October 7, 2013

New KUSP Publications
Grants & Awards

New KUSP Publications

A profile of residents in prairie nursing homes.
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Estabrooks CA, Poss JW, Squires JE, Teare GF, Morgan DG, Stewart N, et al.
Canadian journal on aging = La revue canadienne du vieillissement 2013 Sep;32(3):223-231.

Nursing homes have become complex care environments where residents have significant needs and most have age-related dementia. We describe a resident profile in a representative sample of 30 urban nursing homes in the prairie provinces using Resident Assessment Instrument – Minimum Data Set 2.0 data from 5,196 resident assessments completed between 1 October 2007 and 31 December 2011. Residents were chiefly over age 85, female, and with an age-related dementia. We compared facility support and related services and resident characteristics by province, owner-operator model, and number of facility units. We observed differences in support and related services by both unit count and province. We also found that public facilities tend to care for residents with more demanding characteristics: notably cognitive impairment, aggressive behaviours, and incontinence. No clear trends associating the number of units in a facility with resident characteristics were observed.

Report of a Pilot Study of Quality Improvement in Nursing Homes Led by Healthcare Aides
P Norton, L Cranley, G Cummings, C Estabrooks
European Journal for Person Centered Healthcare; 2013 1(1):255-64

Objective: Healthcare aides (unregulated care providers), who deliver the majority of direct care in Canadian nursing homes, have high levels of emotional exhaustion and cynicism. However, they also have remarkably high levels of job efficacy. Strategies to empower this workforce may reduce cynicism and draw on their high levels of job efficacy. The primary objective of this study was to act as proof-of-principle to determine whether quality improvement teams led by healthcare aides could be established in nursing homes and function on a daily basis. Methods: This study was a pilot test of a complex intervention using a mixed methods approach. We used a combination of education, networking and coaching to engage staff teams in quality improvement in 1 of 3 areas (pain control, skin care or behaviour management). We measured healthcare aides’ quality of work life, informal communication and research (best practice) use before and after the intervention. To understand the effect of quality of care at the bedside we used risk-adjusted quality indicators derived from Resident Assessment Instrument – Minimum Data Set 2.0 data. Results: A total of 10 teams participated in the intervention. At least 70% of the teams succeeded in learning and applying the improvement model and methods for local measurement. For 50% of the teams, data showed measurable improvement in the clinical areas. There were no significant differences between pre and post measures of survey variables. Conclusions: We have demonstrated the ability of healthcare aides to engage in quality improvement initiatives at the bedside in a collaborative environment and advance our results as an important contribution to person-centered healthcare.

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Book recommended by Dr. Carole Estabrooks
Troubling Care Critical Perspectives on Research and Practices Canada-flat-icon
Edited by Pat Armstrong and Susan Braedley

Using the example of residential services, Troubling Care: Critical Perspectives on Research and Practices investigates the fractures in our care systems and challenges how caring work is understood in social policy, in academic theory, and among health care providers. In this era defined by government cutbacks and a narrowing sense of collective responsibility, long-term residential care for the elderly and disabled is being undervalued and undermined.

New Report by Kim Fraser
Data for Improvement and Clinical Excellence
CFHI, 2013

Audit and feedback as a quality improvement mechanism has been shown to have modest effects. This study supports the evidence in this regard. Translating data into usable knowledge for quality improvement could lead to better client/resident outcomes. However, organizations are not equipped with resources, structures, or processes to do this in a timely or sustainable manner. This finding is not unique to Alberta. Increasing demands and quality requirements such as reporting mechanisms and accreditation processes tax resources available within organizations. However, using actual client-based indicators could help organizations to provide better care. While the data are available with the use of the standardized Resident Assessment Instrument in Long Term Care, Home Care, and Supportive Living, these data are not easily translated into knowledge that organizations can use to improve care.

Article recommended by Dr. Carole Estabrooks
Frailty: A time for action.
Morley JE.
European Geriatric Medicine

A recent consensus conference, which included experts from 6 international societies including the European Union of Geriatric Medicine Society, found that physical frailty is an important medical syndrome that can be prevented or treated and can be screened for with simple screening tests.

Article recommended by Dr. Carole Estabrooks
Delirium in the nursing home.
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Flaherty JH, Morley JE.
Journal of the American Medical Directors Association 2013 Sep;14(9):632-634.

This editorial calls for increased in early detection of delirium for nursing home residents.

CALL FOR ABSTRACTS: RIA: Walk with me: Changing the culture of aging in Canada
24-25 March 2013, Toronto ON
DEADLINE: Tuesday 15 October 2013

There are many exciting initiatives and projects underway in Canada that are shifting the culture of aging and long-term care in significant and positive ways. Walk with me: Changing the culture of aging in Canada aims to accelerate and give profile to this social movement by engaging researchers, educators, policy makers, older adults/residents and their families.

