July 29, 2013

Grants & Awards


New article by Dr. Carole Estabrooks The Hidden Complexity of Long-Term Care: How Context Mediates Knowledge Translation and Use of Best Practices.
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Cammer A, Morgan D, Stewart N, McGilton K, Rycroft-Malone J, Dopson S, et al.
The Gerontologist 2013 Jul 15

PURPOSE: Context is increasingly recognized as a key factor to be considered when addressing healthcare practice. This study describes features of context as they pertain to knowledge use in long-term care (LTC). DESIGN AND METHODS: As one component of the research program Translating Research in Elder Care, an in-depth qualitative case study was conducted to examine the research question “How does organizational context mediate the use of knowledge in practice in long-term care facilities?” A representative facility was chosen from the province of Saskatchewan, Canada. Data included document review, direct observation of daily care practices, and interviews with direct care, allied provider, and administrative staff. RESULTS: The Hidden Complexity of Long-Term Care model consists of 8 categories that enmesh to create a context within which knowledge exchange and best practice are executed. These categories range from the most easily identifiable to the least observable: physical environment, resources, ambiguity, flux, relationships, and philosophies. Two categories (experience and confidence, leadership and mentoring) mediate the impact of other contextual factors. Inappropriate physical environments, inadequate resources, ambiguous situations, continual change, multiple relationships, and contradictory philosophies make for a complicated context that impacts care provision. IMPLICATIONS: A hidden complexity underlays healthcare practices in LTC and each care provider must negotiate this complexity when providing care. Attending to this complexity in which care decisions are made will lead to improvements in knowledge exchange mechanisms and best practice uptake in LTC settings.

Article recommended by Dr. Carole Estabrooks Bridging research and practice: models for dissemination and implementation research.
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Tabak RG, Khoong EC, Chambers DA, Brownson RC.
American Journal of Preventive Medicine 2012 Sep;43(3):337-350

CONTEXT: Theories and frameworks (hereafter called models) enhance dissemination and implementation (D&I) research by making the spread of evidence-based interventions more likely. This work organizes and synthesizes these models by (1) developing an inventory of models used in D&I research; (2) synthesizing this information; and (3) providing guidance on how to select a model to inform study design and execution. EVIDENCE ACQUISITION: This review began with commonly cited models and model developers and used snowball sampling to collect models developed in any year from journal articles, presentations, and books. All models were analyzed and categorized in 2011 based on three author-defined variables: construct flexibility, focus on dissemination and/or implementation activities (D/I), and the socioecologic framework (SEF) level. Five-point scales were used to rate construct flexibility from broad to operational and D/I activities from dissemination-focused to implementation-focused. All SEF levels (system, community, organization, and individual) applicable to a model were also extracted. Models that addressed policy activities were noted. EVIDENCE SYNTHESIS: Sixty-one models were included in this review. Each of the five categories in the construct flexibility and D/I scales had at least four models. Models were distributed across all levels of the SEF; the fewest models (n=8) addressed policy activities. To assist researchers in selecting and utilizing a model throughout the research process, the authors present and explain examples of how models have been used. CONCLUSIONS: These findings may enable researchers to better identify and select models to inform their D&I work. Copyright © 2012 American Journal of Preventive Medicine. All rights reserved.

CALL FOR ABSTRACTS: 17th Annual International Philosophy of Nursing Conference
Atlanta GA 7-9 September 2013
DEADLINE 3 August 2013

The 17th International Philosophy of Nursing Conference will explore the relationship between 21st century knowledge of the human body and nursing care. How should biological models be integrated into nursing knowledge and practice, especially given nursing’s concern with the psychological, emotional, and social dimensions of health? Does understanding of genetic or neurological mechanisms change how we should think about “evidence-based practice”? What are the political implications and presuppositions of mechanistic models of disease processes? And what are the ethical issues that arise out of managing the vast amounts of data about both populations and individuals? What challenges does this biological knowledge base present for patient communication and education? Should it change the way we think about the nurse’s role, nursing education, and the shape of the discipline of nursing?

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Grants & Awards

CIHR: Frederick Banting and Charles Best Canada Graduate Scholarships Doctoral Awards
DEADLINE: 1 October 2013

The specific objectives of this funding opportunity are: to provide recognition and funding to students early in their academic research career, providing them with an opportunity to gain research experience; and to provide a reliable supply of highly skilled and qualified researchers.

American Society on Aging: Graduate Student Research Award
DEADLINE: 1 October 2013

The Graduate Student Research Award is given to spur academic and clinical interest in the field of aging, and rewards the best unpublished graduate research paper on a completed project relevant to aging and applicable to practice. Membership in ASA is not a requirement, but is a consideration. Applicants must be enrolled in a graduate-degree program or have completed their studies less than one year before submission, and be sponsored by a faculty member.

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Health Care Administration and Organization
Health Care Innovation and Quality Assurance


Is Openness to Using Empirically Supported Treatments Related to Organizational Culture and Climate?
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Patterson DA, Dulmus CN, Maguin E.
Journal of Social Service Research 2013

The overall purpose of this study is to investigate workers’ openness toward implementing a new empirically supported treatment (EST) and to determine whether the workers’ openness scores relate to their workplace culture and climate scores. Participants in this study (N = 1,273) worked in a total of 55 different programs in a large child and family services organization and completed a survey measuring their attitudes toward ESTs. Results indicate that work groups that measure themselves as being more open to using ESTs rated their organizational cultures as being significantly more proficient and significantly less resistant to change. With ESTs becoming the gold standard for professional social work practices, it is important to have accessible pathways to EST implementation. © 2013 Copyright Taylor and Francis Group, LLC.

