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Abstracts
New article highlighting TREC
Improving Long Term Care
International Innovation 2014 March pgs 88-90
This article provides a high level view of the work of TREC 1.0 and TREC 2.0.
New article by Dr. Shannon Scott
Influences shaping nurses’ use of distraction for children’s procedural pain
Non UofA Access
Olmstead DL, Scott SD, Mayan M, Koop PM, Reid K.
Journal for Specialists in Pediatric Nursing 2014
Purpose This study explored pediatric nurses’ choices to use distraction for managing painful procedures. Design and Methods Using interpretive description approaches, interviews with pediatric nurses provided descriptions of choices to manage procedural pain. Results Nurses’ distress influenced distraction use to mitigate the suffering of children and themselves. Newer nurses described task mastery as influencing distraction choices. Nurses’ accounts of performing painful procedures on children mirrored children’s descriptions of pain from the literature. Practice Implications Nurses’ distress and competency performing painful procedures on children influenced practice. Future qualitative studies could extend understanding of pain management choices by pediatric nurses and the impact on undermanaged pain.
New articles by Dr. Greta Cummings
Testing a theoretical model of clinical nurses’ intent to stay.
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Cowden TL, Cummings GG.
Health care management review 2014 Feb 21
Published theoretical models of nurses’ intent to stay (ITS) report inconsistent outcomes, and not all hypothesized models have been adequately tested. Research has focused on cognitive rather than emotional determinants of nurses’ ITS. PURPOSE:: The aim of this study was to empirically verify a complex theoretical model of nurses’ ITS that includes both affective and cognitive determinants and to explore the influence of relational leadership on staff nurses’ ITS. METHODOLOGY: The study was a correlational, mixed-method, nonexperimental design. A subsample of the Quality Work Environment Study survey data 2009 (n = 415 nurses) was used to test our theoretical model of clinical nurses’ ITS as a structural equation model. RESULTS:: The model explained 63% of variance in ITS. Organizational commitment, empowerment, and desire to stay were the model concepts with the strongest effects on nurses’ ITS. Leadership practices indirectly influenced ITS. PRACTICE IMPLICATIONS: How nurses evaluate and respond to their work environment is both an emotional and rational process. Health care organizations need to be cognizant of the influence that nurses’ feelings and views of their work setting have on their intention decisions and integrate that knowledge into the development of retention strategies. Leadership practices play an important role in staff nurses’ perceptions of the workplace. Identifying the mechanisms by which leadership influences staff nurses’ intentions to stay presents additional focus areas for developing retention strategies.
Methodological characteristics and treatment effect sizes in oral health randomised controlled trials: Is there a relationship? Protocol for a meta-epidemiological study
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Saltaji H, Armijo-Olivo S, Cummings GG, Amin M, Flores-Mir C.
BMJ open 2014 Feb 25;4(2):e004527-2013-004527
It is fundamental that randomised controlled trials (RCTs) are properly conducted in order to reach well-supported conclusions. However, there is emerging evidence that RCTs are subject to biases which can overestimate or underestimate the true treatment effect, due to flaws in the study design characteristics of such trials. The extent to which this holds true in oral health RCTs, which have some unique design characteristics compared to RCTs in other health fields, is unclear. As such, we aim to examine the empirical evidence quantifying the extent of bias associated with methodological and non-methodological characteristics in oral health RCTs. METHODS AND ANALYSIS: We plan to perform a meta-epidemiological study, where a sample size of 60 meta-analyses (MAs) including approximately 600 RCTs will be selected. The MAs will be randomly obtained from the Oral Health Database of Systematic Reviews using a random number table; and will be considered for inclusion if they include a minimum of five RCTs, and examine a therapeutic intervention related to one of the recognised dental specialties. RCTs identified in selected MAs will be subsequently included if their study design includes a comparison between an intervention group and a placebo group or another intervention group. Data will be extracted from selected trials included in MAs based on a number of methodological and non-methodological characteristics. Moreover, the risk of bias will be assessed using the Cochrane Risk of Bias tool. Effect size estimates and measures of variability for the main outcome will be extracted from each RCT included in selected MAs, and a two-level analysis will be conducted using a meta-meta-analytic approach with a random effects model to allow for intra-MA and inter-MA heterogeneity.
Resonant Leadership and Workplace Empowerment: The Value of Positive Organizational Cultures in Reducing Workplace Incivility
Spence, Wong C, A., Cummings G, G., Grau A, L.
Nursing economics 2014 2014;32(1):5-44.
This research adds to the growing body of knowledge documenting the key role of positive leadership practices in creating healthy work environments that promote retention of nurses in a time of severe nursing shortage.
New article by Dr. 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 2014 Feb;11(1):55-64
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.
CALL FOR ABSTRACTS: AcademyHealth 2014 Annual Research Meeting
San Diego 8-10 June
DEADLINE 4 April
The ARM Planning Committee invites investigators to submit research to be considered for presentation at one or more special Late-Breaking sessions. With the goal of providing the most recent, relevant, and high quality research to our attendees, the purpose of this session is to allow for the presentation of important research that was not complete by the regular abstract deadline.