CALL FOR ABSTRACTS: Third Global Symposium on Health Systems Research
30 September-3 October 2014 Cape Town, South Africa

Abstracts covering any of the following are welcome for submission:
1. cutting-edge research around the dimension of people-centred health systems and how to strengthen them to promote greater responsiveness, better health, human rights and social justice;
2. innovative research approaches and measures for generating systematic and rigorous knowledge of, and engaging people in action towards, people-centred health systems;
3. novel strategies for developing the capacities needed to conduct people-centred health policy and systems research, covering formal teaching programmes and broader capacity-development initiatives;
4. original experience of learning communities and knowledge translation platforms engaged in strengthening health systems.

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Grants & Awards

AIHS: Knowledge-to-Action Grant
DEADLINE: 15 November 2013 16:00

The Alberta Innovates – Health Solution Knowledge-to-Action (KTA) Grant opportunity is intended to support the uptake of research evidence into health policy, practice and commercial development of products; and to help build on the growing body of evidence for the most effective ways to approach knowledge translation (KT). The KTA Grant is a competitive, peer-reviewed award.

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


Nurses’ perceived barriers to and facilitators of research utilization in mainland China: a cross-sectional survey.
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Chien WT, Bai Q, Wong WK, Wang H, Lu X.
The open nursing journal 2013 Jul 12;7:96-106

Despite the drive towards evidence-based practice, the extent to which research evidence is being implemented in nursing practice is unclear, particularly in developing countries. This study was to assess the levels of perceived barriers to and facilitators of research utilization in practice among Chinese nurses and inter-relationships between these barriers and facilitators and their socio-demographic characteristics. A cross-sectional, descriptive survey was conducted in 2011 with 743 registered nurses randomly selected from four general hospitals in China. They completed the Barriers to Research Utilization and Facilitators of Research Utilization scales. Correlation tests were used to test the relationships between the nurses’ perceived barriers and facilitators, their demographic characteristics and research training and involvement. The Chinese nurses’ level of perceived barriers was moderate on average and lower than that in previous research. Among the 10 top-ranked items, six were from the subscale ‘Organizational Characteristics’. Their perceived barriers were correlated positively with age and post-registration experience and negatively with research training undertaken. Junior diplomatic nurses reported a significantly higher degree of barriers than those senior ones with postgraduate education. Higher and more diverse barriers to research utilization in practice are perceived by Chinese nurses than those in Western countries and they are associated with a few socio-demographic factors.

From theoretical model to practical use: an example of knowledge translation.
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Bjork IT, Lomborg K, Nielsen CM, Brynildsen G, Frederiksen AM, Larsen K, et al.
Journal of advanced nursing 2013 Oct;69(10):2336-2347

Knowledge translation is a cyclic process involving both the creation and application of knowledge in several phases. The case presented in this paper is the translation of the Model of Practical Skill Performance into education and practice. Advantages and problems with the use of this model and its adaptation and tailoring to local contexts illustrate the cyclic and iterative process of knowledge translation. DISCUSSION: The cultivation of a three-sided relationship between researchers, educators, and clinical nurses was a major asset in driving the process of knowledge translation. The knowledge translation process gained momentum by replacing passive diffusion strategies with interaction and teamwork between stakeholders. The use of knowledge creates feedback that might have consequences for the refinement and tailoring of that same knowledge itself. With end-users in mind, several heuristics were used by the research group to increase clarity of the model and to tailor the implementation of knowledge to the users. © 2013 Blackwell Publishing Ltd.

Improving the adoption of evidence-based practice among nurses in army outpatient medical treatment facilities.
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Yackel EE, Short NM, Lewis PC, Breckenridge-Sproat ST, Turner BS.
Military medicine 2013 Sep;178(9):1002-1009

This quality improvement project implemented and evaluated an evidence-based practice (EBP) program at two Army outpatient health care facilities. The EBP program consisted of five implementation strategies that aimed to inculcate EBP into organizational culture as well as nursing practice and culture. A conceptual model of the “Diffusion of Innovations” theory was adapted to explain the application of the program. The Institutional Review Boards at Walter Reed National Military Medical Center and Duke University School of Medicine reviewed and exempted this quality improvement project. A pretest-posttest design was used with four instruments at each facility. The EBP program was successful in enhancing organizational culture and readiness for EBP (p < 0.01) and nursing staff’s belief about the value of EBP and their ability to implement it (p < 0.05). Another indicator that the EBP program achieved its goals was the significant difference (p = 0.002) in the movement of the outpatient health care facilities toward an EBP culture. These results suggest that this EBP program may be an effective method for empowering outpatient nursing staff with the knowledge and tools necessary to use evidence-based nursing practice. Reprint & Copyright © 2013 Association of Military Surgeons of the U.S.