Development and psychometric testing of the Nursing Research Self-Efficacy Scale (NURSES).
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Swenson-Britt E, Berndt A.
Journal of nursing measurement 2013;21(1):4-22

BACKGROUND AND PURPOSE: The Nursing Research Self-Efficacy Scale (NURSES) was designed to measure individual nurses’ degree of research self-efficacy and their perceptions regarding their unit’s collective support of research use. Development for the NURSES instrument spanned a 4-year period, which included initial development, revisions, and psychometric evaluations. METHOD: The NURSES is a 38-item Likert-scale instrument developed through ongoing instrument validation that included content validation and exploratory and confirmatory analysis. The 5 subscales include obtaining science-based knowledge resources, critically reading and evaluating quantitative research literature, critically reading and evaluating qualitative research literature, understanding and applying theory, and collective research efficacy. RESULTS: Over a 4-year period, approximately 1000 practicing nurses from multiple hospitals responded to the instrument. Exploratory and confirmatory factor analyses supported the existence of four subscales for research self-efficacy and one subscale for collective research efficacy. Reliability for the subscales was excellent, ranging from .94 to .97. CONCLUSIONS: Hospitals may wish to use the NURSES instrument as an orientation tool, or to examine relationships between research efficacy and nurses’ professional development. Health care facilities on a Magnet journey might also use the NURSES instrument to assess their nursing staff as they pursue evidence-based practice and conduct research.

Guideline implementation strategies for specialist mental healthcare.
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Girlanda F, Fiedler I, Ay E, Barbui C, Koesters M.
Current opinion in psychiatry 2013 Jul;26(4):369-375

PURPOSE OF REVIEW: Clinical practice guidelines in mental healthcare are viewed as an essential asset if appropriately developed and implemented. The purpose of this article was to review the existing literature on how guidelines should be implemented to optimize their impact on provider performance and patient outcomes in specialist mental healthcare settings. RECENT FINDINGS: Findings from recent studies suggest a trend toward an improvement in process and patient outcomes following guideline implementation. However, studies are heterogeneous in terms of design, implementation strategies and outcome measures, making it very difficult to draw firm conclusions about which implementation strategy is effective in different healthcare contexts. SUMMARY: Current knowledge about how guidelines should be implemented is still sparse and inconclusive in mental healthcare. Future studies should attempt to employ more rigorous designs, including random allocation of patients or clusters of patients, to shed further light on this compelling issue. Research on guideline implementation strategies should additionally take into account potential barriers to knowledge translation, which can heavily influence the implementability of treatment recommendations.

Research utilization and evidence-based practice in occupational therapy: a scoping study.
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Thomas A, Law M.
The American Journal of Occupational Therapy 2013 Jul-Aug;67(4):e55-65

Many articles have been written on the barriers to and facilitators of the use of evidence in practice in nursing and medicine, but to date no extensive review has been published of the literature on evidence-based practice (EBP) supports in occupational therapy. This article presents the results of a scoping review that examined factors that support the integration of research into practice. A review of 69 articles revealed four themes: (1) attitudes toward, perceptions of, confidence in, and use of research and EBP; (2) factors that support the use of research in practice; (3) effects of interventions targeting changes in knowledge, attitudes, skills, behaviors, and evidence-based practices; and (4) identification of the processes involved in the acquisition of EBP skills and their application in clinical practice. A process that integrates client-centered practice, structured reflection, case application, and peer consultations within a scholarship of practice model facilitates occupational therapists’ evaluation and integration of research evidence. Copyright © 2013 by the American Occupational Therapy Association

Knowledge translation: An overview and recommendations in relation to the Fourth Canadian Consensus Conference on the Diagnosis and Treatment of Dementia
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Cook C, Rockwood K.
Alzheimer’s Research and Therapy 2013;5(SUPPL. 1)

The growing population of persons with dementia in Canada and the provision of quality care for this population is an issue that no healthcare authority will escape. Physicians often view dementia as a difficult and time-consuming condition to diagnose and manage. Current evidence must be effectively transformed into usable recommendations for physicians; however, we know that use of evidence-based practice recommendations is a challenge in all realms of medical care, and failure to utilize these leads to less than optimal care for patients. Despite this expanding need for readily available resources, knowledge translation (KT) is often seen as a daunting, if not confusing, undertaking for researchers. Here we offer a brief introduction to the processes around KT, including terms and definitions, and outline some common KT frameworks including the knowledge to action cycle, the Promoting Action on Research Implementation in Health Services framework and the Consolidated Framework for Implementation Research. We also outline practical steps for planning and executing a KT strategy particularly around the implementation of recommendations for practice, and offer recommendations for KT planning in relation to the Fourth Canadian Consensus Conference on the Diagnosis and Treatment of Dementia. © 2013 BioMed Central Ltd.

Translating research findings into community based theatre: More than a dead man’s wife
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Feldman S, Hopgood A, Dickins M.
Journal of Aging Studies 2013

Increasingly, qualitative scholars in health and social sciences are turning to innovative strategies as a way of translating research findings into informative, accessible and enjoyable forms for the community. The aim of this article is to describe how the research findings of a doctoral thesis – a narrative study about 58 older women’s experiences of widowhood – were translated into a unique and professionally developed script to form the basis for a successful theatrical production that has travelled extensively within Australia. This article reports on the process of collaboration between a researcher, a highly regarded Australian actor/script writer and an ensemble of well-known and experienced professional actors. Together the collaborating partners translated the research data and findings about growing older and ‘widowhood’ into a high quality theatre production. In particular, we argue in this paper that research-based theatre is an appropriate medium for communicating research findings about important life issues of concern to older people in a safe, affirming and entertaining manner. By outlining the process of translating research findings into theatre we hope to show that there is a real value in this translation approach for both researcher and audience alike. © 2013.

