September 25, 2013


Congratulation to Anne-Marie Boström. Her article Nutrition status among residents living in a veterans’ long-term care facility in Western Canada: a pilot study is among the top 20 highly cited articles published in 2011 in the journal JAMDA.


New KUSP Article
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 Sep;50(9):1229-1239

Evidence shows that front-line caregivers’ sufficient working time with residents is associated with performance, excellence, comprehensive care, quality of outcomes, 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. Copyright © 2012 Elsevier Ltd. All rights reserved.

New Article by Carole Estabrooks, Shannon Scott, and Greta Cummings
Pain in Hospitalized Children: Effect of a Multidimensional Knowledge Translation Strategy on Pain Process and Clinical Outcomes.
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Stevens BJ, Yamada J, Estabrooks CA, Stinson J, Campbell F, Scott SD, et al.
Pain 2013 Sep 7

The objective was to determine the effect of a multidimensional knowledge translation intervention, Evidence-based Practice for Improving Quality (EPIQ), on procedural pain practices and clinical outcomes for children hospitalized in medical, surgical, and critical care units. A prospective cohort study compared 16 intervention (EPIQ) and 16 standard care (SC) units in eight Canadian pediatric hospitals. Chart reviews at baseline (Time 1) and intervention completion (Time 2) determined the nature and frequency of painful procedures and pain assessment and management practices. Trained pain experts evaluated pain intensity six months post intervention (Time 3), during routine, scheduled painful procedures. Generalized estimating equation models compared changes in outcomes between EPIQ and SC units over time. EPIQ units used significantly more validated pain assessment tools (P<0.001), and had a greater proportion of patients who received analgesics (P=0.03) and physical pain management strategies (P=0.02). Mean pain intensity scores were significantly lower in the EPIQ group (P=0.03). Comparisons of moderate (4-6/ 10) and severe (7-10/ 10) pain, controlling for child and unit level factors, indicated that the odds of having severe pain were 51% less for children in the EPIQ group (Adjusted OR: 0.49, 95% CI: 0.26-0.83; P=0.009). EPIQ was effective in improving practice and clinical outcomes for hospitalized children. Additional exploration of the influence of contextual factors on research use in hospital settings is required to explain variability in pain processes and clinical outcomes. Copyright © 2013. Published by Elsevier B.V.

New Article by Janet Squires, Carole Estabrooks, Shannon Scott, & Sung Hyun Kang
The influence of organizational context on the use of research by nurses in Canadian pediatric hospitals.
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Squires JE, Estabrooks CA, Scott SD, Cummings GG, Hayduk L, Kang SH, et al.
BMC health services research 2013 Sep 14;13(1):351

The objective of this study was to identify dimensions of organizational context and individual (nurse) characteristics that influence pediatric nurses’ self-reported use of research. Data on research use, individual, and contextual variables were collected from registered nurses (N = 735) working on 32 medical, surgical and critical care units in eight Canadian pediatric hospitals using an online survey. We used Generalized Estimating Equation modeling to account for the correlated structure of the data and to identify which contextual dimensions and individual characteristics predict two kinds of self-reported research use: instrumental (direct) and conceptual (indirect). RESULTS: Significant predictors of instrumental research use included: at the individual level; belief suspension-implement, research use in the past, and at the hospital unit (context) level; culture, and the proportion on nurses possessing a baccalaureate degree or higher. Significant predictors of conceptual research use included: at the individual nurse level; belief suspension-implement, problem solving ability, use of research in the past, and at the hospital unit (context) level; leadership, culture, evaluation, formal interactions, informal interactions, organizational slack-space, and unit specialty.

New Article by Ali Hutchison & Lars Wallin
A realist review of interventions and strategies to promote evidence-informed healthcare: a focus on change agency.
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McCormack B, Rycroft-Malone J, Decorby K, Hutchinson AM, Bucknall T, Kent B, et al.
Implementation science : IS 2013 Sep 8;8(1):107

This review adopts a realist approach and addresses the following question: What change agency characteristics work, for whom do they work, in what circumstances and why? METHODS: The literature reviewed spanned the period 1997-2007. Change agency was operationalized as roles that are aimed at effecting successful change in individuals and organizations. A theoretical framework, developed through stakeholder consultation formed the basis for a search for relevant literature. Team members, working in sub groups, independently themed the data and developed chains of inference to form a series of hypotheses regarding change agency and the role of change agency in knowledge use. RESULTS: A review of full document versions of potentially relevant papers resulted in a final list of 52 papers. The findings add to the knowledge of change agency as they raise issues pertaining to how change agents’ function, how individual change agent characteristics effect evidence-informed health care, the influence of interaction between the change agent and the setting and the overall effect of change agency on knowledge utilization. Particular issues are raised such as how accessibility of the change agent, their cultural compatibility and their attitude mediate overall effectiveness. Findings also indicate the importance of promoting reflection on practice and role modeling. The findings of this study are limited by the complexity and diversity of the change agency literature, poor indexing of literature and a lack of theory-driven approaches.

New Article by Lars Wallin
The Concept of Research Utilization as Understood by Swedish Nurses: Demarcations of Instrumental, Conceptual, and Persuasive Research Utilization.
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Strandberg E, Catrine Eldh A, Forsman H, Rudman A, Gustavsson P, Wallin L.
Worldviews on evidence-based nursing 2013 Jul 23

BACKGROUND AND AIMS: The literature implies research utilization (RU) to be a multifaceted and complex phenomenon, difficult to trace in clinical practice. A deeper understanding of the concept of RU in a nursing context is needed, in particular, for the development of instruments for measuring nurses’ RU, which could facilitate the evaluation of interventions to support the implementation of evidence-based practice. In this paper, we explored nurses’ demarcation of instrumental RU (IRU), conceptual RU (CRU), and persuasive RU (PRU) using an item pool proposed to measure IRU, CRU, and PRU. METHODS: The item pool (12 items) was presented to two samples: one of practicing registered nurses (n = 890) in Sweden 4 years after graduating and one of recognized content experts (n = 7). Correlation analyses and content validity index (CVI) calculations were used together with qualitative content analysis, in a mixed methods design. FINDINGS: According to the item and factor analyses, CRU and PRU could not be distinguished, whereas IRU could. Analyses also revealed problems in linking the CRU items to the external criteria. The CVIs, however, showed excellent or good results for the IRU, CRU, and PRU items as well as at the scale level. The qualitative data indicated that IRU was the least problematic for the experts to categorize, whereas CRU and PRU were harder to demarcate. CONCLUSIONS: Our findings illustrate a difficulty in explicitly demarcating between CRU and PRU in clinical nursing. We suggest this overlap is related to conceptual incoherence, indicating a need for further studies. The findings constitute new knowledge about the RU concepts in a clinical nursing context, and highlight differences in how the concepts can be understood by RNs in clinical practice and experts within the field. We suggest that the findings are useful for defining RU in nursing and further development of measures of RU. © 2013 Sigma Theta Tau International.

New Article by Joanne Profetto-McGrath
Implementing the Supportive Supervision Intervention for Registered Nurses in a Long-Term Care Home: A Feasibility Study.
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McGilton KS, Profetto-McGrath J, Robinson A.
Worldviews on evidence-based nursing 2013 Mar 21

The aim of this pilot study was to test the feasibility of a three-part supportive supervisory intervention to improve supervisory skills of registered nurses in long-term care. METHODS: A repeated measures group design was used. Quantitative data were collected from healthcare aides, licensed practical nurses, and registered nurses. Focus groups with care managers and supervisors examined perceptions of the intervention. RESULTS: There were nonsignificant changes in both the registered nurse supervisors’ job satisfaction and the supervised staff’s perception of their supervisors’ support. Supervised staff scores indicated an increase in the use of research utilization but did not reflect an increase in job satisfaction. Focus group discussions revealed that the supervisors and care managers perceived the workshop to be valuable; however, the weekly self-reflection, coaching, and mentoring components of the intervention were rare and inconsistent. © 2013 Sigma Theta Tau International.

New Article by Greta Cummings
The relationship between nursing leadership and patient outcomes: a systematic review update.
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Wong CA, Cummings GG, Ducharme L.
Journal of nursing management 2013 Jul;21(5):709-724

AIM: Our aim was to describe the findings of a systematic review of studies that examine the relationship between nursing leadership practices and patient outcomes. METHODS: Published English-only research articles that examined leadership practices of nurses in formal leadership positions and patient outcomes were selected. RESULTS: A total of 20 studies satisfied our inclusion criteria and were retained. Current evidence suggests relationships between positive relational leadership styles and higher patient satisfaction and lower patient mortality, medication errors, restraint use and hospital-acquired infections. CONCLUSIONS: The findings document evidence of a positive relationship between relational leadership and a variety of patient outcomes, although future testing of leadership models that examine the mechanisms of influence on outcomes is warranted. © 2013 John Wiley & Sons Ltd.

New Article by Janet Squires
Systematic reviews of complex interventions: framing the review question
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Squires JE, Valentine JC, Grimshaw JM.
Journal of clinical epidemiology 2013 Aug 14

The first and most important decision in preparing any systematic review is to clearly frame the question the review team seeks to answer. However, this is not always straightforward, particularly if synthesis teams are interested in the effects of complex interventions. In this article, we discuss how to formulate good systematic review questions of complex interventions. We describe the rationale for developing well-formulated review questions and review the existing guidance on formulating review questions. We discuss that complex interventions can contain a mix of effective and ineffective (or even harmful) actions, which may interact synergistically or dysynergistically or be interdependent, and how these interactions and interdependencies need to be considered when formulating systematic review questions. We discuss complexity specifically in terms of how it relates to the type of question, the scope of the review (i.e., lumping vs. splitting debate), and specification of the intervention. We offer several recommendations to assist review authors in developing a definition for their complex intervention of interest, which is an essential first step in formulating the review question. We end by identifying areas in which future methodological research aimed at improving question formulation, especially as it relates to complex interventions, is needed. Copyright © 2013 Elsevier Inc. All rights reserved.

Articles recommended by Dr. Carole Estabrooks
Use of Implementation Theory: A Focus on PARIHS
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Ullrich PM, Sahay A, Stetler CB.
Worldviews on Evidence-Based Nursing 2013

Limited understanding and application of theory in implementation research contributes to variable effectiveness of implementation studies. Better understanding of direct experiences with theory could improve implementation research and the potency of interventions. Aims This study was a conceptual exercise aimed at characterizing experiences with and applications of the Promoting Action on Research Implementation in Health Services (PARIHS) framework. Methods This was a structured, qualitative study involving document reviews and interviews used to answer the following overarching questions about nine implementation research centers: Why and how was PARIHS used? What strengths and weaknesses were identified for PARIHS? Findings PARIHS was being used for varied purposes, at varied levels, in varied ways, and to a varying extent within and across centers. Lack of implementation theory use in investigators’ early years was common. Variability in the nature of theory use was attributable to characteristics of the centers, individual investigators, and features of PARIHS. Strengths and weaknesses of the PARIHS framework were identified. Linking Evidence to Action The study provides information to researchers and theorists about the use of one well-known implementation framework. The information suggests areas for improvements in PARIHS as well as theory use in general, and should assist in the development of theory-based programs of research.

Site of Death Among Nursing Home Residents in the United States: Changing Patterns, 2003-2007.
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Temkin-Greener H, Zheng NT, Xing J, Mukamel DB.
Journal of the American Medical Directors Association 2013 May 7

CONTEXT: The proportion of US deaths occurring in nursing homes (NHs) has been increasing in the past 2 decades and is expected to reach 40% by 2020. We assessed longitudinal trends and geographic variations in place of death among NH residents, and examined the association between residents’ characteristics, treatment preferences, and the probability of dying in hospitals. METHODS: We used the Minimum Data Set (NH assessment records), Medicare denominator (eligibility) file, and Medicare inpatient and hospice claims to identify decedent NH residents. In CY2003-2007, there were 2,992,261 Medicare-eligible NH decedents from 16,872 US Medicare- and/or Medicaid-certified NHs. Our outcome of interest was death in NH or in a hospital. The analytical strategy included descriptive analyses and multiple logistic regression models, with facility fixed effects, to examine risk-adjusted temporal trends in place of death. FINDINGS: Slightly more than 20% of decedent NH residents died in hospitals each year. Controlling for individual-level risk factors and for facility fixed effects, the likelihood of residents dying in hospitals has increased significantly each year between 2003 through 2007. Copyright © 2013 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.

DEADLINE 4 October 2013

CADTH invites proposals for full or half-day workshops of significant interest to producers and users of evidence-based information and advice on health technologies. Workshops will be held on April 6, 2014.

CALL FOR ABSTRACTS: Wound, Ostomy and Continence Nurses Society 46th Annual Conference
21-25 June 2014 Nashville, TN
DEADLINE: Tuesday 12 November 2013

The WOCN National Conference Planning Committee invites you to submit an abstract describing a research study, case study, or practice innovation in the areas of professional practice, wound, ostomy or continence. Case Study and Practice Innovation abstracts are eligible only for poster presentations

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Health Care Administration and Organization
Health Care Innovation and Quality Assurance
Organizational Change
Research Practice & Methodology
Health Care in Canada


The use of quality information by general practitioners: does it alter choices? A randomized clustered study.
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Ikkersheim D, Koolman X.
BMC family practice 2013 Jul 8;14:95-2296-14-95

In this study we investigate to what extent hospital preferences of GP’s are affected by performance indicators on medical effectiveness and patient experiences. We selected three conditions: breast cancer, cataract surgery, and hip and knee replacement. METHODS: After an inquiry 26 out of 226 GPs in the region signed up to participate in our study. After a 2:1 randomization, we analyzed the referral patterns in the region using three groups of GPs: GPs (n=17) who used the report cards and received personal clarification, GPs that signed up for the study but were assigned to the control group (n=9), and the GPs outside the study (n=200). We conducted a difference in differences analysis where the choice for a particular hospital was the dependent variable and time (2009 or 2010), the sum score of the CQI, the sum score of the PI’s and dummy variables for the individual hospitals were used as independent variables. RESULTS: The analysis of the conditions together and cataract surgery and hip and knee replacement separately, showed no significant relationships between the scores on the report cards and the referral patterns of the GPs. For breast cancer our analysis revealed that GPs in the intervention group refer 1.0% (p=0.01) more to hospitals that score one percent point better on the indicators for medical effectiveness. CONCLUSION: Our study provides empirical evidence that GP referral patterns were unaffected by the available quality information, except for the outcome indicators for breast cancer care that were presented. We believe that the current set of (largely process) hospital quality indicators do not serve the GP’s information needs and consequently quality plays little role in the selection of hospitals for treatment.