Institutionalising knowledge brokering as a sustainable knowledge translation solution in healthcare: How can it work in practice?
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Chew S, Armstrong N, Martin G.
Evidence and Policy 2013;9(3):335-351

In healthcare, translating evidence into changed practice remains challenging. Novel interventions are being used to address these challenges, including the use of ‘knowledge brokers’. But how sustainable these roles might be, and the consequences for the individual of enacting such roles, are unknown. We explore these questions by drawing on qualitative data from case studies of fulltime roles in research-practice collaboration. We suggest that structural issues around professional boundaries, organisational norms and career pathways may make such roles difficult to sustain in the long term, but highlight interventions that might improve their feasibility. © Policy Press 2013.

Tools to assess evidence-based practice behaviour among healthcare professionals.
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Oude Rengerink K, Zwolsman SE, Ubbink DT, Mol BW, van Dijk N, Vermeulen H.
Evidence-based medicine 2013 Aug;18(4):129-138

OBJECTIVE: To identify and compare tools to assess Evidence-Based Practice (EBP) behaviour among healthcare professionals. RESULTS: Of 19 310 identified articles, 172 studies were included. We identified 117 questionnaires, 10 interviews or focus groups, nine observational studies, 27 chart evaluations and nine studies used a combination of methods. Psychometric properties of the questionnaires used were reported in about half of the studies, in seven studies that assess a single EBM step and in six studies that assess a combination of EBM steps. One of these assessed all five steps of EBP. CONCLUSIONS: Valid and reliable EBP behaviour assessment tools are available. However, only one questionnaire validly assessed all five EBP steps, covering the entire concept of EBP.

Knowledge of and Perceived Need for Evidence-Based Education About Antipsychotic Medications Among Nursing Home Leadership and Staff.
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Lemay CA, Mazor KM, Field TS, Donovan J, Kanaan A, Briesacher BA, et al.
Journal of the American Medical Directors Association 2013 Sep 24

A survey of leadership and direct care staff of nursing homes in Connecticut was conducted in June 2011. Questionnaire domains included knowledge of antipsychotic risks, attitudes about caring for residents with dementia, satisfaction with current behavior management training, beliefs about antipsychotic effectiveness, and need for staff training about antipsychotics and behavior management. RESULTS: A total of 138 nursing home leaders and 779 direct care staff provided useable questionnaires. Only 24% of nursing home leaders identified at least 1 severe adverse effect of antipsychotics; 13% of LPNs and 12% of RNs listed at least 1 severe adverse effect. Fifty-six percent of direct care staff believed that medications worked well to manage resident behavior. Leaders were satisfied with the training that staff received to manage residents with challenging behaviors (62%). Fifty-five percent of direct care staff felt that they had enough training on how to handle difficult residents; only 37% felt they could do so without using medications. CONCLUSIONS: Findings suggest that a comprehensive multifaceted intervention designed for nursing homes should aim to improve knowledge of antipsychotic medication risks, change beliefs about appropriateness and effectiveness of antipsychotics for behavior management, and impart strategies and approaches for nonpharmacologic behavior management. Copyright © 2013 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.

The Impact of Volunteer Mentoring Schemes on Carers of People With Dementia and Volunteer Mentors: A Systematic Review.
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Smith R, Greenwood N.
American Journal of Alzheimer’s Disease and Other Dementias 2013 Oct 1

This systematic review aims to examine the differences and similarities between the various types of volunteer mentoring (befriending, mentoring and peer support) and to identify the benefits for carers and volunteers. Literature searching was performed using 8 electronic databases, gray literature, and reference list searching of relevant systematic reviews. Searches were carried out in January 2013. Four studies fitted the inclusion criteria, with 3 investigating peer support and 1 befriending for carers. Quantitative findings highlighted a weak but statistically significant (P =.04) reduction in depression after 6 months of befriending. Qualitative findings highlighted the value carers placed on the volunteer mentors’ experiential similarity. Matching was not essential for the development of successful volunteer mentoring relationships. In conclusion, the lack of need for matching and the importance of experiential similarity deserve further investigation. However, this review highlights a lack of demonstrated efficacy of volunteer mentoring for carers of people with dementia.

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Health Care Administration and Organization

Measuring a caring culture in hospitals: a systematic review of instruments.
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Hesselink G, Kuis E, Pijnenburg M, Wollersheim H.
BMJ open 2013 Sep 23;3(9):e003416-2013-003416

OBJECTIVE: To identify instruments or components of instruments that aim to measure aspects of a caring culture-shared beliefs, norms and values that direct professionals and managers to act caring in hospitals, and to evaluate their psychometric properties. RESULTS: Of the 6399 references identified, 75 were examined in detail. 7 studies each covering a unique instrument met our inclusion criteria. On average, 24% of the instrument’s items were considered relevant for measuring aspects of the hospital’s caring culture. Studies showed moderate-to-high validity and reliability scores. Validity was addressed for 6 of the 7 instruments. Face, content (90%) and construct (60%) validity were the most frequently reported psychometric properties described. One study (14%) reported discriminant validity of the instrument. Reliability data were available for all of the instruments. Internal consistency was the most frequently reported psychometric property for the instruments and demonstrated by: a Cronbach’s α coefficient (80%), subscale intercorrelations (60%), and item-total correlations (40%). CONCLUSIONS: The ultimate standard for measuring a caring culture in hospitals does not exist. Existing instruments provide partial coverage and lack information on discriminant validity, responsiveness and feasibility. Characteristics of the instruments included in this review could provide useful input for the design of a reliable and valid instrument for measuring a caring culture in hospitals.

