Latest KUSP Publications
Health care aides use of time in a residential long-term care unit: A time and motion study.
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Mallidou AA, Cummings GG, Schalm C, Estabrooks CA.
International journal of nursing studies 2013 Jan 8
Organizational resources such as caregiver time use with older adults in residential long-term care facilities (nursing homes) have not been extensively studied, while levels of nurse staffing and staffing-mix are the focus of many publications on all types of healthcare organizations. Evidence shows that front-line caregivers’ sufficient working time with residents is associated with performance, excellence, comprehensive care, quality of outcomes (e.g., reductions in pressure ulcers, urinary tract infections, and falls), quality of life, cost savings, and may be affiliated with transformation of organizational culture. OBJECTIVES: To explore organizational resources in a long-term care unit within a multilevel residential facility, to measure healthcare aides’ use of time with residents, and to describe working environment and unit culture. METHODS: An observational pilot study was conducted in a Canadian urban 52-bed long-term care unit within a faith-based residential multilevel care facility. A convenience sample of seven healthcare aides consented to participate. To collect the data, we used an observational sheet (to monitor caregiver time use on certain activities such as personal care, assisting with eating, socializing, helping residents to be involved in therapeutic activities, paperwork, networking, personal time, and others), semi-structured interview (to assess caregiver perceptions of their working environment), and field notes (to illustrate the unit culture). Three hundred and eighty seven hours of observation were completed. RESULTS: The findings indicate that healthcare aides spent most of their working time (on an eight-hour day-shift) in “personal care” (52%) and in “other” activities (23%). One-to-three minute activities consumed about 35% of the time spent in personal care and 20% of time spent in assisting with eating. Overall, caregivers’ time spent socializing was less than 1%, about 6% in networking, and less than 4% in paperwork. CONCLUSIONS: Re-organizing healthcare aides’ routine practices may minimize the short one-to-three minute intervals spent on direct care activities, which can be interpreted as interruptions to continuity of care or waste of time. Fewer interruptions may allow healthcare aides to use their time with residents more effectively.
A data quality control program for computer-assisted personal interviews.
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Squires JE, Hutchinson AM, Bostrom AM, Deis K, Norton PG, Cummings GG, et al.
Nursing research and practice 2012;2012:303816
Researchers strive to optimize data quality in order to ensure that study findings are valid and reliable. In this paper, we describe a data quality control program designed to maximize quality of survey data collected using computer-assisted personal interviews. The quality control program comprised three phases: (1) software development, (2) an interviewer quality control protocol, and (3) a data cleaning and processing protocol. To illustrate the value of the program, we assess its use in the Translating Research in Elder Care Study. We utilize data collected annually for two years from computer-assisted personal interviews with 3004 healthcare aides. Data quality was assessed using both survey and process data. Missing data and data errors were minimal. Mean and median values and standard deviations were within acceptable limits. Process data indicated that in only 3.4% and 4.0% of cases was the interviewer unable to conduct interviews in accordance with the details of the program. Interviewers’ perceptions of interview quality also significantly improved between Years 1 and 2. While this data quality control program was demanding in terms of time and resources, we found that the benefits clearly outweighed the effort required to achieve high-quality data.
CALL FOR PAPERS: Nursing Science Quarterly Special Issue on Leadership
Nursing Science Quarterly (NSQ) is a peer-reviewed, quarterly publication for nurse researchers, educators, practitioners, and graduate students in nursing science, philosophy, or research. The journal publishes original manuscripts focusing on nursing theory development, nursing theory-guided practice, quantitative and qualitative research, and practice.
CALL FOR PAPERS: Journal of the American Psychiatric Nurses Association Special Issue on Advancing Health Equity in Disparity Populations: A Focused Issue on Lesbian, Gay, Bisexual, and Transgender People
DEADLINE: February 15, 2013
The Journal of the American Psychiatric Nurses Association is inviting papers for a focused issue of the journal that focus on a range of topics related to the emotional and behavioral health of members of the lesbian, gay, bisexual and transgender (LGBT) communities.
CALL FOR PRESENTATIONS: The 2013 Canadian Knowledge Mobilization Forum
June 3-4, 2013 Mississauga, ON
DEADLINE: Feb 22, 2013
Please submit your session or poster proposal under the following 4 themes. Each presentation will be 20 minutes long. We encourage formats that include discussion, as well as presentation time. Posters will also be accepted.
1) Building on existing capacity and building new capacity
2) Learning from each other: Comparisons across sectors
3) The Next Generation – Students and Apprentices in Knowledge Mobilization
4) Methods, Tools, and Theories: The Art and Craft of Knowledge Mobilization
CALL FOR PAPERS: International Journal of User-Driven Healthcare (IJUDH) Special Issue On: Theory-driven Interventions in Health Care Using Health Information Systems
DEADLINE: February 1, 2013
In this special issue we seek to showcase papers that are driven by theory – in planning, in action, in diagnosis and in evaluations. Theory-driven interventions is used here to distinguish from report-style papers, position papers or papers that draw concepts purely from observations without theoretical basis prior to intervention.
Grants & Awards
WCB Research Program
DEADLINE for submission of Letters of Intent is March 1, 2013.
This year the Research Committee has expressed certain interest areas as possible topics for the upcoming year’s research activities and funding will be considered for research related to:
- Disability Management and Rehabilitation, reducing the impact of workplace injury and disease
- Return to Work, reducing barriers to employability; integrating best practices to promote safe, effective, appropriate and sustainable return to work
- Medical/rehabilitative interventions, evaluating the efficacy of medical or rehabilitative interventions with a focus on treating occupational disease or injury
- Occupational disease, improving understandings of the relationship between occupational risk factors and the onset of disease
- Changing nature of work and the work environment, examining current technological, economic, demographic, or social factors affecting the nature of work; exploring implications for Alberta’s workers’ compensation system
- Improving the predictability of WCB financing, including costs and funding, through a better understanding of their relationship with economic and demographic changes.
- Policy, system-design, and decision-making in workers’ compensation, examining systemic fairness and efficacy in terms of benefit structure, financing of workers’ compensation and incentive plans, decision-making models and review and appeal structures
- Knowledge transfer, evaluating effective ways of putting research findings into practice for communities of interest
American Sociological Association: Aging and the Life Course Call for Award Nominations
DEADLINES: March 1, 2013
Matilda White Riley Distinguished Scholar Award
This annual award honors a scholar in the field of aging and the life course who has shown exceptional achievement in research, theory, policy analysis, or who has otherwise advanced knowledge of aging and the life course. Letters of nomination should describe the nominee’s contributions to the study of aging and the life course that warrant consideration.
Outstanding Publication Award
This annual award honors an outstanding recent contribution to the field of sociology of aging and the life course as determined by the Outstanding Publication Award Committee. Eligible publications include original research reports, theoretical or methodological developments, and policy-related contributions. The outstanding publication can be an article, chapter, or book published within the past three years.
Graduate Student Paper Award
This annual award honors the outstanding paper written by a graduate student (or students) member(s) of the Section on Aging and the Life Course, as determined by the Graduate Student Paper Award committee. Papers authored or coauthored solely by students are eligible; faculty co-authorship is not allowed. Eligible student authors include master’s students and pre-doctoral student members of the section who are currently enrolled in a graduate program or who have graduated no earlier than December of 2012.
Enhancing the primary care team to provide redesigned care: the roles of practice facilitators and care managers.
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Taylor EF, Machta RM, Meyers DS, Genevro J, Peikes DN.
Annals of family medicine 2013 Jan;11(1):80-83
Efforts to redesign primary care require multiple supports. Two potential members of the primary care team-practice facilitator and care manager-can play important but distinct roles in redesigning and improving care delivery. Facilitators, also known as quality improvement coaches, assist practices with coordinating their quality improvement activities and help build capacity for those activities-reflecting a systems-level approach to improving quality, safety, and implementation of evidence-based practices. Care managers provide direct patient care by coordinating care and helping patients navigate the system, improving access for patients, and communicating across the care team. These complementary roles aim to help primary care practices deliver coordinated, accessible, comprehensive, and patient-centered care.
Adoption of a clinical decision support system to promote judicious use of antibiotics for acute respiratory infections in primary care.
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Litvin CB, Ornstein SM, Wessell AM, Nemeth LS, Nietert PJ.
