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Abstracts
CALL FOR ABSTRACTS:
21st International Conference on Health Promoting Hospitals and Health Services (HPH)
May 22-24, 2013, Gothenburg, Sweden
DEADLINE January 5, 2013
This conference will mark the 20th anniversary of the European Pilot Hospital Project of Health Promoting Hospitals (EPHP). This project came to life in 1993 with the aim to make the WHO Ottawa Charters’ demand to “reorient health services” a reality for hospitals. This endeavor was taken up with regard to positive health, a comprehensive health orientation that refers to body and mind alike, and a stronger contribution of health services towards public health.
7th International Shared Decision Making conference
Lima, Perú, June 16-19 2013
DEADLINE November 30, 2012
ISDM conferences are a unique venue for worldwide sharing of knowledge and experiences about shared decision making. This year’s theme seeks to highlight that shared decision making is a key component of something more global, i.e., patient‐centered care, and that its application is only relevant as part of a commitment to care for and about patients. We invite investigators and concerned partners in healthcare delivery research and practice to struggle with the issues that arise as shared decision making globalizes in scope (as a component of patient‐centered care) and spread (as a component of healthcare everywhere for everyone).
CapitalCare Foundation’s 26th People & Progress Continuing Care Conference
February 7-8, 2013 Edmonton, AB
DEADLINE November 15, 2012
Please email or fax completed form to Elizabeth Tanti, Administrator, CapitalCare Strathcona Email: elizabeth.tanti@capitalcare.net
Canadian Public Health Association Conference
June 9-12, 2013 Ottawa, ON
DEADLINE Wednesday November 21, 2012
Abstracts accepted for the CPHA 2013 Annual Conference may be presented in the form of either an Oral or Poster Presentation. Submission of an abstract implies the submitter’s agreement to register for the conference, pay the appropriate conference registration fee, and make this presentation as scheduled.
AcademyHealth Research Meeting
June 23-25 Baltimore, MD
DEADLINE 15:00 MT January 17, 2013
The AcademyHealth 2013 Annual Research Meeting (ARM) call for abstracts is now open. With a significant portion of the conference agenda selected through the call for abstracts process, the ARM is an opportunity for researchers to share important findings with policymakers and providers who can move the research into action. Abstracts are invited for four categories: call for papers, call for posters, call for research panels, and call for policy roundtables. AcademyHealth seeks abstracts on 18 themes reflecting a variety of critical areas of study in health services research, as well as proposals for panels that present research or discuss key health policy topics. Abstracts submitted to the call for papers will also be considered for publication in JAMA and HSR
Sigma Theta Tau International: Creating Healthy Work Environments
12-14 April 2013 Indianapolis, IN
DEADLINE 14 November 2012
Abstracts are invited that demonstrate a direct link to the theme Creating Healthy Work Environments and to the overall objectives of the program. Oral and poster presentations will serve as a networking arena to bring together students, academicians, clinicians, and volunteers to address the creating and sustaining a healthy work environment. Based on the American Association of Critical-Care Nurses Standards for Establishing and Sustaining Health Work Environments, STTI asks that abstracts are submitted that reference the six essential standards of a healthy work environment.
2013 CAHSPR Conference
May 28-30 Vancouver BC
DEADLINE January 24, 2013
The Canadian Association for Health Services and Policy Research is now accepting online submissions of abstracts for Oral Presentations, Poster Presentations, Panel Presentations
Conference theme What will it take to achieve the Triple Aim in Canadian health care? Can we simultaneously increase population health and improve the patient and provider experience while constraining cost growth? The conference provides an opportunity to learn from improvement initiatives in Canada and other jurisdictions, to identify the factors necessary to drive improvements across the Canadian health system, and to explore what it means to pursue the triple aim within the promise of universal access. Themes for abstracts: CAHSPR’s annual conference features a wide range of work related to health services and health policy. Abstracts do not have to be on the conference theme. We therefore encourage all research producers, users, and brokers to submit abstracts for presentation formats that are appropriate to their work.
Grants & Awards
CJSRF: EXTRA
DEADLINE 12 p.m. EST on February 5, 2013.
Geared toward teams of Healthcare Executives, the new Executive Training for Research Application (EXTRA) program 14-month team-based fellowship offers a shorter and more focused training in better management and use of evidence for quality and performance improvement. EXTRA training gives participants the skills and knowledge to become change agents in healthcare improvement. It offers unique opportunities for participants to conduct evidence-informed intervention projects in their organizations, with the goal of enhancing patient outcomes, quality of care and cost- effectiveness. Led by prestigious Canadian and international faculty and practice leaders, the new 14-month EXTRA fellowships support teams in initiating and leading evidence-informed improvements in their own organizations, or across jurisdictions with multi-site teams and cross-boundary intervention projects.
Fellowship : Winter 2013 Priority Announcements: Knowledge Translation
DEADLINE February 1, 2013
The Knowledge Translation (KT) Branch of CIHR will provide funding for applications that are determined to be relevant to the following research priority areas described below:
KT Science (the determinants of knowledge use and effective methods of promoting the uptake of knowledge):
- Increase understanding of the theory and practice of KT
- Develop tools/measures to evaluate the effectiveness/impact of KT practices/interventions
- KT Practice (Moving research into action)
- Increase the uptake/application of knowledge to bridge knowledge to action gap.
- Increase the understanding of knowledge application.
The purpose of this funding opportunity is to advance KT (synthesis, dissemination, exchange and ethically sound application of knowledge). It is expected that this targeted investment will lead to a better understanding of concepts, theories and practices that underlie effective KT in order to improve the health of Canadian, provide more effective health services and products and strengthen the health care system.
Publications
KT
Health Care Administration and Organization
Health Care Innovation and Quality Assurance
Research Methodology
Aging
KT
Translating research into practice in nursing homes: can we close the gap?
Non UofA Access
Rahman AN, Applebaum RA, Schnelle JF, Simmons SF.
The Gerontologist 2012 Oct;52(5):597-606
A gap between research and practice in many nursing home (NH) care areas persists despite efforts by researchers, policy makers, advocacy groups, and NHs themselves to close it. The reasons are many, but two factors that have received scant attention are the dissemination process itself and the work of the disseminators or change agents. This review article examines these two elements through the conceptual lens of Roger’s innovation dissemination model. DESIGN AND METHODS: The application of general principles of innovation dissemination suggests that NHs are characteristically slow to innovate and thus may need more time as well as more contact with outside change agents to adopt improved practices. RESULTS: A review of the translation strategies used by NH change agents to promote adoption of evidence-based practice in NHs suggests that their strategies inconsistently reflect lessons learned from the broader dissemination literature. IMPLICATIONS: NH-related research, policy, and practice recommendations for improving dissemination strategies are presented. If we can make better use of the resources currently devoted to disseminating best practices to NHs, we may be able to speed NHs’ adoption of these practices.
Guidance for evidence-informed policies about health systems: rationale for and challenges of guidance development.
Non UofA Access
Bosch-Capblanch X, Lavis JN, Lewin S, Atun R, Rottingen JA, Droschel D, et al.
PLoS medicine 2012;9(3):e1001185
In the first paper in a three-part series on health systems guidance, Xavier Bosch-Capblanch and colleagues examine how guidance is currently formulated in low- and middle-income countries, and the challenges to developing such guidance.
Sources of non-compliance with clinical practice guidelines in trauma triage: a decision science study.
Non UofA Access
Mohan D, Rosengart MR, Farris C, Fischhoff B, Angus DC, Barnato AE.