Using High-Performance Work Practices in Health Care Organizations: A Perspective for Nursing.
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McAlearney AS, Robbins J.
Journal of nursing care quality 2013 Sep 18

Studies suggest that the use of high-performance work practices (HPWPs) may help improve quality in health care. We interviewed 67 administrators and clinicians across 5 health care organizations and found that the use of HPWPs was valued and salient for nurses. Communication appeared particularly important to facilitate HPWP use. Enhancing our understanding of HPWP use may help improve the work environment for nurses while also increasing care quality.

How to take care of nurses in your organization: two types of exchange relationships compared.
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Veld M, Van De Voorde K.
Journal of advanced nursing 2013 Sep 11

AIM: To explore the relationships between climate for well-being, economic and social exchange, affective ward commitment and job strain among nurses in the Netherlands. DESIGN: A cross-sectional survey among nurses. RESULTS: The response rate was 41% (271 questionnaires). The results show that climate for well-being positively influences social exchange relationships, which are in turn associated with enhanced ward commitment and reduced strain. Climate for well-being negatively influences evaluations of economic exchange, which are in turn negatively related to ward commitment. CONCLUSION: This study shows that nurses use the information available in their immediate work environment to evaluate their exchange relationship with the organization. Second, the findings point towards the importance of economic and social exchange relationships as a mechanism between climate for well-being on the one hand and affective ward commitment and job strain on the other hand. © 2013 John Wiley & Sons Ltd.

Nursing home employee perceptions of culture change.
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Palmer JA, Meterko M, Zhao S, Berlowitz D, Mobley E, Hartmann CW.
Research in gerontological nursing 2013 Jul;6(3):152-160

This study examined nursing home staff members’ comfort levels with specific culture change scenarios and observed whether there were differences by occupation. We conducted a cross-sectional survey of 218 staff members in all occupational categories at four Veterans Health Administration Community Living Centers (i.e., nursing homes). Staff indicated their comfort level using a 9-point scale (1 = not at all comfortable to 9 = extremely comfortable). The culture change scenarios were divided into three subscales: Resident Safety (5 items), Resident Experience (5 items), and Staff Experience (2 items). Overall, respondents were slightly uncomfortable with the scenarios (overall mean = 4.57). Staff reported least comfort with the Resident Safety subscale (mean = 3.63) and most comfort with the Resident Experience subscale (mean = 5.65), with significant differences within these two subscales by occupational category. Existent power differentials among staff may influence comfort levels with culture change. Assessing staff comfort with culture change may help guide implementation efforts in a strategic manner. Copyright 2013, SLACK Incorporated.

The relationship between the nursing work environment and the occurrence of reported paediatric medication administration errors: a pan Canadian study. Canada-flat-icon
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Sears K, O’Brien-Pallas L, Stevens B, Murphy GT.
Journal of pediatric nursing 2013 Jul-Aug;28(4):351-356

Paediatric medication administration errors (PMAEs) occur frequently, with devastating consequences for children and their families. This study explored the relationship between the nursing work environment and the occurrence of reported PMAEs. In total, 127 potential and 245 actual PMAEs were reported. Workload, distraction, and ineffective communication were identified as significant contributors to the occurrence of PMAEs. Medical/surgical units reported more errors than critical care environments (p=.000) and a 2.9% increase in the frequency of reported PMAEs was noted for each additional bed on units (p=.001). This study supports the awareness that a systems reform is required to reduce PMAEs. Published by Elsevier Inc.

CIHR: Evaluation of CIHR’s Knowledge Translation Funding Program Canada-flat-icon

This report presents key findings and recommendations resulting from an evaluation of the Canadian Institutes of Health Research (CIHR) Knowledge Translation (KT) Funding Program.

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Health Care Innovation and Quality Assurance

The critical role of nurses to the successful implementation of the National Safety and Quality Health Service Standards.
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Twigg DE, Duffield C, Evans G.
Australian Health Review : A Publication of the Australian Hospital Association 2013 Sep;37(4):541-546

The National Safety and Quality Health Service Standards requires health service compliance by 2013 and covers several areas including governance arrangements, partnerships with consumers and eight key clinical processes. Nurses in Australia comprise 62% of the hospital workforce, are the largest component and hence play a critical role in meeting these standards and improving the quality of patient care. Several of the standards are influenced by nursing interventions, which incorporate any direct-care treatment that the nurse performs for a patient that may be nurse or physician initiated. The ability for nurses to undertake these interventions is influenced by the hours of care available, the skill mix of the nursing workforce and the environment in which they practice. Taking into consideration the predicted nursing shortages, the challenge to successfully implement the National Safety and Quality Health Service Standards will be great. This paper examines the role of nursing in the delivery of the National Standards, analyses the evidence with regard to nursing-sensitive outcomes and discusses the implications for health service decision makers and policy.