International journal of medical informatics 2012 Aug;81(8):521-526
Overuse of antibiotics for acute respiratory infections (ARIs) in primary care is an established risk factor for worsening antimicrobial resistance. The “Reducing Inappropriate Prescribing of Antibiotics by Primary Care Clinicians” study is assessing the impact of a clinical decision support system (CDSS) on antibiotic prescribing for ARIs using a multimethod intervention to facilitate CDSS adoption. The purpose of this report is to describe use of the CDSS, as well as facilitators and barriers to its adoption, during the first year of the 15-month intervention. METHODS: Between January 1, 2010 and December 31, 2010, 39 providers in 9 practices in US states participated in this study. Quarterly EHR based audit and feedback, practice site visits for academic detailing, performance review and CDSS training, and “best-practice” dissemination during two meetings of study participants were used to facilitate CDSS adoption. Mixed methods were used to evaluate adoption of the CDSS. Using data extracted from the EHR, CDSS use for ARI was calculated. To determine facilitators and barriers of CDSS adoption, semi-structured group interviews were conducted with providers and staff at each practice. RESULTS: During the first year of implementation, the ABX-TRIP CDSS was used 14,086 times for ARI encounters. Overall, practice use of the CDSS during ARI encounters ranged from 39.4% to 77.2%. Median use of the CDSS for adult patients was 58.2% and 68.6% for pediatric patients. Key factors associated with CDSS adoption include the perception by providers that it assists with decision making and stimulates patient discussions, engagement of non-physician staff and an iterative CDSS development process. CONCLUSIONS: Adoption of a custom designed CDSS in the first year of implementation is promising. Successful implementation of such technology requires a focus not only on the technological solution itself, but on its integration with the entire clinical workplace. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.
Preventive evidence into practice (PEP) study: implementation of guidelines to prevent primary vascular disease in general practice protocol for a cluster randomised controlled trial.
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Harris MF, Lloyd J, Litt J, van Driel M, Mazza D, Russell G, et al.
Implementation science : IS 2013 Jan 18;8(1):8
BACKGROUND: There are significant gaps in the implementation and uptake of evidence-based guideline recommendations for cardiovascular disease (CVD) and diabetes in Australian general practice. This study protocol describes the methodology for a cluster randomised trial to evaluate the effectiveness of a model that aims to improve the implementation of these guidelines in Australian general practice developed by a collaboration between researchers, non-government organisations, and the profession. METHODS: We hypothesise that the intervention will alter the behaviour of clinicians and patients resulting in improvements of recording of lifestyle and physiological risk factors (by 20%) and increased adherence to guideline recommendations for: the management of CVD and diabetes risk factors (by 20%); and lifestyle and physiological risk factors of patients at risk (by 5%). Thirty-two general practices will be randomised in a 1:1 allocation to receive either the intervention or continue with usual care, after stratification by state. The intervention will be delivered through: small group education; audit of patient records to determine preventive care; and practice facilitation visits adapted to the needs of the practices. Outcome data will be extracted from electronic medical records and patient questionnaires, and qualitative evaluation from provider and patient interviews. DISCUSSION: We plan to disseminate study findings widely and directly inform implementation strategies by governments, professional bodies, and non-government organisations including the partner organisations.
Spanish nurses’ attitudes towards research and perceived barriers and facilitators of research utilisation: a comparative survey of nurses with and without experience as principal investigators.
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Moreno-Casbas T, Fuentelsaz-Gallego C, de Miguel AG, Gonzalez-Maria E, Clarke SP.
Journal of clinical nursing 2011 Jul;20(13-14):1936-1947
AIMS AND OBJECTIVE: To examine attitudes towards research and perceived barriers and facilitators of research utilisation in clinical practice in a broad cross-section of Spanish nurses. BACKGROUND: Nurses’ attitudes towards research are critical in determining whether study findings are used to improve practice. DESIGN: Cross-sectional comparative survey in Hospitals, Primary Care Centres and University-affiliated schools of nursing. METHODS: Surveys were completed by 917 nurses: 69 who received funding from the Spanish national agency (1998-2004) and a nationally representative sample of 848 nurses who did not have the same research experience (the Comparison group). Two instruments (BARRIERS and Attitudes towards nursing research) were translated and culturally adapted for use in Spain. A descriptive analysis of demographic and practice characteristics was performed. Total scale scores, as well as subscale scores, were computed and compared across the two groups using one-way analysis of variance (anova) and multivariate analysis of variance (manova) with post hoc tests. Pearson product-moment correlation coefficients were computed between the total tool scores and subscales measuring barriers and attitudes in both groups. RESULTS: The investigators differed from other nurses on several demographic and work characteristics (more males, older age and more likely to work a fixed day shift schedule). On the whole, investigators showed more favourable attitudes but perceived several elements as posing greater barriers to research utilisation than the Comparison groups. Across all respondents, issues related to the quality of research were rated as the greatest barriers to research utilisation, followed by organisational barriers, barriers involving the communication of findings and finally, those related to nurses’ values, awareness and skills. CONCLUSIONS: Very similar profiles of perceptions and attitudes regarding research were found in these samples of Spanish nurses relative to those from other countries in earlier reports. Nurses who had experience conducting research demonstrated more favourable research-related attitudes and perceived barriers differently than those without such experience. RELEVANCE TO CLINICAL PRACTICE: Understanding different organisational and experience perspectives is important to identify challenges and opportunities to ensure research utilisation in clinical practice. © 2011 Blackwell Publishing Ltd.
The U.S. training institute for dissemination and implementation research in health.
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Meissner HI, Glasgow RE, Vinson CA, Chambers D, Brownson RC, Green LW, et al.
Implementation science : IS 2013 Jan 24;8(1):12
BACKGROUND: The science of dissemination and implementation (D&I) is advancing the knowledge base for how best to integrate evidence-based interventions within clinical and community settings and how to recast the nature or conduct of the research itself to make it more relevant and actionable in those settings. While the field is growing, there are only a few training programs for D&I research; this is an important avenue to help build the field’s capacity. To improve the United States’ capacity for D&I research, the National Institutes of Health and Veterans Health Administration collaborated to develop a five-day training institute for postdoctoral level applicants aspiring to advance this science. METHODS: We describe the background, goals, structure, curriculum, application process, trainee evaluation, and future plans for the Training in Dissemination and Implementation Research in Health (TIDIRH). RESULTS: The TIDIRH used a five-day residential immersion to maximize opportunities for trainees and faculty to interact. The train-the-trainer-like approach was intended to equip participants with materials that they could readily take back to their home institutions to increase interest and further investment in D&I. The TIDIRH curriculum included a balance of structured large group discussions and interactive small group sessions.Thirty-five of 266 applicants for the first annual training institute were accepted from a variety of disciplines, including psychology (12 trainees); medicine (6 trainees); epidemiology (5 trainees); health behavior/health education (4 trainees); and 1 trainee each from education & human development, health policy and management, health services research, public health studies, public policy and social work, with a maximum of two individuals from any one institution. The institute was rated as very helpful by attendees, and by six months after the institute, a follow-up survey (97% return rate) revealed that 72% had initiated a new grant proposal in D&I research; 28% had received funding, and 77% had used skills from TIDIRH to influence their peers from different disciplines about D&I research through building local research networks, organizing formal presentations and symposia, teaching and by leading interdisciplinary teams to conduct D&I research. CONCLUSIONS: The initial TIDIRH training was judged successful by trainee evaluation at the conclusion of the week’s training and six-month follow-up, and plans are to continue and possibly expand the TIDIRH in coming years. Strengths are seen as the residential format, quality of the faculty and their flexibility in adjusting content to meet trainee needs, and the highlighting of concrete D&I examples by the local host institution, which rotates annually. Lessons learned and plans for future TIDIRH trainings are summarized.
WhatisKT wiki: a case study of a platform for knowledge translation terms and definitions — Descriptive analysis.
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McKibbon KA, Lokker C, Keepanasseril A, Colquhoun H, Haynes RB, Wilczynski NL.
Implementation science : IS 2013 Jan 24;8(1):13
BACKGROUND: More than a hundred terms, often with unclear definitions and varying emphases, are used by health research and practice communities across the world who are interested in getting the best possible evidence applied (e.g., knowledge translation, implementation science, diffusion of innovations, and technology transfer). This makes finding published evidence difficult and can result in reduced, misinterpreted, or challenging interactions among professionals. Open dialogue and interaction among various professionals is needed to achieve consolidation of vocabulary. We use case report methods to describe how we sought to build an online tool to present the range of terms and facilitate the dialogue process across groups and disciplines interested in harnessing research evidence for healthcare. METHODS: We used a wiki platform from Wikispaces to present the problem of terminology and make a case and opportunity for collaboration on usage. Wikis are web sites where communities of users can collaborate online to build content and discuss progress. We gathered terms related to getting research into practice, sought published definitions, and posted these on the wiki (WhatisKT http://whatiskt.wikispaces.com/). We built the wiki in mid-2008 and promoted it through various groups and publications. This report describes the content of the site, our promotion efforts, use of the site, and how the site was used for collaboration up to the end of 2011. RESULTS: The WhatisKT wiki site now includes more than 120 pages. Traffic to the site has increased substantially from an average of 200 monthly visits in 2008 to 1700 in 2011. Visitors from 143 countries viewed the wiki in 2011, compared with 12 countries in 2008. However, most use has been limited to short term accesses of about 40 seconds per visit, and discussion of consolidation and solidifying terminology is conspicuously absent. CONCLUSIONS: Although considerable interest exists in the terms and definitions related to getting research into practice based on increasing numbers of accesses, use of the WhatisKT wiki site for anything beyond quick lookups was minimal. Additional efforts must be directed towards increasing the level of interaction among the members of the site to encourage collaboration on term use.