CALL FOR ABSTRACTS: International Society of Quality of Life Research Annual Conference
15-18 October Berlin Germany
DEADLINE 18 April
The ISOQOL Annual Conference is the premiere opportunity for those in the quality of life research field to connect and network. The conference provides ISOQOL members an opportunity to present their research, plus learn more about new and exciting topics through oral, poster, and plenary sessions as well as in-depth workshops.
Grants & Awards
Horizon 2020 is the largest European Union Research and Innovation program ever. Nearly 80 billion Euros of funding is available over the next seven years through this program. Although Canada is not explicitly mentioned as a collaborator in Horizon 2020, there are unique opportunities for the Canadian research on aging community. The CIHR Institute of Aging has recently sought clarifications from EU officers on these potential opportunities. Please follow the link to learn more about this funding opportunity.
CIHR IA Student Poster Competition
DEADLINE 15 April
The CIHR Institute of Aging is again pleased to sponsor a student poster competition at CAG2014. A $500 prize will be awarded by the Institute of Aging in each of the following categories: Master’s, Doctoral and Post Doctoral Fellow.
CAG2014 Student Travel Grants
DEADLINE 15 April
The Legacy Fund of the Canadian Association on Gerontology is pleased to provide funding to assist CAG student members to attend CAG2014: Landscapes of Aging, October 16 – 18, 2014 in Niagara Falls, Ontario, Canada.
CFHI Spreading Healthcare Innovations Initiative on Reducing Antipsychotic Medication in Long Term Care
DEADLINE 15 April
CFHI is supporting the spread of practices in healthcare delivery that show promise in addressing gaps in the quality of patient care. Our new Spreading Healthcare Innovations Initiative consists of two quality improvement collaboratives to help teams from healthcare delivery organizations and ministries advance innovations that make care more patient- and family-centred, better coordinated and more efficient. Successful recipients will receive funding as well as coaching from CFHI faculty, who are experienced leaders in quality and performance improvement, and staff to help implement and evaluate the innovations.
Publications
KT
Health Care Administration and Organization
Health Care Innovation and Quality Assurance
Health Care in Canada
Research Practice & Methodology
Aging
KT
The establishment of evidence-based practice competencies for practicing registered nurses and advanced practice nurses in real-world clinical settings: proficiencies to improve healthcare quality, reliability, patient outcomes, and costs.
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Melnyk BM, Gallagher-Ford L, Long LE, Fineout-Overholt E.
Worldviews on evidence-based nursing 2014 Feb;11(1):5-15
Although it is widely known that evidence-based practice (EBP) improves healthcare quality, reliability, and patient outcomes as well as reduces variations in care and costs, it is still not the standard of care delivered by practicing clinicians across the globe. Adoption of specific EBP competencies for nurses and advanced practice nurses (APNs) who practice in real-world healthcare settings can assist institutions in achieving high-value, low-cost evidence-based health care. AIM: The aim of this study was to develop a set of clear EBP competencies for both practicing registered nurses and APNs in clinical settings that can be used by healthcare institutions in their quest to achieve high performing systems that consistently implement and sustain EBP. METHODS: Seven national EBP leaders developed an initial set of competencies for practicing registered nurses and APNs through a consensus building process. Next, a Delphi survey was conducted with 80 EBP mentors across the United States to determine consensus and clarity around the competencies. FINDINGS: Two rounds of the Delphi survey resulted in total consensus by the EBP mentors, resulting in a final set of 13 competencies for practicing registered nurses and 11 additional competencies for APNs. LINKING EVIDENCE TO ACTION: Incorporation of these competencies into healthcare system expectations, orientations, job descriptions, performance appraisals, and clinical ladder promotion processes could drive higher quality, reliability, and consistency of healthcare as well as reduce costs. Research is now needed to develop valid and reliable tools for assessing these competencies as well as linking them to clinician and patient outcomes. © 2014 Sigma Theta Tau International.
Implementing national guidelines for person-centered care of people with dementia in residential aged care: effects on perceived person-centeredness, staff strain, and stress of conscience.
Non UofA Access
Edvardsson D, Sandman PO, Borell L.