Implementation science 2012 Oct 25;7(1):103
BACKGROUND: United States trauma system guidelines specify when to triage patients to specialty centers. Nonetheless, many eligible patients are not transferred as per guidelines. One possible reason is emergency physician decision-making. The objective of the study was to characterize sensory and decisional determinants of emergency physician trauma triage decision-making. METHODS: We conducted a decision science study using a signal detection theory-informed approach to analyze physician responses to a web-based survey of 30 clinical vignettes of trauma cases. We recruited a national convenience sample of emergency medicine physicians who worked at hospitals without level I/II trauma center certification. Using trauma triage guidelines as our reference standard, we estimated physicians’ perceptual sensitivity (ability to discriminate between patients who did and did not meet guidelines for transfer) and decisional threshold (tolerance for false positive or false negative decisions). RESULTS: We recruited 280 physicians: 210 logged in to the website (response rate 74%) and 168 (80%) completed the survey. The regression coefficient on American College of Surgeons – Committee on Trauma (ACS-COT) guidelines for transfer (perceptual sensitivity) was 0.77 (p<0.01, 95% CI 0.68 – 0.87) indicating that the probability of transfer weakly increased as the ACS-COT guidelines would recommend transfer. The intercept (decision threshold) was 1.45 (p<0.01, 95% CI 1.27 – 1.63), indicating that participants had a conservative threshold for transfer, erring on the side of not transferring patients. There was significant betweenphysician variability in perceptual sensitivity and decisional thresholds. No physician demographic characteristics correlated with perceptual sensitivity, but men and physicians working at non-trauma centers without a trauma-center affiliation had higher decisional thresholds. CONCLUSIONS: On a case vignette-based questionnaire, both sensory and decisional elements in emergency physicians' cognitive processes contributed to the under-triage of trauma patients.
Integration of evidence-based knowledge management in microsystems: a tele-ICU experience.
Non UofA Access
Rincon TA.
Critical care nursing quarterly 2012 Oct-Dec;35(4):335-340
The Institute of Medicine’s proposed 6 aims to improve health care are timely, safe, effective, efficient, equitable, and patient-centered care. Unfortunately, it also asserts that improvements in these 6 dimensions cannot be achieved within the existing framework of care systems. These systems are based on unrealistic expectations on human cognition and vigilance, and demonstrate a lack of dependence on computerized systems to support care processes and put information at the point of use. Knowledge-based care and evidence-based clinical decision-making need to replace the unscientific care that is being delivered in health care. Building care practices on evidence within an information technology platform is needed to support sound clinical decision-making and to influence organizational adoption of evidence-based practice in health care. Despite medical advances and evidence-based recommendations for treatment of severe sepsis, it remains a significant cause of mortality and morbidity in the world. It is a complex disease state that has proven difficult to define, diagnose, and treat. Supporting bedside teams with real-time knowledge and expertise to target early identification of severe sepsis and compliance to Surviving Sepsis Campaign, evidence-based practice bundles are important to improving outcomes. Using a centralized, remote team of expert nurses and an open-source software application to advance clinical decision-making and execution of the severe sepsis bundle will be examined.
Inter-professional Barriers and Knowledge Brokering in an Organizational Context: The Case of Healthcare
Non UofA Access
Currie G, White L.
Organization Studies 2012 October 01;33(10):1333-1361
Our study examines brokering of situated knowledge within an organizational context, characterized by professional hierarchy. We examine how professional affiliation and associated power differentials impact upon knowledge brokering at the individual and group levels within an organization. Our empirical case, which combines social network analysis and qualitative fieldwork, is set in healthcare with a focus upon integration of management, psychosocial and clinical component knowledge domains deemed necessary for treatment of a long-term condition. Our study shows that peer-to-peer knowledge brokering, which is framed by professional hierarchy, remains pervasive with respect to medical knowledge brokering. However, social structures might be mediated through developing architectural knowledge, reflected in both formal and informal organizational routines and schema, which engenders community tendencies that transcend professional hierarchy, so that knowledge brokering is more widely distributed to benefit patients.
Working at the nexus between public health policy, practice and research. Dynamics of knowledge sharing in the Netherlands.
Non UofA Access
Jansen MW, De Leeuw E, Hoeijmakers M, De Vries NK.
Health research policy and systems / BioMed Central 2012 Oct 17;10(1):33
BACKGROUND: Joining the domains of practice, research and policy is an important aspect of boosting the quality performance required to tackle complex public health problems. “Joining domains” implies a departure from the linear and technocratic knowledge-translation approach. Integrating the practice, research and policy triangle means knowing its elements, appreciating the barriers, identifying possible cooperation strategies and studying strategy effectiveness under specified conditions.This article examines the dynamic process of developing an Academic Collaborative Centre for Public Health in the Netherlands, with the objective of achieving that the three domains of policy, practice and research become working partners on an equal footing. METHOD: An interpretative hermeneutic approach was used to interpret the phenomenon of collaboration at the nexus between the three domains. The project was explicitly grounded in current organizational culture and routines, applied to nexus action. In the process of examination, we used both quantitative (e.g. records) and qualitative data (e.g., interviews and observations). The data were interpreted using the Actor-Network, Institutional Re-Design and Blurring the Boundaries theories. RESULTS: Results show commitment at strategic level. At the tactical level, however, managers were inclined to prioritize daily routine, while the policy domain remained absent. At the operational level, practitioners learned to do PhD research in real-life practice and researchers became acquainted with problems of practice and policy, resulting in new research initiatives. CONCLUSION: We conclude that working at the nexus is an ongoing process of formation and reformation. Strategies based on Institutional Re-Design theories in particular might help to more actively stimulate managers’ involvement to establish mutually supportive networks.
Factors influencing the development of evidence-based practice among nurses: a self-report survey.
Non UofA Access
Dalheim A, Harthug S, Nilsen RM, Nortvedt MW.
BMC health services research 2012 Oct 24;12(1):367
BACKGROUND: Health authorities in several countries have decided that the health care services should be evidence-based. Recent research indicates that evidence-based practice may be more successfully implemented if the interventions overcome identified barriers. AIMS: The present study aimed to examine factors influencing the implementation of evidence-based practice among nurses in a large Norwegian university hospital. METHODS: Cross-sectional data was collected from 407 nurses during the period November 8 to December 3, 2010, using the Norwegian version of Developing Evidence-based Practice questionnaire (DEBP). The DEBP included data on various sources of information used for support in practice, on potential barriers for evidence-based practice, and on self-reported skills on managing research-based evidence. The DEBP was translated into Norwegian in accordance with standardized guidelines for translation and cultural adaptation. RESULTS: Nurses largely used experienced-based knowledge collected from their own observations, colleagues and other collaborators for support in practice. Evidence from research was seldom used. The greatest barriers were lack of time and lack of skills to find and manage research evidence. The nurse’s age, the number of years of nursing practice, and the number of years since obtaining the last health professional degree influenced the use of sources of knowledge and self-reported barriers. Self-reported skills in finding, reviewing and using different sources of evidence were positively associated with the use of research evidence and inversely related to barriers in use of research evidence. CONCLUSION: Skills in evidence-based practice seem to reduce barriers to using research evidence and to increase use of research evidence in clinical practice.
Implementing nutrition guidelines for older people in residential care homes: a qualitative study using normalization process theory.
Non UofA Access
Bamford C, Heaven B, May C, Moynihan P.
Implementation science : IS 2012 Oct 30;7(1):106
BACKGROUND: Optimising the dietary intake of older people can prevent nutritional deficiencies and dietrelated diseases thereby improving quality of life. However, there is evidence that the nutritional intake of older people living in care homes is suboptimal, with high levels of saturated fat, salt and added sugars. The UK Food Standards Agency therefore developed nutrient and food based guidance for residential care homes. The acceptability of these guidelines and their feasibility in practice is unknown. This study used Normalisation Process Theory (NPT) to understand the barriers and facilitators to implementing the guidelines and inform future implementation. METHODS: We conducted a process evaluation in five care homes in the north of England using qualitative methods (observation and interviews) to explore the views of managers, care staff, catering staff and domestic staff. Data were analysed thematically and discussed in data workshops; emerging themes were then mapped to the constructs of NPT. RESULTS: Many staff perceived the guidelines as unnecessarily restrictive and irrelevant to older people. In terms of NPT the guidelines simply did not make sense (coherence) and as a result relatively few staff invested in the guidelines (cognitive participation). Even where staff supported the guidelines, implementation was hampered by a lack of nutritional knowledge and institutional support (collective action). Finally, the absence of observable benefits to clients confirmed the negative preconceptions of many staff, with limited evidence of reappraisal following implementation (reflexive monitoring). CONCLUSIONS: The successful implementation of the nutrition guidelines requires the fundamental issues relating to their perceived value and fit’ with other priorities and goals to be addressed. Specialist support is needed to equip staff with the technical knowledge and skills required for menu analysis and development and to devise ways of evaluating the outcomes of modified menus. NPT proved useful in conceptualising barriers to implementation; robust links with behaviour change theories would further increase the practical utility of NPT.