Health Care Administration and Organization
The Relationship Between the Nursing Work Environment and the Occurrence of Reported Paediatric Medication Administration Errors: A Pan Canadian Study.
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Sears K, O’Brien-Pallas L, Stevens B, Murphy GT.
Journal of pediatric nursing 2013 Jan 2
Paediatric medication administration errors (PMAEs) occur frequently, with devastating consequences for children and their families. This study explored the relationship between the nursing work environment and the occurrence of reported PMAEs. In total, 127 potential and 245 actual PMAEs were reported. Workload, distraction, and ineffective communication were identified as significant contributors to the occurrence of PMAEs. Medical/surgical units reported more errors than critical care environments (p=.000) and a 2.9% increase in the frequency of reported PMAEs was noted for each additional bed on units (p=.001). This study supports the awareness that a systems reform is required to reduce PMAEs. Published by Elsevier Inc.
A case study of nurse practitioner role implementation in primary care: what happens when new roles are introduced?
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Sangster-Gormley E, Martin-Misener R, Burge F.
BMC nursing 2013 Jan 23;12(1):1
BACKGROUND: At the time of this study (2009) the role of the nurse practitioner was new to the province of British Columbia. The provincial government gave the responsibility for implementing the role to health authorities. Managers of health authorities, many of whom were unfamiliar with the role, were responsible for identifying the need for the NP role, determining how the NP would function, and gaining team members’ acceptance for the new role. METHOD: The purpose of the study was to explain the process of nurse practitioner role implementation as it was occurring and to identify factors that could enhance the implementation process. An explanatory, single case study with embedded units of analysis was used. The technique of explanation building was used in data analysis. Three primary health care settings in one health authority in British Columbia were purposively selected. Data sources included semi-structured interviews with participants (n=16) and key documents RESULTS: The results demonstrate the complexity of implementing a new role in settings unfamiliar with it. The findings suggest that early in the implementation process and after the nurse practitioner was hired, team members needed to clarify intentions for the role and they looked to senior health authority managers for assistance. Acceptance of the nurse practitioner was facilitated by team members’ prior knowledge of either the role or the individual nurse practitioner. Community health care providers needed to be involved in the implementation process and their acceptance developed as they gained knowledge and understanding of the role. CONCLUSION: The findings suggest that the interconnectedness of the concepts of intention, involvement and acceptance influences the implementation process and how the nurse practitioner is able to function in the setting. Without any one of the three concepts not only is implementation difficult, but it is also challenging for the nurse practitioner to fulfill role expectations. Implications for research, policy, practice and education are discussed.
Facilitating change among nursing assistants in long term care
Aubry F, Etheridge F, Couturier Y.
Online Journal of Issues in Nursing 2013;18(1)
In this article, the authors consider the implementation of change in long term care organizations (LTCOs) and present their study describing the process by which new nursing assistants are informally integrated into LTCOs in Quebec, Canada. The study method included 23 in-depth interviews with nursing assistants in two long term care centres. The findings enabled the authors to describe the informal process by which new nursing assistants are integrated into LTCOs and the manner in which informal work strategies enhance the work of nursing care, thus enabling the nursing assistants to manage heavy workloads. The authors discuss whether this teamwork is a deterrent to change or a lever for change and address issues regarding the collective structure of nursing assistant teams. Implications for practice include a Five-Step Innovation Plan. In conclusion, the authors propose that organizational change among nursing assistants in a LTCO is best accomplished when the leaders consider the nursing assistants’ strong sense of community to be a change engine rather than a change obstacle. © 2012 OJIN: The Online Journal of Issues in Nursing Article published November 9, 2012.
The association of patient safety climate and nurse-related organizational factors with selected patient outcomes: A cross-sectional survey.
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Ausserhofer D, Schubert M, Desmedt M, Blegen MA, De Geest S, Schwendimann R.
International journal of nursing studies 2013 Feb;50(2):240-252
Patient safety climate (PSC) is an important work environment factor determining patient safety and quality of care in healthcare organizations. Few studies have investigated the relationship between PSC and patient outcomes, considering possible confounding effects of other nurse-related organizational factors. OBJECTIVE: The purpose of this study was to explore the relationship between PSC and patient outcomes in Swiss acute care hospitals, adjusting for major organizational variables. METHODS: This is a sub-study of the Swiss arm of the multicenter-cross sectional RN4CAST (Nurse Forecasting: Human Resources Planning in Nursing) study. We utilized data from 1630 registered nurses (RNs) working in 132 surgical, medical and mixed surgical-medical units within 35 Swiss acute care hospitals. PSC was measured with the 9-item Safety Organizing Scale. Other organizational variables measured with established instruments included the quality of the nurse practice environment, implicit rationing of nursing care, nurse staffing, and skill mix levels. We performed multilevel multivariate logistic regression to explore relationships between seven patient outcomes (nurse-reported medication errors, pressure ulcers, patient falls, urinary tract infection, bloodstream infection, pneumonia; and patient satisfaction) and PSC. RESULTS: In none of our regression models was PSC a significant predictor for any of the seven patient outcomes. From our nurse-related organizational variables, the most robust predictor was implicit rationing of nursing care. After controlling for major organizational variables and hierarchical data structure, higher levels of implicit rationing of nursing care resulted in significant decrease in the odds of patient satisfaction (OR=0.276, 95%CI=0.113-0.675) and significant increase in the odds of nurse reported medication errors (OR=2.513, 95%CI=1.118-5.653), bloodstream infections (OR=3.011, 95%CI=1.429-6.347), and pneumonia (OR=2.672, 95%CI=1.117-6.395). CONCLUSIONS: We failed to confirm our hypotheses that PSC is related to improved patient outcomes, which we need to re-test with more reliable outcome measures, such as 30-day patient mortality. Based on our findings, general medical/surgical units should monitor the rationing of nursing care levels which may help to detect imbalances in the “work system”, such as inadequate nurse staffing or skill mix levels to meet patients’ needs. Copyright © 2012 Elsevier Ltd. All rights reserved.
District nurses’ perceptions of the concept of delegating administration of medication to home care aides working in the municipality: A discrepancy between legal regulations and practice.
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Craftman AG, von Strauss E, Rudberg SL, Westerbotn M.
Journal of clinical nursing 2013 Feb;22(3-4):569-578
Aims and objectives. To describe district nurses’ perceptions of the concept of delegating medication management to unlicensed personnel working in municipal social care. Background. The delegation of medical tasks involves responsibility and is regulated by law to avoid damage and injuries and to protect the patient. The delegation of the administration of medication is a multifaceted task. The delegating district nurse is responsible for the outcome and should also follow up the delegated task. Design. A descriptive qualitative study, involving semi-structured interviews and content analysis. Methods. Twenty district nurses were interviewed. The interviews were audio taped. The data were collected from April 2009-August 2010 and analysed using content analysis. Results. The findings revealed that the statutes of delegation appear to be incompatible with practice, however, mostly due to lack of time. Communication between district nurses and home care aides, as well as tutoring, was regarded as important. The district nurses found it imperative to be available to the home care aides and made an effort to create a trusting atmosphere. Conclusions. District nurses cannot manage their workload without delegating the administration of medication in the present organisational model of health care and social care. The statutes regarding delegating medicine tasks are also cumbersome and difficult to incorporate for district nurses who are responsible for the delegation. Relevance to clinical practice. The findings elucidate the current situation as regards district nurses and the need to delegate the administration of medication. Health care and social care for home-dwelling older patients, as well as statutes, needs to be evaluated and updated to meet and be prepared for the increasing demands of care. © 2012 Blackwell Publishing Ltd.
The impact of the work environment of nurses on patient safety outcomes: A multi-level modelling approach.
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Kirwan M, Matthews A, Scott PA.
International journal of nursing studies 2013 Feb;50(2):253-263
Patient safety is a priority for health services in all countries. The importance of the nurse’s role in patient safety has been established. Effective nurse staffing levels, nurse education levels, and a positive work environment for nurses are factors which are known to impact on patient safety outcomes. OBJECTIVES: This study sought to explore the relationship between the ward environment in which nurses practice and specific patient safety outcomes, using ward level variables as well as nurse level variables. The outcomes were nurse-reported patient safety levels in the wards in which they work, and numbers of formal adverse events reports submitted by nurses in the last year. DESIGN: This cross-sectional quantitative study was carried out within a European FP7 project: Nurse Forecasting: Human Resources Planning in Nursing (RN4CAST) project. SETTINGS: 108 general medical and surgical wards in 30 hospitals throughout Ireland. PARTICIPANTS: All nurses in direct patient care in the study wards were invited to participate. Data from 1397 of these nurses were used in this analysis. METHODS: A nurse survey was carried out using a questionnaire incorporating the Practice Environment Scale of the Nursing Work Index (PES-NWI). Ethical approval was obtained from the authors’ institution and all ethics committees representing the 30 study hospitals. Multilevel modelling was carried out to examine the impact of ward level factors on patient safety. These included proportions of nurses on the ward educated to degree level, and aggregated ward-level mean for PES-NWI scores. RESULTS: The study results support other research findings indicating that a positive practice environment enhances patient safety outcomes. Specifically at ward level, factors such as the ward practice environment and the proportion of nurses with degrees were found to significantly impact safety outcomes. The models developed for this study predicted 76% and 51% of the between-ward variance of these outcomes. The results can be used to enhance patient safety within hospitals by demonstrating factors at ward-level which enable nurses to effectively carry out this aspect of their role. CONCLUSIONS: The importance of ward-level nurse factors such as nurse education level and the work environment should be recognised and manipulated as important influences on patient safety. Copyright © 2012 Elsevier Ltd. All rights reserved.