International psychogeriatrics 2014 Feb 27:1-9
Person-centeredness has had substantial uptake in the academic literature on care of older people and people with dementia. However, challenges exist in interpreting and synthesizing the evidence on effects of providing person-centered care, as the person-centered components of some intervention studies are unclear – targeting very different and highly specific aspects of person-centeredness, as well as not providing empirical data to indicate the extent to which care practice was actually perceived to become more person-centered post-intervention. Methods: The study employed a quasi-experimental, one-group pre-test-post-test design with a 12-month follow-up to explore intervention effects on person-centeredness of care and the environment (primary endpoints), and on staff strain and stress of conscience (secondary endpoints). Results: The intervention resulted in significantly higher scores on person-centeredness of care at follow-up, and the facility was rated as being significantly more hospitable at follow-up. A significant reduction of staff stress of conscience was also found at follow-up, which suggests that, to a larger extent, staff could provide the care and activities they wanted to provide after the intervention. Conclusions: The results indicated that an interactive and step-wise action-research intervention consisting of knowledge translation, generation, and dissemination, based on national guidelines for care of people with dementia, increased the staff self-reported person-centeredness of care practice, perceived hospitality of the setting, and reduced staff stress of conscience by enabling staff to provide the care and activities they want to provide.
Factors Influencing the Uptake of Research Evidence in Child Welfare: A Synthesis of Findings from Australia, Canada and Ireland
Buckley H, Tonmyr L, Lewig K, Jack S.
Child Abuse Review 2014;23(1):5-16
This paper draws on three studies conducted in Australia, Canada and Ireland which explore the factors influencing research utilisation in the child protection sector in each country. The paper recognises that research uptake is complicated by a number of factors. It also acknowledges critiques which cite the equally significant influence of ideologies, context, unpredictability, time constraints and political expediency. However, all three studies recognised the increasing importance of evidence-based practice. The methods used in the three studies were not identical but the frameworks used were sufficiently similar to enable the classification of both common and dissimilar barriers and facilitators to research use. Those which they identified were categorised into four types: individual, organisational, environmental and characteristics relating to the nature of research material. Implications were identified for policy makers, service providers and research producers. The point was made that we now live in a period where unprecedented means of knowledge transfer and exchange provide unique opportunities to improve the lives of children and families. Copyright © 2013 John Wiley & Sons, Ltd.
Implementation of evidence-based practice for a pediatric pain assessment instrument.
Non UofA Access
Obrecht JA, Van Hulle Vincent C, Ryan CS.
Clinical nurse specialist CNS 2014 Mar-Apr;28(2):97-104
The purpose of this project was to facilitate the successful implementation of an evidence-based practice (EBP) change to the Faces Pain Scale-Revised (FPS-R) using the Promoting Action on Research Implementation in Health Services (PARIHS) framework. BACKGROUND/RATIONALE: Accurate pain assessment is a high priority in the clinical setting. Despite the availability of valid pain assessment instruments, use in practice remains deficient. Compared with the Wong-Baker FACES Pain Scale, the FPS-R has stronger evidence for validity and reliability and is identified as a preferred instrument to measure children’s pain. The PARIHS framework, developed to guide the change process of EBP implementation through strong evidence, quality of context, and type of facilitation, was used in the development and implementation of the project. DESCRIPTION: The clinical nurse specialist implemented an education program about EBP and FPS-R for nurses, followed by a 2-week pilot using FPS-R to assess children’s pain. We measured perceptions of strength of evidence, quality of context, and barriers to research utilization. OUTCOME: Nurses reported positive perceptions about the strength of evidence for FPS-R and identified unit context as moderately receptive to change before the project. Nurses’ perceived barriers to research utilization did not significantly change after the project. CONCLUSION: Nurses’ positive perceptions about the use of FPS-R were based on strong evidence, quality context, and type of facilitation. The PARIHS framework supported this successful EBP change. The PARIHS framework can be applied by the clinical nurse specialist in the clinical setting, with minimal effort, to facilitate EBP implementation.
‘Translational formative evaluation’: critical in up-scaling public health programmes.
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O’Hara BJ, Phongsavan P, King L, Develin E, Milat AJ, Eggins D, et al.
Health promotion international 2014 Mar;29(1):38-46
The process of generating evidence-based public health interventions is understood to include steps that define the issue, generate and test solutions in controlled settings, replicate and then disseminate more widely. However, to date models have not considered the types and scale of formative evaluation tasks that are needed to up-scale interventions, from efficacy to population-wide dissemination in the real world. In this paper, we propose that an additional stage of ‘translational formative evaluation’ is necessary for the translation of effectiveness evidence into wide-scale public health practice. We illustrate the utility of translational formative evaluation, through a case study of the Get Healthy Information and Coaching Service(®) (GHS), a population-based telephone service designed to assist adults change lifestyle-related behaviours. The additional translational formative evaluation steps comprised synthesis of efficacy studies, qualitative research with the wider target audience, environmental analysis and stakeholder consultation. They produced precise recommendations to refine GHS design and implementation. Translational formative evaluation is a necessary intermediate step, following efficacy studies and a precursor to population-wide implementation of public health programmes.
Are indicators of faculty members’ credibility associated with how often they present research evidence to public or partly government-owned organisations? A cross-sectional survey 
Non UofA Access
Ouimet M, Bédard P, Léon G, Dagenais C.