Translating research into evidence-based practice in juvenile justice: brand-name programs, meta-analysis, and key issues
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Welsh BC, Rocque M, Greenwood PW.
Journal of Experimental Criminology 2013:1-19

Objectives: To investigate the utility of two main approaches for translating research into evidence-based practice in juvenile justice: (a) brand-name programs that are identified by lists of various expert groups and come with implementation and quality assurance packages offered by program developers; and (b) results of large-scale meta-analyses that offer a number of generalized strategies (or generics) for improving existing programs. Methods: Informed by prospect theory, a first-stage analytic decision-tree model was developed that included three comparable evidence-based programs (two brand names and one generic). Implementation success was a key factor, and analyses were conducted under two conditions. Results: Under the first condition, where brand-name programs have a large advantage in implementation success over generic programs, it was found that the brand-name programs had the highest expected values. Under the second condition, which considered the role of Lipsey et al.’s (2010) Standardized Program Evaluation Protocol, it was found that all three programs produced highly favorable expected values. Conclusions: Brand-name programs and meta-analyses represent two rigorous and transparent approaches for advancing evidence-based practice in juvenile justice. State governments should consider the merits of both approaches through a decision-tree model, paying particular attention to implementation success as well as financial costs and benefits derived from rigorous cost-benefit analysis. © 2013 Springer Science+Business Media Dordrecht.

Linking evidence-based nursing practice and patient-centered care through patient preferences.
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Burman ME, Robinson B, Hart AM.
Nursing administration quarterly 2013 Jul-Sep;37(3):231-241

Calls for both patient-centered care and evidence-based practice (EBP) have increased dramatically over the last decade despite a tension between the two. Patient preferences, one of the cornerstones of EBP, can provide the link between the two. Although current research supports the added value of patient preferences in care, there is currently a “gap” between EBP and patient-centered care, with the two often viewed as opposing ideas. The purpose of this article is to provide an overview of patient preferences, summarize research on patient preferences, and discuss implications for nursing and nursing administration. Efforts to incorporate patient preferences into nursing care must be multifaceted, targeting multiple levels from individual nurses to organizations and systems. Four critical elements have been identified for integrating patient preferences into EBP: (1) health care redesign, (2) decision support, (3) empowered organizational culture, and (4) informed and empowered nurses.

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Health Care Administration and Organization

The impact of organizational support and leader-member exchange on the work-related behaviour of nursing professionals: The moderating effect of professional and organizational identification
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Trybou J, Gemmel P, Pauwels Y, Henninck C, Clays E.
Journal of advanced nursing 2013 Jul 3

AIM: The aim of this study was to examine the relations between perceived organizational support, the quality of leader-member exchange, in-role and extra-role behaviour, professional identification and organizational identification among registered nurses and nurse assistants. BACKGROUND: Theoretically, employees will reciprocate received beneficial treatment with positive attitudes and behaviour. Recently, it has been shown that this principle may be more complex than originally anticipated. DESIGN: A quantitative, cross-sectional survey design was used. The quality of social exchange and identification was scored by the involved registered nurses and nurse assistants; in-role and extra-role behaviour was rated by the head nurse. METHODS: The survey was administered to nurses and nurse assistants (n = 196) working in five Belgian nursing homes. Data were collected from February-March 2012. Pearson correlation analyses, t-test analyses and hierarchical regression were used to analyse the data. RESULTS: Our results showed no relationship between perceived organizational support and leader-member exchange and in-role behaviour. A positive relationship was found between perceived organizational support and extra-role behaviour and a trend towards significance between leader-member exchange and extra-role behaviour. Organizational and professional identification moderated the relationship between perceived organizational support and extra-role behaviour. CONCLUSIONS: Our study demonstrates the importance of social exchange to nurses and nurse assistants and therefore nursing administrators and leaders. When registered nurses and nurse assistants perceive high-quality social exchange, they are more likely to go the extra mile on behalf of the organization. Fostering social identification could enhance this. © 2013 John Wiley & Sons Ltd.

The consequences of poor communication during transitions from hospital to skilled nursing facility: a qualitative study.
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King BJ, Gilmore-Bykovskyi AL, Roiland RA, Polnaszek BE, Bowers BJ, Kind AJ.
Journal of the American Geriatrics Society 2013 Jul;61(7):1095-1102

OBJECTIVES: To examine how skilled nursing facility (SNF) nurses transition the care of individuals admitted from hospitals, the barriers they experience, and the outcomes associated with variation in the quality of transitions. DESIGN: Qualitative study using grounded dimensional analysis, focus groups, and in-depth interviews. SETTING: Five Wisconsin SNFs. PARTICIPANTS: Twenty-seven registered nurses. MEASUREMENTS: Semistructured questions guided the focus group and individual interviews. RESULTS: SNF nurses rely heavily on written hospital discharge communication to transition individuals into the SNF effectively. Nurses cited multiple inadequacies of hospital discharge information, including regular problems with medication orders (including the lack of opioid prescriptions for pain), little psychosocial or functional history, and inaccurate information regarding current health status. These communication inadequacies necessitated repeated telephone clarifications, created care delays (including delays in pain control), increased SNF staff stress, frustrated individuals and family members, contributed directly to negative SNF facility image, and increased risk of rehospitalization. SNF nurses identified a specific list of information and components that they need to facilitate a safe, high-quality transition. CONCLUSION: Nurses note multiple deficiencies in hospital-to-SNF transitions, with poor quality discharge communication being identified as the major barrier to safe and effective transitions. This information should be used to refine and support the dissemination of evidence-based interventions that support transitions of care, including the Interventions to Reduce Acute Care Transfers program. © 2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society.

The employment and recruitment of immigrant care workers in Canada
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Atanackovic J, Bourgeault IL.
Canadian Public Policy 2013;39(2):335-350

This paper examines the employment and recruitment of immigrant care workers in the older adult care sector in Canada, based on data from interviews with 77 workers and 24 employers in care settings, as well as from 149 online employer surveys conducted in 2007-08. We find that workers enter this sector largely through social networks. Although recruitment agencies do not play a critical role in the employment and recruitment of immigrant workers, regulation could prevent instances of abuse we found. Our findings also suggest that immigration admission policies could be better aligned with Canada’s needs for older adult care.

