proactive management of operational issues such as staffing or equipment shortages. All participants reported that ‘The ABC of Handover’ improved handover regardless of the seniority of the doctor giving it, and found the ABC method easy to learn.ConclusionsSuccessful implementation of ‘The ABC of Handover’ led to a change of practice in the ED. Improving handover resulted in better organisation of the shift and heightened awareness of potential patient safety issues. The ABC method provides a framework for organising the shift and preparing for events in the subsequent shift.

Roles of managers, frontline staff and local champions, in implementing quality improvement: stakeholders’ perspectives.
Kirchner JE, Parker LE, Bonner LM, Fickel JJ, Yano EM, Ritchie MJ.
Journal of evaluation in clinical practice 2012 Feb;18(1):63-69

BACKGROUND: Translating promising research findings into routine clinical care has proven difficult to achieve; even highly efficacious programmes remain unadopted. Critical to changing care is an understanding of the context within which the improvement effort occurs, including the climate or culture. Health care systems are multicultural due to the wide variety of professionals, subgroups, divisions and teams within them. Yet, little work describes and compares different stakeholders’ views on their and others’ roles in promoting successful quality improvement implementation. OBJECTIVE: To identify manager and frontline staff perspectives about which organizational stakeholders should play a role in implementation efforts as well as what implementation roles these stakeholders should perform. METHODS: We conducted qualitative semi-structured interviews of a purposive sample of stakeholders at the clinic, medical centre and regional network levels. Participants included stakeholders across five clinics (n = 49), their four affiliated medical centres (n = 12) and three regional networks (n = 7). Working in coding teams, we conducted a content analysis utilizing Atlas.ti Version 5. RESULTS: According to informants, individuals at each organizational level have unique and critical roles to play in implementing and sustaining quality improvement efforts. Informants advocated for participation of a wide range of organizational members, described distinct roles for each group, and articulated the need for and defined the characteristics of frontline programme champions. CONCLUSIONS: Involvement of multiple types of stakeholders is likely to be costly for health care organizations. Yet, if such organizations are to achieve the highest quality care, it is also likely that such involvement is essential.

Effective Governance for Quality and Patient Safety Program: An Evaluative Assessment
CHSRF, 2011

Key Messages:

  • Based on matched pre- and post-survey responses, the Effective Governance for Quality and Patient Safety program curriculum was effective in improving the respondents’ group knowledge and skills in the area of quality and patient safety.
  • The program was successful in providing the participants with the required knowledge, resources and tools that they intend to apply to advance quality and patient safety improvements within their respective healthcare organizations.
  • There may exist a potential need for a more integrated curriculum that would help participants better understand the importance of levers to improve quality and patient safety.
  • There may exist a need for future educational sessions to be custom-tailored for professional groups according to their specific knowledge and information needs. The program’s curriculum may benefit from greater customization to the needs of small hospitals and community-based healthcare organizations.

A follow-up evaluation to determine the longer-term changes in knowledge application, organizational performance, and patient outcomes is recommended.

IOM: Living Well with Chronic Illness: A Call for Public Health Action

The epidemic of chronic illness – which represents 75 percent of the $2 trillion in annual U.S. health care spending – is steadily moving toward crisis proportions, yet maintaining or enhancing quality of life for individuals living with these illnesses has not been given the attention it deserves. Longevity is no longer the only goal as more focus is placed on living a long and healthy life. The CDC and the nonprofit Arthritis Foundation asked the IOM to help identify ways to reduce disability and improve the function and quality of life for people living with chronic illness. The report lays out a comprehensive framework intended as a guide to develop and implement cross-cutting strategies that reduce the individual and societal burdens of chronic illness by helping people with chronic illnesses live well. The IOM makes recommendations to the CDC as well as HHS on the development and support of programs to meet the health and social needs of people living with chronic illnesses.

Research Methodology
Excluding Older, Sicker Patients from Clinical Trials: Issues, Concerns, and Solutions
AARP, 2011

This Insight on the Issues discusses issues, concerns, and possible approaches
to expanding clinical trials to include older people and those with chronic
conditions to make research more relevant for clinicians treating these people.