Evidence & Policy: A Journal of Research, Debate & Practice 2014 01;10(1):5-27
This study provides an empirical test of the assumption that the credibility of the messenger is one of the factors that influence knowledge mobilisation among policy makers. This general hypothesis was tested using a database of 321 social scientists from the province of Quebec that combines survey and bibliometric data. A regression model was used to study the association between indicators of faculty members’ credibility and the number of times they have presented research evidence to public or partly government-owned organisations over an 18-month period. Overall, empirical results provide new evidence supporting the credibility hypothesis.
Barriers to and Facilitators of Research Utilization: A Survey of Registered Nurses in China
Non UofA Access
Wang LP, Jiang XL, Wang L, Wang GR, Bai YJ.
PloS one 2013 Nov 29;8(11):e81908
This survey aims to describe the perception of barriers to and facilitators of research utilization by registered nurses in Sichuan province, China, and to explore the factors influencing the perceptions of the barriers to and facilitators of research utilization. METHODS: A cross sectional survey design and a double cluster sampling method were adopted. A total of 590 registered nurses from 3 tertiary level hospitals in Sichuan province, China, were recruited in a period from September 2006 to January 2007. A modified BARRUERS Scale and a Facilitators Scale were used. Data were analyzed with descriptive statistics, rank transformation test, and multiple linear regression. RESULTS: Barriers related to the setting subscale were more influential than barriers related to other subscales. The lack of authority was ranked as the top greatest barrier (15.7%), followed by the lack of time (13.4%) and language barrier (15.0%). Additional barriers identified were the reluctance of patients to research utilization, the lack of funding, and the lack of legal protection. The top three greatest facilitators were enhancing managerial support (36.9%), advancing education to increase knowledge base (21.1%), and increasing time for reviewing and implementing (17.5%), while cooperation of patients to research utilization, establishing a panel to evaluate researches, and funding were listed as additional facilitators. Hospital, educational background, research experience, and knowledge on evidence-based nursing were the factors influencing perceptions of the barriers and facilitators. CONCLUSIONS: Nurses in China are facing a number of significant barriers in research utilization. Enhancing managerial support might be the most promising facilitator, given Chinese traditional culture and existing health care system. Hospital, educational background, research experience and knowledge on evidence-based nursing should be taken into account to promote research utilization. The BARRIERS Scale should consider funding and involvement of patients in research utilization.
A systematic review of the effectiveness of knowledge translation interventions for chronic noncancer pain management.
Non UofA Access
Ospina MB, Taenzer P, Rashiq S, MacDermid JC, Carr E, Chojecki D, et al.
Pain research & management 2013 Nov-Dec;18(6):e129-41
Reliable evidence detailing effective treatments and management practices for chronic noncancer pain exists. However, little is known about which knowledge translation (KT) interventions lead to the uptake of this evidence in practice. OBJECTIVES: To conduct a systematic review of the effectiveness of KT interventions for chronic noncancer pain management. METHODS: Comprehensive searches of electronic databases, the gray literature and manual searches of journals were undertaken. Randomized controlled trials, controlled clinical trials and controlled before-and-after studies of KT interventions were included. Data regarding interventions and primary outcomes were categorized using a standard taxonomy; a risk-of-bias approach was adopted for study quality. A narrative synthesis of study results was conducted. RESULTS: More than 8500 titles and abstracts were screened, with 230 full-text articles reviewed for eligibility. Nineteen studies were included, of which only a small proportion were judged to be at low risk of bias. Interactive KT education for health care providers has a positive effect on patients’ function, but its benefits for other health provider- and patient-related outcomes are inconsistent. Interactive education for patients leads to improvements in knowledge and function. Little research evidence supports the effectiveness of structural changes in health systems and quality improvement processes or coordination of care. CONCLUSIONS: KT interventions incorporating interactive education in chronic noncancer pain led to positive effects on patients’ function and knowledge about pain. Future studies should provide implementation details and use consistent theoretical frameworks to better estimate the effectiveness of such interventions.
Particularizing the general: Sustaining theoretical integrity in the context of an evidence-based practice agenda.
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Thorne S, Sawatzky R.
ANS Advances in nursing science 2014 Jan-Mar;37(1):5-18
Proliferation of demands for accountability and health care quality places nurses under constant pressure to ensure professional practice is evidence-based. The corresponding emphasis on knowledge that pertains to general populations challenges nursing’s traditional focus on the uniqueness of each individual patient. Considering how nurses engage with professional systematic thinking processes, we reflect on ways competing agendas in the evidence-based practice environment compromise the professional vision aspired to by an earlier era of nursing model and framework builders. Exploring the scientific thinking underpinning practice evidence, we contemplate implications for applying general knowledge to particular practice, reconsidering options for conceptualizing nursing praxis.
Implementation Science: Implications for Intervention Research in Hospice and Palliative Care.
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Demiris G, Parker Oliver D, Capurro D, Wittenberg-Lyles E.