Ten principles of good interdisciplinary team work.
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Nancarrow SA, Booth A, Ariss S, Smith T, Enderby P, Roots A.
Human resources for health 2013 May 10;11(1):19-4491-11-19

BACKGROUND: Interdisciplinary team work is increasingly prevalent, supported by policies and practices that bring care closer to the patient and challenge traditional professional boundaries. To date, there has been a great deal of emphasis on the processes of team work, and in some cases, outcomes. METHOD: This study draws on two sources of knowledge to identify the attributes of a good interdisciplinary team; a published systematic review of the literature on interdisciplinary team work, and the perceptions of over 253 staff from 11 community rehabilitation and intermediate care teams in the UK. These data sources were merged using qualitative content analysis to arrive at a framework that identifies characteristics and proposes ten competencies that support effective interdisciplinary team work. RESULTS: Ten characteristics underpinning effective interdisciplinary team work were identified: positive leadership and management attributes; communication strategies and structures; personal rewards, training and development; appropriate resources and procedures; appropriate skill mix; supportive team climate; individual characteristics that support interdisciplinary team work; clarity of vision; quality and outcomes of care; and respecting and understanding roles. CONCLUSIONS: We propose competency statements that an effective interdisciplinary team functioning at a high level should demonstrate.

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Health Care Innovation and Quality Assurance

Seven propositions of the science of improvement: exploring foundations.
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Perla RJ, Provost LP, Parry GJ.
Quality management in health care 2013 Jul-Sep;22(3):170-186

CONTEXT: The phrase “Science of Improvement” or “Improvement Science” is commonly used today by a range of people and professions to mean different things, creating confusion to those trying to learn about improvement. In this article, we briefly define the concepts of improvement and science, and review the history of the consideration of “improvement” as a science. METHODS: We trace key concepts and ideas in improvement to their philosophical and theoretical foundation with a focus on Deming’s System of Profound Knowledge. We suggest that Deming’s system has a firm association with many contemporary and historic philosophic and scientific debates and concepts. With reference to these debates and concepts, we identify 7 propositions that provide the scientific and philosophical foundation for the science of improvement. FINDINGS: A standard view of the science of improvement does not presently exist that is grounded in the philosophical and theoretical basis of the field. The 7 propositions outlined here demonstrate the value of examining the underpinnings of improvement. This is needed to both advance the field and minimize confusion about what the phrase “science of improvement” represents. We argue that advanced scientists of improvement are those who like Deming and Shewhart can integrate ideas, concepts, and models between scientific disciplines for the purpose of developing more robust improvement models, tools, and techniques with a focus on application and problem solving in real world contexts. CONCLUSIONS: The epistemological foundations and theoretical basis of the science of improvement and its reasoning methods need to be critically examined to ensure its continued development and relevance. If improvement efforts and projects in health care are to be characterized under the canon of science, then health care professionals engaged in quality improvement work would benefit from a standard set of core principles, a standard lexicon, and an understanding of the evolution of the science of improvement.

Documenting Quality Improvement and Patient Safety Efforts: The Quality Portfolio. A Statement from the Academic Hospitalist Taskforce.
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Taylor BB, Parekh V, Estrada CA, Schleyer A, Sharpe B.
Journal of general internal medicine 2013 Jun 27

Physicians increasingly investigate, work, and teach to improve the quality of care and safety of care delivery. The Society of General Internal Medicine Academic Hospitalist Task Force sought to develop a practical tool, the quality portfolio, to systematically document quality and safety achievements. The quality portfolio was vetted with internal and external stakeholders including national leaders in academic medicine. The portfolio was refined for implementation to include an outlined framework, detailed instructions for use and an example to guide users. The portfolio has eight categories including: (1) a faculty narrative, (2) leadership and administrative activities, (3) project activities, (4) education and curricula, (5) research and scholarship, (6) honors, awards, and recognition, (7) training and certification, and (8) an appendix. The authors offer this comprehensive, yet practical tool as a method to document quality and safety activities. It is relevant for physicians across disciplines and institutions and may be useful as a standalone document or as an adjunct to traditional promotion documents. As the Next Accreditation System is implemented, academic medical centers will require faculty who can teach and implement the systems-based practice requirements. The quality portfolio is a method to document quality improvement and safety activities.

Culture Change in Infection Control: Applying Psychological Principles to Improve Hand Hygiene.
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Cumbler E, Castillo L, Satorie L, Ford D, Hagman J, Hodge T, et al.
Journal of nursing care quality 2013 May 10

Hand hygiene occurs at the intersection of habit and culture. Psychological and social principles, including operant conditioning and peer pressure of conforming social norms, facilitate behavior change. Participatory leadership and level hierarchies are needed for sustainable patient safety culture. Application of these principles progressively and significantly improved hand hygiene compared with the hospital aggregate control. Changes to hand hygiene auditing and response processes demonstrate ability to improve and sustain adherence rates within a clinical microsystem.

Implementing an organization-wide quality improvement initiative: insights from project leads, managers, and frontline nurses.
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Jeffs LP, Lo J, Beswick S, Campbell H.
Nursing administration quarterly 2013 Jul-Sep;37(3):222-230

With the movement to advance quality care and improve health care outcomes, organizations have increasingly implemented quality improvement (QI) initiatives to meet these requirements. Key to implementation success is the multilevel involvement of frontline clinicians and leadership. To explore the perceptions and experiences of frontline nurses, project leads, and managers associated with an organization-wide initiative aimed at engaging nurses in quality improvement work. To address the aims of this study, a qualitative research approach was used. Two focus groups were conducted with a total of 13 nurse participants, and individual interviews were done with 10 managers and 6 project leads. Emergent themes from the interview data included the following: improving care in a networked approach; driving QI and having a sense of pride; and overcoming challenges. Specifically, our findings elucidate the value of communities of practice and ongoing mentorship for nurses as key strategies to acquire and apply QI knowledge to a QI project on their respective units. Key challenges emerged including workload and time constraints, as well as resistance to change from staff. Our study findings suggest that leaders need to provide learning opportunities and protected time for frontline nurses to participate in QI projects.