Action-oriented study circles facilitate efforts in nursing homes to “go from feeding to serving”: conceptual perspectives on knowledge translation and workplace learning.
Non UofA Access
Westergren A.
Journal of aging research 2012;2012:627371
Background. Action-oriented study circles (AOSC) have been found to improve nutrition in 24 nursing homes in Sweden. Little, however, is known about the conceptual use of knowledge (changes in staffs’ knowledge and behaviours). Methods. Qualitative and quantitative methods, structured questionnaires for evaluating participants’ (working in nursing homes) experiences from study circles (n = 592, 71 AOSC) and for comparisons between AOSC participants (n = 74) and nonparticipants (n = 115). Finally, a focus group interview was conducted with AOSC participants (in total n = 12). Statistical, conventional, and directed content analyses were used. Results. Participants experienced a statistically significant increase in their knowledge about eating and nutrition, when retrospectively comparing before participating and after, as well as in comparison to non-participants, and they felt that the management was engaged in and took care of ideas regarding food and mealtimes to a significantly greater extent than non-participants. The use of AOSC was successful judging from how staff members had changed their attitudes and behaviours toward feeding residents. Conclusions. AOSC facilitates professional development, better system performance, and, as shown in previous studies, better patient outcome. Based on a collaborative learning perspective, AOSC manages to integrate evidence, context, and facilitation in the efforts to achieve knowledge translation in a learning organisation. This study has implications also for other care settings implementing AOSC.
A collaborative approach to defining the usefulness of impact: lessons from a knowledge exchange project involving academics and social work practitioners.
Non UofA Access
Wilkinson H, Gallagher M, Smith M.
Evidence & Policy: A Journal Of Research, Debate & Practice. Aug 2012;8(3):311-27
This paper reports on a knowledge exchange project involving academics and practitioners in six local authority social work departments. It contributes to recent debates about the co-production of knowledge, presenting findings in three key areas: the importance of relationships for knowledge exchange; ‘what works’ for practitioners engaging with academics; and the value of practitioner research for enabling knowledge exchange. It also considers the assessment of ‘impact’ against the shifting landscape of the Research Excellence Framework, arguing that academic and performance management notions of impact and research quality risk eclipsing the perspectives of research users.Copyright of Evidence & Policy: A Journal of Research, Debate, & Practice.
WHO: Embedding of research into decision-making processes
Alliance for health Policy and Systems Research, 2012
As health systems have become more complex and public demands for accountability have increased, the salience of overall health system performance for better services and health outcomes has grown. The current international emphasis on evaluating performance has positioned health systems research as an important vehicle for promoting evidence-based policy making. In turn, this emphasis has also encouraged health systems research to become relevant to policy making. The divide between research and policy is substantial in many low and middle-income countries (LMIC). Both supply and demand factors are responsible for this. On the supply side, the limited local pool of human and financial resources has constrained the production of quality research. The result is that many LMICs are characterized by limited institutional capacity to generate research to aid policy making. On the other hand, avenues for research to influence policy are severely limited. One reason for this is the bureaucratization of policy making, in which, researchers and research institutions have only a minor role. Other common obstacles in this regard are centralized decision making and a policy making culture that gives little importance to evidence based research.
Knowledge Mobilization in Education A cross-case analysis of 44 research brokering organizations across Canada 
Amanda Cooper
An emerging field of inquiry has arisen in order to address the oft-cited gaps between research, policy and practice called knowledge mobilization (KMb) in education and knowledge translation in the health sector (names vary across sectors and countries). For the purposes of this study, KMb includes efforts to increase the use of research evidence in policy and practice in education. KMb occurs through iterative, social processes involving interaction among two or more different groups or contexts (researchers, policymakers, practitioners, third party agencies, community members) in order to improve the broader education system. This study uses the term ‘research brokering organization’ (RBO) to describe third party, intermediary organizations whose active role between research producers and users is a catalyst for research use in education.
Using Science as Evidence in Public Policy
Center for Education (CFE) & Behavioral and Social Sciences and Education (DBASSE), 2012
Using Science as Evidence in Public Policy encourages scientists to think differently about the use of scientific evidence in policy making. This report investigates why scientific evidence is important to policy making and argues that an extensive body of research on knowledge utilization has not led to any widely accepted explanation of what it means to use science in public policy. Using Science as Evidence in Public Policy identifies the gaps in our understanding and develops a framework for a new field of research to fill those gaps. For social scientists in a number of specialized fields, whether established scholars or Ph.D. students, Using Science as Evidence in Public Policy shows how to bring their expertise to bear on the study of using science to inform public policy. More generally, this report will be of special interest to scientists who want to see their research used in policy making, offering guidance on what is required beyond producing quality research, beyond translating results into more understandable terms, and beyond brokering the results through intermediaries, such as think tanks, lobbyists, and advocacy groups. For administrators and faculty in public policy programs and schools, Using Science as Evidence in Public Policy identifies critical elements of instruction that will better equip graduates to promote the use of science in policy making.
Active Implementation Frameworks for Program Success: How to Use Implementation Science to Improve Outcomes for Children
Allison Metz & Leah Bartley
Zero to Three: National Center for Infants, Toddlers, and Families, 2012
Over the past decade the science related to developing and identifying evidence-based programs and practices for children and families has improved significantly. However, the science related to implementing these programs in early childhood settings has lagged far behind. This article outlines how the science of implementation and the use of evidence-based Active Implementation Frameworks (Fixsen, Naoom, Blase, Friedman, & Wallace, 2005) can close the research-to-practice gap in early childhood and ensure sustainable program success. Four implementation frameworks include: Implementation Stages; Implementation Drivers; Policy–Practice Feedback Loops; and Organized, Expert Implementation Support. The authors provide examples and discuss implications for early childhood settings
RAND: Dissemination and adoption of comparative effectiveness research findingins when findings challenge current practices
Eric C. Schneider, Justin W. Timbie, D. Steven Fox, Kristin R. Van Busum, John Caloyeras, 2011
Insufficient evidence regarding the effectiveness of medical treatments has been identified as a key source of inefficiency in the U.S. healthcare system. Variation in the use of diagnostic tests and treatments for patients with similar symptoms or conditions has been attributed to clinical uncertainty, since the published scientific evidence base does not provide adequate information to determine which treatments are most effective for patients with specific clinical needs. The federal government has made a dramatic investment in comparative effectiveness research (CER), with the expectation that CER will influence clinical practice and improve the efficiency of healthcare delivery. To do this, CER must provide information that supports fundamental changes in healthcare delivery and informs the choice of diagnostic and treatment strategies. This report summarizes findings from a qualitative analysis of the factors that impede the translation of CER into clinical practice and those that facilitate it. A case-study methodology is used to explore the extent to which these factors led to changes in clinical practice following five recent key CER studies. The enabling factors and barriers to translation for each study are discussed, the root causes for the failure of translation common to the studies are synthesized, and policy options that may optimize the impact of future CER — particularly CER funded through the American Recovery and Reinvestment Act of 2009 — are proposed.
Implementing evidence-based programmes in children’s services: key issues for success
UK Department of Education, 2012
Evidence suggests that a carefully planned and well-resourced implementation is key to better outcomes and programme success. Across disciplines, implementation researchers have devised a number of frameworks that can be used to encourage the best practice in implementation and greatest fidelity to the original programme. This report brings together the latest international thinking about the key issues relating to the implementation of evidence-based programmes, utilising both published work and expert opinion. The aim is to provide a summary of issues that should be considered and planned for by those about to start implementing a new programme in order to increase the chances of success; to draw attention to sources of further information; and to share lessons that have been learned by others when implementing similar programmes. The research consisted of a literature review undertaken initially using snowballing techniques following the identification of key experts in the field. This was followed by a systematic search of electronic databases for previous reviews of implementation studies. For the second section of the report, electronic database searches were carried out for published academic papers relating to the MST, FFT, MTFC, and KEEP programmes.