The Gerontologist 2013 Apr 4
This article provides a general introduction to implementation science-the discipline that studies the implementation process of research evidence-in the context of hospice and palliative care. By discussing how implementation science principles and frameworks can inform the design and implementation of intervention research, we aim to highlight how this approach can maximize the likelihood for translation and long-term adoption in clinical practice settings. We present 2 ongoing clinical trials in hospice that incorporate considerations for translation in their design and implementation as case studies for the implications of implementation science. This domain helps us better understand why established programs may lose their effectiveness over time or when transferred to other settings, why well-tested programs may exhibit unintended effects when introduced in new settings, or how an intervention can maximize cost-effectiveness with strategies for effective adoption. All these challenges are of significance to hospice and palliative care, where we seek to provide effective and efficient tools to improve care services. The emergence of this discipline calls for researchers and practitioners to carefully examine how to refine current and design new and innovative strategies to improve quality of care.
A Critical Analysis and Adaptation of a Clinical Practice Guideline for the Management of Behavioral Problems in Residents with Dementia in Long-Term Care.
Non UofA Access
Lavoie-Vaughan N.
The Nursing clinics of North America 2014 Mar;49(1):105-113
The purpose of this project was to analyze the clinical practice guidelines for management of long-term care residents with dementia and draft an adaptation for implementation. The adaptation focused on individualizing interventions derived from evidence-based research and included strategies to maximize staff buy-in and implementation. The overall goal of the guideline is to decrease psychotropic medication use, particularly antipsychotics. Copyright © 2014 Elsevier Inc. All rights reserved.
Making Evidence Matter in Canadian Health Policy
Editors: Noralou Roos, Kathleen O’Grady, Shannon Turczak, Camilla Tapp and Lindsay Jolivet
Free e-book from EvidenceNetwork.ca
Making Evidence Matter in Canadian Health Policy is a compendium of Op-Eds published in the media in 2012-2013 by some of Canada’s leading experts in the field, offering a snapshot of the evidence on the issues of the day. It is the second in a series of ebooks produced by EvidenceNetwork.ca, the first being Canadian Health Policy in the News, which achieved 13,000 reads in the first year of release. This second volume addresses a range of controversial topics, such as whether or not our health system is sustainable and how our healthcare dollars are spent. Other sections address pharmaceutical policy, private-for-profit delivery of care, social determinants of health, aging, mental health and obesity.
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Health Care Administration and Organization
Relationships of organizational social capital with the presence of “gossip and slander,” “quarrels and conflicts,” sick leave, and poor work ability in nursing homes.
Non UofA Access
Kiss P, De Meester M, Kristensen TS, Braeckman L.
International archives of occupational and environmental health 2014 Mar 1
This study aimed to explore the associations of organizational social capital (OSC) with the presence of “gossip and slander,” the presence of “conflicts and quarrels,” sick leave prevalence, and prevalence of poor work ability in frontline working personnel of nursing homes. METHODS: A total of 239 subjects (81 % participation), working in 11 different nursing homes, took part in a cross-sectional questionnaire study. Following end points were considered, they are as follows: prevalence of “gossip and slander,” “conflicts and quarrels,” sick leave, and poor work ability. Associations with OSC were explored at individual level (binomial log-linear regression analysis) and on group level (Kendall’s tau correlation coefficients). RESULTS: Significant associations were found between OSC and “gossip and slander,” sick leave, and poor work ability, both in the individual- and group-level analyses. The associations showed a higher significance level in the group-level analyses, with the strongest association found between mean OSC of the workplace and the prevalence of poor work ability at the workplace (τ = -0.722; p = 0.002). CONCLUSIONS: This study demonstrated significant associations of OSC with three end points that are relevant within the framework of well-being at work in nursing homes. The results are suggestive that OSC should be treated as a characteristic of the entire workplace, rather than as an individually experienced characteristic. The strikingly strong association between OSC and prevalence of poor work ability is suggestive for an important role of OSC within the context of maintaining work ability.
‘Catching up’: The significance of occupational communities for the delivery of high quality home care by community nurses.
Non UofA Access
Adams M, Robert G, Maben J.
Health (London, England : 1997) 2013 Jul;17(4):422-438
This article examines the importance of some informal work practices among community nurses during a period of significant organizational change. Ethnographic fieldwork in two purposively selected adult community nursing services in England comprised 79 hours of observation of routine practice, 21 interviews with staff and 23 interviews with patients. We identified the informal work practice of ‘catching up’, informal work conversations between immediate colleagues, as an important but often invisible aspect of satisfying work relationships and of the relational care of patients. Drawing on anthropological literatures on ‘communities of practice’ the article examines two central issues concerning the practices of ‘catching up’: (1) how informal learning processes shape community nursing work; (2) how this informal learning is shaped both in relation to the ideals of community nursing work and the wider political and organizational contexts of community nursing practice. Our findings highlight the distinctive value of informal workplace ‘catch ups’ for nurses to manage the inherent challenges of good home care for patients and to develop a shared ethic of care and professional identity. Our findings also indicate the decline of ‘catching up’ between nurses along with diminishing time and opportunity for staff to care holistically for patients in present service climates.