Mapping the Mixed Methods–Mixed Research Synthesis Terrain.
Sandelowski M, Voils CI, Leeman J, Crandell JL.
Journal of Mixed Methods Research 2011 December 28

Mixed methods–mixed research synthesis is a form of systematic review in which the findings of qualitative and quantitative studies are integrated via qualitative and/or quantitative methods. Although methodological advances have been made, efforts to differentiate research synthesis methods have been too focused on methods and not focused enough on the defining logics of research synthesis—each of which may be operationalized in different ways—or on the research findings themselves that are targeted for synthesis. The conduct of mixed methods–mixed research synthesis studies may more usefully be understood in terms of the logics of aggregation and configuration. Neither logic is preferable to the other nor tied exclusively to any one method or to any one side of the qualitative/quantitative binary.

Prioritizing Culture Change in Nursing Homes: Perspectives of Residents, Staff, and Family Members.
White HK, Corazzini K, Twersky J, Buhr G, McConnell E, Weiner M, et al.
Journal of the American Geriatrics Society 2012 Feb 8

OBJECTIVES: To explore the perspectives and priorities of nursing home residents, family members, and frontline nursing staff concerning a broad range of items representing common targets of culture change initiatives. DESIGN: Qualitative study. SETTING: A Veterans Affairs Community Living Center and two community nursing homes in North Carolina. PARTICIPANTS: Residents (n = 21), family members (n = 21), and direct-care nursing staff (n = 21) were recruited, with equal numbers in each group from each site. MEASUREMENTS: Participants rated the importance of 62 items from the Centers for Medicare and Medicaid Services Artifacts of Culture Change instrument. Participants sorted cards reflecting each culture change artifact in two phases, identifying and ranking those of more and less importance to them to derive one distribution of preferences for each respondent. Q-sort analysis identified groups of respondents who prioritized similar items; qualitative analysis sought themes or explanations for the responses. RESULTS: Wide variation in respondent preferences was observed. Some respondents viewed several items that others valued highly as unimportant or undesirable. Some items were not high priorities for any respondents. Four groups of respondents with similar preferences were identified: practical and independence-focused respondents, who prioritized ease of use of the physical environment; staff-focused respondents, who prioritized nursing staff retention and development; consistency and choice-focused respondents, who prioritized stable nurse staff-resident relationships and resident choice; and activity and community-focused respondents, who prioritized community gathering spaces and activities. CONCLUSION: Resident, family, and staff priorities for culture change vary, and diverse priorities of stakeholders should be considered to inform culture change efforts on a local and national level.

Resident-directed long-term care: staff provision of choice during morning care
Simmons SF, Rahman A, Beuscher L, Jani V, Durkin DW, Schnelle JF.
The Gerontologist 2011 Dec;51(6):867-875

PURPOSE: To develop an observational protocol to assess the quality of staff-resident communication relevant to choice and describe staff-resident interactions as preliminary evidence of the usefulness of the tool to assess current nursing home practices related to offering choice during morning care provision. DESIGN AND METHODS: This study included 73 long-stay residents in 2 facilities. Research staff conducted observations for 4 consecutive morning hours during targeted care activities (transfer out of bed, incontinence, dressing, and dining location). Observations were conducted weekly for 12 consecutive weeks. Staff-resident interactions were measured related to staff offers of choice and residents’ responses. RESULTS: Interrater agreement was achieved for measures of staff offers of choice (kappa = .83, p < .001), type of choice provided (kappa = .75, p < .001), and resident requests related to choice (kappa = .72, p < .001). Observations over 2,766 care episodes during 4 aspects of morning care showed that staff offered residents choice during 18% of the episodes. Most observations (70%) were coded as staff offering “no choice.” IMPLICATIONS: Nursing home staff can use a simplified version of this standardized observational tool to reliably measure staff-resident interactions related to choice during morning care provision as a first step toward improving resident-directed care practice.

The Informal Caregivers’ Perception of Wandering.
Houston AM, Brown LM, Rowe MA, Barnett SD.
American Journal of Alzheimer’s Disease and Other Dementias 2012 Jan 31

Although the term wandering is routinely used by clinicians, researchers, and informal caregivers (ICs), the meaning of this term varies depending on the source of the definition and the context in which it is used. The purpose of this study was to examine the terms ICs used to describe different scenarios that have been identified in literature as “wandering,” determine their perception of risk, and compare their definitions of wandering with the perspectives of researchers. Structured interviews were conducted with 128 ICs of older adults with dementia. Informal Caregivers rarely used the term wandering to label different scenarios that had been previously identified in the literature as wandering. Responses to a survey of 17 wandering experts did not reflect agreement on a definition for wandering. These findings suggest that a broad set of terms should be used to describe this potentially dangerous behavior when health care providers communicate with ICs.