Moving employment research into practice: Knowledge and application of evidence-based practices by state vocational rehabilitation agency staff
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Graham C, Inge K, Wehman P, Murphy K, Revell WG, West M.
Journal of Vocational Rehabilitation 2013;39(1):75-81

The objective of this study was to identify barriers and facilitators to the use of evidence by professional staff of state Vocational Rehabilitation (VR) agencies. Data were collected via an online survey administered to 355 staff at three state VR departments. Over half of respondents could locate and comprehend research findings. Evidence-based practice (EBP) was not widely encouraged, but there was a positive relationship between the agency having sufficient funds and its support for EBP (r = 0.27, p = 0.001). The top two sources of information respondents used on the job were professional collaboration and the Internet, but not social media. State VR agencies tend not to expect that counselors will use EBP and provide limited incentives for them to do so. While VR staff value research and are open to trying new strategies based on research, translating evidence into usable and accessible products and developing efficient delivery strategies present challenges that the authors intend to investigate further in upcoming research. Knowledge translation strategies need to be developed for this audience. © 2013 – IOS Press and the authors. All rights reserved.

Swedish nurses’ perception of nursing research and its implementation in clinical practice: a focus group study.
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Bohman DM, Ericsson T, Borglin G.
Scandinavian journal of caring sciences 2013 Sep;27(3):525-533

The aim of this naturalistic inquiry was to explore nurses’ perception of nursing research and its implementation in a clinical context. METHOD AND SAMPLE: A qualitative approach was chosen, and four focus group discussions were conducted. The groups comprised a total of 16 RNs working in a secondary care setting. FINDINGS: The texts were interpreted as representing three predominant themes: scholastic, individual and contextual influences highlighted as influential components impacting on the RNs’ views on research and its implementation as well as on their readiness to accept and support it. However, the most influential aspect permeating our themes was their educational background–the type of qualification they held. In general, the RNs with a Bachelor of Science in Nursing viewed research and the implementation of knowledge in practice more favourably than those RNs with a diploma. © 2012 The Authors. Scandinavian Journal of Caring Sciences © 2012 Nordic College of Caring Science.

Integrating an evidence-based intervention into clinical practice: ‘transitional relationship model’. Canada-flat-icon
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Forchuk C, Martin ML, Jensen E, Ouseley S, Sealy P, Beal G, et al.
Journal of psychiatric and mental health nursing 2013 Sep;20(7):584-594

The transitional relationship model (TRM) facilitates the discharge process by providing peer support and hospital staff involvement until a therapeutic relationship has been established with a community care provider. A quasi-experimental, action-oriented research design was employed in which psychiatric wards at six hospital sites implemented the model in three waves. Helpful strategies were identified by each wave of wards for consideration by subsequent wards. Using an ethnographic approach, qualitative data were examined to uncover experiences and perceptions of TRM implementation and to help identify key issues that were supporting or hampering implementation. Specific strategies that facilitate the implementation of TRM include: (1) the use of educational modules for on-ward hospital staff training and peer training; (2) presence of on-site champions; and (3) supportive documentation systems. Issues identified as barriers to implementation included: (1) feeling drowned, swamped and overwhelmed; (2) death by process; (3) team dynamics; and (4) changes in champions. Staged large-scale implementation of the TRM allowed for iterative improvements to the model leading to positive outcomes. © 2012 John Wiley & Sons Ltd.

A randomized controlled dismantling trial of post-workshop consultation strategies to increase effectiveness and fidelity to an evidence-based psychotherapy for Posttraumatic Stress Disorder.
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Wiltsey Stirman S, Shields N, Deloriea J, Landy MS, Belus JM, Maslej MM, et al.
Implementation science : IS 2013 Aug 1;8:82-5908-8-82

BACKGROUND: Posttraumatic Stress Disorder (PTSD) is a serious mental health condition with substantial costs to individuals and society. Numerous research studies have demonstrated that short-term cognitive-behavioral psychotherapies, such as Cognitive Processing Therapy (CPT), lead to substantial and sustained improvements in PTSD symptoms. Despite known benefits, only a minority of clinicians provide these therapies. Attending a workshop alone is insufficient to promote adequate knowledge transfer and sustained skill; however, relatively little research has been conducted to identify effective post-training support strategies. METHODS: The current study investigates whether clinicians receiving post-workshop support (six-month duration) will deliver CPT with greater fidelity and have improved patient outcomes compared with clinicians receiving no formal post-workshop support. The study conditions are: technology-enhanced group tele-consultation; standard group tele-consultation; and fidelity assessment with no consultation. The primary outcome is independent assessment (via audio-recordings) of the clinicians’ adherence and competence in delivering CPT. The secondary outcome is observed changes in patient symptoms during and following treatment as a function of clinician fidelity. Post-consultation interviews with clinicians will help identify facilitators and barriers to psychotherapy skill acquisition. TRIAL REGISTRATION: NCT01861769.

Multi-level barriers analysis to promote guideline based nursing care: a leadership strategy from home health care. Canada-flat-icon
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Gifford WA, Graham ID, Davies BL.
Journal of nursing management 2013 Jul;21(5):762-770

The aim of this paper is to present an organising framework, the Barriers Assessment Taxonomy, for understanding barriers to nurses’ use of clinical practice guideline recommendations.METHOD: As part of a pilot implementation study, semi-structured interviews (n = 26) were conducted to understand barriers to nurses’ use of nine guideline recommendations for diabetic foot ulcers. Content analysis of verbatim transcripts included thematic coding and categorising barriers using the Barriers Assessment Taxonomy. RESULTS: Nineteen barriers were associated with nine recommendations, crossing five levels of the health care delivery system. The Barriers Assessment Taxonomy revealed that all recommendations had individual and organisational level barriers, with one recommendation having barriers at all levels. Individual level barriers were most frequent and lack of knowledge and skills was the only barrier that crossed all recommendations. © 2013 John Wiley & Sons Ltd.

An intervention to improve program implementation: findings from a two-year cluster randomized trial of Assets-Getting To Outcomes.
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Acosta J, Chinman M, Ebener P, Malone PS, Paddock S, Phillips A, et al.
Implementation science 2013 Aug 7;8:87-5908-8-87

The purpose of this article is to present two-year outcomes from an evaluation of the Assets Getting To Outcomes (AGTO) intervention in 12 Maine communities engaged in promoting Developmental Assets, a positive youth development approach to prevention. AGTO is an implementation support intervention that consists of: a manual of text and tools; face-to-face training, and onsite technical assistance, focused on activities shown to be associated with obtaining positive results across any prevention program. METHODS: This study uses a nested and cross-sectional, cluster randomized controlled design. Participants were coalition members and program staff from 12 communities in Maine. Each coalition nominated up to five prevention programs to participate. At random, six coalitions and their respective 30 programs received the two-year AGTO intervention and the other six maintained routine operations. The study assessed prevention practitioner capacity (efficacy and behaviors), practitioner exposure to and use of AGTO, practitioner perceptions of AGTO, and prevention program performance. Capacity of coalition members and performance of their programs were compared between the two groups across the baseline, one-, and two-year time points. RESULTS: We found no significant differences between AGTO and control group’s prevention capacity. However, within the AGTO group, significant differences were found between those with greater exposure to and use of AGTO. Programs that received the highest number of technical assistance hours showed the most program improvement. CLINICALTRIALS.GOV IDENTIFIER: NCT00780338.

What supports do health system organizations have in place to facilitate evidence-informed decision-making? A qualitative study. Canada-flat-icon
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Ellen ME, Leon G, Bouchard G, Lavis JN, Ouimet M, Grimshaw JM.
Implementation science : IS 2013 Aug 6;8:84-5908-8-84

The purpose of this study was to profile the supports and instruments (i.e., programs, interventions, instruments or tools) that healthcare organizations currently have in place and which ones were perceived to facilitate evidence-informed decision-making. METHODS: In-depth semi-structured telephone interviews were conducted with individuals in three different types of positions (i.e., a senior management team member, a library manager, and a ‘knowledge broker’) in three types of healthcare organizations (i.e., regional health authorities, hospitals and primary care practices) in two Canadian provinces (i.e., Ontario and Quebec). RESULTS: A total of 57 interviews were conducted in 25 organizations in Ontario and Quebec. The main findings suggest that, for the healthcare organizations that participated in this study, the following supports facilitate evidence-informed decision-making: facilitating roles that actively promote research use within the organization; establishing ties to researchers and opinion leaders outside the organization; a technical infrastructure that provides access to research evidence, such as databases; and provision and participation in training programs to enhance staff’s capacity building.

Promoting nurses’ knowledge in evidence-based practice: do educational methods matter?
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Toole BM, Stichler JF, Ecoff L, Kath L.
Journal for nurses in professional development 2013 Jul-Aug;29(4):173-181

The authors describe a randomized controlled pretest/posttest design testing the differences in effectiveness of two educational methods to improve nurses’ knowledge, attitudes, and practice of EBP. Results indicated both methods improved self-reported practice. On the basis of the study findings, staff development educators can select the teaching method that best complements their organizational environment.

Knowledge translation in healthcare: Incorporating theories of learning and knowledge from the management literature.
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Oborn E, Barrett M, Racko G.
Journal of health organization and management 2013;27(4):412-431

The authors draw selectively on theories of learning and knowledge and suggest how they might usefully inform future development of the KT literature. DESIGN/METHODOLOGY/APPROACH: The authors conducted a narrative review to synthesise two streams of literature and examine evolving conceptual landscape concerning knowledge translation over the previous three decades. Conceptual mapping was used iteratively to develop and synthesise the literature. Iterative feedback from relevant research and practice stakeholder groups was used to focus and strengthen the review. FINDINGS: KT has been conceptualised along three competing frames; one focusing on linear (largely unidirectional) transfer of knowledge; one focusing on KT as a social process; and another that seeks to more fully incorporate contextual issues in understanding research implementation. Three overlapping themes are found in the management literature that inform these debates in the health literature, namely knowledge boundaries, organisational learning and absorptive capacity. Literature on knowledge boundaries problematizes the nature of boundaries and the stickiness of knowledge. Organisational learning conceptualises the need for organisational wide systems to facilitate learning processes; it also draws on a more expansive view of knowledge. Absorptive capacity focuses at the firm level on the role of developing organisational capabilities that enable the identification, assimilation and use of new knowledge to enable innovation.

Improving evidence-based primary care for chronic kidney disease: study protocol for a cluster randomized control trial for translating evidence into practice (TRANSLATE CKD).
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Fox CH, Vest BM, Kahn LS, Dickinson LM, Fang H, Pace W, et al.
Implementation science 2013 Aug 8;8:88-5908-8-88

This protocol consists of a cluster randomized controlled trial (CRCT) followed by a process and cost analysis. Only practices providing ambulatory primary care as their principal function, located in non-hospital settings, employing at least one primary care physician, with a minimum of 2,000 patients seen in the prior year, are eligible. The intervention will occur at the cluster level and consists of providing chronic kidney disease (CKD)-specific computer decision support (CDS) versus CKD-specific CDS plus practice facilitation for all elements of the TRANSLATE model. Patient-level data will be collected from each participating practice to examine adherence to guideline-concordant care, progression of CKD and all-cause mortality. The process evaluation (cluster level) will determine through qualitative methods the fidelity of the facilitated TRANSLATE program and find the challenges and enablers of the implementation process. The cost-effectiveness analysis will compare the benefit of the intervention of CDS alone against the intervention of CDS plus TRANSLATE (practice facilitation) in relationship to overall cost per quality adjusted years of life. The study is testing virtual facilitation and Academic detailing making the findings generalizable to any area of the country. TRIAL REGISTRATION: Registered as NCT01767883 on

Evidence-Based Practice Process Quality Assessment: EPQA Guidelines.
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Lee MC, Johnson KL, Newhouse RP, Warren JI.
Worldviews on evidence-based nursing 2013 Aug;10(3):140-149

The purpose of this study was to achieve consensus among nationally recognized EBP nurse experts on criteria that could be used to appraise the methodological quality of an EBP project as well as to serve as a guideline to plan for an EBP project. METHODS: A modified two-round Delphi method was used. Twenty-three nationally known EBP experts were invited by e-mail to participate in completing a web-based questionnaire. RESULTS: Items converged after two rounds (response rate [52% (n = 12/23) for Round 1 and 35% (n = 8/23) for Round 2]) and resulted in the development of the EBP Process Quality Assessment (EPQA) guidelines that include 34 items. IMPLICATIONS: The EPQA guidelines can be used to guide and evaluate the methodological quality of EBP projects. They can be used in practice settings to critically appraise an EBP project prior to translating recommendations into practice. Educators can use the EPQA guidelines as a rubric to evaluate student EBP projects. EPQA guidelines can be utilized in research to assess interventions and to build or improve EBP capacity. © 2013 Sigma Theta Tau International.