Attracting and retaining qualified nurses in aged and dementia care: outcomes from an Australian study.
Non UofA Access
Chenoweth L, Merlyn T, Jeon YH, Tait F, Duffield C.
Journal of nursing management 2014 Mar;22(2):234-247
To identify key issues and factors affecting retention of qualified nurses who care for older people and persons with dementia in Australian acute, subacute, community and residential health-care settings. BACKGROUND: As the number of older people with chronic conditions needing health care continues to increase research is needed to optimize nurse retention. METHODS: Qualified nurses were surveyed with a set of items derived from four published nurse workforce questionnaires (Cronbach’s alpha range 0.75-0.96). There were 3983 complete responses and 10 focus groups with 58 volunteer survey respondents. RESULTS: In addition to reporting a number of workplace issues, nurses also reported reasonable levels of satisfaction. Intrinsic factors related to caregiving, work relations and colleague support. Extrinsic factors included professional opportunities and organisational support. CONCLUSIONS: Altruism is a primary motivation for choosing to nurse older people and persons with dementia. Nurses are most positive when they feel valued and supported by their organisation and colleagues, through education, training, supervision, mentoring opportunities and appropriate remuneration. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing managers need to take positive steps to address the organisational factors outlined in this paper that either inhibit or promote nurse retention. © 2013 John Wiley & Sons Ltd.
Addressing workplace violence among nurses who care for the elderly.
Non UofA Access
Rodwell J, Demir D.
The Journal of nursing administration 2014 Mar;44(3):152-157
The objective of this study was to examine the social-situational (ie, Job Demands-Resource model) and individual (ie, negative affectivity) factors that might be associated with violence among nurses caring for the elderly (aged care nurses). BACKGROUND: Workplace violence is recognized as a serious issue among nurses. Effective intervention and prevention require an understanding of antecedent factors. METHODS: Nurses working in elderly care facilities across an Australian healthcare organization participated in a cross-sectional survey. RESULTS: Job demands were associated with all of the externally sourced types of violence. Low job control was linked with external emotional abuse and physical assault. Outside work support was related to external physical assault and verbal sexual harassment. Finally, high negative affectivity was linked to internal and external emotional abuse and threat of assault. CONCLUSIONS: Both the Job Demands-Resource model and negative affectivity were useful in identifying relationships with violence, supporting suggestions that situational and individual factors are associated with violence among nurses who care for the elderly.
The mediating effects of job satisfaction on turnover intention for long-term care nurses in Taiwan.
Non UofA Access
Kuo HT, Lin KC, Li IC.
Journal of nursing management 2014 Mar;22(2):225-233
This study explores the mediating effects of job satisfaction on work stress and turnover intention among long-term care nurses in Taiwan. BACKGROUND: Healthcare institutions face a nursing shortage, and it is important to examine the factors that influence turnover intention among nurses. Excessive levels of work stress may lead to employee dissatisfaction and a significant inverse relationship between work stress and job satisfaction, including subsequent effects on turnover among nurses. However, little is known about the mediating role of job satisfaction on work stress and turnover intention among long-term care nurses. METHODS: A cross-sectional survey and a correlation design were used. Multistage linear regression was used to test the mediation model. RESULTS: This study showed that job satisfaction significantly mediated the relationship between work stress and turnover intention. Thirty-eight percent of the variance in turnover intention explained by work stress was accounted for by the mediation pathway. CONCLUSION: The results of this study showed that higher job satisfaction significantly decreased work stress and turnover intention among long-term care nurses. IMPLICATIONS FOR NURSING MANAGEMENT: This study provides nursing administrators with a resource to build a supportive environment to increase nurses’ job satisfaction and to decrease their stress and turnover. © 2013 John Wiley & Sons Ltd.
Gaps in nurse staffng and nursing home resident needs.
Non UofA Access
Zhang NJ, Unruh L, Wan TT.
Nursing economics 2013 Nov-Dec;31(6):289-297
Trends in nurse staffing levels in nursing homes from 1997 to 2011 varied across the category of nurse and the type of nursing home. The gaps found in this study are important to consider because nurses may become overworked and this may negatively affect the quality of services and jeopardize resident safety. Nursing home administrators should consider improving staffing strategically. Staffing should be based not only on the number of resident days, but also allocated according to particular resident needs. As the demand for nursing home care grows, bridging the gap between nurse staffing and resident nursing care needs will be especially important in light of the evidence linking nurse staffing to the quality of nursing home care. Until more efficient nursing care delivery exits, there may be no other way to safeguard quality except to increase nurse staffing in nursing homes.
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Health Care Innovation and Quality Assurance
Minnesota’s provider-initiated approach yields care quality gains at participating nursing homes.
Non UofA Access
Arling G, Cooke V, Lewis T, Perkins A, Grabowski DC, Abrahamson K.