An assessment of the construct validity of the ASCOT measure of social care-related quality of life with older people.
Malley JN, Towers AM, Netten AP, Brazier JE, Forder JE, Flynn T.
Health and quality of life outcomes 2012 Feb 10;10(1):21

BACKGROUND: The adult social care outcomes toolkit (ASCOT) includes a preference-weighted measure of social care-related quality of life for use in economic evaluations. ASCOT has eight attributes: personal cleanliness and comfort, food and drink, control over daily life, personal safety, accommodation cleanliness and comfort, social participation and involvement, occupation and dignity. This paper aims to demonstrate the construct validity of the ASCOT attributes. METHODS: A survey of older people receiving publicly-funded home care services was conducted by face-to-face interview in several sites across England. Additional data on variables hypothesised to be related and unrelated to each of the attributes were also collected. Relationships between these variables and the attributes were analysed through chi-squared tests and analysis of variance, as appropriate, to test the construct validity of each attribute. RESULTS: 301 people were interviewed and approximately 10% of responses were given by a proxy respondent. Results suggest that each attribute captured the extent to which respondents exercised choice in how their outcomes were met. There was also evidence for the validity of the control over daily life, occupation, personal cleanliness and comfort, personal safety, accommodation cleanliness and comfort, and social participation and involvement attributes. There was less evidence regarding the validity of the food and drink and dignity attributes, but this may be a consequence of problems finding good data against which to validate these attributes, as well as problems with the distribution of the food and drink item. CONCLUSIONS: This study provides some evidence for the construct validity of the ASCOT attributes and therefore support for ASCOT’s use in economic evaluation. It also demonstrated the feasibility of its use among older people, although the need for proxy respondents in some situations suggests that developing a version that is suitable for proxies would be a useful future direction for this work. Validation of the instrument on a sample of younger social care users would also be useful.

Questionnaire study of the association between patient numbers and regular visiting by general practitioners in care homes.
Evans G, Grimley Evans J, Lasserson DS.
Age and Ageing 2012 Jan 17

Background: regular visiting in care homes enables proactive care. Surveys of managers found variation in medical care yet little is known about factors influencing general practitioners (GPs) visiting patterns. We examined whether practice factors including numbers of registered patients are associated with regular visiting.Design and setting: postal questionnaires sent to 73 care homes of European Care Group and separate questionnaires to visiting practices.Methods: information on regularity of visiting was requested from homes and practices. Practices were asked for numbers of doctors and training status. As data were not normally distributed, non-parametric tests were used to compare practices regularly visiting with those visiting only on request in terms of numbers of registered care home patients.Results: forty-seven (64%) of homes responded, with care provided for 1,867 patients by 162 practices. Practices visiting regularly had significantly more patients than practices that did not [median (IQR) 32 (28) versus 3 (5), P < 0.001]. Ninety-five (31%) of practices responded showing a similar association of registrations with regular visiting [median (IQR) 20 (37) versus 4 (4), P < 0.001]. There was no association between numbers of doctors or training status on regular visiting.Conclusion: the number of registered patients is strongly associated with regular care home visiting. Aligning practices with care homes thereby increasing registered patients per practice could encourage proactive care.

Predictors of adverse outcomes on an acute geriatric rehabilitation ward.
Singh I, Gallacher J, Davis K, Johansen A, Eeles E, Hubbard RE.
Age and Ageing 2012 Feb 1

Background: multidisciplinary rehabilitation is of proven benefit in the management of older inpatients. However, the identification of patients who will do well with rehabilitation currently lacks a strong evidence base.Objectives: the aims of this study were to compare the importance of chorological age, gender, co-morbidities and frailty in the prediction of adverse outcomes for patients admitted to an acute geriatric rehabilitation ward.Design: prospective observational cohort study.Subjects and setting: two hundred and sixty-five patients admitted consecutively to an acute geriatric rehabilitation ward at a tertiary care teaching hospital.Methods: frailty status was measured by an index of accumulated deficits, giving a potential score from 0 (no deficits) to 1.0 (all 40 deficits present). Patients were stratified into three outcomes: good (discharged to original residence within 28 days), intermediate (discharged to original residence but longer hospital stay) and poor (newly institutionalised or died).Results: patients were old (82.6 +/- 8.6 years) and frail (mean frailty index (FI) 0.34 +/- 0.09). Frailty status correlated significantly with length of stay and was a predictor of poor functional gain. The odds ratio of intermediate and poor outcome relative to a good outcome was 4.95 (95% CI = 3.21, 7.59; P < 0.001) per unit increase in FI. Chronological age, gender and co-morbidity showed no significant association with outcomes.Conclusion: frailty is associated with adverse rehabilitation outcomes. The FI may have clinical utility, augmenting clinical judgement in the management of older inpatients.