Turning Knowledge Into Action at the Point-of-Care: The Collective Experience of Nurses Facilitating the Implementation of Evidence-Based Practice. Canada-flat-icon
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Dogherty EJ, Harrison MB, Graham ID, Vandyk AD, Keeping-Burke L.
Worldviews on evidence-based nursing 2013 Aug;10(3):129-139

AIM: To describe the tacit knowledge regarding facilitation embedded in the experiences of nurses implementing evidence into practice. METHODS: Twenty nurses from across Canada were purposively selected to attend an interactive knowledge translation symposium to examine what has worked and what has not in implementing evidence in practice. This study is an additional in-depth analysis of data collected at the symposium that focuses on facilitation as an intervention to enhance evidence uptake. Critical incident technique was used to elicit examples to examine the nurses’ facilitation experiences. Participants shared their experiences with one another and completed initial data analysis and coding collaboratively. The data were further thematically analyzed using the qualitative inductive approach of constant comparison. RESULTS: A number of factors emerged at various levels associated with the successes and failures of participants’ efforts to facilitate evidence-based practice. Successful implementation related to: (a) focus on a priority issue, (b) relevant evidence, (c) development of strategic partnerships, (d) the use of multiple strategies to effect change, and (e) facilitator characteristics and approach. Negative factors influencing the process were: (a) poor engagement or ownership, (b) resource deficits, (c) conflict, (d) contextual issues, and (e) lack of evaluation and sustainability. CONCLUSIONS: Factors at the individual, environmental, organizational, and cultural level influence facilitation of evidence-based practice in real situations at the point-of-care. © 2013 The Authors. Worldviews on Evidence-Based Nursing published by Wiley Periodicals, Inc. on behalf of Sigma Theta Tau International.

Protocol for a qualitative study of knowledge translation in a participatory research project.
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Lillehagen I, Vollestad N, Heggen K, Engebretsen E.
BMJ open 2013 Aug 19;3(8):e003328-2013-003328

The purpose of this article is to describe a methodological design for investigating how KTs come about in participatory research. METHODS AND ANALYSIS: An ethnographic study which investigates meetings between participants in a participatory research project. The participants are researchers and primary healthcare clinicians. Data are collected through observation, interviews and document studies. The material is analysed using the analytical concepts of knowledge objects, knowledge forms and knowledge positions. These concepts represent an analytical framework enabling us to observe knowledge and how it is translated between participants. The main expected outcome of our study is to develop a typology of KT practices relevant to participatory research.

Evidence-based care of older people with suspected cognitive impairment in general practice: protocol for the IRIS cluster randomised trial.
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McKenzie JE, French SD, O’Connor DA, Mortimer DS, Browning CJ, Russell GM, et al.
Implementation science 2013 Aug 19;8:91-5908-8-91

This protocol describes methods of a randomised trial that tests a theory-informed implementation intervention. AIMS: This trial aims to estimate the effectiveness of a theory-informed intervention to increase GPs’ (in Victoria, Australia) adherence to a clinical guideline for the detection, diagnosis, and management of dementia in general practice, compared with providing GPs with a printed copy of the guideline. METHODS: The design is a parallel cluster randomised trial, with clusters being general practices. We aim to recruit 60 practices per group. Practices will be randomised to the intervention and control groups using restricted randomisation. Patients meeting the inclusion criteria, and GPs’ detection and diagnosis behaviours directed toward these patients, will be identified and measured via an electronic search of the medical records nine months after the start of the intervention. Practitioners in the control group will receive a printed copy of the guideline. In addition to receipt of the printed guideline, practitioners in the intervention group will be invited to participate in an interactive, opinion leader-led, educational face-to-face workshop. The theory-informed intervention aims to address identified barriers to and enablers of implementation of recommendations. Researchers responsible for identifying the cohort of patients with suspected cognitive impairment, and their detection and diagnosis outcomes, will be blind to group allocation.

Can a theory-based educational intervention change nurses’ knowledge and attitudes concerning cancer pain management? a quasi-experimental design.
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Gustafsson M, Borglin G.
BMC health services research 2013 Aug 19;13(1):328

BACKGROUND: Our study aimed to investigate if a theory-based educational intervention could change RNs’ knowledge and attitudes to cancer pain and pain management. METHODS: A quasi-experimental design with non-equivalent control groups was used. The primary outcome was measured using a modified version of the instrument Nurses’ Knowledge and Attitudes Survey Regarding Pain (NKAS) at baseline, four weeks and 12 weeks after the start of the intervention to evaluate its persistence. The intervention’s educational curriculum was based on the principles of Ajzen’s Theory of Planned Behaviour and consisted of interactive learning activities conducted in workshops founded on evidence-based knowledge. The RN’s own experiences from cancer pain management were used in the learning process. RESULTS: The theory-based educational intervention aimed at changing RNs knowledge and attitudes regarding cancer pain management measured by primary outcome NKAS resulted in a statistical significant (p<0.05) improvement of total mean score from baseline to four weeks at the intervention ward. Trial registration: Clinical Trials. Gov: NCT01313234.

Perspectives on the role of stakeholders in knowledge translation in health policy development in Uganda.
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Nabyonga Orem J, Marchal B, Mafigiri D, Ssengooba F, Macq J, Da Silveira VC, et al.
BMC health services research 2013 Aug 19;13:324-6963-13-324

This study employed qualitative approaches to examine the roles of and links among various stakeholders in KT. In-depth interviews were conducted with 21 key informants and focused on the key actors in KT, their perceived roles, and challenges. RESULTS: Major stakeholders included civil society organizations with perceived roles of advocacy, community mobilization, and implementation. These stakeholders may ignore unconvincing evidence. The community’s role was perceived as advocacy and participation in setting research priorities. The key role of the media was perceived as knowledge dissemination, but respondents noted that the media may misrepresent evidence if it is received in a poorly packaged form. The perceived roles of policy makers were evidence uptake, establishing platforms for KT and stewardship; negative roles included ignoring or even misrepresenting evidence that is not in their favor. The roles of parliamentarians were perceived as advocacy and community mobilization, but they were noted to pursue objectives that may not be supported by the evidence. The researchers’ main role was defined as evidence generation, but focusing disproportionately on academic interests was cited as a concern. The donors’ main role was defined as funding research and KT, but respondents were concerned about the local relevance of donor-supported research. Respondents reported that links among stakeholders were weak due to the absence of institutionalized, inclusive platforms. Challenges facing the stakeholders in the process of KT were identified.

Barriers and enablers to implementing multiple stroke guideline recommendations: a qualitative study.
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McCluskey A, Vratsistas-Curto A, Schurr K.
BMC health services research 2013 Aug 19;13:323-6963-13-323

This study aimed to identify barriers and enablers to implementing multiple stroke guideline recommendations at one Australian stroke unit. METHODS: A qualitative methodology was used. A sample of 28 allied health, nursing and medical professionals participated in a group or individual interview. These interviews occurred after staff had received audit feedback and identified areas for practice change. RESULTS: The six key barriers identified were: (1) Beliefs about capabilities of individual professionals and their discipline, and about patient capabilities (2) Beliefs about the consequences, positive and negative, of implementing the recommendations (3) Memory of, and attention to, best practices (4) Knowledge and skills required to implement best practice; (5) Intention and motivation to implement best practice, and (6) Resources. Some barriers were also enablers to change. CONCLUSIONS: Major challenges included sexuality education and depression screening. Limited knowledge and skills was a common barrier. Knowledge about specific interventions was needed before implementation could commence, and to maintain treatment fidelity.

Dissemination of performance information and continuous improvement: A narrative systematic review Canada-flat-icon
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Lemire M, Demers-Payette O, Jefferson-Falardeau J.
Journal of Health, Organisation and Management 2013;27(4):449-478

The purpose of this paper is to highlight the factors associated with the dissemination of performance information that generate and support continuous improvement in health organizations. Design/methodology/approach: A systematic data collection strategy that includes empirical and theoretical research published from 1980 to 2010, A narrative synthesis method was used. The sample consisted of 114 articles, including seven systematic or exhaustive reviews. Findings: Results showed that dissemination in itself is not enough to produce improvement initiatives. Successful dissemination depends on various factors, which influence the way collective actors react to performance information such as the clarity of objectives, the relationships between stakeholders, the system’s governance and the available incentives. © Emerald Group Publishing Limited.

Using Performance Measures to Promote Evidence-Based Care: A Bayesian Approach

This issue brief from the Center on Health Care Effectiveness explores a unique approach to performance measurement based on the Bayes theorum. Over the long term, this approach could strengthen the relationship between the measurement of provider performance and the growth of evidence-based, patient-centered clinical practices.

Using a knowledge utilization framework to explore how findings from one study can be applied to other nursing contexts.
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Olsen PR, Bradbury-Jones C.
International nursing review 2013 Sep;60(3):381-388

The processes of moving research findings into practice are complex and multidimensional. In this paper, an innovative approach to social support, network-focused nursing (NFN), is used as a case example to illustrate these complexities. METHODS: A knowledge utilization framework is used to explore how empirical findings from the NFN study could be applied to nursing more generally. Aligned with this, the specific considerations for implementing NFN are explicated. DISCUSSION: Strong leadership, education, management support and effective communication are critical factors for research utilization. Moving research into practice requires openness to new ideas. Nursing and healthcare policies therefore need to support environments in which creativity and innovation can flourish. NFN was developed in teenager and young adult cancer care, but its principles may be transferable to other clinical environments.© 2013 The Authors. International Nursing Review © 2013 International Council of Nurses.

An interdisciplinary and development lens on knowledge translation
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Huzair F, Borda-Rodriguez A, Upton M, Mugwagwa JT.
Science and Public Policy 2013;40(1):43-50

We use two case studies from South Africa: an AIDS vaccine trial site and a policy arena for the attempted harmonisation of biotechnology policies. We demonstrate how the use of an interdisciplinary methodology asks different questions of the knowledge translation (KT) process and foregrounds the importance of the wider socio-economic and political context. The case studies highlight particular problems for the KT process in developing countries and resource-constrained environments which conventional analyses of technology and policy processes may not demonstrate. We conclude that context-specific and dynamic capabilities and capacities are required for effective KT in developing countries. © The Author 2013. Published by Oxford University Press.All rights reserved.

A study protocol for applying the co-creating knowledge translation framework to a population health study.
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Powell K, Kitson A, Hoon E, Newbury J, Wilson A, Beilby J.
Implementation science 2013 Aug 29;8(1):98

A population health study in Port Lincoln, South Australia offered the opportunity to develop and apply the co-KT Framework to the entire research process. This is a new framework to facilitate knowledge formation collaboratively between researchers and communities throughout a research to intervention implementation process. DESIGN: This study employs a five step framework (the co-KT Framework) that is formulated from engaged scholarship and action research principles. By following the steps a knowledge base will be cumulatively co-created with the study population that is useful to the research aims. Step 1 is the initiating of contact between the researcher and the study contexts, and the framing of the research issue, achieved through a systematic data collection tool. Step 2 refines the research issue and the knowledge base by building into it context specific details and conducting knowledge exchange events. Step 3 involves interpreting and analysing the knowledge base, and integrating evidence to inform intervention development. In Step 4 the intervention will be piloted and evaluated. Step 5 is the completion of the research process where outcomes for improvement will be instituted as regular practice with the facilitation of the community.In summary, the model uses an iterative knowledge construction mechanism that is complemented by external evidence to design interventions to address health priorities within the community.

Balancing exploration and exploitation in transferring research into practice: a comparison of five knowledge translation entity archetypes.
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Oborn E, Barrett M, Prince K, Racko G.
Implementation science 2013 Sep 5;8(1):104

Translating knowledge from research into clinical practice has emerged as a practice of increasing importance. This has led to the creation of new organizational entities designed to bridge knowledge between research and practice. Within the UK, the Collaborations for Leadership in Applied Health Research and Care (CLAHRC) have been introduced to ensure that emphasis is placed in ensuring research is more effectively translated and implemented in clinical practice. Knowledge translation (KT) can be accomplished in various ways and is affected by the structures, activities, and coordination practices of organizations. METHODS: Using a qualitative research approach, the study was based on 106 semi-structured, in-depth interviews with the directors, theme leads and managers, key professionals involved in research and implementation in nine CLAHRCs. Data was also collected from intensive focus group workshops. RESULTS: In this article we develop five archetypes for organizing KT. The results show how the various CLAHRC entities work through partnerships to create explorative research and deliver exploitative implementation. The different archetypes highlight a range of structures that can achieve ambidextrous balance as they organize activity and coordinate practice on a continuum of exploration and exploitation.

Organizational factors associated with readiness to implement and translate a primary care based telemedicine behavioral program to improve blood pressure control: the HTN-IMPROVE study
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Shaw RJ, Kaufman MA, Bosworth HB, Weiner BJ, Zullig LL, Lee SY, et al.
Implementation science 2013 Sep 8;8(1):106

We sought to answer the following questions: What is the level of organizational readiness to implement the intervention? What are the specific facilitators, barriers, and contextual factors that may affect organizational readiness to change?Study design: Each intervention site from three separate Veterans Integrated Service Networks (VISNs), which represent 21 geographic regions across the US, agreed to enroll 500 participants over a year with at least 0.5 full time equivalent employees of nursing time. Our mixed methods approach used a priori semi-structured interviews conducted with stakeholders (n = 27) including nurses, physicians, administrators, and information technology (IT) professionals between 2010 and 2011. Researchers iteratively identified facilitators and barriers of organizational readiness to change (ORC) and implementation. Additionally, an ORC survey was conducted with the stakeholders who were (n = 102) preparing for program implementation. RESULTS: Key ORC facilitators included stakeholder buy-in and improving hypertension. Positive organizational characteristics likely to impact ORC included: other similar programs that support buy-in, adequate staff, and alignment with the existing site environment; improved patient outcomes; is positive for the professional nurse role, and is evidence-based; understanding of the intervention; IT infrastructure and support, and utilization of existing equipment and space.The primary ORC barrier was unclear long-term commitment of nursing. Negative organizational characteristics likely to impact ORC included: added workload, competition with existing programs, implementation length, and limited available nurse staff time; buy-in is temporary until evidence shows improved outcomes; contacting patients and the logistics of integration into existing workflow is a challenge; and inadequate staffing is problematic. Findings were complementary across quantitative and qualitative analyses.