- Nursing workforce a global priority area for health policy and health services research: A special issue (editorial)
Koen Van den Heede, Linda H. Aiken
- Impacts of unit-level nurse practice environment, workload and burnout on nurse-reported outcomes in psychiatric hospitals: A multilevel modelling approach
Peter Van Bogaert, Sean Clarke, Kristien Wouters, Erik Franck, et al.
- A systematic survey instrument translation process for multi-country, comparative health workforce studies
Allison Squires, Linda H. Aiken, Koen van den Heede, Walter Sermeus, et al.
- Hospital nursing, care quality, and patient satisfaction: Cross-sectional surveys of nurses and patients in hospitals in China and Europe
Li-ming You, Linda H. Aiken, Douglas M. Sloane, Ke Liu, et al.
- Effective strategies for nurse retention in acute hospitals: A mixed method study
Koen Van den Heede, Mieke Florquin, Luk Bruyneel, Linda Aiken, et al.
- The association of patient safety climate and nurse-related organizational factors with selected patient outcomes: A cross-sectional survey
Dietmar Ausserhofer, Maria Schubert, Mario Desmedt, Mary A. Blegen, et al.
- A multi-country perspective on nurses’ tasks below their skill level: Reports from domestically trained nurses and foreign trained nurses from developing countries
Luk Bruyneel, Baoyue Li, Linda Aiken, Emmanuel Lesaffre, et al.
- Group-level impact of work environment dimensions on burnout experiences among nurses: A multivariate multilevel probit model
Baoyue Li, Luk Bruyneel, Walter Sermeus, Koen Van den Heede, et al.
- The introduction of DRG funding and hospital nurses’ changing perceptions of their practice environment, quality of care and satisfaction: Comparison of cross-sectional surveys over a 10-year period
Britta Zander, Lydia Dobler, Reinhard Busse
- Changes in hospital nurse work environments and nurse job outcomes: An analysis of panel data
Ann Kutney-Lee, Evan S. Wu, Douglas M. Sloane, Linda H. Aiken
- Factors associated with needlestick and sharp injuries among hospital nurses: A cross-sectional questionnaire survey
Eunhee Cho, Hyeonkyeong Lee, Miyoung Choi, Su Ho Park, et al.
- Validation of the Spanish version of the questionnaire Practice Environment Scale of the Nursing Work Index
Carmen Fuentelsaz-Gallego, María Teresa Moreno-Casbas, Esther González-María
- Levels and correlates of implicit rationing of nursing care in Swiss acute care hospitals—A cross sectional study
Maria Schubert, Dietmar Ausserhofer, Mario Desmedt, René Schwendimann, et al.
- The impact of the work environment of nurses on patient safety outcomes: A multi-level modelling approach
Marcia Kirwan, Anne Matthews, P. Anne Scott
- Nurses’ intention to leave their profession: A cross sectional observational study in 10 European countries
Maud M. Heinen, Theo van Achterberg, René Schwendimann, Britta Zander, et al.
- Is “failure to rescue” derived from administrative data in England a nurse sensitive patient safety indicator for surgical care? Observational study
Peter Griffiths, Simon Jones, Alex Bottle
- A tale of two systems—Nurses practice environment, well being, perceived quality of care and patient safety in private and public hospitals in South Africa: A questionnaire survey
Siedine K. Coetzee, Hester C. Klopper, Suria M. Ellis, Linda H. Aiken
- Nurses’ reports of working conditions and hospital quality of care in 12 countries in Europe
Linda H. Aiken, Douglas M. Sloane, Luk Bruyneel, Koen Van den Heede, et al.
- Nurse migration in Europe—Can expectations really be met? Combining qualitative and quantitative data from Germany and eight of its destination and source countries
Britta Zander, Miriam Blümel, Reinhard Busse
This brief examines the policy proposals for allowing nurse practitioners to practice to their full potential and the accompanying debate.
Health Care Innovation and Quality Assurance
Improving organizational climate for quality and quality of care: does membership in a collaborative help?
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Nembhard IM, Northrup V, Shaller D, Cleary PD.
Medical care 2012 Nov;50 Suppl:S74-82
The lack of quality-oriented organizational climates is partly responsible for deficiencies in patient-centered care and poor quality more broadly. To improve their quality-oriented climates, several organizations have joined quality improvement collaboratives. The effectiveness of this approach is unknown. OBJECTIVE: To evaluate the impact of collaborative membership on organizational climate for quality and service quality. SUBJECTS: Twenty-one clinics, 4 of which participated in a collaborative sponsored by the Institute for Clinical Systems Improvement. RESEARCH DESIGN: Pre-post design. Preassessments occurred 2 months before the collaborative began in January 2009. Postassessments of service quality and climate occurred about 6 months and 1 year, respectively, after the collaborative ended in January 2010. We surveyed clinic employees (eg, physicians, nurses, receptionists, etc.) about the organizational climate and patients about service quality. MEASURES: Prioritization of quality care, high-quality staff relationships, and open communication as indicators of quality-oriented climate and timeliness of care, staff helpfulness, doctor-patient communication, rating of doctor, and willingness to recommend doctor’s office as indicators of service quality. RESULTS: There was no significant effect of collaborative membership on quality-oriented climate and mixed effects on service quality. Doctors’ ratings improved significantly more in intervention clinics than in control clinics, staff helpfulness improved less, and timeliness of care declined more. Ratings of doctor-patient communication and willingness to recommend doctor were not significantly different between intervention and comparison clinics. CONCLUSION: Membership in the collaborative provided no significant advantage for improving quality-oriented climate and had equivocal effects on service quality.
Reducing unnecessary hospital days to improve quality of care through physician accountability: a cluster randomised trial.
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Caminiti C, Meschi T, Braglia L, Diodati F, Iezzi E, Marcomini B, et al.
BMC health services research 2013 Jan 10;13(1):14
BACKGROUND: Over 20% of hospital bed use is inappropriate, implying a waste of resources and the increase of patient iatrogenic risk. METHODS: This is a cluster, pragmatic, randomised controlled trial, carried out in a large University Hospital of Northern Italy, aiming to evaluate the effect of a strategy to reduce unnecessary hospital days. The primary outcome was the percentage of patient-days compatible with discharge. Among secondary objectives, to describe the strategy’s effect in the long-term, as well as on hospital readmissions, considered to be a marker of the quality of hospital care. The 12 medical wards with the longest length of stay participated. Effectiveness was measured at the individual level on 3498 eligible patients during monthly index days. Patients admitted or discharged on index days, or with stay >90 days, were excluded. All ward staff was blinded to the index days, while staff in the control arm and data analysts were blinded to the trial’s objectives and interventions. The strategy comprised the distribution to physicians of the list of their patients whose hospital stay was compatible with discharge according to a validated Delay Tool, and of physician length of stay profiles, followed by audits managed autonomously by the physicians of the ward. RESULTS: During the 12 months of data collection, over 50% of patient-days were judged to be compatible with discharge. Delays were mainly due to problems with activities under medical staff control. Multivariate analysis considering clustering showed that the strategy reduced patient-days compatible with discharge by 16% in the intervention vs control group, (OR = 0.841; 95%CI, 0.735–0.963; P = 0.012). Follow-up at 1 year did not yield a statistically significant difference between the percentages of patient-days judged to be compatible with discharge between the two arms (OR = 0.818; 95% CI, 0.476–1.405; P = 0.47). There was no significant difference in 30-day readmission and mortality rates for all eligible patients (N = 3498) between the two arms. CONCLUSIONS: Results indicate that a strategy, involving physician direct accountability, can reduce unnecessary hospital days. Relatively simple interventions, like the one assessed in this study, should be implemented in all hospitals with excessive lengths of stay, since unnecessary prolongation may be harmful to patients.Trial registration: ClinicalTrials.gov, identifier NCT01422811.
Evaluating the implementation of health and safety innovations under a regulatory context: A collective case study of Ontario’s safer needle regulation.
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Chambers A, Mustard CA, Breslin C, Holness L, Nichol K.