Formal home help services and institutionalization.
Yamada Y, Siersma V, Avlund K, Vass M.
Archives of Gerontology and Geriatrics 2011 Jul 15

The effect of home help services has been inconsistent. Raising the hypothesis that receiving small amounts of home help may postpone or prevent institutionalization, the aim of the present study is to analyze how light and heavy use of home help services was related to the risk for institutionalization. The study was a secondary analysis of a Danish intervention study on preventive home visits in 34 municipalities from 1999 to 2003, including 2642 home-dwelling older people who were nondisabled and did not receive public home help services at baseline in 1999 and who lived at home 18 months after baseline. Cox regression analysis showed that those who received home help services during the first 18 months after baseline were at higher risk of being institutionalized during the subsequent three years than those who did not receive such services. However, receiving home help for less than 1h per week during the first 18 months after baseline was not associated with an increased risk of institutionalization during the study period among those with physical or mental decline. Receiving public home help services was a strong indicator for institutionalization in Denmark. Receiving small amounts of home help and experiencing physical or mental decline was not associated with higher hazard for institutionalization compared with those who received no help.

Risk factors for hospital readmissions in elderly patients: a systematic review.
Garcia-Perez L, Linertova R, Lorenzo-Riera A, Vazquez-Diaz JR, Duque-Gonzalez B, Sarria-Santamera A.
QJM : monthly journal of the Association of Physicians 2011 Aug;104(8):639-651

Population ageing is associated with an increase in hospital admissions. Defining the factors that affect the risk of hospital readmission could identify individuals at high risk and enable targeted interventions to be designed. This aim of this study was to identify the risk factors for hospital readmission in elderly people. A systematic review of the literature published in English or Spanish was performed by electronically searching EMBASE, MEDLINE, CINAHL, SCI and SSCI. Some keywords were aged, elder, readmission, risk, etc. Selection criteria were: prospective cohort studies with suitable statistical analysis such as logistic regression, that explored the relationship between the risk of readmission with clinical, socio-demographic or other factors in elderly patients (aged at least 75 years) admitted to hospital. Studies that fulfilled these criteria were reviewed and data were extracted by two reviewers. We assessed the methodological quality of the studies and prepared a narrative synthesis. We included 12 studies: 11 were selected from 1392 articles identified from the electronic search and one additional reference was selected by manual review. Socio-demographic factors were only explanatory in a few models, while prior admissions and duration of hospital stay were frequently relevant factors in others. Morbidity and functional disability were the most common risk factors. The results demonstrate the need for increased vigilance of elderly patients who are admitted to hospital with specific characteristics that include previous hospital admissions, duration of hospital stay, morbidity and functional disability.

Elimination of Position-Change Alarms in an Alzheimer’s and Dementia Long-Term Care Facility.
Bressler K, Redfern RE, Brown M.
American Journal of Alzheimer’s Disease and Other Dementias 2011 Dec 28

In a long-term care facility, whose residents have been diagnosed with Alzheimer’s disease or dementia, falls are a particularly prominent issue. Technology in health care has continued to evolve and play a larger role in how we care for our patients, even in preventing falls. However, overreliance on these types of technologies may have detrimental effects. In our facility, it was felt that staff reliance on position-change alarms was inappropriate due to the high rate of false alarms associated with these devices. We took a tiered approach to removing position-change alarms from our facility, monitoring the fall incidence rate for a period before, during, and after the elimination of these alarms. After discontinuing their use, we found a decrease in the rate of falls, and a decrease in the percentage of our residents who fell. Staff has easily adapted and reports a calmer, more pleasant environment.