Knowledge dissemination interventions: A literature review Canada-flat-icon
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Lafrenière D, Menuz V, Hurlimann T, Godard B.
SAGE Open 2013;3(3):1-14

This literature review seeks to examine knowledge dissemination interventions (KDIs) implemented in health research and gauge their effectiveness on three kinds of outcomes: (a) knowledge acquisition, (b) changes in attitudes, and (c) changes in practice. MEDLINE and Cumulative Index to Nursing and Allied Health Literature databases from 2006 to 2011 were searched. Nineteen articles were retrieved. Most of the KDIs that were evaluated had a positive impact on knowledge acquisition and changes in attitudes, but a limited one on practice. KDIs are diverse in terms of knowledge, actors, contexts, and dissemination methods. They cannot be readily applicable to other projects. © The Author(s) 2013.

Evidence for the frontline: A report for the Alliance for Useful Evidence

The Alliance for Useful Evidence is an open-access network of individuals from across government, universities, charities, business and others in the UK and internationally who champion the use of evidence in social policy and practice. This paper describes the challenges of producing evidence and the dangers of operating without it. It explores advances across a range of fields to mobilize research knowledge more effectively.

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Health Care Administration and Organization

The value of bedside shift reporting enhancing nurse surveillance, accountability, and patient safety. Canada-flat-icon
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Jeffs L, Acott A, Simpson E, Campbell H, Irwin T, Lo J, et al.
Journal of nursing care quality 2013 Jul-Sep;28(3):226-232

A study was undertaken to explore nurses’ experiences and perceptions associated with implementation of bedside nurse-to-nurse shift handoff reporting. Interviews were conducted with nurses and analyzed using directed content analysis. Two themes emerged that illustrated the value of bedside shift reporting. These themes included clarifying information and intercepting errors and visualizing patients and prioritizing care. Nurse leaders can leverage study findings in their efforts to embed nurse-to-nurse bedside shift reporting in their respective organizations.

The roles of unit leadership and nurse-physician collaboration on nursing turnover intention.
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Galletta M, Portoghese I, Battistelli A, Leiter MP.
Journal of advanced nursing 2013 Aug;69(8):1771-1784

AIM: To report a study of the relationship between variables at the group and individual level with nurses’ intention to leave their unit. DESIGN: The study was a cross-sectional design with self-administered questionnaires. METHODS: A questionnaire including measures of leader-member exchange and nurse-physician collaboration analysed at group-level and affective commitment and turnover intention analysed at individual level, was administered individually to 1018 nurses in five Italian hospitals.RESULTS: The results showed that affective commitment at individual level completely mediated the relationship between leader-member exchange at group-level and nursing turnover intention. Furthermore, the cross-level interaction was significant: at individual level, the nurses with high levels of individual affective commitment towards their unit showed low levels of turnover intention and this relationship was stronger when the nurse-physician collaboration at group-level was high. © 2012 Blackwell Publishing Ltd.

Nursing intellectual capital theory: operationalization & empirical validation of concepts. Canada-flat-icon
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Covell CL, Sidani S.
Journal of advanced nursing 2013 Aug;69(8):1785-1796

The nursing intellectual capital theory proposes that the stocks of nursing knowledge in an organization are embedded in two concepts, nursing human capital and nursing structural capital. The theory also proposes that two concepts in the work environment, nurse staffing and employer support for nursing continuing professional development, influence nursing human capital. DESIGN: A cross-sectional design. METHODS: A systematic three-step process was used to operationalize the concepts of the theory. In 2008, data were collected for 147 inpatient units from administrative departments and unit managers in 6 Canadian hospitals. Exploratory factor analyses were conducted to determine if the indicator variables accurately reflect their respective concepts. RESULTS: The proposed indicator variables collectively measured the nurse staffing concept. Three indicators were retained to construct nursing human capital: clinical expertise and experience concept. The nursing structural capital and employer support for nursing continuing professional development concepts were not validated empirically. © 2012 Blackwell Publishing Ltd.

Clinicians’ views on improving inter-organizational care transitions. Canada-flat-icon
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Jeffs L, Lyons RF, Merkley J, Bell CM.
BMC health services research 2013 Jul 30;13:289-6963-13-289

Patients with complex health conditions frequently require care from multiple providers and are particularly vulnerable to poorly executed transitions from one healthcare setting to another. METHODS: A qualitative study using semi-structured interviews was conducted with clinicians employed at two selected healthcare facilities: an acute care hospital and a complex continuing care/rehabilitation organization, respectively. RESULTS: Three themes emerged from the data. These themes are: 1) communicating more effectively; 2) being vigilant around the patients’ readiness for transfer and care needs; and 3) documenting more accurately and completely in the patient transfer record. CONCLUSION: Our study provides insights from the perspectives of multiple clinicians that have important implications for health care leaders and clinicians in their efforts to enhance inter-organizational care transitions.

Work engagement and occupational stress in nurses and other healthcare workers: the role of organisational and personal factors.
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Fiabane E, Giorgi I, Sguazzin C, Argentero P.
Journal of clinical nursing 2013 Sep;22(17-18):2614-2624

The aims of this study were to: (1) identify the role of organisational and personal factors in predicting work engagement in healthcare workers and (2) compare work engagement and occupational stress perceptions of healthcare professional categories. DESIGN: A cross-sectional survey research was conducted with self-report questionnaires. METHODS: The Maslach Burnout Inventory-General Survey, the Areas of Worklife Scale and four scales from the Occupational Stress Indicator were administered to a sample of 198 hospital staff (registered nurses, nurse aides, physicians and physiotherapists), of which 110 participated in the study. RESULTS: The most significant predictors of energy were workload, mental health and job satisfaction; the best predictors of involvement were community, workload, mental health and job satisfaction; professional efficacy was best predicted by values and job satisfaction. In relation to the second aim, physiotherapists had the highest levels of occupational stress and disengagement from their work, while nurse aides were the most work-engaged and job-satisfied professional category, with positive perceptions of the work environment. © 2013 Blackwell Publishing Ltd.

Determinants of regulated nurses’ intention to stay in long-term care homes. Canada-flat-icon
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McGilton KS, Tourangeau A, Kavcic C, Wodchis WP.
Journal of nursing management 2013 Jul;21(5):771-781

AIM: To examine determinants of intent to stay among regulated nurses employed in long-term care facilities. BACKGROUND: Regulated nursing staff employed in long-term care facilities represent the largest group of health-care providers who intend to leave their current jobs. METHODS: Survey responses from 155 nurses from 12 long-term care facilities were analyzed to test the impact of six predictors on intent to stay. RESULTS: Intention to stay was positively associated with lower burnout, higher job satisfaction, older nurses and resident relationships. Work relationships were negatively associated with intention to stay. Leadership support was not a significant predictor. CONCLUSION: Most predictors were correlated with intention to stay as hypothesized. © 2013 John Wiley & Sons Ltd.

Using evidence-based leadership initiatives to create a healthy nursing work environment.
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Nayback-Beebe AM, Forsythe T, Funari T, Mayfield M, Thoms W,Jr, Smith KK, et al.
Dimensions of critical care nursing 2013 Jul-Aug;32(4):166-173

In an effort to create a healthy nursing work environment in a military hospital Intermediate Care Unit (IMCU), stakeholders brainstormed and piloted several unit-level evidence-based leadership initiatives to improve the IMCU nursing work environment. These initiatives were guided by the American Association of Critical Care Nurses Standards for Establishing and Sustaining Healthy Work Environments which encompass: (1) skilled communication, (2) true collaboration, (3) effective decision making, (4) appropriate staffing, (5) meaningful recognition, and (6) authentic leadership. Interim findings suggest implementation of these six evidence-based, relationship-centered principals, when combined with IMCU nurses’ clinical expertise, management experience, and personal values and preferences, improved staff morale, decreased staff absenteeism, promoted a healthy nursing work environment, and improved patient care.

Care pathways across the primary-hospital care continuum: using the multi-level framework in explaining care coordination.
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Van Houdt S, Heyrman J, Vanhaecht K, Sermeus W, De Lepeleire J.
BMC health services research 2013 Aug 6;13:296-6963-13-296

The aim of this study was to assess the extent to which care pathways support or create elements of the multi-level framework necessary to improve care coordination across the primary-hospital care continuum. METHODS: This study is an in-depth analysis of five existing local community projects located in four different regions in Flanders (Belgium) to determine whether the available evidence supported or refuted the theoretical expectations from the multi-level framework. Data were gathered using mixed methods. Multiple cases were analyzed performing a cross case synthesis to strengthen the results. RESULTS: The development of a care pathway across the primary-hospital care continuum, supported by a step-by-step scenario, led to the use of existing and newly constructed structures, data monitoring and the development of information tools. The construction and use of these inter-organizational mechanisms had a positive effect on exchanging information, formulating and sharing goals, defining and knowing each other’s roles, expectations and competences and building qualitative relationships.

Absenteeism in Health Care: Using Interlocking Behavioral Contingency Feedback to Increase Attendance With Certified Nursing Assistants
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Camden MC, Ludwig TD.
Journal of Organizational Behavior Management 2013;33(3):165-184

This research used an ABA multiple baseline design across hospitals to evaluate a behavioral intervention designed to reduce absenteeism among 64 certified nursing assistants (CNA) in a rural health care organization. Pre-baseline assessments suggested that when CNAs were absent from work, other employees had to work unscheduled shifts. Because of this metacontingency, employees reported that they skipped work themselves to make up for the extra shifts they had to cover. This cycle created more unscheduled shifts and potentially caused the high absenteeism prevalent at the organization. An intervention with normative and metacontingency feedback significantly decreased the total number of days CNAs were absent per week across the three hospitals from a baseline mean of 0.24 (SD = 0.19) days per week (7.74% of their scheduled hours) to a mean of 0.13 (SD = 0.17) days per week (3.81% of their scheduled hours) during the intervention. In a return to baseline the total number of days CNAs were absent per week across the three hospitals increased to a mean of 0.24 (SD = 0.20) days per week (7.47% of their scheduled hours). © 2013 Taylor & Francis Group, LLC.

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Health Care Innovation and Quality Assurance

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

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.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.

Improving continence services for older people from the service-providers’ perspective: a qualitative interview study.
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Orrell A, McKee K, Dahlberg L, Gilhooly M, Parker S.
BMJ open 2013 Jul 30;3(7):10.1136/bmjopen-2013-002926

OBJECTIVE: To examine the views and experiences of continence service leads in England on key service and continence management characteristics. DESIGN: Qualitative semistructured interviews using a purposive sample recruited across 16 continence services. SETTING: 3 acute and 13 primary care National Health Service Trusts in England. PARTICIPANTS: 16 continence service leads in England actively treating and managing older people with UI. RESULTS: In terms of barriers to a good-quality service, participants highlighted a failure on the part of commissioners, managers and other health professionals in recognising the problem of UI and in acknowledging the importance of continence for older people and prevalent negative attitudes towards continence and older people. Patient assessment and continence promotion regardless of age, rather than pad provision, were identified as important steps for a good-quality service for older people with UI. More rapid and appropriate patient referral pathways, investment in service capacity, for example, more trained staff and strengthened interservice collaborations and a higher profile within medical and nurse training were specified as being important facilitators for delivering an equitable and high-quality continence service. There is a need, however, to consider the accounts given by our participants as perhaps serving the interests of their professional group within the context of interprofessional work.

Improving patient care through leadership engagement with frontline staff: a Department of Veterans Affairs case study.
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Singer SJ, Rivard PE, Hayes JE, Shokeen P, Gaba D, Rosen A.
Joint Commission journal on quality and patient safety / Joint Commission Resources 2013 Aug;39(8):349-360

Leveraging Frontline Expertise (LFLE) is a patient safety intervention for engaging senior managers with the work-systems challenges faced by frontline workers and ensuring follow-up and accountability for systemic change. A study was conducted to assess the ability to refine, implement, and demonstrate the effectiveness of LFLE, which was designed for and tested in private-sector hospitals, in a Department of Veterans Affairs medical center (VAMC), typically a more hierarchical setting. METHODS: LFLE was pilot tested in an urban, East coast-based VAMC, which implemented LFLE in its emergency department and operating room, with the medical/surgical ward and ICU serving as controls. A 20-month multimethod evaluation involved interviews, observation, data-tracking forms, and surveys to measure participant perceptions of the program, operational benchmarks of effectiveness, and longitudinal change in safety climate. RESULTS: Implementation showed fidelity to program design. Participating units identified 22 improvement opportunities, 16 (73%) of which were fully or partially resolved. Senior managers’ attitudes toward LFLE were more positive than those of frontline staff, whose attitudes were mixed. Perceptions of safety climate deteriorated during the study period in the implementation units relative to controls.

Inpatient fall prevention programs as a patient safety strategy: a systematic review.
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Miake-Lye IM, Hempel S, Ganz DA, Shekelle PG.
Annals of Internal Medicine 2013 Mar 5;158(5 Pt 2):390-396

Falls are common among inpatients. The purpose of this updated review is to reassess the benefits and harms of fall prevention programs in acute care settings and to identify factors associated with successful implementation of these programs. Eleven studies showed that the following themes were associated with successful implementation: leadership support, engagement of front-line staff in program design, guidance of the prevention program by a multidisciplinary committee, pilot-testing interventions, use of information technology systems to provide data about falls, staff education and training, and changes in nihilistic attitudes about fall prevention.

“We have to what?”: lessons learned about engaging support staff in an interprofessional intervention to implement MVA for management of spontaneous abortion.
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Darney BG, VanDerhei D, Weaver MR, Stevens NG, Prager SW.
Contraception 2013 Aug;88(2):221-225

The Resident Training Initiative in Miscarriage Management (RTI-MM) is an intervention designed to facilitate implementation of manual vacuum aspiration (MVA) for management of spontaneous abortion. The purpose of this study was to identify training program components that enhanced interprofessional training and provide lessons learned for engaging support staff in implementing uterine evacuation services. STUDY DESIGN: Secondary analysis of qualitative data identified themes within three broad areas: interprofessional education, the role of support staff, and RTI-MM program components that facilitated support staff engagement in the process of implementing MVA services. RESULTS: We identified three key themes around interprofessional training and the role of support staff: “Training together is rare,” “Support staff are crucial to practice change,” and “Transparency, peers and champions.” Copyright © 2013 Elsevier Inc. All rights reserved.