Canadian Knowledge Mobilization Forum 2012 Report
The first annual Canadian Knowledge Mobilization Forum was held June 19 and 20, 2012 in Ottawa. As noted in the welcome message, by host Peter Levesque, the 75 attendees are knowledge mobilization pioneers. These pioneers came from academia, Federal and Provincial/Territorial Government Ministries, Municipalities and non-governmental agencies working in diverse sectors, including public health and health promotion, education, natural resources and environmental research, traffic injury research, the United Way, Canadian Blood Services, and services for children and youth.
Health Care Administration & Organization
Professional practice leadership roles: The role of organizational power and personal influence in creating a professional practice environment for nurses.
Non UofA Access
Lankshear S, Kerr MS, Spence Laschinger HK, Wong CA.
Health care management review 2012 Oct 5
Professional practice leadership (PPL) roles are those roles responsible for expert practice, providing professional leadership, facilitating ongoing professional development, and research. Despite the extensive implementation of this role, most of the available literature focuses on the implementation of the role, with few empirical studies examining the factors that contribute to PPL role effectiveness. This article will share the results of a research study regarding the role of organizational power and personal influence in creating a high-quality professional practice environment for nurses. Survey results from nurses and PPLs from 45 hospitals will be presented. Path analysis was used to test the hypothesized model and relationships between the key variables of interest. Results indicate that there is a direct and positive relationship between PPL organizational power and achievement of PPL role functions, as well as an indirect, partially mediated effect of PPL influence tactics on PPL role function. There is also a direct and positive relationship between PPL role functions and nurses’ perceptions of their practice environment. The evidence generated from this study highlights the importance of organizational power and personal influence as significantly contributing to the ability of those in PPL roles to achieve desired outcomes. This information can be used by administrators, researchers, and clinicians regarding the factors that can optimize the organizational and systematic strategies for enhancing the practice environment for nursing and other health care professionals
Exploring the structure and organization of information within nursing clinical handovers.
Non UofA Access
Johnson M, Jefferies D, Nicholls D.
International journal of nursing practice 2012 Oct;18(5):462-470
Clinical handover is the primary source of patient information for nurses; however, inadequate information transfer compromises patient safety. We investigated the content and organization of information conveyed at 81 handovers. A structure that captures and presents the information transferred at handover emerged: identification of the patient and clinical risks, clinical history/presentation, clinical status, care plan and outcomes/goals of care (ICCCO). This approach covers essential information while allowing for prioritization of information when required. Further research into the impact of ICCCO on patient safety is in progress. © 2012 Wiley Publishing Asia Pty Ltd
A Leadership Challenge: Staff Nurse Perceptions After an Organizational TeamSTEPPS Initiative.
Non UofA Access
Castner J, Foltz-Ramos K, Schwartz DG, Ceravolo DJ.
The Journal of nursing administration 2012 Oct;42(10):467-472
The purpose of this study was to measure RNs’ perceptions of teamwork skills and behaviors in their work environment during a multiphase multisite nursing organizational teamwork development initiative. Teamwork is essential for patient safety in healthcare organizations and nursing teams. Organizational development supporting effective teamwork should include a just culture, engaged leadership, and teamwork training. A cross-sectional survey study of bedside RNs was conducted in one 5-hospital healthcare system after a TeamSTEPPS teamwork training initiative. TeamSTEPPS teamwork training related to improved RN perceptions of leadership. Initiatives to align the perspectives and teamwork efforts of leaders and bedside nurses are indicated and should involve charge nurses in the design.
RNAO’s Enhancing Community Care for Ontarians (ECCO) – A Three Year Plan (White Paper)
2012
Ontario’s nurses call on government and stakeholders to collectively strengthen our publicly-funded, not-for-profit health system and make it more responsive to the public’s needs, easier to navigate and more efficient and cost-effective. To make this happen, focus must be placed on advancing primary health care for all through health promotion, disease prevention, social and environmental determinants of health and community care. Equally important are changes that enable nurses and all other regulated health professionals to work to their full scope of practice, a commitment to reducing structural duplication, and advancing system integration and alignment.
Health Care Professionals as Second Victims After Adverse Events : A Systematic Review.
Non UofA Access
Seys D, Wu AW, Van Gerven E, Vleugels A, Euwema M, Panella M, et al.
Evaluation & the health professions 2012 Sep 12
Adverse events within health care settings can lead to two victims. The first victim is the patient and family and the second victim is the involved health care professional. The latter is the focus of this review. The objectives are to determine definitions of this concept, research the prevalence and the impact of the adverse event on the second victim, and the used coping strategies. Therefore a literature research was performed by using a three-step search procedure. A total of 32 research articles and 9 nonresearch articles were identified. The second victim phenomenon was first described by Wu in 2000. In 2009, Scott et al. introduced a detailed definition of second victims. The prevalence of second victims after an adverse event varied from 10.4% up to 43.3%. Common reactions can be emotional, cognitive, and behavioral. The coping strategies used by second victims have an impact on their patients, colleagues, and themselves. After the adverse event, defensive as well as constructive changes have been reported in practice. The second victim phenomenon has a significant impact on clinicians, colleagues, and subsequent patients. Because of this broad impact it is important to offer support for second victims. When an adverse event occurs, it is critical that support networks are in place to protect both the patient and involved health care providers.
Who rides the glass escalator? Gender, race and nationality in the national nursing assistant study
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Price-Glynn K, Rakovski C.
Work, Employment and Society 2012;26(5):699-715
Evidence for Christine Williams’s ‘glass escalator’ effect documents how professional men entering female-dominated occupations may advance more quickly toward authority positions and higher salaries. However, studies of men’s benefits from occupational segregation have neglected low-wage and diverse groups of workers. Using the representative US National Nursing Assistant Study (NNAS), the article examines organizational measures of inequality and discrimination – wages, benefits and working conditions – to understand whether a glass escalator exists among nursing assistants and how it is affected by gender, race, citizenship and facility characteristics. Though gender inequalities were present, citizenship, race, facility type and size emerged as the most important factors in determining advantages for workers, suggesting a revision of the glass escalator metaphor may be in order. NNAS results imply that identity characteristics like nationality and contextual factors like workplace matter and underscore the importance of using an intersectional approach to examine inequality. © The Author(s) 2012.
The moderating role of decision authority and coworker- and supervisor support on the impact of job demands in nursing homes: a cross-sectional study.
Non UofA Access
Willemse BM, de Jonge J, Smit D, Depla MF, Pot AM.
International journal of nursing studies 2012 Jul;49(7):822-833
Healthcare workers in nursing homes are faced with high job demands that can have a detrimental impact on job-related outcomes, such as job satisfaction. Job resources may have a buffering role on this relationship. The Demand-Control-Support (DCS) Model offers a theoretical framework to study how specific job resources can buffer the adverse effects of high demands, and can even activate positive consequences of high demands. OBJECTIVES: The present study tests the moderating (i.e. buffering and activating) effects of decision authority and coworker- and supervisor support that are assumed by the hypotheses of the DCS Model. DESIGN: A national cross-sectional survey was conducted with an anonymous questionnaire. SETTING: One hundred and thirty six living arrangements that provide nursing home care for people with dementia in the Netherlands. PARTICIPANTS: Fifteen healthcare workers per living arrangement. In total, 1147 people filled out the questionnaires (59% response rate). METHODS: Hierarchical multilevel regression analyses were conducted to test the assumption that the effect of job demands on the dependent variables is buffered or activated the most when both decision authority and social support are high. This moderation is statistically represented by three-way interactions (i.e. demands×authority×support), while lower-order effects are taken into account (i.e. two-way interactions). The hypotheses are supported when three-way interaction effects are found in the expected direction. The dependent variables studied are job satisfaction, emotional exhaustion, and personal accomplishment. RESULTS: The proposed buffering and activation hypotheses of the DCS Model were not supported in our study. Three-way interaction effects were found for emotional exhaustion and personal accomplishment, though not in the expected direction. In addition, two-way interaction effects were found for job satisfaction and emotional exhaustion. Decision authority was found to buffer the adverse effect of job demands and to activate healthcare staff. Supervisor support was found to buffer the adverse effect of job demands on emotional exhaustion in situations with low decision authority. Finally, coworker support was found to have an adverse effect on personal accomplishment in high strain situations. CONCLUSIONS: Findings reveal that decision authority in particular makes healthcare workers in nursing homes less vulnerable to adverse effects of high job demands, and promotes positive consequences of work. Copyright © 2012 Elsevier Ltd. All rights reserved.