Do written mandatory accreditation standards for residential care positively model learning organizations? Textual and critical discourse analysis.
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Bell E, Robinson A, See C.
International journal of nursing studies 2013 Nov;50(11):1446-1458

The research question was ‘Do mandatory national accreditation standards for residential aged care, as they are written, positively model learning organisations?’. METHOD: Automatic text analysis was combined with critical discourse analysis to analyse the presence of learning concepts from Senge’s learning organisation theory in an exhaustive sample of national accreditation standards from 7 countries. The two stages of analysis were: (1) quantitative mapping of the presence of learning organisation concepts in standards using Bayesian-based textual analytics software and (2) qualitative critical discourse analysis to further examine how the language of standards so identified may be modelling learning organisation concepts. RESULTS: The learning concepts ‘training’, ‘development’, ‘knowledge’, and ‘systems’ are present with relative frequencies of 19%, 11%, 10%, and 10% respectively in the 1944 instances, in paragraph-sized text blocks, considered. Concepts such as ‘team’, ‘integration’, ‘learning’, ‘change’ and ‘innovation’ occur with 7%, 6%, 5%, 5%, and 1% relative frequencies respectively. Learning concepts tend to co-occur with negative rather than positive sentiment language in the 3176 instances in text blocks containing sentiment language. Critical discourse analysis suggested that standards generally use the language of organisational change and learning in limited ways that appear to model ‘learning averse’ communities of practice and organisational cultures. CONCLUSION: The aged care quality challenge and the role of standards need rethinking. All standards implicitly or explicitly model an organisation of some type. If standards can model a limited and negative learning organisation language, they could model a well-developed and positive learning organisation language. In the context of the global aged care crisis, the modelling of learning organisations is probably critical for minimal competence in residential aged care and certainly achievable in the language of standards. Copyright © 2013 Elsevier Ltd. All rights reserved.

Conventional evaluations of improvement interventions: more trials or just more tribulations? Canada-flat-icon
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Shojania KG.
BMJ quality & safety 2013 Sep 27

When we really believe that contextual factors play important roles in an intervention’s effectiveness, it may be premature to conduct an RCT. Better to first identify the key contextual factors, so that modifiable ones can be addressed as part of the intervention and unmodifiable ones can be avoided through the trial’s exclusion criteria.

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Research Methodology

IOM: Observational Studies in a Learning Health System – Workshop Summary
September 2013

Clinical research is constantly advancing, although perhaps not fast enough to meet the challenges and seize the opportunities presented. New tools are emerging. While challenges remain, these tools have the potential to accelerate the research process and to allow an approach to clinical research that applies the most appropriate methods given the requirements of the situation. This approach includes the leveraging of the information collected in the process of delivering care to drive processes for new insights and continuous improvement, which is at the heart of a learning health system.

IOM: Large Simple Trials and Knowledge Generation in a Learning Health System – Workshop Summary
September 2013

Despite a robust clinical research enterprise, a gap exists between the evidence needed to support care decisions and the evidence available. Streamlined approaches to clinical research provide options for progress on these challenges. Large simple trials (LSTs), for example, generally have simple randomization, broad eligibility criteria, enough participants to distinguish small to moderate effects, focus on outcomes important to patient care, and use simplified approaches to data collection.

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Health care in Canada

CIHI Survey Seniors and Alternative Level of Care: Building on Our Knowledge Canada-flat-icon
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Norma Jutan, Lacey Langlois and,Natalie Damiano.
Healthcare Quarterly 2013 07/23;16(3):7-10

There is ongoing concern that acute care beds in Canada are occupied by seniors who are waiting to be discharged to a more appropriate level of care (ALC Expert Panel 2006). These individuals, who no longer require acute care services, are commonly designated as alternative level of care (ALC) patients. In this article, we briefly discuss the findings of a study that we performed to examine the characteristics of patients transitioning from acute care to home care or residential care.

Manitoba Centre for Health Policy: Who is in our hospitals and why? Canada-flat-icon

This deliverable describes who is occupying acute care hospital beds in Manitoba: where they are from, what they are there for, how long they stay, and their demographic profile. This research also identifies individuals who are ‘Alternate Level of Care’ (ALC) patients, and report on the number of hospital days used by these people while waiting for personal care admission, home care acceptance, etc. Results are provided for each hospital in Manitoba and are also summarized by RHA and hospital type. The report also provides some descriptive results regarding ‘heavy users’ of the acute care system, for example, patients in the top 5% of hospital day use.