The risk for nursing home admission (NHA) did not change in ten years-A prospective cohort study with five-year follow-up.
Braunseis F, Deutsch T, Frese T, Sandholzer H.
Archives of Gerontology and Geriatrics 2011 Aug 24

In an aging population the burden on health care systems depends on the proportion of lifetime spent in good or poor health. The objective of this study was to examine the effect of a ten-year cohort difference on NHA, indicating changes in lifetime spent without severe disabilities. Additionally, important risk factors for NHA were identified. The data were obtained from two cohort studies of elderly people. Cohort A (1991-1993) comprised 74+ patients from 20 German general practices and cohort B (2002-2003) 70+ patients from 14 general practices. The merged sample consisted of 2301 community dwelling patients that contacted their general practitioner within a 12-month period during the respective enquiry period. After an initial assessment at study entry, participants were monitored over a five-year period respective NHA and death. The Cox proportional hazards model was used including socio-epidemic data, state of health, chronic diseases, dementia, health system usage, and social support. The ten-year cohort-difference was no predictor of NHA within a 5-year period. Significant influencing variables were: age (OR 1.10), living with others (OR 0.59), no auxiliary person (OR 1.69), mild forgetfulness (OR 2.12), clear cognitive impairment (OR 3.74), severe cognitive disturbance (3.61), loss of memory (11.83), walking difficulties (OR 1.53), impaired vision (OR 1.90), and cancer (OR 0.22). This study could not find a cohort effect on NHA. With regard to increased life expectancy the findings do not support the compression of morbidity hypothesis. The identified influencing variables contribute to the understanding of NHA risk factors.

Aging in Place: A State Survey of Livability Policies and Practices
AARP, NCSL, 2011

The great majority of older adults have a strong desire to live in their own homes and communities. However, unsupportive community design, unaffordable and inaccessible housing, and a lack of access to needed services can thwart this desire. Starting in 2011, growth of the older American population will accelerate, in part because the leading edge of the baby boomer generation will reach age 65. This report examines state policies that can help older adults age in place.

Formula for success Research project helps reduce need for medication at personal care home
Joel Schlesinger, Winnipeg Health Authority Wave Magazine, Jan/Feb 2012

Article about using RAI/MDS to improve care.

The 4th annual Dr. Olive Yonge Teaching and Learning Scholarship Day: Through the Looking Glass: Reflecting on the Scholarship of Teaching and Learning
March 23, 2012, Lister Conference Centre University of Alberta Edmonton, Alberta/h4>

The 4th Annual Dr. Olive Yonge Teaching and Learning Scholarship Day takes place on March 23, 2012 at the Lister Centre, University of Alberta. It is offered by the Nursing Pedagogy, Philosophy and History Area of Excellence in collaboration with the Centre for Teaching and Learning and supported by the Faculty of Education.

uPNR Philosophical Conversation
Wednesday 29th February, 12.00-13.00, ECHA 5-001

Anna Santos Salas will lead a discussion on Diagnosing culture: body dysmorphic disorder and cosmetic surgery by Cressida Heyes

Non UofA
Alzheimer’s Association International Conference
Vancouver, BC July 14-19, 2012

At AAIC 2012, join the world’s leading dementia scientists to share the latest thoughts and theories in the field — and spark new ideas along the way. Share your work, advance emerging models and shape new ideas.

CHSRF: CEO Forum Driving Innovation: Reinventing ambulatory and community care
Feb 15, 2012, Montreal, PQ

Canada’s healthcare systems face mounting pressures as populations increase and age, and the prevalence of chronic illness continues to rise. Citizens, healthcare providers and researchers are calling for the reinvention of ambulatory care services, including the expansion of community care, in order to redirect patients with complex needs away from overcrowded hospitals and toward more appropriate and cost-effective services. In short, they want the right care in the right place. Better coordination along the continuum of care promises to significantly improve the health outcomes of these patients, as well as reduce the high cost associated with their care.Every year, the CEO Forum assembles the best evidence on key health policy issues and offers a rare opportunity for healthcare leaders from across Canada to connect with their peers and other key players in Canadian health services. The sixth annual CEO Forum will focus on strategies, levers, and incentives to:
Promote innovation to improve ambulatory and community care for patients with complex, chronic conditions;
Examine alternate models of care to avoid unnecessary hospitalization;
Explore and share strategies for improving coordination and accountability among caregivers along the continuum of care; and
Identify optimal practices to improve the management of chronic care conditions in the community setting.

Evidence-Informed Decision Making Workshop
McMaster University, Hamilton Ontario, April 30 – May 4, 2012

One-week intensive course at
• Advance your skills in critical appraisal of research literature
• Learn strategies for implementing evidence-informed decisions
• Small and large group sessions led by faculty at McMaster
• Tutorial groups for health professionals, administrators, managers, and policymakers who wish to use evidence-informed decision making in their various disciplines.