Implementing a provider-initiated testing and counselling (PITC) intervention in Cape town, South Africa: a process evaluation using the normalisation process model.
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Leon N, Lewin S, Mathews C.
Implementation science 2013 Aug 26;8(1):97

BACKGROUND: Provider-initiated HIV testing and counselling (PITC) increases HIV testing rates in most settings, but its effect on testing rates varies considerably. This paper reports the findings of a process evaluation of a controlled trial of PITC for people with sexually transmitted infections (STI) attending publicly funded clinics in a low-resource setting in South Africa. METHOD: This longitudinal study used a variety of qualitative methods. Data were content analysed by identifying the main influences shaping the implementation process. The Normalisation Process Model (NPM) was used as a theoretical framework to analyse implementation processes and explain the trial outcomes. RESULTS: The new PITC intervention became embedded in practice (normalised) during a two-year period (2006 to 2007). Factors that promoted the normalising include strong senior leadership, implementation support, appropriate accountability mechanisms, an intervention design that was responsive to service needs and congruent with professional practice, positive staff and patient perceptions, and a responsive organisational context. Nevertheless, nurses struggled to deploy the intervention efficiently, mainly because of poor sequencing and integration of HIV and STI tasks, a focus on HIV education, tension with a patient-centred communication style, and inadequate training on dealing with the operational challenges. This resulted in longer consultation times, which may account for the low test coverage outcome. Trial registration: Current controlled trials ISRCTN93692532.

A person-centered care intervention for geriatric certified nursing assistants.
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Coleman CK, Medvene LJ, Van Haitsma K.
The Gerontologist 2013 Aug;53(4):687-698

PURPOSE: To pilot test a multicomponent intervention to increase certified nursing assistants’ (CNAs) awareness of person-centered care. To establish the feasibility of implementing an intervention involving videotaped biographies of residents and videotapes of resident/CNA caregiving interactions. DESIGN AND METHODS: A training program was provided at two nursing homes (NHs) using a wait-list control design. Levels of dyadic relationship closeness and satisfaction were compared prepost. Video recordings of CNA/resident interactions were coded for person-centered care using two observational instruments. RESULTS: Based on data from 19 resident/aide dyads, the findings were that resident’s perceptions of relationship closeness increased significantly posttraining at both NHs, NH1, z = -1.89, p < .05, and the NH2, z = -1.95, p < .05. Effects were also seen with the CNA’s perceptions of satisfaction and closeness, and resident satisfaction. IMPLICATIONS: The findings suggest that this type of intervention is feasible and warrants further research.

Administrator turnover and quality of care in nursing homes
Coleman CK, Medvene LJ, Van Haitsma K.
The Gerontologist 2013 Aug;53(4):687-698

Many studies indicate that a shortage in manpower in long-term care facilities may adversely affect the quality of care given to elderly persons. They gathered data every month for a period of 2 years from 151 nursing homes in Iowa to determine whether there was a statistically significant relationship between administrative turnover and the number of failures reported at the facilities. Bivariate correlation analyses and a linear regression model were used to examine the relationships, and other facility characteristics, such as the number of beds, ownership type, and facility location (rural vs urban setting) were used as control variables. Through their assessments, the authors found a statistically significant relationship between administrative turnover and the number of deficiencies reported at a facility, with more deficiencies being identified at facilities with a higher rate of turnover.

Consistent Assignment of Nursing Staff to Residents in Nursing Homes: A Critical Review of Conceptual and Methodological Issues.
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Roberts TJ, Nolet KA, Bowers BJ.
The Gerontologist 2013 Aug 31

Consistent assignment of nursing staff to residents is promoted by a number of national organizations as a strategy for improving nursing home quality and is included in pay for performance schedules in several states. However, research has shown inconsistent effects of consistent assignment on quality outcomes. A literature review was conducted to critique conceptual and methodological understandings of consistent assignment. DESIGN AND METHODS: Twenty original research reports of consistent assignment in nursing homes were found through a variety of search strategies. RESULTS: Consistent assignment was conceptualized and operationalized in multiple ways with little overlap from study to study. There was a lack of established methods to measure consistent assignment. Methodological limitations included a lack of control and statistical analyses of group differences in experimental-level studies, small sample sizes, lack of attention to confounds in multicomponent interventions, and outcomes that were not theoretically linked.

Licensed Practical Nurse Scope of Practice and Quality of Nursing Home Care.
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Corazzini KN, Anderson RA, Mueller C, Thorpe JM, McConnell ES.
Nursing research 2013 September/October;62(5):315-324

BACKGROUND: Although higher levels of registered nurse (RN) staffing in nursing homes are related to better care quality, licensed practical nurses (LPNs) provide most licensed-nursing care. The nature of LPN practice, and RN direction of that practice, follows in part from state nurse practice acts (NPAs). OBJECTIVE: The aims of this study were to describe regulatory differences in how LPNs contribute to nursing assessment, care planning, delegation and supervision, and RN practice in these domains and to explore how these regulatory differences relate to quality of care in nursing homes. METHODS: The study design was a sequential explanatory mixed-methods design of NPAs and Centers for Medicare and Medicaid quality measures of long-stay nursing home residents. 51 NPAs and related administrative code were analyzed to classify guidance on RN and LPN practice; then, the coded data were transformed to quantitative indicators of specificity regarding LPN and RN scope of practice. In the quantitative strand, state NPA data were linked to facility-level Centers for Medicare and Medicaid staffing and quality measures (N = 12,698 facilities) for cross-sectional, quantitative analyses. RESULTS: States varied considerably in how NPAs guided LPN and RN scope of practice. NPA differences were related to quality indicators of resident pain, catheter use, weight loss, and restraints, even when accounting for nursing home staff mix. DISCUSSION: Care quality was better in states where the NPA clearly described LPN scope, but only when there was also greater RN availability (p < .05).

Oral health care in older people in long term care facilities: a systematic review of implementation strategies.
Non UofA Access
Weening-Verbree L, Huisman-de Waal G, van Dusseldorp L, van Achterberg T, Schoonhoven L.
International journal of nursing studies 2013 Apr;50(4):569-582

The aim of this study is to review implementation strategies used to promote or improve oral health care for older people in long term care facilities. DESIGN: Systematic review of literature. RESULTS: Twenty studies were included in this review. Implementation strategies were delivered by dental hygienists or dentists. Oral health care was performed by nurses and nurse assistants in all studies. All studies addressed knowledge, mostly operationalized as one educational session. Knowledge was most often combined with interventions addressing self efficacy. Implementation strategies aimed at knowledge (providing general information), self-efficacy (modelling) or facilitation of behaviour (providing materials to facilitate behaviour) were most often identified as successful in improving oral health. Copyright © 2012 Elsevier Ltd. All rights reserved.

A multi-faceted tailored strategy to implement an electronic clinical decision support system for pressure ulcer prevention in nursing homes: a two-armed randomized controlled trial.
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Beeckman D, Clays E, Van Hecke A, Vanderwee K, Schoonhoven L, Verhaeghe S.
International journal of nursing studies 2013 Apr;50(4):475-486

OBJECTIVES: To determine whether a multi-faceted tailored strategy to implement an electronic clinical decision support system for pressure ulcer prevention improves adherence to recommendations for pressure ulcer prevention in nursing homes. DESIGN: Two-armed randomized controlled trial in a nursing home setting in Belgium. The trial consisted of a 16-week implementation intervention, including one baseline, four intermediate, and one post-testing measurement. Primary outcome was the adherence to guideline-based care recommendations (in terms of allocating adequate pressure ulcer prevention in residents at risk). Secondary outcomes were the change in resident outcomes (pressure ulcer prevalence) and intermediate outcomes (knowledge and attitudes of healthcare professionals). SETTING: Random sample of 11 wards (6 experimental; 5 control) in a convenience sample of 4 nursing homes in Belgium. PARTICIPANTS: In total, 464 nursing home residents and 118 healthcare professionals participated. METHODS: The experimental arm was involved in a multi-faceted tailored implementation intervention of a clinical decision support system, including interactive education, reminders, monitoring, feedback and leadership. The control arm received a hard-copy of the pressure ulcer prevention protocol, supported by standardized 30 min group lecture. RESULTS: Patients in the intervention arm were significantly more likely to receive fully adequate pressure ulcer prevention when seated in a chair (F=16.4, P=0.003). No significant improvement was observed on pressure ulcer prevalence and knowledge of the professionals. While baseline attitude scores were comparable between both groups [exp. 74.3% vs. contr. 74.5% (P=0.92)], the mean score after the intervention was 83.5% in the experimental group vs. 72.1% in the control group (F=15.12, P<0.001). CONCLUSION: The intervention was only partially successful to improve the primary outcome. Copyright © 2012 Elsevier Ltd. All rights reserved.

Communication and coordination during transition of older persons between nursing homes and hospital still in need of improvement.
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Kirsebom M, Wadensten B, Hedstrom M.
Journal of advanced nursing 2013 Apr;69(4):886-895

AIM: To investigate registered hospital and nursing home nurses’ experiences of coordination and communication within and between care settings when older persons are transferred from nursing homes to hospital and vice versa. DESIGN: A descriptive study design with a qualitative approach was used. METHODS: In 2008, three focus group discussions were conducted with registered nurses from hospitals and nursing homes (n=20). RESULTS: Nursing home registered nurses found it difficult to decide whether the older person should be referred to hospital from the nursing home. Hospital registered nurses reported often trying to stop premature discharges or having to carry out the discharge although it had not been fully prepared. Both hospital and nursing home registered nurses suggested increased collaboration to understand each other’s work situation better. © 2012 Blackwell Publishing Ltd.

Designing and Implementing Research on a Statewide Quality Improvement Initiative: The DIAMOND Study and Initiative.
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Lauren Crain A, Solberg LI, Unutzer J, Ohnsorg KA, Maciosek MV, Whitebird RR, et al.
Medical care 2013 Sep;51(9):e58-66

STUDY DESIGN AND SETTING: Several operational features of the DIAMOND (Depression Improvement Across Minnesota, Offering a New Direction) Initiative suggested that the DIAMOND Study use a staggered implementation design with repeated cross-sections of patients across clinical settings. A multilevel recruitment strategy elicited virtually complete study participation from the medical groups, clinics, and health plans that coordinated efforts to deliver and reimburse DIAMOND care. RESULTS: The staggered implementation design and multilevel recruitment strategy made it possible to evaluate DIAMOND by holding confounding factors constant and accurately identifying an intent-to-treat population of patients treated for depression without intruding on or requiring effort from their clinics. CONCLUSIONS: Recruitment and data collection from health plans, medical groups and clinics, and patients ensured a representative, intent-to-treat sample of study-enrolled patients. Separating patient identification from care delivery reduced threats of selection bias and enabled comparisons between the treated population and study sample. A key challenge is that intent-to-treat patients may not be exposed to DIAMOND which dilutes the effect size but offers realistic expectations of the impact of quality improvement in a population of treated patients.

A promise to learn – a commitment to act (UK)
National Advisory Group on the Safety of Patients in England, 2013

Patient safety problems exist throughout the NHS. NHS staff are not to blame – in the vast majority of cases it is the systems, procedures, conditions, environment and constraints they face that lead to patient safety problems. Improvement requires a system of support: the NHS needs a considered, resourced and driven agenda of capability-building in order to deliver continuous improvement.

RWJF: Evaluating Quality Improvement Training Programs: Do they increase the ability of people to successfully engage in work to improve health and health care?

The goal of Evaluating Quality Improvement Training Programs was to learn what works in QI training programs so that more organizations adopt best practices and more health providers acquire training in quality improvement.

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Organizational Change

Culture as a predictor of resistance to change: A study of competing values in a psychiatric nursing context.
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Johansson C, Astrom S, Kauffeldt A, Helldin L, Carlstrom E.
Health policy (Amsterdam, Netherlands) 2013 Aug 6

A conservative organizational culture can hinder the implementation of new organizational models. Prior to introducing something new it is important to identify the culture within the organization. This paper sets out to detect the feasibility of reform in a psychiatric clinic in a Swedish hospital prior to implementation of a new working method – a structured tool based on the International Classification of Functioning Disability and Health. A survey consisting of two instruments – an organizational values questionnaire (OVQ) and a resistance to change scale (RTC) – was distributed to registered and assistant nurses at the clinic. The association between the organizational subcultures and resistance to change was investigated with regression analysis. The results revealed that the dominating cultures in the outpatient centers and hospital wards were characterized by human relation properties such as flexibility, cohesion, belongingness, and trust. The mean resistance to change was low, but the subscale of cognitive rigidity was dominant, reflecting a tendency to avoid alternative ideas and perspectives. An instrument like the one employed in the study could be a useful tool for diagnosing the likelihood of extensive and costly interventions. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Nurses amidst change: the concept of change fatigue offers an alternative perspective on organizational change. Canada-flat-icon
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McMillan K, Perron A.
Policy, politics & nursing practice 2013 Feb;14(1):26-32

This article aims to clarify the concept of change fatigue and deems further exploration of the concept within the discipline of nursing is relevant and necessary. The concept of change fatigue has evolved from the discipline of management as a means to explore organization change and its associated triumphs and failures. Change fatigue has typically been described as one and the same as change resistance, with very little literature acknowledging that they are in fact distinct concepts. Concept clarification has highlighted the striking differences and few similarities that exist between the concepts of change fatigue and change resistance. Further exploration and subsequent research on the concept of change fatigue is needed within the discipline of nursing. The concept not only presents new and alternative perspectives on the processes of organization change, but provides opportunity for theory development that recognizes the impact organizational change has on nurses’ work lives.

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Research Practice & Methodology

Editorial: Research data ownership and dissemination: is it too simple to suggest that ‘possession is nine-tenths of the law’?
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Cleary M, Jackson D, Walter G.
Journal of clinical nursing 2013 Aug;22(15-16):2087-2089.