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Mini Nutritional Assessment as a Useful Method of Predicting the Development of Pressure Ulcers in Elderly Inpatients.
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Yatabe MS, Taguchi F, Ishida I, Sato A, Kameda T, Ueno S, et al.
Journal of the American Geriatrics Society 2013 Sep 19

OBJECTIVES: To determine the usefulness of the Mini Nutritional Assessment (MNA) and plasma amino acid analysis in predicting the formation of pressure ulcers (PUs) in inpatients. DESIGN: Prospective, observational cohort study with a mean observation period of 62.2 ± 86.4 days. SETTING: Intermediate and acute care wards of a hospital in rural Japan. PARTICIPANTS: Inpatients with an average age of 85.0 ± 7.6 (N = 422). MEASUREMENTS: Mini Nutritional Assessment, Subjective Global Assessment (SGA), Braden Scale (PU prognostic score), PU formation, and biochemical analysis including plasma amino acid concentrations. RESULTS: PUs developed in 7.1% of participants. A MNA score of less than 8 was more sensitive than a rating of moderate or severe malnourishment on the SGA combined with a Braden Scale score of less than 15 in predicting future PUs. The area under the receiver operating characteristic curve (AUC) of the MNA was superior to that of the Braden Scale. The Braden Scale nutrition subscore had the lowest AUC of the six Braden Scale subscores. Individuals who developed PUs had significantly lower plasma arginine concentrations than those who did not. CONCLUSION: Mini Nutritional Assessment was able to predict the development of PUs. A MNA score of less than 8 performed better than the SGA, Braden Scale, and plasma arginine levels in predicting PU development. Although lower plasma arginine concentration at time of admission was associated with PU development, the AUC for arginine was not significantly different from 0.50. © 2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society.

Outcomes of Feeding Problems in Advanced Dementia in a Nursing Home Population.
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Hanson LC, Ersek M, Lin FC, Carey TS.
Journal of the American Geriatrics Society 2013 Sep 19

OBJECTIVES: To describe quality of care for feeding problems in advanced dementia and probability and predictors of weight loss and mortality. DESIGN: Prospective cohort. PARTICIPANTS: Nursing home residents with advanced dementia and feeding problems and family surrogates (N = 256). MEASUREMENTS: Family reported on quality of feeding care at enrollment and 3 months. Chart reviews at enrollment and 3, 6, and 9 months provided data on feeding problems, treatments, weight loss of more than 5% in 30 days or more than 10% in 6 months, and mortality. Organizational variables were obtained from administrator surveys and publically reported data. RESULTS: Residents with advanced dementia and feeding problems had an average age of 85; 80% had chewing and swallowing problems, 11% weight loss, and 48% poor intake. Family reported feeding assistance of moderate quality; 23% felt the resident received less assistance than needed. Mortality risk was significant; 8% died within 3 months, 17% within 6 months, and 27% within 9 months. Residents with advanced dementia who had stable weight over 3 months had a 5.4% rate of significant weight loss and a 2.1% risk of death over the next 3 months. Residents with advanced dementia and weight loss over 3 months had a 38.9% chance of stabilizing weight over the next 3 months but also had a 19.2% chance of dying. Weight loss was the only independent predictor of death. CONCLUSION: Weight loss is a predictor of death in advanced dementia. Treatments can often stabilize weight, but weight loss should be used to trigger discussion of goals of care and treatment options. © 2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society.

Turning for Ulcer ReductioN: A Multisite Randomized Clinical Trial in Nursing Homes.
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Bergstrom N, Horn SD, Rapp MP, Stern A, Barrett R, Watkiss M.
Journal of the American Geriatrics Society 2013 Sep 19

OBJECTIVES: To determine optimal repositioning frequency of nursing home (NH) residents at risk for pressure ulcers (PrUs) when cared for on high-density foam mattresses. DESIGN: Multisite, randomized, clinical trial, known as Turning for Ulcer ReductioN (TURN Study). SETTINGS: NHs in the United States (n = 20) and Canada (n = 7) using high-density foam mattresses. PARTICIPANTS: Consenting residents (N = 942) aged 65 and older without PrUs at moderate (scores 13-14) or high (scores 10-12) risk of PrUs according to the Braden Scale. INTERVENTION: Participants were randomly allocated using risk stratification (moderate vs high) to a repositioning schedule (2, 3, or 4 hour) for 3 weeks. Blinded assessors assessed skin weekly. MEASUREMENTS: PrU incidence (coccyx or sacrum, trochanter, heels). RESULTS: Participants were mostly female (77.6%) and Caucasian (80.5%) and had a mean age of 85.1 ± 7.7. The most common diagnoses were cardiovascular (76.9%) and dementia (72.5%). Nineteen (2.0%) participants developed superficial PrUs. There was no significant difference (Wilcoxon test for ordered categories) in PrU incidence (P = .68) according to repositioning group (2 hour, 8/321, 2.5%; 3 hour, 2/326, 0.6%; 4 hour, 9/295, 3.1%), nor was there a statistically significant difference in the incidence of PrU between the high and moderate-risk groups (P = .79). Also, PrU incidence was not statistically significantly different between high-risk participants based on repositioning schedule (6/325, 1.8%, P = .90) or between moderate-risk participants based on repositioning schedule (13/617, 2.1%, P = .68). CONCLUSION: There was no difference in PrU incidence over 3 weeks of observation between those turned at 2-, 3-, or 4-hour intervals in this population of residents using high-density foam mattresses at moderate and high risk of developing PrUs when they were repositioned consistently and skin was monitored. © 2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society.