Early-career registered nurses’ participation in hospital quality improvement activities
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Djukic M, Kovner CT, Brewer CS, Fatehi FK, Bernstein I.
Journal of nursing care quality 2013 Jul-Sep;28(3):198-207

We surveyed 2 cohorts of early-career registered nurses from 15 states in the US, 2 years apart, to compare their reported participation in hospital quality improvement (QI) activities. We anticipated differences between the 2 cohorts because of the growth of several initiatives for engaging nurses in QI. There were no differences between the 2 cohorts across 14 measured activities, except for their reported use of appropriate strategies to improve hand-washing compliance to reduce nosocomial infection rates.

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Factors Associated With Remaining in a Skilled Nursing Facility for Over 90 Days from Admission: Residents’ Participation in Therapy and Desire to Return to the Community
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Yoo JW, Choi JB, Kim SJ, Shin HP, Kim K, Ryu WS, et al.
Journal of the American Medical Directors Association 2013 Jul 13

BACKGROUND: To identify the factors associated with stay in a skilled nursing facility (SNF) among new enrollees who did not fully participate in therapy sessions. METHODS: Data (n = 36,133) were obtained from the Minimum Data Set version 2.0 in the state of Michigan in 2009. Study participants were new SNF enrollees (n = 699) who did not fully participate in therapy sessions despite their desire to return to the community. Multivariate logistic regressions were performed to identify factors contributing to remaining in a nursing home for 91 days or longer. RESULTS: New SNF enrollees were more likely to remain in nursing home when they were depressed (odds ratio [OR] = 1.41; 95% confidence interval [CI], 1.09-2.08; P = .01), experiencing delirium (OR = 3.20; 95% CI, 1.48-5.92; P < .001), were not in pain (OR = 0.83; 95% CI, 0.60-0.95; P = .03), or in less complex care (OR = 0.57; 95% CI, 0.44-0.81; P < .01). CONCLUSIONS: A higher number of new SNF enrollees than previously reported were likely to stay in nursing homes (28.0%). Depression and delirium were associated with stay in an SNF, while pain and higher complexity of care were associated with returning to the community. Copyright © 2013 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.

Effect of a person-centered mouth care intervention on care processes and outcomes in three nursing homes.
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Sloane PD, Zimmerman S, Chen X, Barrick AL, Poole P, Reed D, et al.
Journal of the American Geriatrics Society 2013 Jul;61(7):1158-1163

OBJECTIVES: To develop and test a person-centered, evidence-based mouth care program in nursing homes. DESIGN: Pre-post assessment, with an 8-week intervention period and a pilot 6-month extension at one site. SETTING: Three North Carolina nursing homes. PARTICIPANTS: Ninety-seven residents and six certified nursing assistants (CNAs). INTERVENTION: CNAs already working in the facilities were trained as dedicated mouth care aides. A psychologist and dental hygienist provided didactic and hands-on training in evidence-based mouth care products and techniques and in person-centered behavioral care. MEASUREMENTS: Primary outcome measures for natural teeth were the Plaque Index for Long-Term Care (PI-LTC) and Gingival Index for Long-Term Care(GI-LTC) and for dentures the Denture Plaque Index (DPI); a dentist unmasked to study design obtained measures. Secondary outcomes included quantity and quality of care provided. RESULTS: Outcome scores significantly improved (P < .001 for PI-LTC and GI-LTC; P = .04 for DPI). Coding of videotaped care episodes indicated that care was more thorough (P < .001-P = .03) but took more time (P < .001) after training. Consistency of care appeared to be more important for natural teeth than dentures. CONCLUSION: As little as 8 weeks of mouth care can significantly improve oral hygiene outcomes. Given the consequences of poor oral hygiene, greater attention to mouth care education and provision are merited. The dedicated worker model is controversial, and future work should assess whether other models of care are equally beneficial. © 2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society.

A two-decade comparison of prevalence of dementia in individuals aged 65 years and older from three geographical areas of England: results of the Cognitive Function and Ageing Study I and II.
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Matthews FE, Arthur A, Barnes LE, Bond J, Jagger C, Robinson L, et al.
Lancet 2013 Jul 17