Health Care Innovation and Quality Assurance
Organizational culture and the implementation of person centered care: Results from a change process in Swedish hospital care.
Non UofA Access
Sweden has one of the oldest, most coherent and stable healthcare systems in the world. The culture has been described as conservative, mechanistic and increasingly standardized. In order to provide a care adjusted to the patient, person centered care (PCC) has been developed and implemented into some parts of the health care industry. The model has proven to decrease patient uncertainty. However, the impact of PCC has been limited in some clinics and hospital wards. An assumption is that organizational culture has an impact on desired outcomes of PCC, such as patient uncertainty. Therefore, in this study we identify the impact of organizational culture on patient uncertainty in five hospital wards during the implementation of PCC. Data from 220 hospitalized patients who completed the uncertainty cardiovascular population scale (UCPS) and 117 nurses who completed the organizational values questionnaire (OVQ) were investigated with regression analysis. The results seemed to indicate that in hospitals where the culture promotes stability, control and goal setting, patient uncertainty is reduced. In contrast to previous studies suggesting that a culture of flexibility, cohesion and trust is positive, a culture of stability can better sustain a desired outcome of reform or implementation of new care models such as person centered care. It is essential for health managers to be aware of what characterizes their organizational culture before attempting to implement any sort of new healthcare model. The organizational values questionnaire has the potential to be used as a tool to aid health managers in reaching that understanding. Copyright © 2012. Published by Elsevier Ireland Ltd.
More quality measures versus measuring what matters: a call for balance and parsimony.
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Meyer GS, Nelson EC, Pryor DB, James B, Swensen SJ, Kaplan GS, et al.
BMJ quality & safety 2012 Nov;21(11):964-968
External groups requiring measures now include public and private payers, regulators, accreditors and others that certify performance levels for consumers, patients and payers. Although benefits have accrued from the growth in quality measurement, the recent explosion in the number of measures threatens to shift resources from improving quality to cover a plethora of quality-performance metrics that may have a limited impact on the things that patients and payers want and need (ie, better outcomes, better care, and lower per capita costs). Here we propose a policy that quality measurement should be: balanced to meet the need of end users to judge quality and cost performance and the need of providers to continuously improve the quality, outcomes and costs of their services; and parsimonious to measure quality, outcomes and costs with appropriate metrics that are selected based on end-user needs.
Managing boundaries in primary care service improvement: A developmental approach to communities of practice.
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Kislov R, Walshe K, Harvey G.
Implementation science : IS 2012 Oct 15;7(1):97
BACKGROUND: Effective implementation of change in healthcare organisations involves multiple professional and organisational groups and is often impeded by professional and organisational boundaries that present relatively impermeable barriers to sharing knowledge and spreading work practices. Informed by the theory of communities of practice (CoPs), this study explored the effects of intra-organisational and inter-organisational boundaries on the implementation of service improvement within and across primary healthcare settings and on the development of multiprofessional and multi-organisational CoPs during this process. METHODS: The study was conducted within the Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for Greater Manchester–a collaborative partnership between the University of Manchester and local National Health Service organisations aiming to undertake applied health research and enhance its implementation in clinical practice. It deployed a qualitative embedded case study design, encompassing semistructured interviews, direct observation and documentary analysis, conducted in 2010-2011. The sample included practice doctors, nurses, managers and members of the CLAHRC implementation team. FINDINGS: The study showed that in spite of epistemic and status differences, professional boundaries between general practitioners, practice nurses and practice managers co-located in the same practice over a relatively long period of time could be successfully bridged, leading to the formation of multiprofessional CoPs. While knowledge circulated relatively easily within these CoPs, barriers to knowledge sharing emerged at the boundary separating them from other groups existing in the same primary care setting. The strongest boundaries, however, lay between individual general practices, with inter-organisational knowledge sharing and collaboration between them remaining unequally developed across different areas due to historical factors, competition and strong organisational identification. Manipulated emergence of multi-organisational CoPs in the context of primary care may thus be problematic. CONCLUSIONS: In cases when manipulated emergence of new CoPs is problematic, boundary issues could be addressed by adopting a developmental perspective on CoPs, which provides an alternative to the analytical and instrumental perspectives previously described in the CoP literature. This perspective implies a pragmatic, situational approach to mapping existing CoPs and their characteristics and potentially modifying them in the process of service improvement through the combination of internal and external facilitation.
Ten challenges in improving quality in healthcare: lessons from the Health Foundation’s programme evaluations and relevant literature.
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Dixon-Woods M, McNicol S, Martin G.
BMJ quality & safety 2012 Oct;21(10):876-884
Formal evaluations of programmes are an important source of learning about the challenges faced in improving quality in healthcare and how they can be addressed. The authors aimed to integrate lessons from evaluations of the Health Foundation’s improvement programmes with relevant literature. METHODS: The authors analysed evaluation reports relating to five Health Foundation improvement programmes using a form of ‘best fit’ synthesis, where a pre-existing framework was used for initial coding and then updated in response to the emerging analysis. A rapid narrative review of relevant literature was also undertaken. RESULTS: The authors identified ten key challenges: convincing people that there is a problem that is relevant to them; convincing them that the solution chosen is the right one; getting data collection and monitoring systems right; excess ambitions and ‘projectness’; organisational cultures, capacities and contexts; tribalism and lack of staff engagement; leadership; incentivising participation and ‘hard edges’; securing sustainability; and risk of unintended consequences. The authors identified a range of tactics that may be used to respond to these challenges. DISCUSSION: Securing improvement may be hard and slow and faces many challenges. Formal evaluations assist in recognising the nature of these challenges and help in addressing them.
Care Quality Commission: Case study: Protecting the rights of care home residents
Our latest case study is from Hayling Island (Hampshire), a small care home for people with physical and learning disabilities. Read how our actions and work with the provider, after finding poor care, have resulted in a much improved service.
IOM: Best Care at Lower Cost: The Path to Continuously Learning Health Care in America
September 2012
America’s health care system has become far too complex and costly to continue business as usual. Pervasive inefficiencies, an inability to manage a rapidly deepening clinical knowledge base, and a reward system poorly focused on key patient needs, all hinder improvements in the safety and quality of care and threaten the nation’s economic stability and global competitiveness. Achieving higher quality care at lower cost will require fundamental commitments to the incentives, culture, and leadership that foster continuous “learning”, as the lessons from research and each care experience are systematically captured, assessed, and translated into reliable care. In the face of these realities, the IOM convened the Committee on the Learning Health Care System in America to explore these central challenges to health care today. The product of the committee’s deliberations, Best Care at Lower Cost, identifies three major imperatives for change: the rising complexity of modern health care, unsustainable cost increases, and outcomes below the system’s potential. But it also points out that emerging tools like computing power, connectivity, team-based care, and systems engineering techniques—tools that were previously unavailable—make the envisioned transition possible, and are already being put to successful use in pioneering health care organizations. Applying these new strategies can support the transition to a continuously learning health system, one that aligns science and informatics, patient-clinician partnerships, incentives, and a culture of continuous improvement to produce the best care at lower cost. The report’s recommendations speak to the many stakeholders in the health care system and outline the concerted actions necessary across all sectors to achieve the needed transformation.