Implementation science : IS 2013 Jan 22;8(1):9
BACKGROUND: Implementation effectiveness models have identified important factors that can promote the successful implementation of an innovation; however, these models have been examined within contexts where innovations are adopted voluntarily and often ignore the socio-political and environmental context. In the field of occupational health and safety, there are circumstances where organizations must adopt innovations to comply with a regulatory standard. Examining how the external environment can facilitate or challenge an organization’s change process may add to our understanding of implementation effectiveness. The objective of this study is to describe implementation facilitators and barriers in the context of a regulation designed to promote the uptake of safer engineered needles in healthcare. METHODS: The proposed study will focus on Ontario’s safer needle regulation (2007) which requires healthcare organizations to transition to the use of safer engineered needles for the prevention of needlestick injuries. A collective case study design will be used to learn from the experiences of three acute care hospitals in the province of Ontario, Canada. Interviews with management and front-line healthcare workers and analysis of supporting documents will be used to describe the implementation experience and examine issues associated with the integration of these devices. The data collection and analysis process will be influenced by a conceptual framework that draws from implementation science and the occupational health and safety literature. DISCUSSION: The focus of this study in addition to the methodology creates a unique opportunity to contribute to the field of implementation science. First, the study will explore implementation experiences under circumstances where regulatory pressures are influencing the organization’s change process. Second, the timing of this study provides an opportunity to focus on issues that arise during later stages of implementation, a phase during the implementation cycle that has been understudied. This study also provides the opportunity to examine the relevance and utility of current implementation science models in the field of occupational health where the adoption of an innovation is meant to enhance the health and safety of workers. Previous work has tended to focus almost exclusively on innovations that are designed to enhance an organization’s productivity or competitive advantage.
Improving the effectiveness of health care innovation implementation: middle managers as change agents.
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Birken SA, Lee SY, Weiner BJ, Chin MH, Schaefer CT.
Medical care research and review : MCRR 2013 Feb;70(1):29-45
The rate of successful health care innovation implementation is dismal. Middle managers have a potentially important yet poorly understood role in health care innovation implementation. This study used self-administered surveys and interviews of middle managers in health centers that implemented an innovation to reduce health disparities to address the questions: Does middle managers’ commitment to health care innovation implementation influence implementation effectiveness? If so, in what ways does their commitment influence implementation effectiveness? Although quantitative survey data analysis results suggest a weak relationship, qualitative interview data analysis results indicate that middle managers’ commitment influences implementation effectiveness when middle managers are proactive. Scholars should account for middle managers’ influence in implementation research, and health care executives may promote implementation effectiveness by hiring proactive middle managers and creating climates in which proactivity is rewarded, supported, and expected.
The overall research question was: What can be learned from the experience of enacting the Darzi model of clinical leadership in practice? What are the main enabling and constraining conditions for its effective realization and performance? Subsidiary research questions that feed-in to this main research question were: 1) What general lessons about its nature and its practice can be educed from a series of examples of effective clinical leadership in introducing more integrated models of care? What variations are required when enacting the model in very different service areas? 2) What are the enablers and the blockers of effective clinical leadership? 3) How do effective clinical leaders both initiate and lead service improvements while also engaging constructively with top-down service redesign and improvements initiatives? 4) How do service-level clinical leaders in acute and primary care develop and implement service quality improvements through achieving greater integration between primary and acute care? How do they go about mobilising other clinicians while also engaging with commissioners and managers?
The report reviews the evidence and potential for use of ’emergency readmissions within 28 days of discharge from hospital’ as an indicator within the NHS Outcomes Framework. It draws on a rapid review of systematic reviews, complemented by a synopsis of work in four countries designed to better understand current patterns of readmissions and the interpretation of observed patterns. Reviewed studies suggest that between 5 percent and 59 percent of readmissions may be avoidable. Studies are highly heterogeneous, but based on the evidence reviewed, about 15 percent up to 20 percent may be considered reasonable although previous authors have advised against producing a benchmark figure for the percentage of readmissions that can be avoided. The majority of published studies focus on clinical factors associated with readmission. Studies are needed of NHS organisational factors which are associated with readmission or might be altered to prevent readmission.
The introduction of new performance indicators always has the potential to produce gaming. Observers from the USA cite experience which suggests hospitals might increase income by admitting less serious cases, thus simultaneously increasing their income and reducing their rate of readmission. There is also the possibility that there may be some shift in coding of admissions between ’emergency’ and ‘elective’ depending on the incentives. If hospitals are performance managed on the basis of readmission rates, it would be reasonable to expect that some behaviour of this type would occur.
What will health and health care look like in the United States in the year 2032? It is a complex question, particularly given the immediate challenges facing the U.S. today. We really could improve health and health care in this country over the decades to come. However, there is a good chance that we could also spend more than we can afford on an American population whose health continues to decline.
Alternative scenarios of the future can help us understand such uncertainties. Scenarios are stories describing how the future may unfold in different ways. They help us view the dynamic systems around us in more complex terms. That accept uncertainty, and then clarify and challenge the assumptions about what we can do. We have carried many assumptions with us from the past that constrain our thinking about options for the future. While the future is inherently uncertain, scenarios help us bound that uncertainty into a limited number of likely paths. We can then explore the uncertainty to find the opportunities and challenges that might otherwise surprise us. People and organizations who work with scenarios find more creative options than those who develop plans based only on the past and present.
To find these more creative options for health and health care, the Robert Wood Johnson Foundation engaged the Institute for Alternative Futures (IAF) to develop a set of four scenarios of health and health care in 2032. The purpose of these scenarios is to help leaders in health and health care apply a futures perspective to their own work, and to access the kind of creativity and dynamism that can lead to surprising success.
Health Care in Canada
WHO: Health Systems in Transition Canada Health Systems Review 2013
Gregory P. Marchildon, 2013
The governance, organization and delivery of health services is highly decentralized, with the provinces and territories responsible for administering medicare and planning health services. In the last ten years there have been no major pan-Canadian health reform initiatives but individual provinces and territories have focused on reorganizing or fine tuning their regional health systems and improving the quality, timeliness and patient experience of primary, acute and chronic care. The medicare system has been effective in providing Canadians with financial protection against hospital and physician costs. However, the narrow scope of services covered under medicare has produced important gaps in coverage and equitable access may be a challenge in these areas.
The Health Quality Council of Alberta (HQCA) has been conducting population-based surveys on satisfaction and experience with the healthcare system since 2003. The continuous monitoring of patient experience is part of the HQCA’s commitment to ongoing improvement in the public health system in Alberta.
Bulletin 7 in the Canadian Health Care Matters compares the experiences of primary care physicians across Canada and internationally in the areas of access to care, coordination of care, use of information technology, and practice improvement and incentives.
PROSPERO at one year: an evaluation of its utility.
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Booth A, Clarke M, Dooley G, Ghersi D, Moher D, Petticrew M, et al.
Systematic reviews 2013 Jan 15;2(1):4
BACKGROUND: PROSPERO, an international prospective register of systematic review protocols in health and social care, was launched in February 2011. After one year of operation we describe access and use, explore user experience and identify areas for future improvement. METHODS: We collated administrative data and web statistics and conducted an online survey of users’ experiences. RESULTS: On 21 February 2012, there were 1,076 registered users and 359 registration records published on PROSPERO. The database usage statistics demonstrate the international interest in PROSPERO with high access around the clock and around the world. Based on 232 responses from PROSPERO users (response rate 22%), almost all respondents found joining and navigation was easy or very easy (99%); turn round time was good or excellent (96%); and supporting materials provided were helpful or very helpful (80%). The registration fields were found by 80% to be relevant to their review; 99% rated their overall experience of registering with PROSPERO as good or excellent. Most respondents (81%) had a written protocol before completing the registration form and 19% did not. The majority, 136 (79%), indicated they completed the registration form in 60 minutes or less. Of those who expressed an opinion, 167 (87%) considered the time taken to be about right. CONCLUSIONS: The first year of PROSPERO has shown that registration of systematic review protocols is feasible and not overly burdensome for those registering their reviews. The evaluation has demonstrated that, on the whole, survey respondents are satisfied and the system allows registration of protocol details in a straightforward and acceptable way. The findings have prompted some changes to improve user experience and identified some issues for future consideration.
Do patients’ reports of their health care experiences reflect the quality of care? Despite the increasing role of such measures in research and policy, there’s no consensus regarding their legitimacy in quality assessment. Indeed, as physician and hospital compensation becomes increasingly tied to patient feedback, health care providers and academics are raising strong objections to the use of patient-experience surveys. These views are fueled by studies indicating that patient-experience measures at best have no relation to the quality of delivered care and at worst are associated with poorer patient outcomes. Conversely, other studies have found that better patient experiences — even more than adherence to clinical guidelines — are associated with better outcomes. Which conclusion is correct? We believe that when designed and administered appropriately, patient-experience surveys provide robust measures of quality, and our efforts to assess patient experiences should be redoubled.
Barriers to the routine collection of health outcome data in an Australian community care organization.