BACKGROUND: The prevalence of dementia is of interest worldwide. Contemporary estimates are needed to plan for future care provision, but much evidence is decades old. We aimed to investigate whether the prevalence of dementia had changed in the past two decades by repeating the same approach and diagnostic methods as used in the Medical Research Council Cognitive Function and Ageing Study (MRC CFAS) in three of the original study areas in England. METHODS BETWEEN: 1989 and 1994, MRC CFAS investigators did baseline interviews in populations aged 65 years and older in six geographically defined areas in England and Wales. A two stage process, with screening followed by diagnostic assessment, was used to obtain data for algorithmic diagnoses (geriatric mental state-automated geriatric examination for computer assisted taxonomy), which were then used to estimate dementia prevalence. Data from three of these areas-Cambridgeshire, Newcastle, and Nottingham-were selected for CFAS I. Between 2008 and 2011, new fieldwork was done in the same three areas for the CFAS II study. For both CFAS I and II, each area needed to include 2500 individuals aged 65 years and older to provide power for geographical and generational comparison. Sampling was stratified according to age group (65-74 years vs ≥75 years). CFAS II used identical sampling, approach, and diagnostic methods to CFAS I, except that screening and assessement were combined into one stage. Prevalence estimates were calculated using inverse probability weighting methods to adjust for sampling design and non-response. Full likelihood Bayesian models were used to investigate informative non-response. FINDINGS: 7635 people aged 65 years or older were interviewed in CFAS I (9602 approached, 80% response) in Cambridgeshire, Newcastle, and Nottingham, with 1457 being diagnostically assessed. In the same geographical areas, the CFAS II investigators interviewed 7796 individuals (14 242 approached, 242 with limited frailty information, 56% response). Using CFAS I age and sex specific estimates of prevalence in individuals aged 65 years or older, standardised to the 2011 population, 8·3% (884 000) of this population would be expected to have dementia in 2011. However, CFAS II shows that the prevalence is lower (6·5%; 670 000), a decrease of 1·8% (odds ratio for CFAS II vs CFAS I 0·7, 95% CI 0·6-0·9, p=0·003). Sensitivity analyses suggest that these estimates are robust to the change in response. INTERPRETATION: This study provides further evidence that a cohort effect exists in dementia prevalence. Later-born populations have a lower risk of prevalent dementia than those born earlier in the past century. FUNDING: UK Medical Research Council. Copyright © 2013 Matthews et al. Open Access article distributed under the terms of CC BY. Published by Elsevier Ltd. All rights reserved.

Systematic Review: Effective Characteristics of Nursing Homes and Other Residential Long-Term Care Settings for People with Dementia.
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Zimmerman S, Anderson WL, Brode S, Jonas D, Lux L, Beeber AS, et al.
Journal of the American Geriatrics Society 2013 Jul 19

OBJECTIVES: In response to the need for an evidence-based review of factors within long-term care settings that affect the quality of care, this review compared characteristics of nursing homes and other residential long-term care settings for people with dementia and their informal family caregivers with respect to health and psychosocial outcomes. DESIGN: Databases were searched for literature published between 1990 and March 2012 that met review criteria, including that at least 80% of the subject population had dementia. RESULTS: Fourteen articles meeting review criteria that were of at least fair quality were found: four prospective cohort studies, nine randomized controlled trials (RCTs), and one nonrandomized controlled trial. Overall, low or insufficient strength of evidence was found regarding the effect of most organizational characteristics, structures, and processes of care on health and psychosocial outcomes for people with dementia and no evidence for informal caregivers. Findings of moderate strength of evidence indicate that pleasant sensory stimulation reduces agitation for people with dementia. Also, although the strength of evidence is low, protocols for individualized care and to improve function result in better outcomes for these individuals. Finally, outcomes do not differ between nursing homes and residential care or assisted living settings for people with dementia except when medical care is indicated. CONCLUSION: Given the paucity of high-quality studies in this area, additional research is needed to develop a sufficient evidence base to support consumer selection, practice, and policy regarding the best settings and characteristics of settings for residential long-term care of people with dementia. © 2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society.

Caregiver Outcomes of Partners in Dementia Care: Effect of a Care Coordination Program for Veterans with Dementia and Their Family Members and Friends.
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Bass DM, Judge KS, Lynn Snow A, Wilson NL, Morgan R, Looman WJ, et al.
Journal of the American Geriatrics Society 2013 Jul 19

The objective is to test the effectiveness of Partners in Dementia Care (PDC), a care-coordination program that integrates and improves access to medical and nonmedical services, while strengthening the informal care network and providing information, coaching, and emotional support. PDC was delivered via a partnership between Veterans Affairs (VA) Medical Centers (VAMCs) and Alzheimer’s Association chapters, for caregivers of veterans with dementia living in the community and receiving primary care from the VA. The initial sample was 486 caregivers of 508 veterans with diagnosed dementia. Outcomes were evaluated for 394 and 324 caregivers who completed 6- and 12- month follow-up, respectively. PDC had a standardized protocol that included assessment and reassessment, action planning, and ongoing monitoring. It was delivered by telephone and e-mail for cost efficiency and the ability to handle caseloads of 100 to 125. Care coordinators from VAMCs and Alzheimer’s Association chapters worked as a team using a shared computerized record. A variety of caregiver outcomes was measured after 6 and 12 months. Intervention group caregivers had significant improvements in outcomes representing unmet needs, three types of caregiver strains, depression, and two support resources. Most improvements were evident after 6 months, with more-limited improvements from Months 6 to 12. Some outcomes improved for all caregivers, whereas some improved for caregivers experiencing more initial difficulties or caring for veterans with more-severe impairments. PDC is a promising model that improves linkages between healthcare services and community services, which is a goal of several new national initiatives such as the National Plan to Address Alzheimer’s Disease and a proposed amendment to the Older Americans Act. © 2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society.

Design and methods of the Hospital Elder Life Program (HELP), a multicomponent targeted intervention to prevent delirium in hospitalized older patients: efficacy and cost-effectiveness in Dutch health care.
Non UofA Access
Strijbos MJ, Steunenberg B, van der Mast RC, Inouye SK, Schuurmans MJ.
BMC geriatrics 2013 Jul 23;13(1):78