Health affairs (Project Hope) 2013 Sep;32(9):1631-1638
Minnesota’s Performance-Based Incentive Payment Program uses a collaborative, provider-initiated approach to nursing home quality improvement: up-front funding of evidence-based projects selected and designed by participating facilities, with accountable performance targets. During the first 4 rounds of funding (2007-10), 66 projects were launched at 174 facilities. Using a composite quality measure representing multiple dimensions of clinical care, we found that facilities participating during this period exhibited significantly greater gains than did nonparticipating facilities, in both targeted areas and overall quality, and maintained their quality advantage after project completion. Participating and nonparticipating facilities were similar at baseline with respect to quality scores and improvement trends, as well as acuity-adjusted payment, operating costs, and nurse staffing. Although self-selection precludes firm conclusions regarding the program’s impacts, early findings indicate that the program shows promise for incentivizing nursing home quality improvement, both in facility-identified areas of concern and overall.
Using high-performance work practices in health care organizations: a perspective for nursing.
Non UofA Access
McAlearney AS, Robbins J.
Journal of nursing care quality 2014 Apr-Jun;29(2):E11-20
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.
Health System Relationships – A Paradigm Shift for Safety and Quality in Healthcare
Hugh MacLeod and Mary Ditton.
Longwoods Essays 2014 03/04.
One of our biggest challenges, and therefore our biggest opportunity, is that we spend much of our time evaluating the evidence pertaining to the hard side of healthcare. Our attention is constantly focused on outcomes, cost and harm. We do not spend nearly enough time, if any, talking about the soft relationship side of healthcare. These are the relationship patterns, the teachable moments, the integrity between physicians, between physicians and nurses, between care providers and patients. These relationship patterns have a direct and potent outcome on the hard side of the business. Just think about how these relationship patterns relate to crisis frequency, the cost of doing business and harm events.
Using linked hospitalisation data to detect nursing sensitive outcomes: A retrospective cohort study.
Non UofA Access
Schreuders LW, Bremner AP, Geelhoed E, Finn J.
International journal of nursing studies 2014 Mar;51(3):470-478
Nursing sensitive outcomes are adverse patient health outcomes that have been shown to be associated with nursing care. Researchers have developed specific algorithms to identify nursing sensitive outcomes using administrative data sources, although contention still surrounds the ability to adjust for pre-existing conditions. Existing nursing sensitive outcome detection methods could be improved by using look-back periods that incorporate relevant health information from patient’s previous hospitalisations. DESIGN AND SETTING: Retrospective cohort study at three tertiary metropolitan hospitals in Perth, Western Australia. OBJECTIVES: The objective of this research was to explore the effect of using linked hospitalisation data on estimated incidence rates of eleven adverse nursing sensitive outcomes by retrospectively extending the timeframe during which relevant patient disease information may be identified. The research also explored whether patient demographics and/or the characteristics of their hospitalisations were associated with nursing sensitive outcomes. RESULTS: During the 5 year study period there were 356,948 hospitalisation episodes involving 189,240 patients for a total of 2,493,654 inpatient days at the three tertiary metropolitan hospitals. There was a reduction in estimated rates for all nursing sensitive outcomes when a look-back period was applied to identify relevant health information from earlier hospitalisations within the preceding 2 years. Survival analysis demonstrates that the majority of relevant patient disease information is identified within approximately 2 years of the baseline nursing sensitive outcomes hospitalisation. Compared to patients without, patients with nursing sensitive outcomes were significantly more likely to be older (70 versus 58 years), female, have Charleson comorbidities, be direct transfers from another hospital, have a longer inpatient stay and spend time in intensive care units (p≤0.001). CONCLUSIONS: The results of this research suggest that nursing sensitive outcome rates may be over-estimated using current detection methods. Linked hospitalisation data enables the use of look-back periods to identify clinically relevant diagnosis codes recorded prior to the hospitalisation in which a nursing sensitive outcome is detected. Using linked hospitalisation data to incorporate look-back periods offers an opportunity to increase the accuracy of nursing sensitive outcome detection when using administrative data sources. Copyright © 2013 Elsevier Ltd. All rights reserved.
Perceptions of staff quality improvement training needs among Veterans Affairs nursing home leadership.
Non UofA Access
Zakoscielna KM, Parmelee PA, Lichtenstein S.
Journal of Research in Nursing 2014 03;19(2):131
This study seeks to describe clinical leadership’s perceptions of staff understanding of the minimum data set (MDS) quality indicators (QIs) and ways to improve staff understanding of this system, as well as specific perceived training needs among Department of Veterans Affairs (VA) nursing home care unit (NHCU) clinical leadership. This cross-sectional online survey using structured (quantitative) and open-ended (qualitative) items took place in 97 VA NHCUs nationwide. A total of 289 leadership staff including directors of nursing, medical directors, MDS coordinators participated. Qualitative analysis yielded several themes regarding why staff do/do not understand MDS QIs, and strategies to improve staff understanding included involvement, staffing/staff roles, education/training, mechanics, big picture. Regarding how to improve understanding, respondents recommended education/training, involvement, reinforcement and others. Of specific training strategies/needs, the most frequently identified were using the MDS as a clinical assessment tool. Quantitative analyses were not significant. These results highlight the range of causes identified by managers for frontline staff’s understanding (or lack thereof) of the QIs, and their preference for ways to improve staff understanding of what the MDS means. Understanding and applying these strategies may help improve staff’s use of the MDS QIs in VA and non-VA skilled nursing facilities.