Multidimensional team-based intervention using musical cues to reduce odds of facility-acquired pressure ulcers in long-term care: a paired randomized intervention study.
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Yap TL, Kennerly SM, Simmons MR, Buncher CR, Miller E, Kim J, et al.
Journal of the American Geriatrics Society 2013 Sep;61(9):1552-1559

OBJECTIVES: To test the effectiveness of a pressure ulcer (PU) prevention intervention featuring musical cues to remind all long-term care (LTC) staff (nursing and ancillary) to help every resident move or reposition every 2 hours. INTERVENTION: All facility staff received in-person education, video, and handouts, and visiting family members received informational pamphlets on PU prevention and an intervention featuring musical cues. Nurse-led multidisciplinary staff teams presented the cues as prompts for staff and family to reposition residents or remind them to move. Musical selections (with and without lyrics) customized to facility preferences were played daily over the facility intercom or public address system every 2 hours for the 12-hour daytime period. MEASUREMENTS: Primary outcome measure was the frequency of new facility-acquired PUs divided by the total number of facility Minimum Data Set (MDS) resident assessments conducted during the study period. RESULTS: Odds of a new PU were lower in intervention facilities (P = .08) for MDS 2.0 assessments and were significantly lower (P = .05) for MDS 3.0. Mean odds ratios suggested intervention facility residents were 45% less likely than comparison facility residents to develop a new PU. CONCLUSION: Customized musical cues that prompt multidisciplinary staff teams to encourage or enable movement of all residents hold promise for reducing facility-acquired PUs in LTC settings. © 2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society.

What is Family-Centered Care for Nursing Home Residents With Advanced Dementia?
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Lopez RP, Mazor KM, Mitchell SL, Givens JL.
American Journal of Alzheimer’s Disease and Other Dementias 2013 Oct 1

To understand family members’ perspectives on person- and family-centered end-of-life care provided to nursing home (NH) residents with advanced dementia, we conducted a qualitative follow-up interview with 16 respondents who had participated in an earlier prospective study, Choices, Attitudes, and Strategies for Care of Advance Dementia at End of Life (CASCADE). Family members of NH residents (N = 16) with advanced dementia participated in semistructured qualitative interviews that inquired about overall NH experience, communication, surrogate decision making, emotional reaction, and recommendations for improvement. Analysis identified 5 areas considered important by family members: (1) providing basic care; (2) ensuring safety and security; (3) creating a sense of belonging and attachment; (4) fostering self-esteem and self-efficacy; and (5) coming to terms with the experience. These themes can provide a framework for creating and testing strategies to meet the goal of person- and family-centered care.

World Alzheimer Report 2013: Journey of Caring: An analysis of long-term care for dementia
Alzheimer’s Disease International

The World Alzheimer Report 2013 ‘Journey of Caring: An analysis of long-term care for dementia’, reveals that, as the world population ages, the traditional system of “informal” care by family, friends, and community will require much greater support. Globally, 13% of people aged 60 or over require long-term care. Between 2010 and 2050, the total number of older people with care needs will nearly treble from 101 to 277 million.

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Non UofA

The First National Conference on Academic Detailing
Boston, MA 7-8 November 2013

A two day interactive discussion on implementing educational outreach to improve patient care and outcomes.


AHRQ Webinar: Enhancing Patient Safety for Patients with Limited English Proficiency (LEP): TeamSTEPPSR
Tuesday 8 October 2013 1100-1200 MT

Laura Maynard, MDiv, the Director of Collaborative Learning at the North Carolina Quality Center will discuss the following objectives:
1. Highlight what we know about patient safety and LEP patients
2. Identify common causes of adverse events for LEP and culturally diverse patients
3. Present five key strategies for improving detection of medical errors and preventing high-risk scenarios from becoming safety events
4. Provide an approach to preventing safety events through use of TeamSTEPPS tools

AMDA Webinar: Palliative Care in LTC: Ensuring Compassionate Care for the Frail Elderly
Thursday 24 October 2013 17:00-18:30 MT Costs $75/members $99/non-members

This live webinar will explore the role of palliative care in long term care facilities. Topics include the content of palliative care, the physician’s ethical mandate to provide compassionate care for the alleviation of suffering, and implementation of a palliative care program. Participants will investigate these topics through lecture, Q&A, and suggested readings.