BACKGROUND: The Hospital Elder Life Program (HELP) has been shown to be highly efficient and (cost-)effective in reducing delirium incidence in the USA. HELP provides multicomponent protocols targeted at specific risk factors for delirium and introduces a different view on care organization, with trained volunteers playing a pivotal role. The primary aim of this study is the quantification of the (cost-)effectiveness of HELP in the Dutch health care system. The second aim is to investigate the experiences of patients, families, professionals and trained volunteers participating in HELP. METHODS: A multiple baseline approach (also known as a stepped-wedge design) will be used to evaluate the (cost-) effectiveness of HELP in a cluster randomized controlled study. All patients aged 70 years and older who are at risk for delirium and are admitted to cardiology, internal medicine, geriatrics, orthopedics and surgery at two participating community hospitals will be included. These eight units are implementing the intervention in a successive order that will be determined at random. The incidence of delirium, the primary outcome, will be measured with the Confusion Assessment Method (CAM). Secondary outcomes include the duration and severity of delirium, quality of life, length of stay and the use of care services up to three months after hospital discharge. The experiences of patients, families, professionals and volunteers will be investigated using a qualitative design based on the grounded theory approach. Professionals and volunteers will be invited to participate in focus group interviews. Additionally, a random sample of ten patients and their families from each hospital unit will be interviewed at home after discharge. DISCUSSION: We hypothesize that HELP will reduce delirium incidence during hospital admission and decrease the duration and severity of delirium and length of hospital stays among these older patients, which will lead to reduced health care costs. The results of this study may fundamentally change our views on care organization for older patients at risk for delirium. The stepped-wedge design was chosen for ethical, practical and statistical reasons. The study results will be generalizable to the Dutch hospital care system, and the proven cost-effectiveness of HELP will encourage the spread and implementation of this program.Trial Registration: Netherlands Trial register: NTR3842.

One-year outcome of frailty indicators and activities of daily living following the randomised controlled trial; “Continuum of care for frail older people”
Non UofA Access
Eklund K, Wilhelmson K, Gustafsson H, Landahl S, Dahlin-Ivanoff S.
BMC geriatrics 2013 Jul 22;13(1):76

Background; The intervention; “Continuum of Care for Frail Older People”, was designed to create an integrated continuum of care from the hospital emergency department through the hospital and back to the older person’s own home. The aim of this study is to evaluate the effects of the intervention on functional ability in terms of activities of daily living (ADL). Methods; The study is a non-blinded controlled trial with participants randomised to either the intervention group or a control group with follow-ups at three-, six- and 12 months. The intervention involved collaboration between a nurse with geriatric competence at the emergency department, the hospital wards and a multi-professional team for care and rehabilitation of the older people in the municipality with a case manager as the hub. Older people who sought care at the emergency department at Sahlgrenska University Hospital/Molndal and who were discharged to their own homes in the municipality of Molndal, Sweden were asked to participate. Inclusion criteria were age 80 and older or 65 to 79 with at least one chronic disease and dependent in at least one ADL. Analyses were made on the basis of the intention-to-treat principle. Outcome measures were ADL independence and eight frailty indicators. These were analysed, using Chi-square and odds ratio (OR). Results; A total of 161 participated in the study, 76 persons allocated to the control group and 85 to the intervention group were analysed throughout the study. There were no significant differences between the groups with regards to change in frailty compared to baseline at any follow-up. At both the three- and twelve-month follow-ups the intervention group had doubled their odds for improved ADL independence compared to the control (OR 2.37, 95% CI; 1.20 – 4.68) and (2.04, 95% CI; 1.03 – 4.06) respectively. At six months the intervention group had halved their odds for decreased ADL independence (OR 0.52, 95% CI; 0.27 – 0.98) compared to the control group. Conclusions; The intervention has the potential to reduce dependency in ADLs, a valuable benefit both for the individual and for society. Trial registration; ClinicalTrials.gov: NCT01260493 Keywords; integrated care, health care chain, rehabilitation, independence, aging in place, frail older people.

Training and Sustaining: A Model for Volunteer Spiritual Care Visitors in Long-Term Care
Non UofA Access
Landau L, Brazil K, Kaasalainen S, Crawshaw D.
Journal of Religion, Spirituality and Aging 2013;25(3):216-237

Volunteer provision of spiritual care in an Ontario, Canada, long-term care home was the focus of a case study regarding resident spiritual care needs in a municipal environment that does not fund professional chaplains. Scope of practice issues, spiritual care skills in long-term care, and diversity sensitivity were identified as key areas for volunteer education. Volunteer training modules were designed using Theological Reflection as the theoretical framework for spiritual care provision. An innovative model for sustainable spiritual care provision in long-term care is proposed, which relies upon leadership from a professional chaplain (staff or volunteer). © 2013 Copyright Taylor and Francis Group, LLC.

CDC: The State of Aging & Health in America 2013 (US)

The State of Aging and Health in America 2013 presents several calls to action intended to encourage individuals, professionals, and communities to take specific steps to improve the health and well-being of older adults. They include the following:
‡*Developing a new Healthy Brain Initiative Road Map.
‡*Addressing lesbian, gay, bisexual, and transgender (LGBT) aging and health issues.
‡*Using data on physically unhealthy days to guide interventions.
‡*Addressing mental distress among older adults.
‡*Monitoring vaccination rates for shingles.

AHRQ: Long-Term Care for Older Adults: Future Research Needs (US)
18 July 2013

Objectives. To identify gaps in the current research on long-term care (LTC) for older adults that limited the conclusions of the comparative effectiveness review (CER) “Long-Term Care for Older Adults: A Review of Home and Community-Based Services Versus Institutional Care” in order to inform those who conduct and fund research about the research needs on this topic. Results. Of 13 stakeholders invited to participate, 10 completed the ranking exercise. Among the methodological questions for the comparison of LTC delivered through HCBS (Home and Community Based Services) and in NHs, the identification of standardized outcome measures for HCBS and NH recipients was the highest priority. For the broader set of methodological questions about LTC through HCBS and in NHs, the highest rankings were given to four questions related to outcome measures and descriptions of the interventions. For the topical questions for the comparison of LTC delivered through HCBS and in NHs, the highest rankings were given to questions related to the pattern of transitions for LTC uses, and the factors leading to transitions. We also identified four highpriority topical questions primarily related to the populations that benefit most from interventions and the types of interventions that lead to improved outcomes. Future studies on LTC for older adults should aim to reduce bias as much as possible through research design and statistical techniques. Larger sample sizes will allow more research on subpopulations, and longer followup tim

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IHI Webinar: Improving Care for Frail Older Adults with Complex Needs
Begins 1 October and lasts for 10 weeks Costs US$750

The current system providing care for frail older adults with complex needs is seriously flawed, yielding unreasonable suffering and waste. Health care organizations can partner with community services to redesign the system for this growing population—taking one that is fragmented, inefficient, and expensive and making it cohesive, efficient, and affordable.