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Journal of multidisciplinary healthcare 2013;6:1-16
For over a decade, organizations have attempted to include the measurement and reporting of health outcome data in contractual agreements between funders and health service providers, but few have succeeded. This research explores the utility of collecting health outcomes data that could be included in funding contracts for an Australian Community Care Organisation (CCO). An action-research methodology was used to trial the implementation of outcome measurement in six diverse projects within the CCO using a taxonomy of interventions based on the International Classification of Function. The findings from the six projects are presented as vignettes to illustrate the issues around the routine collection of health outcomes in each case. Data collection and analyses were structured around Donabedian’s structure-process-outcome triad. Health outcomes are commonly defined as a change in health status that is attributable to an intervention. This definition assumes that a change in health status can be defined and measured objectively; the intervention can be defined; the change in health status is attributable to the intervention; and that the health outcomes data are accessible. This study found flaws with all of these assumptions that seriously undermine the ability of community-based organizations to introduce routine health outcome measurement. Challenges were identified across all stages of the Donabedian triad, including poor adherence to minimum dataset requirements; difficulties standardizing processes or defining interventions; low rates of use of outcome tools; lack of value of the tools to the service provider; difficulties defining or identifying the end point of an intervention; technical and ethical barriers to accessing data; a lack of standardized processes; and time lags for the collection of data. In no case was the use of outcome measures sustained by any of the teams, although some quality-assurance measures were introduced as a result of the project.
Objective. The Agency for Healthcare Research and Quality (AHRQ) Effective Health Care (EHC) Program conducts systematic reviews on a range of health care topics. Topics are nominated by a variety of stakeholders. Nominated topics undergo a refinement process to ensure that the Key Questions are relevant, of appropriate scope, and will ultimately yield a useful systematic review. Topic refinement investigators gather input from Key Informants, topical experts, and a literature scan to inform changes in the PICOTS (population, intervention, comparator, outcomes, timing, and setting), analytic framework and Key Questions. Evidencebased Practice Centers (EPCs) have approached the topic refinement process in similar and different ways. AHRQ convened a work group to assess current approaches and to develop recommendations for best practices; we report our findings here. Design and setting. We formed a workgroup of four investigators from four different EPCs in the United States and Canada and one AHRQ Project Officer. All participants held experience in topic refinement. We generated a prioritized list of methodological questions and possible guiding principles considered in the topic refinement process. We discussed each issue until we reached agreement. Results. A refined topic should address an important health care question or dilemma; consider the priorities and values of relevant stakeholders; reflect the state of the science; and be consistent with systematic review research methods. The guiding principles of topic refinement are: fidelity to the original nomination, public health and/or clinical relevance, research feasibility, responsiveness to stakeholder input, reducing investigator bias, transparency, and suitable scope. We describe the mechanics of the topic refinement process, and discuss approaches and variability in methods used by EPCs to engage Key Informants, integrate and synthesize input, and report findings. Practical suggestions and challenges in preparing and recruiting Key Informants, facilitating engagement, synthesis, and reporting are described and discussed. Decisions about integrating input from various sources require investigator judgment in the application and balance of the guiding principles. The relative importance and application of these principles will vary by topic and purpose of the systematic review. Variability in topics precludes a prescriptive approach to application of the guiding principles. Transparency and consistent documentation of decisions are important for public accountability and integrity of the topic refinement process. Conclusion. Systematic reviews that are accurate, methodologically rigorous, and as relevant and useful as possible for stakeholders require that topics be well refined. This report details guiding principles and methodological recommendations that may help investigators to better refine topics for systematic reviews, both within and outside of the EHC Program.
The effect of pharmaceutical innovation on the functional limitations of elderly Americans: evidence from the 2004 National Nursing Home Survey.
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Advances in Health Economics and Health Services Research 2012;23:73-101
To examine the effect of pharmaceutical innovation on the functional status of nursing home residents. METHODOLOGY/APPROACH: Estimation of econometric models of the ability of nursing home residents to perform activities of daily living (ADLs) using cross-sectional, patient-level data from the 2004 National Nursing Home Survey. The explanatory variables of primary interest are the characteristics (e.g., the mean vintage (FDA approval year)) of the medications used by the resident. We control for age, sex, race, marital status, veteran status, where the resident lived prior to admission, primary diagnosis at the time of admission, up to 16 diagnoses at the time of the interview, sources of payment, and facility fixed effects. FINDINGS: The ability of nursing home residents to perform ADLs is positively related to the number of “new” (post-1990) medications they consume, but unrelated to the number of old medications they consume. I estimate that if 2004 nursing home residents had used only old medications, the fraction of residents with all five ADL dependencies (number of activities for which the resident is not independent) would have been 58% instead of 50%. SOCIAL IMPLICATIONS: During 1990-2004, pharmaceutical innovation for reduced the functional limitations of nursing home residents by between and 1.2% and 2.1% per year. ORIGINALITY/VALUE OF CHAPTER: The first public-use survey of nursing homes that contains detailed information about medication use, and better data on functional status than previous surveys, is used to help explain why there has been a significant decline in the functional limitations of older people.
Patient safety culture in home care: experiences of home-care nurses.
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Berland A, Holm AL, Gundersen D, Bentsen SB.
Journal of nursing management 2012 Sep;20(6):794-801
To explore home-care nurses’ experiences of patient safety in their delivery of home care to older clients. BACKGROUND: High-risk organisations, such as the airline industry and the petroleum industry, have long been preoccupied with safety. Only recently has this also become a central theme in health care. METHOD: Four focus group interviews with 20 nurses who work in home care. A qualitative thematic analysis was performed. RESULTS: One main theme was identified: struggling with responsibility in different situations. It comprises five subthemes: poor work morale and work ethic; documentation; lack of functional leadership; competence; and lack of updated routines and guidelines. CONCLUSIONS: Patient safety culture is compromised by a lack of leadership, lack of responsibility among leadership, lack of routines, failure to update procedures, and a lack of knowledge and education among health-care workers. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers need to be made more aware of the dilemmas faced by nurses, how they struggle with their responsibilities, how they experience powerlessness in certain situations, and the lack of support they receive in decision-making. © 2012 Blackwell Publishing Ltd.
Oral health-related quality of life in an aging Canadian population.
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Kotzer RD, Lawrence HP, Clovis JB, Matthews DC.
Health and quality of life outcomes 2012 May 15;10:50-7525-10-50
The purpose of the study is to describe the impact of oral health-related quality of life (OHRQoL) on the lives of pre-seniors and seniors living in Nova Scotia, Canada. METHODS: This cross-sectional study involved 1461 participants, grouped by age (pre-seniors [45-64] and seniors [65+]) and residential status (long-term care facility [LTC] or community). OHRQoL was measured using the 14-item Oral Health Impact Profile questionnaire (OHIP-14) in a random digit dialing telephone survey (for community residents) or a face-to-face interview (for LTC residents). Intra-oral examinations were performed by one of six dentists calibrated to W.H.O. standards. RESULTS: Approximately one in four pre-seniors and seniors reported at least one OHRQoL impact ‘fairly/very often’. The most commonly reported impacts were within the dimensions ‘physical pain’ and ‘psychological discomfort’. It was found that 12.2% of LTC residents found it uncomfortable to eat any foods ‘fairly/very’ often compared to 7.7% in the community, and 11.6% of LTC residents reported being self-conscious ‘fairly/very often’ compared to 8.2% in the community. Of those residing in the community, pre-seniors (28.8%) reported significantly more impacts than seniors (22.0%); but there were no significant differences in OHRQoL between pre-seniors (21.2%) and seniors (25.3%) in LTC. Pre-seniors living in the community scored significantly higher than community dwelling seniors on prevalence, extent and severity of OHIP-14 scores. Logistic regression revealed that for the community dwelling sample, individuals living in rural areas in addition to those being born outside of Canada were approximately 2.0 times more likely to report an impact ‘fairly/very often’, whereas among the LTC sample, those having a high school education or less were 2.3 times more likely to report an impact. CONCLUSIONS: Findings indicate that the oral health and OHRQoL of both pre-seniors and seniors in LTC residents is poor. Community dwelling pre-seniors have the highest prevalence rate of oral impacts.
An exploration of safety climate in nursing homes.
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Singer S, Kitch BT, Rao SR, Bonner A, Gaudet J, Bates DW, et al.