There are a number of potential owners of research data, including the researchers, host institution (e.g. university or hospital), funding agent (if any), and journal to which a paper describing the research findings is eventually published. For any given piece of research, ownership can potentially vary over time and be subject to various factors and influences.

Detecting, quantifying and adjusting for publication bias in meta-analyses: protocol of a systematic review on methods.
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Mueller KF, Meerpohl JJ, Briel M, Antes G, von Elm E, Lang B, et al.
Systematic reviews 2013 Jul 25;2:60-4053-2-60

The objectives of this systematic review are as follows: to systematically review methodological articles which focus on non-publication of studies and to describe methods of detecting and/or quantifying and/or adjusting for publication bias in meta-analyses; to appraise strengths and weaknesses of methods, the resources they require, and the conditions under which the method could be used, based on findings of included studies. As this will be a qualitative systematic review, data reporting will involve a descriptive summary. This systematic review together with the results of other systematic reviews of the OPEN project (To Overcome Failure to Publish Negative Findings) will serve as a basis for the development of future policies and guidelines regarding the assessment and handling of publication bias in meta-analyses.

A counterfactual approach to bias and effect modification in terms of response types
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Suzuki E, Mitsuhashi T, Tsuda T, Yamamoto E.
BMC medical research methodology 2013 Jul 31;13(1):101

In this study, the authors aim to further clarify the concepts of bias (confounding bias and selection bias) and effect modification in the counterfactual framework. METHODS: The authors show how theoretical data frequencies can be described by using unobservable response types both in observational studies and in randomized controlled trials. By using the descriptions of data frequencies, the authors show epidemiologic measures in terms of response types, demonstrating significant distinctions between association measures and effect measures. These descriptions also demonstrate sufficient conditions to estimate effect measures in observational studies. To illustrate the ideas, the authors show how directed acyclic graphs can be extended by integrating response types and observed variables. RESULTS: This study shows a hitherto unrecognized sufficient condition to estimate effect measures in observational studies by adjusting for confounding bias. The present findings would provide a further understanding of the assumption of conditional exchangeability, clarifying the link between the assumptions for making causal inferences in observational studies and the counterfactual approach. The extension of directed acyclic graphs using response types maintains the integrity of the original directed acyclic graphs, which allows one to understand the underlying causal structure discussed in this study.

Cognitive mapping: using local knowledge for planning health research
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Stadler J, Dugmore C, Venables E, MacPhail C, Delany-Moretlwe S.
BMC medical research methodology 2013 Jul 26;13:96-2288-13-96

BACKGROUND: Cognitive mapping is a participatory research methodology that documents, in visual form, a construct of the local environment in which people live and work. We adapted this method to provide detailed data about study locales to inform recruitment and retention strategies for HIV prevention community based clinical trials. METHODS: Four cognitive mapping studies were undertaken between 2005 and 2010, in and around Johannesburg in Orange Farm, and Hillbrow. Participants included members of clinical trial Community Advisory Boards (CAB), young people recruited from schools in Hillbrow and an organization for out of school youth, and men recruited from a database of men in the community interested in taking part in research. These groups participated in reconnaissance walks and in depth interviews, and drew detailed sketch maps. RESULTS: The cognitive maps defined the physical boundaries of the research locales, provided insights into their social histories, and identified important characteristics of the population such as movement, social and sexual networks, ethnic and other divisions. Important differences between the official cartographic maps and the cognitive maps were raised. The mapping data was applied by identifying key areas for recruitment that recruitment staff members were less familiar with and that may otherwise have been overlooked. CONCLUSIONS: Cognitive mapping is an effective, rapid and low cost method that can be used to inform recruitment and retention strategies.

Editorial decisions may perpetuate belief in invalid research findings.
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Eriksson K, Simpson B.
PloS one 2013 Sep 4;8(9):e73364

Social psychology and related disciplines are seeing a resurgence of interest in replication, as well as actual replication efforts. But prior work suggests that even a clear demonstration that a finding is invalid often fails to shake acceptance of the finding. This threatens the full impact of these replication efforts. Here we show that the actions of two key players – journal editors and the authors of original (invalidated) research findings – are critical to the broader public’s continued belief in an invalidated research conclusion. Across three experiments, we show that belief in an invalidated finding falls sharply when a critical failed replication is published in the same – versus different – journal as the original finding, and when the authors of the original finding acknowledge that the new findings invalidate their conclusions. We conclude by discussing policy implications of our key findings.

Making sense of complex data: a mapping process for analyzing findings of a realist review on guideline implementability.
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Kastner M, Makarski J, Hayden L, Durocher L, Chatterjee A, Brouwers M, et al.
BMC medical research methodology 2013 Sep 12;13(1):112

The objective of this paper is to describe the development of an analytic process to organize and synthesize data from a realist review. METHODS: Clinical practice guidelines have had an inconsistent and modest impact on clinical practice, which may in part be due to limitations in their design. This study illustrates the development of a transparent method for organizing and analyzing a complex data set informed by a Realist Review on guideline implementability to better understand the characteristics of guidelines that affect their uptake in practice (e.g., clarity, format). The data organization method consisted of 4 levels of refinement: 1) extraction and 2) organization of data; 3) creation of a conceptual map of guideline implementability; and 4) the development of a codebook of definitions. RESULTS: This new method is comprised of four steps: data extraction, data organization, development of a conceptual map, and operationalization vis-a-vis a codebook. Applying this method, we extracted 1736 guideline attributes from 278 articles into a consensus-based set of categories, and collapsed them into 5 core conceptual domains for our guideline implementability map: Language, Format, Rigor of development, Feasibility, Decision-making.

The Current State of the Canadian Research Enterprise: Review and Data Analysis Canada-flat-icon
Nova Scotia Health Research Foundation, 2013

It is the intent of this report to provide a comprehensive overview of the national research enterprise, particularly health research in Canada.

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Health Care in Canada

BC Ministry of Health: Health Authority Investment of Revised Residential Care Client Rate Revenue Canada-flat-icon
May 2013

This report summarizes where the extra fees charged to clients required to stay longer-term in our acute care hospitals were re-invested. Highlights of the report:
-76% Of Investments Directed To Contracted Service Providers. Contracted facilities provided almost two thirds (64 percent) of the resident care days in BC.
-Increase in Direct Care and Allied Health Care Worked Hours and FTEs.In 2011/12, there were a total of 28.15 million direct care and allied health care worked hours across BC. This represents an additional 2.08 million worked hours compared to 2009/10.

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Systematic review: effective characteristics of nursing homes and other residential long-term care settings for people with dementia.
Non UofA Access
Zimmerman S, Anderson WL, Brode S, Jonas D, Lux L, Beeber AS, et al.
Journal of the American Geriatrics Society 2013 Aug;61(8):1399-1409

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. 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. © 2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society.

Factors with the management of incontinence and promotion of continence in older people in care homes.
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Flanagan L, Roe B, Jack B, Shaw C, Williams KS, Chung A, et al.
Journal of advanced nursing 2013 Jul 25

AIM: Review of intervention studies of associated factors with incontinence as the primary outcome in older people in care homes to identify and inform practice and future research. RESULTS: Nine studies identified relating to associated factors with the management of incontinence in care homes. Factors included economic data, skin care, exercise studies, staff quality and prompted voiding adherence and the promotion of continence by the management of dehydration and incontinence. CONCLUSION: Managing incontinence and promoting continence in care homes is complex, requiring time and cost-efficient management procedures to contain the problem and deliver quality, achievable care. When developing and designing systems of care in care homes, it is important to also recognize the impact of associated factors. As with any healthcare intervention programme, resources are required to implement the protocols. Economic evaluation studies are limited, with further studies warranted alongside preventative studies to maintain long-term continence in these populations. © 2013 John Wiley & Sons Ltd.

Potentially Avoidable Hospitalizations for Elderly Long-stay Residents in Nursing Homes.
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Spector WD, Limcangco R, Williams C, Rhodes W, Hurd D.
Medical care 2013 Aug;51(8):673-681

To determine the relationship between clinical risk factors, facility characteristics and State policy variables, and both avoidable and unavoidable hospitalizations of long-stay nursing home residents. METHOD: Hospitalization risk is estimated using competing risks proportional hazards regressions. Three hospitalization measures were constructed: (1) ambulatory care-sensitive conditions (ACSCs); (2) additional NH-sensitive avoidable conditions (ANHACs); and (3) nursing home “unavoidable” conditions (NHUCs). In all models, we include clinical risk factors, facility characteristics, and State policy variables that may influence the decision to hospitalize. RESULTS: Three fifths of hospitalizations were potentially avoidable and the majority was for infections, injuries, and congestive heart failure. Clinical risk factors include renal disease, diabetes, and a high number of medications among others. Staffing, quality, and reimbursement affect avoidable, but not unavoidable hospitalizations. CONCLUSIONS: A NH-sensitive measure of avoidable hospitalizations identifies both clinical facility and policy risk factors, emphasizing the potential for both reimbursement and clinical strategies to reduce hospitalizations from NHs.

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

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.

Quantitative analysis of formal caregivers’ use of communication strategies while assisting individuals with moderate and severe Alzheimer’s disease during oral care. Canada-flat-icon
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Wilson R, Rochon E, Mihailidis A, Leonard C.
Journal of communication disorders 2013 May-Jun;46(3):249-263

This cross-sectional observational study examined formal caregivers’ use of task-focused and social communication strategies while assisting individuals with moderate and severe Alzheimer’s disease residing in a long-term care facility during a basic activity of daily living: toothbrushing. Thirteen formal caregiver-resident dyads were observed during a total of 78 separate toothbrushing sessions. All caregiver utterances occurring during the task were transcribed and coded for type of communication strategy. Overall, the majority of residents, irrespective of disease severity, successfully completed toothbrushing with the support of caregiver assistance. Caregivers assisting residents with moderate and severe AD were found to use a variety of communication strategies, with task-focused strategies accounting for the majority of use. For the most part, the communicative strategies employed did not differ across disease severity. However, some differences were identified including the use of one proposition, paraphrased repetition, using the resident’s name, and provision of full assistance, with these strategies being used more often when assisting individuals with severe AD. This study adds to the emerging literature supporting the use of specific communication strategies while assisting residents with AD during the completion of daily tasks. Copyright © 2013 Elsevier Inc. All rights reserved.

Influence of individual and contextual characteristics on the provision of individualized care in long-term care facilities. Canada-flat-icon
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Caspar S, Cooke HA, O’Rourke N, Macdonald SW.
The Gerontologist 2013 Oct;53(5):790-80

PURPOSE: Previous research examining improved provision of individualized care (I-Care) in long-term care (LTC) facilities has primarily considered contextual influences. Using Kanter’s theory of structural empowerment, this study explored the relationship among contextual-level characteristics, individual-level characteristics, and access to empowerment structures on LTC staffs’ perceived ability to provide I-Care. Methods: Multilevel models were used to examine 567 staffs’ (registered nurse [RN], licensed practical nurses [LPN], care aides) reported ability to provide I-Care, nested within 41 LTC facilities. I-Care was first modeled as a function of within-person (e.g., age, job classification, experience) and between-context (e.g., facility ownership status, culture change models) variables. Independent of these predictors, we then assessed the influence of staffs’ access to empowerment structures (information, support, opportunities, resources, informal power, and formal power) on reported ability to provide I-Care. RESULTS: The intraclass correlation coefficient indicated that 91.7% of the total variance in perceived ability to provide I-Care reflected within- versus between-person differences, with the 6 empowerment variables accounting for 31% of this within-person variance independent of the other context- and person-level covariates. In the final model, only informal power (i.e., quality of interprofessional relationships) and resources (i.e., adequate time and supplies) uniquely predicted I-Care. Notably, access to resources also attenuated the significant effect of support, suggesting a possible mediating effect. IMPLICATIONS: These findings suggest that both contextual- and individual-level factors exert considerably less influence on I-Care than factors associated to staffs’ perceptions of empowerment. Consequently, interventions aimed at increasing I-Care in LTC settings should carefully consider staffs’ access to structural empowerment.

Nursing Home Quality: A Comparative Analysis Using CMS Nursing Home Compare Data to Examine Differences Between Rural and Nonrural Facilities.
Non UofA Access
Lutfiyya MN, Gessert CE, Lipsky MS.
Journal of the American Medical Directors Association 2013 Aug;14(8):593-598

The purpose of this study was to compare the quality of rural and nonrural nursing homes by using aggregated rankings on multiple quality measures calculated by the Centers for Medicare and Medicaid Services and reported on their Nursing Home Compare Web site. METHODS: Independent-sample t tests were performed to compare the mean ratings on the reported quality measures of rural and nonrural nursing homes. A linear mixed binary logistic regression model controlling for state was performed to determine if the covariates of ownership, number of beds, and geographic locale were associated with a higher overall quality rating. RESULTS: Of the 15,177 nursing homes included in the study sample, 69.2% were located in nonrural areas and 30.8% in rural areas. The t test analysis comparing the overall, health inspection, staffing, and quality measure ratings of rural and nonrural nursing homes yielded statistically significant results for 3 measures, 2 of which (overall ratings and health inspections) favored rural nursing homes. Although a higher percentage of nursing homes (44.8%-42.2%) received a 4-star or higher rating, regression analysis using an overall rating of 4 stars or higher as the dependent variable revealed that when controlling for state and adjusting for size and ownership, rural nursing homes were less likely to have a 4-star or higher rating when compared with nonrural nursing homes (OR = .901, 95% CI 0.824-0.986). CONCLUSIONS: Mixed model logistic regression analysis suggested that rural nursing home quality was not comparable to that of nonrural nursing homes. When controlling for state and adjusting for nursing home size and ownership, rural nursing homes were not as likely to earn a 4-or higher star quality rating as nonrural nursing homes. Copyright © 2013 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.