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

The healthcare system is inundated with data, indicators and dashboards. Buried in the numbers is an essential function of high-performing healthcare organizations: relying on data to guide quality improvement. But how well do healthcare providers and their organizations rely on data to understand healthcare pathways, processes and systems? To what degree are decisions based on timely and accurate data? Oftentimes, data is too old to make timely decisions, or providers are skeptical about the validity of the information. Collecting and displaying data in ‘real-time’ enables healthcare leaders and staff to rely on data in a meaningful way that improves the quality of care of patients and families. Run charts and control charts are simple yet powerful tools to analyze data in real-time.

SEDL: Developing the Knowledge Translation Plan to Build Research Impact
Thursday 10 October 2013 13:00-14:15

join us for a webcast featuring Dr. Melanie Barwick of the Hospital for Sick Children in Toronto. Dr. Barwick describes critical features in developing a KT plan, and shares the KT Planning Template©, newly revised in July.

Online Conference: Knowledge Translation Measurement Concepts, Strategies and Tools
29-31 October 2013

This online conference is designed to address major strategies in the planning and implementation of effective and efficient KT measurement approaches. Participants will be able to register, view, and ask questions through the event’s virtual conference platform. A pretty impressive group of speakers will be at this conference including our own Dr. Carole Estabrooks.

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CDRAKE: Emergency Management, Frailty, Dementia and Disasters: What Health Care Providers Need to Know

You can help make the world a safer place for older people who are frail and for those with dementia. The Emergency Management, Frailty, Dementia & Disasters e-Learning program will show you the important steps to take.

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Is peer review broken?

BioMed Central and BMC Biology organised a panel discussion to discuss the increasing frustration with the peer review process from the scientific community. Chaired by Greg Petsko (who neatly summarised some of the problems before the discussion here) the panel brought together representatives of each role in the process: scientist, reviewer and Editor (both academic and professional).

Evidence-based hospital nurse staffing: the challenges Canada-flat-icon

One way hospitals can save money is by replacing RNs with LPNs/RPNs. Some applaud this direction, arguing that part of running an efficient hospital is to have all professionals working at their full capacity. However, others point to evidence linking RNs with better patient outcomes and worry that patient care will be negatively affected. What are the challenges in making evidence-based decisions about nursing staff mix?

The latest issue of AHS’s Seniors Health Strategic Clinical Network has been published Canada-flat-icon

Lots of good info in this one. Including a grant opportunity and project updates.

Canada ranks fifth in well-being of elderly: study

The world is aging so fast that most countries are not prepared to support their swelling numbers of elderly people, according to a global study being issued by the United Nations and an elder rights group.

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Peerage of Science

This service provides scientific peer review for academic journals.

Randomise Me

RCTs are used by scientists to find out what works best. Here, you can create a trial on anything you wish, and participate in trials set up by other people. Randomise Me allows you to set up trials to test something on yourself, such as do my new trainers make me run faster? Or does eating cheese before bed give me nightmares?

Hartford Institute for Geriatric Nursing YouTube Channel

The Hartford Institute for Geriatric Nursing, the organization behind ConsultGeriRN, and the clinical assessment tools Try This, have created a new YouTube channel featuring videos on geriatric care. The videos were previously released as DVD’s and are produced by the American Journal of Nursing and Terra Nova Films. They are all free to stream. Several different topics are covered, such as eating and feeding issues, elder abuse, older adult sexuality and depression. You can also subscribe to this channel to be notified when a new video is uploaded to the page.

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Annual International Research Internship for Health Systems Researchers – April 25th – May 28th, 2014
Kisumu, Kenya
DEADLINE 30 December 2013

During the internship, participants will:
• Acquire knowledge and skills in health systems research.
• Examine multiple intervention programs design and evaluation issues in health systems.
• Acquire knowledge and skills essential for competitive grantsmanship.
• Acquire knowledge and skills in networking and extend links with local, national, and international decision-makers.
• Extend repertoire of cutting edge research designs and approaches in health systems.
• Enhance peer review skills
• Develop a complete research proposal, programs of research and/or scientific manuscript and paper during work in progress sessions.
• Attend the three-day International conference organized by the Great Lakes University of Kisumu with opportunity to present a conference paper.

Health Foundation Doctoral Fellowship (2 positions)
Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
DEADLINE: 28 October 2013

The Health Foundation is funding two prestigious Improvement Science awards. The awards, which will fund research leading to a PhD, are designed to help create a sound theoretical, empirical and experiential knowledge base on improvement science. Research will be based in one or two of the following five topics: Optimising the delivery of alcohol health improvement interventions in primary care; Understanding the role and impact of patient activation in supporting implementation of shared decision making; Using economic evaluation and preference elicitation methods to inform decisions about how best to reorganise services; Implementation intentions for creating and breaking habits in care provided to patients with type 2 diabetes: a dual process approach; How can theory-based implementation tools optimise the implementation of complex interventions in health care?

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