Journal of patient safety 2012 Sep;8(3):104-124
Although nursing homes provide complex care requiring attention to safety, research on safety climate in nursing homes is limited. Our study assessed differences in attitudes about safety among nursing home personnel and piloted a new survey, specifically designed for the nursing home context. METHODS: Drawing on previous safety climate surveys for hospitals and nursing homes, researchers developed the Survey on Resident Safety in Nursing Homes and administered it March to June 2008 to frontline caregivers and managers in 8 randomly selected Massachusetts nursing homes. Our sample consisted of 751 employees, including all full-time, direct-care staff and managers from participating facilities. First, we performed factor analysis and determined Cronbach alphas for the Survey on Resident Safety in Nursing Homes. Then, we described facilities’ safety climate and variation by personnel category and among facilities by calculating the proportion of responses that were strongly positive by item, personnel category, and nursing home. RESULTS: Of 432 respondents (57% response), 29% gave their nursing home an excellent rating overall. Scores varied by personnel category and home: 51% of senior managers gave an excellent safety grade versus 26% of nursing assistants; the range in top safety grades among nursing homes was 30 percentage points. CONCLUSIONS: Safety climate varied substantially among this small sample of nursing homes and by personnel category; managers had more positive perceptions about safety than frontline workers. Efforts to measure safety climate in nursing homes should include the full range of staff at a facility and comparisons among staff categories to provide a full understanding for decision making and to promote targeted response to improve resident safety.
Telehealth for nursing homes: the utilization of specialist services for residential care.
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Gray LC, Edirippulige S, Smith AC, Beattie E, Theodoros D, Russell T, et al.
Journal of telemedicine and telecare 2012;18(3):142-146
Specialist care consultations were identified by two research nurses using documentation in patient records, appointment diaries, electronic billing services and on-site observations at a 441-bed long term care facility. Over a six-month period there were 3333 consultations (a rate of 1511 consultations per year per 100 beds). Most consultations were for general practice (n = 2589, 78%); these consultations were mainly on site (99%), with only 27 taking place off site. There were 744 consultations for specialities other than general practice. A total of 146 events related to an emergency or unplanned hospital admission. The remaining medical consultations (n = 598, 18%) related to 23 medical specialities. The largest number of consultations were for surgery (n = 106), podiatry (n = 100), nursing services including wound care (n = 74), imaging (n = 41) and ophthalmology (n = 40). Many services which are currently being provided on site to metropolitan long-term care facilities could be provided by telehealth in both urban and rural facilities.
Health professionals’ attitudes toward older people and older patients: a systematic review.
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Liu YE, While AE, Norman IJ, Ye W.
Journal of interprofessional care 2012 Sep;26(5):397-409
Attitudes toward older people and older patients among healthcare professionals are of concern throughout the world, but there are no recent systematic reviews which have examined and compared the attitudes across the various healthcare professionals who provide healthcare to older people. A comprehensive literature search (2000-2011) was undertaken on electronic databases (CINAHL, MEDLINE, EMBASE, British Nursing Index, PsycINFO, Chinese Biomedical database, China Medical Academic Conference and China Academic Journal) using a combination of terms. We identified 2179 articles indexed with these terms. Initial screening was undertaken by two researchers and then checked by a third researcher. In total, the reviewers selected 117 articles which, on the basis of their abstracts, appeared to meet the criteria for inclusion. We obtained the full texts and two reviewers assessed each full text paper to further examine whether it met all the criteria. The final review identified 51 studies. Publications over the last 10 years show that attitudes towards older people and older patients range from neutral to positive among healthcare professionals and highlight the need for well-designed studies of both qualified and student healthcare professionals recruiting random samples across multiple sites and utilizing validated instruments consistently to permit comparison over time and across countries.
Clinician Roles and Responsibilities During Care Transitions of Older Adults.
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Schoenborn NL, Arbaje AI, Eubank KJ, Maynor K, Carrese JA.
Journal of the American Geriatrics Society 2013 Jan 15
To identify the perceived roles and responsibilities of clinicians during care transitions of older adults. DESIGN: Qualitative study involving 1-hour in-depth semistructured interviews. Audiotapes of interviews were transcribed, coded, and analyzed, and themes and subthemes were generated. SETTING: An acute care hospital, a skilled nursing facility, two community-based outpatient practices, and one home healthcare agency. PARTICIPANTS: Forty healthcare professionals directly involved in care transitions of older adults (18 physicians, 11 home healthcare administrative and field staff, four social workers, three nurse practitioners, three physician assistants, and one hospital case manager). MEASUREMENTS: Perspectives of healthcare professionals regarding clinicians’ roles and responsibilities during care transitions were examined and described. RESULTS: Content analysis revealed several themes: components of clinicians’ roles during care transitions; congruence between self- and others’ perceived ideal roles but incongruence between ideal and routine roles; ambiguity in accountability in the postdischarge period; factors prompting clinicians to act closer to ideal roles; and barriers to performing ideal roles. A conceptual framework was created to summarize clinicians’ roles during care transitions. CONCLUSION: This study reports differences between what healthcare professionals perceive as ideal roles of clinicians during care transitions and what clinicians actually do routinely. Certain patient and clinician factors prompt clinicians to act closer to the ideal roles. Multiple barriers interfere with consistent practice of ideal roles. Future investigations could evaluate interventions targeting various components of the conceptual framework and relevant outcomes. © 2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society.
Person-centredness and its association with resident well-being in dementia care units
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Sjogren K, Lindkvist M, Sandman PO, Zingmark K, Edvardsson D.
Journal of advanced nursing 2013 Jan 21
To report a study of the relationship between person-centred care and ability to perform activities of daily living, quality of life, levels of pain, depressive symptoms, and agitated behaviours among residents with dementia in residential care facilities. BACKGROUND: Standardized measurements of person-centred care have not previously been used to investigate the relationship between person-centred care and well-being for residents with dementia in residential aged care units. DESIGN: This study had a cross-sectional design. METHOD: Staff and resident surveys were used in a sample of 1261 residents with dementia and 1169 staff from 151 residential care units throughout Sweden. Valid and reliable scales were used to measure person-centredness and ability to perform activities of daily living, quality of life, levels of pain, depressive symptoms, and agitated behaviours in residents. All data were collected in May 2010. FINDINGS: Person-centred care was correlated with residents’ ability to perform activities of daily living. Furthermore, residents in units with higher levels of person-centred care were rated as having higher quality of life and better ability to perform activities of daily living compared with residents in units with lower levels of person-centred care. CONCLUSIONS: There seems to be a relationship between person-centredness, residents’ ability to perform activities of daily living, and residents’ quality of life. Further studies are needed to explain the variation of person-centredness between units and the extent and ways this might impact on the quality of life and well-being of frail older residents with cognitive impairments in clinical practice. © 2013 Blackwell Publishing Ltd.
Person-centered Care Practices and Quality in Department of Veterans Affairs Nursing Homes: Is There a Relationship?
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Sullivan JL, Shwartz M, Burgess JF,Jr, Pekoz EA, Christiansen CL, Gerena-Melia M, et al.
Medical care 2013 Feb;51(2):165-171
To examine variation in culture change to a person-centered care (PCC) model, and the association between culture change and a composite measure of quality in 107 Department of Veterans Affairs nursing homes. METHODS: We examined the relationship between a composite quality measure calculated from 24 quality indicators (QIs) from the Minimum Data Set (that measure unfavorable events), and PCC summary scores calculated from the 6 domains of the Artifact of Culture Change Tool, using 3 different methods of calculating the summary scores. We also use a Bayesian hierarchical model to analyze the relationship between a latent construct measuring extent of culture change and the composite quality measure. RESULTS: Using the original Artifacts scores, the highest performing facility has a 2.9 times higher score than the lowest. There is a statistically significant relationship between the composite quality measure and each of the 3 summary Artifacts scores. Depending on whether original scores, standardized scores, or optimal scores are used, a facility at the 10th percentile in terms of culture change compared with one at the 90th percentile has 8.0%, 8.9%, or 10.3% more QI events. When PCC implementation is considered as a latent construct, 18 low performance PCC facilities have, on an average, 16.3% more QI events than 13 high performance facilities. CONCLUSIONS: Our results indicate that culture change to a PCC model is associated with higher Minimum Data Set-based quality. Longitudinal data are needed to better assess whether there is a causal relationship between the extent of culture change and quality.
This brief examines the factors contributing to poor care transitions, describes the elements of effective approaches to improving patient and family experience with transitions, and explores policy issues surrounding payment reforms designed to address the problem.
“Communicating With Older Adults: An Evidence-Based Review of What Really Works,” the latest report from The Gerontological Society of America (GSA), provides 40 pages of recommended guidelines for health care providers interacting with the fastest growing age segment of America’s population.
This publication is intended for physicians, nurses, pharmacists, biologists, psychologists, social workers, caregivers, economists, and health policy experts — anyone who seeks to have the best possible interactions with older patients. It was developed by GSA and supported by McNeil Consumer Healthcare.
“The report is based in the scientific literature, yet the contributors created something extremely accessible,” said Jake Harwood, PhD, head of the Advisory Board that crafted the report. “It covers the full range of communication issues experienced by older adults and health care providers, and gives concrete suggestions for dealing with problems when they arise.”
A Discussion of CIHI Data: Using Health Data to Make a Difference!
ECHA 4-001, Thurs Jan 31, 2013
Presenter: Joe Puchniak, Manager of Client Affairs (Alberta) – CIHI. Pizza and refreshments will be provided.