Process Evaluation of a Multicomponent Intervention Program (EXBELT) to Reduce Belt Restraints in Nursing Homes.
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Bleijlevens MH, Gulpers MJ, Capezuti E, van Rossum E, Hamers JP.
Journal of the American Medical Directors Association 2013 Aug;14(8):599-604

OBJECTIVE: The current study describes the process evaluation of a multicomponent intervention program (Expelling Belts [EXBELT]) to reduce the use of belt restraints in psychogeriatric nursing homes. The aim was to assess the feasibility and ascertain suggestions for optimization of the EXBELT program. DESIGN: A descriptive study comprising longitudinal elements. SETTING: Fifteen psychogeriatric nursing home wards in 6 Dutch nursing homes. PARTICIPANTS: The study population consisted of 4 different groups of participants who took part in the intervention arm of the quasi-experimental study examining the effectiveness of EXBELT: nursing home staff who attended the final session of the educational program; 2 nurse specialists who delivered the educational program and did the consultations; 4 groups of delegates representing the nursing home associations where the EXBELT program was implemented; and the relatives of those residents in the intervention group who were restrained with a belt at the start of the study. RESULTS: The EXBELT study was largely performed according to protocol and very well received by nursing home staff as well as resident’s relatives. Suggestions to improve the EXBELT program include the addition of examples of how to communicate about the policy change, improving the reach of the intended target population, adding more case-based learning strategies, and embedding the available consultants more proactively. CONCLUSIONS: The implementation of EXBELT was highly successful in the current research population and is likely to be feasible in psychogeriatric nursing homes in general. Copyright © 2013 American Medical Directors Association, Inc. All rights reserved.

The Role of Physical Environment in Supporting Person-centered Dining in Long-Term Care: A Review of the Literature. Canada-flat-icon
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Chaudhury H, Hung L, Badger M.
American Journal of Alzheimer’s Disease and Other Dementias 2013 Aug;28(5):491-500

The physical environment of dining rooms in long-term care facilities is increasingly recognized as an important catalyst in implementing a culture based on person-centered care philosophy. Mealtimes are important opportunities to support residents’ personhood in care facilities. This article presents a critical review of the literature on evidence-based physical environmental interventions and examines their implications for creating a more person-centered dining environment, specifically for residents with dementia. The review identifies the role of a supportive dining environment to foster: a) functional ability, b) orientation, c) safety and security, d) familiarity and home-likeness, e) optimal sensory stimulation, f) social interaction, and g) privacy and personal control. It is clear from this review that there is a growing body of research to support the importance of certain physical environmental features in the dining context that can foster positive resident outcomes. The evidence indicates that well-designed physical settings play an important role in creating a person-centered dining environment to support best possible mealtime experience of residents. Gaps in the literature and directions for future research are discussed.

Effect of urinary incontinence on older nursing home residents’ self-reported quality of life.
Non UofA Access
Xu D, Kane RL.
Journal of the American Geriatrics Society 2013 Sep;61(9):1473-1481

OBJECTIVES: To evaluate the effect of urinary incontinence (UI) on elderly nursing home (NH) residents’ self-reported quality of life (QOL), especially on the specific QOL domains most closely associated with UI. DESIGN: Retrospective cross-sectional study using the Minimum Data Set (MDS) and Minnesota Nursing Home Report Card data in 2010 to compare overall QOL and its domains of residents with and without UI using propensity scores and inverse probability weighting (IPW) adjustments to reduce selection bias. SETTING: All Medicare- or Medicaid-licensed NHs in Minnesota. PARTICIPANTS: All residents aged 65 and older except those with conditions that could readily overwhelm the effect of UI on QOL, such as coma and cerebral palsy. MEASUREMENTS: Urinary incontinence (UI) was defined as leakage two or more times a week (score ≥2 on MDS 5-point scale), and continence was defined as continent or usually continent (score 0 or 1 on MDS 5-point scale). QOL was assessed using a self-reported QOL questionnaire that measured general QOL, not QOL specific to UI symptoms. RESULTS: Urinary incontinence (UI) prevalence was 65.8% in 10,683 older NH residents. Self-reported QOL was good (>0.7 on a scale from 0 to 1) in 8,620 eligible residents in 371 NHs. Mood and meaningful activity domains had lower scores; dignity had the highest score. UI was associated with being older and female, ADL dependence, impaired cognitive ability, Alzheimer’s disease, non-Alzheimer’s dementia, bowel incontinence, diabetes mellitus, and long-term NH stay. Bivariate analysis found that residents with UI had lower QOL than those without. Using IPW to reduce selection bias, it was found that, although UI was not associated with overall QOL, it decreased the QOL domains of dignity, autonomy, and mood. CONCLUSION: To improve the QOL of residents with UI, attention should be paid to dignity, autonomy, and mood. © 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 Aug;61(8):1377-1386

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.

Profiles of Older Patients in the Emergency Department: Findings From the interRAI Multinational Emergency Department Study.
Non UofA Access
Gray LC, Peel NM, Costa AP, Burkett E, Dey AB, Jonsson PV, et al.
Annals of Emergency Medicine 2013 Jun 14

STUDY OBJECTIVE: We examine functional profiles and presence of geriatric syndromes among older patients attending 13 emergency departments (EDs) in 7 nations. METHODS: This was a prospective observational study of a convenience sample of patients, aged 75 years and older, recruited sequentially and mainly during normal working hours. Clinical observations were drawn from the interRAI Emergency Department Screener, with assessments performed by trained nurses. RESULTS: A sample of 2,282 patients (range 98 to 549 patients across nations) was recruited. Before becoming unwell, 46% were dependent on others in one or more aspects of personal activities of daily living. This proportion increased to 67% at presentation to the ED. In the ED, 26% exhibited evidence of cognitive impairment, and 49% could not walk without supervision. Recent falls were common (37%). Overall, at least 48% had a geriatric syndrome before becoming unwell, increasing to 78% at presentation to the ED. This pattern was consistent across nations. Copyright © 2013. Published by Mosby, Inc.

First Evidence on the Validity and Reliability of the Safety Organizing Scale-Nursing Home Version (SOS-NH).
Non UofA Access
Ausserhofer D, Anderson RA, Colon-Emeric C, Schwendimann R.
Journal of the American Medical Directors Association 2013 Aug;14(8):616-622

This study aimed to explore the psychometric properties of the Safety Organizing Scale-Nursing Home version (SOS-NH). DESIGN AND METHODS: In a cross-sectional analysis of staff survey data, we examined validity and reliability of the 9-item Safety SOS-NH using American Educational Research Association guidelines. SUBJECTS AND SETTING: This substudy of a larger trial used baseline survey data collected from staff members (n = 627) in a variety of work roles in 13 nursing homes (NHs) in North Carolina and Virginia. RESULTS: Psychometric evaluation of the SOS-NH revealed good response patterns with low average of missing values across all items (3.05%). Analyses of the SOS-NH’s internal structure (eg, comparative fit indices = 0.929, standardized root mean square error of approximation = 0.045) and consistency (composite reliability = 0.94) suggested its 1-dimensionality. Significant between-facility variability, intraclass correlations, within-group agreement, and design effect confirmed appropriateness of the SOS-NH for measurement at the NH level, justifying data aggregation. The SOS-NH showed discriminate validity from one related concept: communication openness. IMPLICATIONS: Initial evidence regarding validity and reliability of the SOS-NH supports its utility in measuring safety behaviors and practices among a wide range of NH staff members, including those with low literacy. Copyright © 2013 American Medical Directors Association, Inc. All rights reserved.

Family caregiving at the intersection of private care by migrant home care workers and public care by nursing staff.
Non UofA Access
Ayalon L, Halevy-Levin S, Ben-Yizhak Z, Friedman G.
International psychogeriatrics / IPA 2013 Sep;25(9):1463-1473

BACKGROUND: This study evaluated private family caregiving at the intersection of private migrant home care and public nursing care on the hospitalization of an older patient. METHODS: Seventy-three individuals were interviewed, including older hospitalized patients, their family members, accompanying migrant home care workers, and nursing personnel. RESULTS: There was no clear consensus concerning the role of family members. Although family members emphasized care management as their main role, the other three groups emphasized that the family members’ mere physical presence was their main role. All four groups identified potential barriers to family caregiving, rather than motives for family caregiving, hence pointing to a potential discrepancy between expected and performed family caregiving roles.

Adverse Events Associated with Hospitalization or Detected through the RAI-HC Assessment among Canadian Home Care Clients. Canada-flat-icon
Non UofA Access
Doran D, Hirdes JP, Blais R, Baker GR, Poss JW, Li X, et al.
Healthcare policy = Politiques de sante 2013 Aug;9(1):76-88

The purpose of this Canadian study was to investigate adverse events (AEs) in home care (HC), specifically those associated with hospitalization or detected through the Resident Assessment Instrument for Home Care (RAI-HC). Method:A retrospective cohort design was used. The cohort consisted of HC clients from the provinces of Nova Scotia, Ontario, British Columbia and the Winnipeg Regional Health Authority. Results:The overall incidence rate of AEs associated with hospitalization ranged from 6% to 9%. The incidence rate of AEs determined from the RAI-HC was 4%. Injurious falls, injuries from other than fall and medication-related events were the most frequent AEs associated with hospitalization, whereas new caregiver distress was the most frequent AE identified through the RAI-HC. Conclusion: The incidence of AEs from all sources of data ranged from 4% to 9%. Copyright © 2013 Longwoods Publishing.

Needs of People With Dementia in Long-Term Care: A Systematic Review. Canada-flat-icon
Non UofA Access
Cadieux MA, Garcia LJ, Patrick J.
American Journal of Alzheimer’s Disease and Other Dementias 2013 Sep 4

The aim of this study is to determine, using the best evidence possible, the care needs of people with dementia (PWD) living in long-term care (LTC). A total of 68 studies, published between January 2000 and September 2010, were identified from six databases. From the selected studies, 19 needs of PWD were identified. The existing evidence suggests that psychosocial needs such as the need to engage in daily individualized activities and care must not be ignored in LTC. This review aims to provide a clearer picture of the needs of this growing patient population.

Association Between Proportion of Provider Clinical Effort in Nursing Homes and Potentially Avoidable Hospitalizations and Medical Costs of Nursing Home Residents.
Non UofA Access
Kuo YF, Raji MA, Goodwin JS.
Journal of the American Geriatrics Society 2013 Sep 3

OBJECTIVES: To assess potential avoidable hospitalizations of nursing home (NH) residents as a function of the percentage of clinical effort their primary care provider (PCP) devotes to NH practice. DESIGN: Retrospective cohort study. SETTING: NHs in Texas. PARTICIPANTS: Residents newly admitted to long-term NHs in 2006 to 2008 were identified by linking the Minimum Data Set to 100% Texas Medicare claims data (N = 12,249). MEASUREMENTS: The care that residents received over successive 6-month periods was measured as a time-dependent covariate. Potentially avoidable hospitalizations and Medicare costs were assessed over 6 to 48 months. RESULTS: Seventy percent of NH residents had a physician as their major PCP, 25% had an advance practice nurse (APN), and 5% had a physician assistant (PA). Physician PCPs who derived less than 20% of their Medicare billings from NH residents cared for 36% of all NH residents. Most NH residents with APN or PA PCPs had providers with 85% or more of Medicare billings generated in NHs. Residents with PCPs who devoted less than 5% of their clinical effort to NH care were at 52% higher risk of potentially avoidable hospitalization than those whose PCPs devoted 85% or more of their clinical effort to NHs (hazard ratio = 1.52, 95% confidence interval = 1.25-1.83) and had $2,179 higher annual Medicare spending, controlling for PCP discipline.

Prevalence and correlates of potentially undetected dementia among residents of institutional care facilities in Ontario, Canada, 2009-2011. Canada-flat-icon
Non UofA Access
Bartfay E, Bartfay WJ, Gorey KM.
International journal of geriatric psychiatry 2013 Oct;28(10):1086-1094

This study aims to determine the prevalence of potentially undetected dementia among institutional care facility residents in Ontario, Canada, and to identify factors associated with undetection. METHODS: We utilized a population-based secondary data analysis approach, pertaining to data from the Canadian Institute for Health Information’s Continuing Care Reporting System, 2009-2011. Potentially undetected dementia was defined as having severely impaired cognitive function and requiring extensive assistance on activity of daily living (ADL) but no records of dementia diagnoses. Cognitive function was measured by the Cognitive Performance Scale (CPS), 0 (intact) to 6 (very severe impairment), and ADL by a hierarchy scale, 0 (independent) to 6 (total dependence). RESULTS: Of the 242,957 residents who had no records of dementia diagnoses, 11.6% (n = 28,078) had a CPS score ≥4 (severe impairment or higher) and ADL score ≥3 (required extensive assistance or more). Data from 11,614 demented residents with corresponding CPS and ADL scores were used for comparison. Residents without dementia diagnosis were younger (77 vs. 84 years), more likely to have never married (20% vs. 6%), and have longer admission (4 vs. 2.8 years). The most significant factors for no diagnoses were never married (adjusted odds ratio = 2.1, 95% confidence interval [CI] = 1.91-2.29), admitted to hospital-based facilities (adjusted odds ratio = 1.58, 95% CI = 1.48-1.69), presence of schizophrenia (adjusted odds ratio = 1.43, 95% CI = 1.22-1.69), depression (adjusted odds ratio = 1.23, 95% CI = 1.16-1.29), and diabetes mellitus (adjusted odds ratio = 1.32, 95% CI = 1.26-1.40). CONCLUSIONS: A large number of residents who had poor cognitive function and inadequate ADL ability did not have dementia diagnoses on record. Social and comorbid conditions were contributing factors to potentially undetected dementia. Copyright © 2013 John Wiley & Sons, Ltd..

AARP: Home Alone Family Caregivers Providing Complex Chronic Care

Family caregivers have traditionally provided assistance with bathing, dressing, eating, and household tasks such as shopping and managing finances. While these remain critically important to the well-being of care recipients, the role of family caregivers has dramatically expanded to include performing medical/nursing tasks of the kind and complexity once provided only in hospitals.