Specifying content and mechanisms of change in interventions to change professionals’ practice: an illustration from the Good Goals study in occupational therapy.
Non UofA Access
Kolehmainen N, Francis JJ.
Implementation science 2012 Oct 18;7(1):100
BACKGROUND: It is widely agreed that interventions to change professionals’ practice need to be clearly specified. This involves (1) selecting and defining the intervention techniques, (2) operationalising the techniques and deciding their delivery, and (3) formulating hypotheses about the mechanisms through which the techniques are thought to result in change. Descriptions of methods to achieve these objectives are limited. This paper reports methods and illustrates outputs from a study to meet these objectives, specifically from the Good Goals study to improve occupational therapists’ caseload management practice.
METHODS: (1) Behaviour change techniques were identified and selected from an existing matrix that maps techniques to determinants. An existing coding manual was used to define the techniques. (2) A team of occupational therapists generated context-relevant, acceptable modes of delivery for the techniques; these data were compared and contrasted with previously collected data, literature on caseload management, and the aims of the intervention. (3) Hypotheses about the mechanisms of change were formulated by drawing on the matrix and on theories of behaviour change. RESULTS: (1) Eight behaviour change techniques were selected: goal specified; self-monitoring; contract; graded tasks; increasing skills (problem solving, decision making, goal setting); coping skills; rehearsal of relevant skills; social processes of encouragement, support, and pressure; demonstration by others; and feedback. (2) A range of modes of delivery were generated (e.g., graded tasks’ consisting of series of clinical cases and situations that become increasingly difficult). Conditions for acceptable delivery were identified (e.g., selfmonitoring’ was acceptable only if delivered at team level). The modes of delivery were specified as face-to-face training, task sheets, group tasks, DVDs, and team-based weekly meetings. (3) The eight techniques were hypothesized to target caseload management practice through eleven mediating variables. Three domains were hypothesized to be most likely to change: beliefs about capabilities, motivation and goals, and behavioural regulation. CONCLUSIONS: The project provides an exemplar of a systematic and reportable development of a qualityimprovement intervention, with its methods likely to be applicable to other projects. A subsequent study of the intervention has provided early indication that use of systematic methods to specify interventions may help to maximize acceptability and effectiveness.
Research Methodology
Writing implementation research grant proposals: Ten key ingredients.
Non UofA Access
Proctor EK, Powell BJ, Baumann AA, Hamilton AM, Santens RL
Implement Sci. 2012 Oct 12;7(1):96.
BACKGROUND: All investigators seeking funding to conduct implementation research face the challenges of preparing a high-quality proposal and demonstrating their capacity to conduct the proposed study. Applicants need to demonstrate the progressive nature of their research agenda and their ability to build cumulatively upon the literature and their own preliminary studies. Because implementation science is an emerging field involving complex and multilevel processes, many investigators may not feel equipped to write competitive proposals, and this concern is pronounced among early stage implementation researchers. DISCUSSION: This article addresses the challenges of preparing grant applications that succeed in the emerging field of dissemination and implementation. We summarize ten ingredients that are important in implementation research grants. For each, we provide examples of how preliminary data, background literature, and narrative detail in the application can strengthen the application. SUMMARY: Every investigator struggles with the challenge of fitting into a page-limited application the research background, methodological detail, and information that can convey the project’s feasibility and likelihood of success. While no application can include a high level of detail about every ingredient, addressing the ten ingredients summarized in this article can help assure reviewers of the significance, feasibility, and impact of the proposed research.
Addressing methodological challenges in implementing the nursing home pain management algorithm randomized controlled trial.
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Ersek M, Polissar N, Pen AD, Jablonski A, Herr K, Neradilek MB.
Clinical trials (London, England) 2012;9(5):634-644
Unrelieved pain among nursing home (NH) residents is a well-documented problem. Attempts have been made to enhance pain management for older adults, including those in NHs. Several evidence-based clinical guidelines have been published to assist providers in assessing and managing acute and chronic pain in older adults. Despite the proliferation and dissemination of these practice guidelines, research has shown that intensive systems-level implementation strategies are necessary to change clinical practice and patient outcomes within a health-care setting. One promising approach is the embedding of guidelines into explicit protocols and algorithms to enhance decision making. PURPOSE: The goal of the article is to describe several issues that arose in the design and conduct of a study that compared the effectiveness of pain management algorithms coupled with a comprehensive adoption program versus the effectiveness of education alone in improving evidence-based pain assessment and management practices, decreasing pain and depressive symptoms, and enhancing mobility among NH residents. METHODS: The study used a cluster-randomized controlled trial (RCT) design in which the individual NH was the unit of randomization. The Roger’s Diffusion of Innovations theory provided the framework for the intervention. Outcome measures were surrogate-reported usual pain, self-reported usual and worst pain, and self-reported pain-related interference with activities, depression, and mobility. RESULTS: The final sample consisted of 485 NH residents from 27 NHs. The investigators were able to use a staggered enrollment strategy to recruit and retain facilities. The adaptive randomization procedures were successful in balancing intervention and control sites on key NH characteristics. Several strategies were successfully implemented to enhance the adoption of the algorithm. LIMITATIONS: /Lessons The investigators encountered several methodological challenges that were inherent to both the design and implementation of the study. The most problematic issue concerned the measurement of outcomes in persons with moderate to severe cognitive impairment. It was difficult to identify valid, reliable, and sensitive outcome measures that could be applied to all NH residents regardless of the ability to self-report. Another challenge was the inability to incorporate advances in implementation science into the ongoing study CONCLUSIONS: Methodological challenges are inevitable in the conduct of an RCT. The need to optimize internal validity by adhering to the study protocol is compromised by the emergent logistical issues that arise during the course of the study.
Challenges in Synthesizing and Interpreting the Evidence from a Systematic Review of Multifactorial Interventions to Prevent Functional Decline in Older Adults.
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Lin JS, Whitlock EP, Eckstrom E, Fu R, Perdue LA, Beil TL, et al.
Journal of the American Geriatrics Society 2012 Oct 16
A systematic review of multifactorial assessment and management interventions to prevent functional decline in older adults was undertaken for the U.S. Preventive Services Task Force. It was not possible to determine net benefit because of heterogeneity of studies, including how older adults were selected and their risk of functional decline; the broad spectrum and multifactorial nature of interventions evaluated; the suboptimal and inconsistent use of outcomes measured; and the inconsistent and inadequate reporting of data that might allow comparison of populations, interventions, and outcomes between studies. This review process illustrated the complexities encountered when synthesizing and interpreting the evidence in geriatric research and methods of reviewing complex interventions and multiple interrelated health outcomes. This article summarizes the review findings, focusing on methodological challenges, and offers suggestions to researchers on the design, reporting, and analysis of trials that would help address these challenges and allow for better interpretation of evidence in the future. © 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.
Aging
The predictive validity of the tilburg frailty indicator: disability, health care utilization, and quality of life in a population at risk.
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Gobbens RJ, van Assen MA, Luijkx KG, Schols JM.
The Gerontologist 2012 Oct;52(5):619-631
To assess the predictive validity of frailty and its domains (physical, psychological, and social), as measured by the Tilburg Frailty Indicator (TFI), for the adverse outcomes disability, health care utilization, and quality of life. DESIGN AND METHODS: The predictive validity of the TFI was tested in a representative sample of 484 community-dwelling persons aged 75 years and older in 2008 (response rate 42%). A subset of all respondents participated 1 year later (N = 336, 69%) and again 2 years later (N = 266, 55%). We used the TFI, the Groningen Activity Restriction Scale assessing disability, seven indicators of health care utilization, and a brief version of the World Health Organization Quality of Life questionnaire (WHOQOL-BREF). The WHOQOL-BREF was assessed in 2008 and 2010; all others were assessed in 2008, 2009, and 2010. RESULTS: The predictive validity of the TFI assessed in 2008 for disability, health care utilization, and quality of life was corroborated by (a) medium to very large associations of frailty with adverse outcomes 1 or 2 years later; (b) mostly good to excellent area under the curve of total frailty; and (c) an increase in predictive accuracy of most adverse outcomes, even after controlling for that same adverse outcome in 2008, and life-course determinants and multimorbidity. Physical frailty was mostly responsible for the predictive validity of the TFI. IMPLICATIONS: This study showed that the TFI is a valid instrument to predict disability, many indicators of health care utilization, and quality of life of older people, 1 and 2 years later.