Training Institute for Dissemination and Implementation Research in Health
San Jose, CA, July 9-13, 2012
Deadline is March 2, 2012

Canadian applicants are welcome for the Training Institute for Dissemination and Implementation Research in Health. The goal of this 5-day training institute is to provide participants with a thorough grounding in conducting dissemination and implementation research in health. Faculty and guest lecturers will consist of leading experts (practitioners and teachers) in theory, implementation and evaluation approaches to D&I, creating partnerships and multi-level transdisciplinary research teams, research design, methods and analyses appropriate for D&I investigations and conducting research at different and multiple levels of intervention (e.g., clinical, community, policy).Participants will be expected to return to their home institutions prepared to share what they have learned at the institute to help grow the field of D&I research (e.g., giving talks, leading seminars, forming new collaborations, mentoring, and submitting D&I grant proposals etc).

CDRAKE: Frontotemporal Dementia: Facing the Challenges for Patients, Family Members, and Clinicians
Mar 27, 2012, 2:00PM-3:00PM MT 12:00PM – 1:00PM ET

Presenter(s): Margaret Crossley (PhD), Registered Doctoral Psychologist, Professor of Psychology and Director of Clinical Psychology Training, Clinical Neuropsychologist with the Rural and Remote Memory Clinic at the University of Saskatchewan

The first half of this presentation will briefly describe some of the challenges associated with diagnosing frontotemporal dementia (FTD), with a focus on the contributions of neuropsychological assessment and interprofessional team collaboration. The second half of the presentation will describe a unique telehealth-delivered support group for spouses of individuals diagnosed with FTD and other atypical dementia, and the lessons learned from our caregiver participants about family member needs and the essential ingredients of therapeutic group interventions.

KT Canada Presents: Michele Hamm & Hannah O’Rourke, PhD Students at the UofA
Thurs, Mar 8, 2012, 10:00-11:30 MT 1200-1330 ET

Michele will discuss a mixed methods study of barriers and facilitators to methodological rigor in pediatric randomized trials
Learning objectives
• To review the empirical evidence describing risk of bias in pediatric randomized controlled trials.
• To describe barriers and facilitators in conducting methodologically rigorous trials, as identified by pediatric trialists
• To discuss how these findings can be applied in the development of a knowledge translation intervention
Hannah will discuss here research that identifies high priority care areas to enhance quality of life for residents with dementia in long-term care
Learning objectives
• To understand the current context of quality indicator utilization in long-term care settings in Canada
• To consider challenges in using quality indicator information to improve care
• To review a research proposal aimed at increasing the use of quality indicator information to improve quality of life for persons with dementia in long-term care settings. http://webcast.otn.ca Session ID 17323044

2 KUSP articles published in BMC Health Services Research are proving to be popular

Assessment of variation in the Alberta Context Tool: The contribution of unit level contextual factors and practice specialty in Canadian pediatric acute care settings has received over 500 views and it was only published in October. And The Resident Assessment Instrument-Minimum Data Set 2.0 quality indicators: a systematic review has been viewed 2920 times and is the 38th most viewed article published in this journal. Good Work!!! And congratulations to all the authors.

Federal Government is Taking Action to Improve the Efficiency of the Healthcare System

This funding opportunity will support teams of researchers and decision-makers to conduct research in two areas: chronic disease prevention and management; and access to care for vulnerable populations, such as children, seniors, poor, elderly, and Aboriginal communities.

NCCMT is conducting survey on public health decision makers’ use of EBP

The National Collaborating Centre for Methods and Tools (NCCMT) is currently conducting an evaluation study exploring public health decision makers’ awareness, use and satisfaction with products and services to support evidence-informed practice. You are being invited to participate in this study based on your registration to use the web-based resources offered by the NCCMT. We would like to invite you to complete an online survey that will take approximately 25 minutes to complete. Respondents will be entered into a draw for a chance to win an iPad2.

CIHR: Evidence Informed Healthcare Renewal

The Evidence-Informed Healthcare Renewal (EIHR) initiative will support researchers and decision makers to work together to advance the current state of knowledge, generate novel and creative solutions, and translate evidence for uptake into policy and practice to strengthen Canada’s healthcare systems.This initiative aims to provide timely and high-quality evidence – both in the short term with the Health Accord, and beyond for the perennial topics of how best to finance, sustain and govern provincial, territorial and federal healthcare systems.

OHA: Internationally Educated Nurses: An Employer’s Guide

The OHA has developed a unique web-based resource, along with researchers in McMaster University’s Nursing Health Services Research Unit (NHSRU), to help hospitals and health care facilities overcome barriers in the integration of internationally educated nurses (IENs) into the workforce.

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