StatsCan: Caregivers in Canada, 2012 Canada-flat-icon

In 2012, about 8.1 million individuals, or 28% of Canadians aged 15 years and older, provided care to a family member or friend with a long-term health condition, disability or aging needs. New data from the 2012 General Social Survey showed that women represented the slight majority of caregivers at 54%. The survey also found that caregiving responsibilities most often fell to those aged 45 to 64, with 44% of caregivers in this age category. Ailing parents were the most common recipients of care, with 39% of caregivers looking after the needs of their own parents and another 9% doing so for their parents-in-law. The least common were spouses, at 8%, and children, at 5%. For the first time, the survey looked at the types of health conditions requiring care. Age-related needs topped the list, with 28% of caregivers providing care for these needs. Cancer was next at 11%, followed by cardio-vascular disease at 9%, and mental illness at 7%.

CIHI: Compromised Wounds in Canada

Wounds are a serious health care issue with profound personal, clinical and economic implications. Compromised Wounds in Canada explores the prevalence of “compromised” wounds in 2011-2012 in Canadian health care settings. Compromised wounds include chronic wounds (such as pressure ulcers or “bedsores,” gangrene and leg ulcers), skin barrier breaches, and surgical wounds that are not healing as expected.

Pilot Project for the Development of a Community Needs Driven Research Network for Continuing Care in Alberta Canada-flat-icon
Institute for Continuing Care Education and Research (ICCER), 2013

In 2012, the Institute for Continuing Care Education and Research (ICCER) conducted a process across Alberta to identify priority themes and issues facing front-line workers in the continuing care sector. In June, ICCER released findings that will help researchers focus on areas of greatest importance to front-line continuing care workers and, where research has already been done, apply research results in practice.

OECD: A Good Life in Old Age? Monitoring and Improving Quality in Long-term Care

As ageing societies are pushing a growing number of frail old people into needing care, delivering quality long-term care services – care that is safe, effective, and responsive to needs – has become a priority for governments. Yet much still remains to be done to enhance evidence-based measurement and improvement of quality of long-term care services across EU and OECD countries. This book offers evidence and examples of useful experiences to help policy makers, providers and experts measure and improve the quality of long-term care services.

United Hospital Fund: New York’s nursing homes : shifting roles and new challenges

This report from the Medicaid Institute at United Hospital Fund examines nursing home trends in New York, noting that nursing homes have evolved since the ‘90s from primarily providing residential care for seniors to focusing on both post-acute services and long-term care today. The report projects that nursing homes are entering a new phase, characterized by greater integration with other components of the health care and long-term care delivery systems and by changing financial models.

Some notes on how to catch a red herring : ageing, time-to-death & care costs for older people in Sweden
Technische Universität Darmstadt, 2011

In this paper we test the ‘red herring’ hypothesis for expenditures on long-term care. The main contribution of this paper is that we assess the ‘red herring’ hypothesis using an aggregated measure that allows us to control for entering the final period of life on the individual level. In addition we implement a model that allows for age specific time-to-death (TTD) effects on Long Term Care. We also account for the problem that mortality, and therefore TTD, are themselves influenced by care expenditure. For our analysis we use administrative data from the Swedish statistical office.

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Non UofA

The 2nd Annual CASRAI International Conference
Ottawa, ON 16-18 October 2013

This conference focuses on this dimension of research: the role of research administration practices and information sharing in supporting knowledge discoveries and innovations. Session topics and presentations will primarily be concerned with the ways in which incorporating recent developments in research data management can lead to a better and more connected research and innovation ecosystem.

Canadian Association for Health Services and Policy Research (CAHSPR) Annual Meeting & Conference
13-15 May 2014, Toronto ON

CAHSPR’s annual conference is Canada’s largest gathering of health care researchers, decision makers, and stakeholders. Held at a different location every year, it is attended by 600+ delegates annually. Conference abstract call is forthcoming.

IHE& AIHS: Going Public: Engaging the Citizen in Health Research and Innovation
Wednesday 16 October 2013 07:30-09:00 Westin Edmonton, AB

The speaker, Simon Denegri, is the chair of INVOLVE-the national advisory group for the promotion and support of pubilc involvement in research funded by the UK’s National Institute for Health Research.


CFHI Webinar: Who needs to be engaged? The staff, patient and leadership trilogy
Wednesday 2 October 2013 10:30-12:00 (MT)

This webinar focuses on key considerations for staff, patients and leaders in making patient and family involvement a ‘way of life’ for healthcare organizations. This shift in culture takes time, strategies, resources—human, financial and educational—and must acknowledge the value of building collaborative and trusting relationships among staff and with patients and their families.

CFHI Webinar: Making Data Matter: Real-time Measurement for Healthcare Improvement
Wednesday 10 October 2013 10:00-11:00 (MT)

This interactive session focuses on using real-time data for quality improvement in healthcare.

Canada’s Virtual Forum on Patient Safety & Quality Improvement
28 October-1 November 2013 10:00-14:00 each day Free

If you’ve yet to experience it for yourself, Canada’s Virtual Forum is 20 hours of live presentations and panel discussions delivered by leaders and experts in healthcare and patient safety streamed online throughout the week. All you need to take part is a computer and an Internet connection. During the broadcast, you’ll have the opportunity to submit your questions and have them answered live on air.

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KT Canada: Psychological Theory In Knowledge Translation
Instructors: Drs. Jamie C. Brehaut and Jeremy Grimshaw
25-27 November 2013

The objectives of the course are to:
– Explore the role theory currently plays in KT science and practice
– Focus on theories and concepts from social and cognitive psychology, and learn how they may
inform KT science and practice
– Consider methods for applying theory to KT science and practice
To register contact Vanessa Lybanon-Daigle”

IWH: Fall 2013 Systematic Review Workshop
27-29 November 2013 Toronto ON Cost: $1500/$500 (student rate)
DEADLINE for registration: 13 November 2013

The systematic review workshops offered by the Institute for Work & Health are designed to teach participants how to plan, conduct and communicate the results of a systematic review.


University of Sheffield: Health Technology Assessment MOOC
28 October 2013-1 December 2013

Our FREE Health Technology Assessment MOOC (massive open online course) introduces you to Health Technology Assessment (HTA) as a concept (what it is, what it involves) and then takes you through the key stages in the HTA and decision-making process:
-Identifying technologies for development;
-Evaluating these technologies in trials and measuring key outcomes, such as Quality of Life (health economics)
-Appraising and pooling the evidence from these trials to determine the effect of a technology (clinical effectiveness review)
-Assessing the cost-effectiveness of those technologies (decision-analytic modelling)
-Considering how the results from this HTA process are used to inform reimbursement and pricing decisions in different countries

NICHE Webinar: The KATZ INDEX: What Can It Do for You?
25 September 2013 11:00 MT Costs $99 non-NICHE site Free NICHE site

Nurses need a tool to measure a patient’s baseline functional status and track it from initial admission, and from shift-to-shift to monitor/prevent functional decline. The KATZ INDEX is that tool. Bayshore Community Hospital incorporated the Katz Index into their charting system to assess patients’ functional status. Learn how the KATZ INDEX was implemented and the results in this important presentation.

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PBS Frontline: Life and Death in Assisted Living

As more and more elderly Americans choose to spend their later years in assisted living facilities, FRONTLINE and ProPublica examine whether this loosely regulated, multi-billion dollar industry is putting seniors at risk? You should be able to watch this episode online. If it doens’t work, there’s also an article summarizing the show.

Alberta Innovates Health Solutions: Streamlining Health Research Ethics in Alberta Canada-flat-icon

For more information about how this being done, please click on the link.

Do fewer hospital staff on weekends puts some patients at risk Canada-flat-icon

It is understandable that health care professionals do not wish work over the weekend, but evidence points to a concerning “weekend effect” at hospitals: a small but meaningful increased risk of death associated with a hospital stay on a weekend versus a weekday. Is it time for hospitals to start staffing at the same level all week?

Would you trust a doctor in a T-shirt?

A senior British doctor has complained that junior members of her profession are getting too scruffy. But since doctors are valued for their skill and knowledge does it really matter what they wear?

In a Culture of Disrespect, Patients Lose Out

In this newspaper article, a physician describes the pervasive issue of disrespect in health care, its connection to patient safety, and clinicians’ responsibility to model respectful behavior.

Immigrant Struggles Compounded by Old Age

Besides being one of the fastest-growing demographic groups in NYC, older immigrants are also among the most vulnerable.

Who will care for Canada’s seniors? Canada-flat-icon

Our health care system faces a disturbing paradox. While seniors represent the fastest growing age group in Canada, the country faces a growing deficiency of specialist physicians with expertise in caring for the elderly. But with seniors accounting for nearly half of all the country’s hospitalizations and visiting their family physician twice as often as younger patients, almost all health care professionals will require competency in care of the older adult.

An Arizona nursing home offers new ways to care for people with dementia.

Without any immediate prospect of a cure for dementia this article outlines care strategies that advocate for comfortable decline instead of imposing a medical model of care.

Musical beds between nursing homes inhumane, families say Canada-flat-icon

Quebec’s Program 68 means seniors face up to three moves before permanent placement

Staff develops Indicative Design for new Swift Current long-term care facility Canada-flat-icon

Cypress Health Region employees took the lead in forming ideas and helping develop the design and concept for Swift Current’s new long-term care facility.

Front-line faltering in Alzheimer’s battle Canada-flat-icon

Tired of waiting for governments to respond to the rising tide of dementia, the Alzheimer Society stepped into the breach.

Netflix launches a 7 episode series set in a nursing home today

Ricky Gervais created and stars in this heartwarming comedy-drama series as a loyal English nursing home caretaker who sees only the good in everyone.

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Knowledge Translation for Employment Research Center Database

This database features articles addressing interventions that lead to successful employment outcomes. Users may sort entries by disability type, population, types of interventions, and more. KTER staff at Virginia Commonwealth University created this database.

Knowledge Translation Strategies Database

This database associates KT strategies with research evidence. Articles cover multiple types of KT strategies and tools.

Eliminating Catheter-Associated Urinary Tract Infections

This guide describes a three-step action plan from the On the CUSP: Stop CAUTI project that helps hospitals and care systems achieve and sustain reductions in CAUTI infection rates.

A guide for HCAs on safe patient transfers.

This commentary offers practical advice for health care assistants to reduce risks during patient transfers.

AHRQ: Toolkit for Modifying Evidence-Based Practices To Increase Cultural Competence

The Toolkit for Modifying Evidence-Based Practices To Increase Cultural Competence provides a step-by-step methodology for mental health practitioners and agency administrators to identify and evaluate evidence-based practices (EBPs) for possible modification for cultural groups.

Statistics for Systematic Review Authors
Non UofA Access

The role of statistics in the systematic review process is extremely important. For healthcare providers and researchers completing a systematic review, this book will teach you how to use the proper statistical method to determine the odds ratio, risk differential and other crucial measurements to verify the validity and applicability of your systematic review.

QI Gateway: Quality Improvement for Residents

QI Gateway is a clearinghouse geared specifically for resident physicians where they can learn about ongoing safety and quality improvement issues that are common to teaching hospitals, access quality improvement literature, tools, and other resources, and communicate directly with colleagues engaged in this work.

Handbook of organizational creativity
Non UofA Access

Handbook of Organizational Creativity is designed to explain creativity and innovation in organizations. This handbook contains 28 chapters dedicated to particularly complex phenomena, all written by leading experts in the field of organizational creativity. The format of the book follows the multi-level structure of creativity in organizations where creativity takes place at the individual level, the group level, and the organizational level. Beyond just theoretical frameworks, applications and interventions are also emphasized.

Reach Effectiveness Adoption Implementation Maintenance (RE-AIM)

This website provides a model for the planning, evaluation, reporting and review of translational research and practice. The site’s Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework is designed to enhance the quality, speed, and public health impact of translational efforts. The website features tools and resources to facilitate implementation, along with a comprehensive list of RE-AIM publications and presentations.

Understanding Research: A Guide for Primary Health Care Nurses

This guide from the Australian Practice Nurses Association consists of 10 modules that provide a general overview of different aspects of the research process and provide basic tools for introductory research.

Communication and Mealtimes Toolkit: Helping People with Dementia to Eat, Drink, & Communicate

The Communication and Mealtimes Toolkit is a guide for caregivers and long-term care professionals on creating a person-centered care approach to communication and mealtime for persons with dementia. The toolkit looks at issues that arise on a daily basis and gives straightforward and practical advice to caregivers wanting solutions to these common problems.

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Professor/Associate Professor of Nursing
Faculty of Nursing and Midwifery, Charles Perkins Centre, University of Sydney
DEADLINE: 13 October 2013

As Professor/Associate Professor of Nursing at the Charles Perkins Centre you will have leadership and representational responsibilities in forming, developing and maintaining links between the faculty and the Charles Perkins Centre by leading research in chronic diseases, specifically obesity, diabetes or cardiovascular disease. Applications from candidates with expertise in any of these areas, or related areas, are welcome.

Term Faculty/Senior Health Policy Adviser
Department of Health Administration and Policy, George Mason University, Fairfax, Virginia
DEADLINE: 29 September 2013

The Department of Health Administration and Policy (HAP) in the College of Health and Human Services of George Mason University invites applications for a full-time, term faculty position (Senior Health Policy Adviser). Applicants must have a background in U.S. health policy, international health systems, or health services research. Rank and salary will be commensurate with qualifications and experience.

Post Doctoral Fellow
Care and Construction: Assessing Differences in Nursing Home Models of Care on Resident Quality of Life
Mount Saint Vincent University, Halifax NS

The purpose of the Care and Construction: Assessing Differences in Nursing Home Models of Care on Resident Quality of Life research study is to examine different models of care, defined by physical design and staffing approach, in relation to resident quality of life within Nova Scotia nursing homes. The successful candidate will work closely with the Principal Investigator, Dr. Janice Keefe and her research
team primarily on knowledge translation and dissemination activities (manuscripts, presentations) and grant

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