Does cognitive impairment influence quality of life among nursing home residents?
Non UofA Access
Abrahamson K, Clark D, Perkins A, Arling G.
The Gerontologist 2012 Oct;52(5):632-640
We investigated the relationship between cognitive status and quality of life (QOL) of Minnesota nursing home (NH) residents and the relationship between conventional or Alzheimer’s special care unit (SCU) placement and QOL. The study may inform development of dementia-specific quality measures. DESIGN AND METHODS: Data for analyses came from face-to-face interviews with a representative sample of 13,130 Minnesota NH residents collected through the 2007 Minnesota NH Resident Quality of Life and Consumer Satisfaction survey. We examined 7 QOL domains: comfort, meaningful activities, privacy, environment, individuality, autonomy, relationships, and a positive mood scale. We applied multilevel models (resident and facility) to examine the relationship between the resident’s score on each QOL domain and the resident’s cognitive impairment (CI) level and SCU placement after controlling for covariates, such as activities of daily living dependency, pain, depression or psychiatric diagnosis, and length of stay. RESULTS: Residents with more severe CI reported higher QOL in the domains of comfort and environment and lower QOL in activities, individuality, privacy and meaningful relationships, and the mood scale. Residents on SCU reported higher QOL in the meaningful activities, comfort, environment, and autonomy domains but had lower mood scores. IMPLICATIONS: Our findings point to QOL domains that show significant variation by CI and thus may be of greatest interest to consumers, providers, advocacy groups, and other stakeholders committed to improving dementia care. Findings are particularly applicable to the development of NH quality indicators that more accurately represent the QOL of NH residents with CI.
Transition from home care to nursing home: unmet needs in a home- and community-based program for older adults.
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Robison J, Shugrue N, Porter M, Fortinsky RH, Curry LA.
Journal of aging & social policy 2012;24(3):251-270
A major effort is under way nationally to shift long-term care services from institutional to home- and community-based settings. This article employs quantitative and qualitative methods to identify unmet needs of consumers who transition from a statewide home- and community-based service program for older adults to long-term nursing home residence. Administrative data, care manager notes, and focus group discussions identified program service gaps that inadequately accommodated acute health problems, mental health issues, and stressed family caregivers; additional unmet needs highlighted an inadequate workforce, transportation barriers, and limited supportive housing options. National and state-level policy implications are considered.
Health status and well-being of older adults living in the community and in residential care settings: are differences influenced by age?
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Rodriguez-Blazquez C, Forjaz MJ, Prieto-Flores ME, Rojo-Perez F, Fernandez-Mayoralas G, Martinez-Martin P, et al.
Aging & mental health 2012;16(7):884-891
The objective is to identify the differences and the main factors influencing health status and well-being variables between institutionalized and non-institutionalized older adults, as well as the interaction effect of institutionalization and age. Data on a total of 468 older adults from a national survey on non-institutionalized and from a study on institutionalized older people were analyzed. Socio-demographic variables and measures on well-being (Personal Well-being Index, PWI), health status (EQ-5D), functional ability (Barthel Index), depression (Hospital Anxiety and Depression Scale-Depression subscale), loneliness and comorbidity were used. Analysis of variance and Kruskal-Wallis tests to examine differences between groups and multiple regression analyses to identify factors associated to health and well-being were performed. Significant differences in health status variables, but not in well-being were detected between groups. Controlling for age, differences in health status (EQ-VAS) were found to be not significant in both groups. In the non-institutionalized group, people aged 78 years or more reported a significantly lower well-being (PWI) than younger counterparts. Step-wise multiple regression analysis showed that depression, functional dependence, loneliness and sex were associated with health status; while depression, health status, loneliness and the interaction of age-institutionalization were related to well-being. The results suggest that age influences community-dwelling older adults’ well-being to a greater extent than it does to institutionalized older people. This finding has implications for resource allocation and interventions addressed to improve health and well-being in older adults.
Quality of life in dementia care–differences in quality of life measurements performed by residents with dementia and by nursing staff.
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Graske J, Fischer T, Kuhlmey A, Wolf-Ostermann K.
Aging & mental health 2012;16(7):819-827
Quality of life (QoL) is a major outcome parameter in dementia care. Self-ratings are considered the best way to evaluate QoL, but staff-ratings also provide valid results. In particular, the discrepancies between self-ratings and staff-ratings are underrepresented. The aim was to identify characteristics of people with dementia that improve the probability of completing a self rating QoL instrument on the ‘Quality of Life – Alzheimers’ Disease’ (QoL-AD). Additionally, a level of agreement was set between self-rated and staff-rated QoL-AD and possible influencing factors. METHOD: A cross-sectional study was conducted in 2010 in Berlin. Using the instrument QoL-AD, the self- and staff-rated QoL of people with dementia was assessed. RESULTS: 104 residents (73.1% female, mean age: 79.0 years, mean cognitive function (MMSE): 11.5) were included in this research project. 49 (47.1%) residents were able to complete the QoL-AD questionnaire. A predictor to complete the QoL-AD was the MMSE-part ‘language’. Residents rated their QoL as significantly higher than the nursing staff did. If the primary nurse rated the QoL, a significantly better agreement was identified. CONCLUSION: The study generated new findings concerning a better understanding of QoL measurements. The results suggest the usefulness of performing self-ratings whenever possible. If proxy-ratings have to be used, these should be performed by primary nurses only in order to get reliable results.
My home life: Promoting quality of life in care homes
Joseph Rowntree Foundation
This report summarises the lessons learnt from the My Home Life Programme examining ‘what works’ in the promotion of ‘voice, choice and control’ for older people who live in care homes. Older people have identified the importance of having control over how they lead their lives and the care that they receive. This is also echoed in government policy across all four nations of the UK. However, there remains a lack of real understanding of what this looks like in care homes and how to make it happen. Through working in partnership with care homes across the UK, the report:
- offers examples of good practice in supporting ‘voice, choice and control’ for older people;
- highlights the vital role of leadership in helping to creating a culture that enables older people to experience ‘voice, choice and control’; and
- describes some of the obstacles to supporting voice, choice and control and how stronger partnership-working between care homes, the community and the wider health and social care system can make a difference.
Case conferences as interventions dealing with the challenging behavior of people with dementia in nursing homes: a systematic review.
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Reuther S, Dichter MN, Buscher I, Vollmar HC, Holle D, Bartholomeyczik S, et al.
International Psychogeriatrics 2012 Dec;24(12):1891-1903
Background: Challenging behaviors such as aggression, screaming, and apathy are often encountered when caring for people with dementia in nursing homes. In this context, a case conference is often recommended for healthcare professionals as an effective instrument to improve the quality of care. However, the subject case conference has not had great consideration in scientific literature. The aim of this review is to describe the effects of case conferences on people with dementia and challenging behavior and the staff in nursing homes. Methods: A search of intervention studies in nursing homes in the German or English language was performed in the following databases: Medline, Cinahl, PsycINFO, Cochrane library, Embase, and Google Scholar. The selection and the methodological quality of the studies were assessed independently by two authors. The results were summarized and compared based on categories such as study quality or outcomes. Results: Seven of 432 studies were included in the review. A total of four of seven studies showed a reduction in the challenging behavior of people with dementia, and five showed an influence on the competence, attitudes, and job satisfaction of the staff. However, due to the middle-range quality of several studies, the methodological heterogeneity and differences in the interventions, the results must be interpreted with caution. Conclusions: In summary, little evidence exists for the positive effects of case conferences in the care of people with dementia. This review highlights the need for methodologically well-designed intervention studies to provide conclusive evidence of the effects of case conferences.