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Alberta Health minister dampens hopes of reversing changes to home care

Health Minister Fred Horne says he is facing a time crunch in his effort to re-examine changes to the home-care system, but has no plans to undo a decision that will see the service primarily provided by a handful of private companies.

Dementia Rate Is Found to Drop Sharply, as Forecast

Two new studies on declining dementia rates have experts on aging saying that there is now confirmation on something they had suspected but had had difficulty proving: that dementia rates would fall and mental acuity improve as the population grew healthier and better educated.

Enlisting Passers-By In Scientific Research

Professor Chris Lowry needed to collect information on stream levels in Western New York but didn’t have enough funding for the traditional methods, so he turned to a more creative option: crowdsourcing. Learn more about his research and the future of crowdsourcing in scientific inquiries.

Let’s Shake Up the Social Sciences

It is time to create new social science departments that reflect the breadth and complexity of the problems we face as well as the novelty of 21st-century science.

In the Doctor’s Office, a Neglected Resource

The good news, confirmed by a study in the Journal of the American Geriatrics Society (highlighted in June 24, 2013 KUSP FYI) , is that nurse practitioners can markedly improve the quality of care for older patients.

Slow Ideas: Some innovations spread fast. How do you speed the ones that don’t?

Why do some innovations spread so swiftly and others so slowly? Consider the very different trajectories of surgical anesthesia and antiseptics, both of which were discovered in the nineteenth century. I really found this article interesting.

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Engaging stakeholders: A planning tool

Since such large amounts of money and effort are being devoted to collecting data from health facilities, communities and populations, maximizing the impact of that data for real-world benefit is essential. This is where the Stakeholder Engagement tool is so valuable.


This resource is for seniors, their families, caregivers and supporting service organizations. The site provides information for seniors on federal, provincial, territorial and some municipal government benefits and services, including information on finances, housing, health and wellness. Seniors.gc.ca also highlights federal seniors-related initiatives and supports the Government’s ongoing efforts to encourage seniors to stay active, engaged and informed.

AHRQ Primer on Root Cause Analysis

Root cause analysis (RCA) is a structured method used to analyze serious adverse events. Initially developed to analyze industrial accidents, RCA is now widely deployed as an error analysis tool in health care. A central tenet of RCA is to identify underlying problems that increase the likelihood of errors while avoiding the trap of focusing on mistakes by individuals. The goal of RCA is thus to identify both active errors (errors occurring at the point of interface between humans and a complex system) and latent errors (the hidden problems within health care systems that contribute to adverse events)

demtalk: Dementia Tookit for Effective Communication

DemTalk is the online toolkit for effective communication with and for people living with dementia. It offers free advice and shares ideas about how everyone can make communication easier and better. Intended for family caregivers, care workers, and health care professionals.

CHAMP Toolkits

These tookits created for homecare workers by CHAMP (Collaboration for Homecare Advances in Management and Practice) are based on evidence. Three toolkits are available: Geriatric Falls Prevention, Geriatric Medication Management, and Geriatric Care Transitions.

Dementia Videos on Social Care TV

Social Care TV, created by the Social Care Institute for Excellence is an online channel with a series of short films intended as an elearning resource for professionals and caregivers, primarily those in social work. Video topics range from dementia, to end of life care, minimizing restraint use and nutrition in older adults.

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Professor of Rehabiliation Sciences
University of Sydney Sydney Australia
DEADLINE: 25 August 2013

The appointee must hold a PhD in a cognate discipline aligned with physiotherapy or allied health. An established research profile demonstrated by a strong publication record and research grant acquisition will be essential, as will a successful record of working collaboratively with clinicians, researchers and other academics.

Senior RN Clinical Research Coordinator
Gordon Sussman Clinical Research Inc.
Toronto, ON

We are looking for an experienced Senior RN Clinical Research Coordinator to manage the successful delivery of allergy / immunology clinical trials. Tasks include securing new studies, patient recruitment and correspondence with patients, physicians, study coordinators and study sponsors. Literature reviews, patient chart reviews, ethics and funding applications and protocol reviews will also be carried out. The successful candidate will help manage a team of 2-3 clinical researcher assistants and 2-4 volunteers. This is an extremely busy, fast-paced, high variety clinic and research department, looking for a senior, experienced coordinator interested in furthering their leadership experience, and in making a long term commitment to a center offering independence, and opportunities for growth.

Knowledge Translation Coordinator
Michael Smith Foundation for Health Research
DEADLINE: 9 August 2013 17:00 (MT)

Reporting to the Manager, Knowledge Translation (KT), the Knowledge Translation Coordinator is responsible for the coordination and execution of all activities in the Foundation’s KT plan.

Journal of Emergency Nursing Seeks New Editor-in-Chief
DEADLINE: 23 August 2013

The Emergency Nurses Association is seeking an experienced nurse editor to guide the strategic direction and provide the highest level of editorial oversight for the Journal of Emergency Nursing (JEN).

Project Coordinator at Canadian Network for the Prevention of Elder Abuse
Canadian Network for the Prevention of Elder Abuse
This position is intended for someone interested in working from home
DEADLINE: Friday 9 August 2013 14:30 MT

This job involves facilitating the following:
1. Creating mechanisms to exchange information on promising approaches in the prevention and intervention of elder abuse leading to a national hub for connecting service providers and seniors’ organizations and that will serve as a central point of contact for elder abuse information and resources in Canada.
2. To increase capacity in organizations and networks to prevent and respond to cases of elder abuse

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