IHI: Improvement Skills for Tomorrow’s Health Care: The Experts’ Perspective
April 30 – May 1, 2013 Cambridge, MA
This seminar will be taught by world-renowned Quality Improvement (QI) leaders, including Don Berwick, Maureen Bisognano, Robert Lloyd, Gilbert Salinas, and Diane Miller. The two-day seminar will cover:
- The foundations of health care improvement and the building blocks for the future of quality improvement
- Strategies and techniques for inspiring front-line staff
- Steps for engaging patients in design and improvement
- Innovative applications of proven improvement tools
- How to implement systems for spread and scale
KT Canada Seminar Series: Respiratory Guidelines: Update, Dissemination and Implementation
Thurs Feb 14, 2013 10:00-11:00 (MT)
Presenter: Louis-Philippe Boulet, Université Laval
Report on current status of respiratory guidelines production in Canada.
Discuss the main barriers to their use in primary care.
Discuss current initiatives to promote their dissemination and implementation into care.
This 5 day course is designed to equip individuals who have a basic understanding of cost effectiveness analysis with the skills required to build two types of decision analytic cost effectiveness models; decision trees and Markov models. Designed and delivered by internationally recognized experts in cost effectiveness analyses, the course will combine focused pedagogic sessions with practical exercises to provide participants with hands-on experience of building the most commonly used types of cost effectiveness model, undertaking deterministic and probabilistic sensitivity analyses, Value of Information Analyses and producing a range of outputs to meet the requirements of reimbursement authorities in North America, Europe and Australasia.
The course is suitable for graduate students, residents and post-doctoral researchers working in academia, public health systems, pharmaceutical and device manufacturers, as well as commercial research organizations. Course participants will be provided with a certificate of completion and an accompanying record of achievement in the learning audits completed after each stage of the course. In addition, participants will be provided with MS Excel macros for implementing many of the techniques taught in the course. Please contact Mira Singh at to register
Writing research funding proposals in the health sciences: A workshop
Tuesday February 5, 2013 12:00-14:00 ECHA 3-001
Please consider participating in this workshop offered by Dr. Roger Graves, from the University of Alberta Centre on Writing. It is based on evidence-based writing techniques and is facilitated by an exceptional internationally renowned expert in writing.
For: Early career Faculty members, Postdoctoral and Research Fellows, PhD students preparing for their candidacy. This workshop combines lecture, discussion, group feedback, and writing time to help participants take an idea for a research project and turn it into a request for funding support. Participants should come with an idea for a research project; if you have a full draft of a funding proposal or are revising one, this workshop will help you think of ways to revise those documents.
Delfini Seminars: Critical Appraisal of the Medical Literature for Therapies
June 21-22, 2013 Portland OR
Join us and improve your critical appraisal skills. Without highly developed critical appraisal skills, the quality of studies tends to look “OK.” In fact, there is a world of difference between “knowing the evidence” and knowing which evidence is valid & clinically useful and which is not. We aim to make critical appraisal of the medical literature meaningful, useful, simple and doable…
This 2-day program includes basics and more advanced topics. This program will be particularly helpful to those who routinely evaluate the medical literature.
NCCHPP & INSPQ: Introduction to Health Impact Assessment of Public Policies
May 1 to June 11, 2013.
REGISTRATION DEADLINE: March 8 , 2013.
An online course on health impact assessment (HIA) of public policies has been developed by the NCCHPP and the Institut national de santé publique du Québec (Québec’s public health institute – INSPQ) in collaboration with Dr. Richard Massé, associate professor at the Department of social and preventive medicine at the University of Montreal, and other partners. This course aims to help participants to develop and improve their competencies for leading an HIA process relating to public policies, and to do this with partners from different sectors.
In April 2012, Bluewater Health began a three-year partnership to become a Best Practice Spotlight Organization (BPSO®) designate. Bluewater Health, with locations in Sarnia and Petrolia, is a 326-bed community hospital with almost 2,500 staff, dedicated to promoting practice excellence as the hospital continues to meet BPSO® program standards. On October 23, the Sarnia site hosted the first Nursing Best Practice Champions workshop based on the newly released Toolkit: Implementation of Best Practice Guidelines. Lori Jennings, Bluewater’s manager of best practices, shared her views with RNAO’s Claire O’Keeffe about the hospital’s BPSO® status with RNAO.
Fraser Health Authority issues a rare, public-health edict requiring all visitors and staff at 125 long-term care facilities to wear a mask, if they have not had a flu shot.
The Canadian Association of Emergency Physicians is urging P.E.I. to be cautious when it comes to moving toward Collaborative Emergency Centres.
British Columbia’s health care system could do better, according to Health Minister Margaret MacDiarmid. Responding to a report by the province’s auditor-general providing a detailed breakdown of last year’s $15.5-billion health budget, Ms. MacDiarmid acknowledged that waiting lists are still too long for her liking.
The province is pledging $71,000 for research to improve facilities for Alberta’s growing senior population. “Health policy is seniors’ policy in Alberta,” said Health Minister Fred Horne during the announcement in Edmonton. The grant will be split among three organizations — the University of Alberta, the Alberta Association of Senior Centres and the Seniors Association of Greater Edmonton — to look at ways for the province’s 400 senior centres to better recruit staff, keep down rising costs and keep seniors healthy.
eGEMs is an open access journal focused on using electronic clinical data to advance research and quality improvement, with the overall goal of improving patient and community outcomes. Authors are welcome to submit papers, images, or other media focused on data methods, informatics, governance, and the learning health system.
The head of the Erie St. Clair Local Health Integration Network says nearly 40 per cent of seniors currently in Windsor hospitals could be at home. “Their complex conditions are no more severe than those waiting at home,” Gary Switzer said. Switzer said a report released last year found 37 per cent of seniors could be at home waiting for a long-term care bed rather than in hospital, where they take up space normally reserved for acute care.
The Task Force is now seeking input from a wide variety of stakeholders to fulfill its mandate. Specific individuals are not being targeted for input; instead all members of the CIHR community are welcome to send submissions on their own accord in response to the following questions:
- What would you like to see happen with ethics at CIHR?
- What is your past/current/future role vis-à-vis ethics at CIHR?
- What would you like to see CIHR do in the area of ethics?
Please ensure your submissions address the Task Force’s limited mandate as strictly as possible. The Task Force is not empowered to look at substantive issues in ethics, but rather the functions, roles, and structures in place at CIHR for ethics. Additionally, given our very tight timeline succinct, usable answers and comments are appreciated.
Recent CCV enhancements have been implemented effective January 16, 2013. These enhancements were technically feasible to implement in advance of the upcoming major competition deadlines. Other enhancements that are more complex will be made in the coming months and we will be sure to inform you about them when they are implemented.
This is a subscription based resource (in other words, it costs $ to use it)
Building on the BMJ Group strengths of using evidence and best practice it aims to empower clinicians and organisations to play a more active role in helping to achieve better outcomes for patients.
The focus for the development of this guideline was managing conflict among nursing and healthcare teams with the view that while some conflict is preventable, healthy conflict can also be beneficial.
The Curriculum is intended for a global audience of students and instructors. While it draws in many instances on evidence and experience in the health sector of low– and middle-income settings, its focus is by no means restricted to this context. Module One is an introduction to KT; Module Two presents a situation analysis of the context surrounding research, policy and social change; and Module Three looks at priority setting.
The mission of the MRM website is to give researchers the tools they need to increase the dissemination and implementation potential of their products. MRM was developed, implemented and tested by researchers from the Cancer Communication Research Center and Washington University in St. Louis who were members of the Centers of Excellence in Cancer Communication (CECCR) Dissemination Research Interest Group (D-RIG).
The MRM website consists of four main tools:
1. Planning Tool-an interactive survey which provides a tailored report that aids researchers with their dissemination plan;
2. Resource Library-a searchable database consisting of a compilation of D&I related articles from multiple sources which is updated monthly;
3. Narrative Library-a freely accessible online library containing video vignettes and transcripts with junior and senior D&I experts of “how-to” knowledge to D&I problems;
4. Glossary-containing over 100 definitions of terminology used in D&I health research.
The design of the built environment can significantly help in compensating for the sensory loss and cognitive impairment associated with dementia, as well as supporting the continued independence of people in hospital who have dementia. To support clinical staff and their estates colleagues The King’s Fund has produced two new resources to enable hospitals to become more dementia friendly.
A promising new program has reduced the number of hospitalizations among nursing home residents, sparing them unnecessary risk and saving significant amounts of money. Learn more about The Commonwealth Fund–supported INTERACT program, which helps nursing home staff identify problems early.
Cochrane Research Fellow (UK) SOCSI – Cardiff School of Social Sciences
DEADLINE February 7, 2013
The Fellow is expected to explore how far the information needs of UK, European and International organisations with a role for public health policy development are met by existing Cochrane reviews and protocols. This exercise should lead to a priority list of review questions and sub-questions that are tailored to the needs of policy makers and inform both the business case and the development of the CPHG as a whole.