Events
UofA
KUSP Brown Bag Seminar Secondary data exploration: Discovering new research opportunities
Tuesday November 6, 2012 12:00-13:00 ECHA 5-140
Presented by Dr. Carole Estabrooks’ MN student Christina Manraj.
Guidelines for Writing Letters of Support for Grant Applications
Monday November 26, 2012: 13:00 – 14:30, 3-003 Katz Building
This videoconference will highlight the guiding principles for developing letters of support from knowledge users for grant applications that are using an integrated knowledge translation approach. Many CIHR programs strongly encourage a knowledge user partner letter indicating they will provide monetary or in-kind support. This guide is geared for this type of letter, but also provides helpful tips and examples for writing letters of support in general. The workshop is being presented by the Knowledge Translation unit at CIHR and is based on their Writing Letters of Support Guidelines.
Hear No Evidence. See No Evidence. Speak No Evidence.
How Omission, Commission and Downright Stupidity Shaped Canada’s Food Guide (and why you should care)
Presenter: Yoni Freedhoff, University of Ottawa Wed Nov 14, 2012 12:00-13:00 Rm 231/237 Law Centre, University of Alberta
Did you know that Canadians don’t eat French fries or potato chips? That as a nation we’ve sworn off chocolate, wine and ketchup? That the average Canadian’s diet is something we should strive to replicate? That we really don’t need to avoid trans-fat? That 50lbs of liquid calories a year will improve your health? That databases over a decade old are useful to scientific modeling? That the newest agricultural rage are juice trees? While the creation of a Food Guide should involve the straightforward translation of our best available evidence regarding the impact of diet on chronic disease, the creation of the 2007 Food Guide, an over 2 year long affair, was anything but. Come out and learn why the second most requested government document behind tax returns may be bad for our nation’s health by means of a raucous romp through some of its most egregious and mind-boggling shortcomings and methodological boondoggles.
Non UofA
CIHR-Institute of Aging: Canadian Researchers Reception
Gerontological Society of America 65th Annual Scientific Meeting, San Diego, CA, Saturday Nov 17, 2012 18:00-20:00, Newport Beach Rm, San Diego Marriott Marquis
This event brings together Canadian scientist working in the field of aging, either in Canada or abroad, as well as international partners of the Institute. Attendees will have the opportunity to meet colleagues and exchange with th CIHR Institute of Aging’s Scientific Director, Yves Joanette. Space is limited. Please RSVP by Monday Nov 5th by emailing ivia@criugm.qc.ca
KT Canada: Pragamatic KT Trials Course
Toronto, ON November 21-22, 2012 Fee $600
The purpose of the 2 day workshop is to review the stages of trial design, from conceiving the question, to defining the intervention and comparators, to estimating the required sample size and developing a logistics plan. Interspersed with the short didactic and discussion review sessions are longer sessions during which you can draft your own protocol for a pilot trial, or even a large definitive trial, of you intervention and discuss it with colleagues doing exactly the same thing, led by experienced trialists, in a supportive environment. Participants must have a KT trial question in order to participate in the course. Please contact Gail Klein (kleing@smh.ca) to register and provide the following:
1. Name
2. Institution
3. Your KT trial question
Online
KT Canada Seminar Series: Effectiveness and development methodology of printed educational materials: the Decision Box example
Thursday November 8, 2012 10:00-11:00
Live viewing will be in ECHA 3-001 please contact Gloria Gao gloria.gao@ualberta.ca Archived webcast can be seen at http://webcast.otn.ca
Learning Objectives:
• To review the evidence on the effectiveness of printed educational materials
• To understand the challenges in involving users in the development of knowledge tools
• To apply the KTA framework to the development and implementation of the Decision Box
The Adaptation Effect: Engaging Community Partners to Adapt and Implement Evidence-based Interventions
Tuesday November 13, 2012 12:00-13:00 MT
This cyber-seminarwill highlight three of the R2R Mentorship Program projects that are working with community partners to adapt and implement evidence-based interventions. Kiameesha Evans is adapting and implementing the diet and nutrition program, Body and Soul, to include a physical activity component and is piloting the intervention with several faith-based organizations in New Jersey. Venice Haynes has partnered with a local foundation to provide technical assistance in the adaptation of a cervical cancer program, Con Amor Aprendemos (With Love We Learn), for African American faith-based communities in Atlanta. Finally, Charlene Mitchell adapted a sun safety program, Pool Cool, for implementation at rural Idaho public pools. Kiameesha, Venice, and Charlene will each share an overview of their projects, outcomes, and lessons learned about partnership, adaptation, and implementation relevant to other communities and researchers interested in these types of cancer control interventions.
Courses
RNAO: Best Practice Champions Workshop (Level 2) – London
Wednesday Nov 14, 2012 8:00-16:00, London, ON
Booster sessions are for those who have already participated in an Orientation Workshop and wish to expand their skills in knowledge transfer. Booster Sessions focus on sustaining implementation of Best Practice Guidelines, building on skills in leadership, mentorship, networking and marketing to enhance the Champion role. The schedule of upcoming Champions Workshops and Boosters Sessions to be released soon! Who can attend? All nurses living and/or working in the province of Ontario are eligible to attend Best Practice Champions® Events. Allied Health professionals are also eligible to attend, however priority is given to RNs and RPNs.
Online
Analyzing Qualitative Data Using QDAS (Qualitative Data Analysis Software)
21 January 2013 – 30 March 2013 Costs £375 + VAT or $700 (educational/public sector rates) or £450 + VAT or $900(commercial rates)
This course will focus on the analysis process involved when using QDAS (ATLAS.ti or NVivo) to support the analysis of qualitative data. The philosophy of the course is that the use of software should not be seen as an ‘add-on’ but should be integrated into the whole approach to analysis. This course will give you the framework to justify the use of software to support qualitative data analysis and to represent your research design in either ATLAS.ti or NVivo. It will enable you to develop an analysis strategy using software tools appropriate to your research questions and to use the affordances in the software to aid reflection and the development of writing. This course is suitable for post-graduate students, academics and researchers new to using a software package to support qualitative analysis. The course is aimed at those about to start a research project using QDAS or who have already started a project using QDAS. You will be working with a small amount of your own data (three or four pieces of data – they can be textual, graphic or video). You do not need to have any experience of any software package but you should have some experience or knowledge of traditional ways of analyzing qualitative data.
News
TEDMED Talks
You’ve probably heard of TED Talks, but you may not know that there are also TEDMED Talks. This is an online forum which seeks broad participation in understanding 20 great challenges in health and medicine. Anyone is welcome to contribute to these conversation. Of particular interest to this group are Achieving More Medical Innovation, More Affordably, Preparing for the Dementia Tsunami, Faster Adoption of Best Practices.
CMAJ Open, a new online open-access journal, will be launched in January 2013 by the Canadian Medical Association. CMAJ Open comes from the same family of journals as the Canadian Medical Association Journal (CMAJ), Canada’s major medical journal. CMAJ Open will publish high-quality medical and health research, without the need for authors to demonstrate high impact. Content will be available online to readers at no charge. CMAJ Open is seeking high-quality medical research papers for publication. Medical and health care research, including from allied health care professions, is welcome.
The Change Foundation launches PANORAMA
PANORAMA, an online panel of Ontario residents exchanging views, experiences and advice to improve healthcare, was launched at the end of September 2012. Created by The Change Foundation to spur public engagement, the online panel is made up of 32 Ontarians representing a wide range of ages and backgrounds.
CHSRF will soon become the Canadian Foundation for Healthcare Improvement
The name change reflects a focus on collaborating with health system leaders to enable, accelerate, amplify and sustain healthcare improvement and transformation. CFHI (not sure if that will be the acronym or not) are dedicated to advancing breakthroughs where healthcare policy and delivery meet.
Resources
Health Innovation Portal
From the Health Council of Canada this site highlights innovative health care practices from across Canada. It includes a searchable database of over 240 innovative practices, information for identifying and sharing health innovations, and information on the Health Council’s Health Innovation Challenge for students.