An evidence-based framework to measure quality of allied health care
Non UofA Access
Grimmer K, Lizarondo L, Kumar S, Bell E, Buist M, Weinstein P.
Health research policy and systems 2014 Feb 26;12(1):10
There is no standard way of describing the complexities of allied health (AH) care, or its quality. AH is an umbrella term which excludes medicine and nursing, and variably includes disciplines which provide therapy, diagnostic, or scientific services. This paper outlines a framework for a standard approach to evaluate the quality of AH therapy services. METHODS: A realist synthesis framework describing what AH does, how it does it, and what is achieved, was developed. This was populated by the findings of a systematic review of literature published since 1980 reporting concepts of quality relevant to AH. Articles were included on quality measurement concepts, theories, debates, and/or hypothetical frameworks. RESULTS: Of 139 included articles, 21 reported on descriptions of quality potentially relevant to AH. From these, 24 measures of quality were identified, with 15 potentially relating to what AH does, 17 to how AH delivers care, 8 relating to short term functional outcomes, and 9 relating to longer term functional and health system outcomes. CONCLUSIONS: A novel evidence-based quality framework was proposed to address the complexity of AH therapies. This should assist in better evaluation of AH processes and outcomes, costs, and evidence-based engagement of AH providers in healthcare teams.
Introduction of Surgical Safety Checklists in Ontario, Canada
Urbach DR, Govindarajan A, Saskin R, Wilton AS, Baxter NN.
New England Journal of Medicine 2014;370(11):1029-1038.
Evidence from observational studies that the use of surgical safety checklists results in striking improvements in surgical outcomes led to the rapid adoption of such checklists worldwide. However, the effect of mandatory adoption of surgical safety checklists is unclear. A policy encouraging the universal adoption of checklists by hospitals in Ontario, Canada, provided a natural experiment to assess the effectiveness of checklists in typical practice settings.
Toward a Model Long-Term Services and Supports System: State Policy Elements
Kaye HS.
The Gerontologist 2014
In response to a new Federal initiative to improve the U.S. long-term services and supports (LTSS) system, this commentary discusses an array of policies and practices that could potentially improve LTSS provision by shifting from institutional to community-based services, increasing equity across populations, offering consumers more choice and control, improving conditions for workers and caregivers, and promoting improved consumer-level outcomes. Policy areas include access to publicly funded LTSS, support for consumer direction, workforce development, caregiver support, transition from institutions to the community, diversion from institutional placement, and quality and outcome measurement. Policy considerations apply both to programs and to the managed care organizations that are increasingly responsible for LTSS provision. Additional policy areas related to managed LTSS include financial risk and capitation rates, enrollment strategies, assessment, outcomes monitoring, care coordination, and support for independent living goals.
‘Care left undone’ during nursing shifts: associations with workload and perceived quality of care.
Non UofA Access
Ball JE, Murrells T, Rafferty AM, Morrow E, Griffiths P.
BMJ quality & safety 2014 Feb;23(2):116-125
There is strong evidence to show that lower nurse staffing levels in hospitals are associated with worse patient outcomes. One hypothesised mechanism is the omission of necessary nursing care caused by time pressure-‘missed care’. AIM: To examine the nature and prevalence of care left undone by nurses in English National Health Service hospitals and to assess whether the number of missed care episodes is associated with nurse staffing levels and nurse ratings of the quality of nursing care and patient safety environment. METHODS: Cross-sectional survey of 2917 registered nurses working in 401 general medical/surgical wards in 46 general acute National Health Service hospitals in England. RESULTS: Most nurses (86%) reported that one or more care activity had been left undone due to lack of time on their last shift. Most frequently left undone were: comforting or talking with patients (66%), educating patients (52%) and developing/updating nursing care plans (47%). The number of patients per registered nurse was significantly associated with the incidence of ‘missed care’ (p<0.001). A mean of 7.8 activities per shift were left undone on wards that are rated as ‘failing’ on patient safety, compared with 2.4 where patient safety was rated as ‘excellent’ (p < 0.001). CONCLUSIONS: Nurses working in English hospitals report that care is frequently left undone. Care not being delivered may be the reason low nurse staffing levels adversely affects quality and safety. Hospitals could use a nurse-rated assessment of ‘missed care’ as an early warning measure to identify wards with inadequate nurse staffing.
Health Foundation: Helping measure person-centred care(UK)
March 2014
Person-centred, individualised, personalised, patient-centred, family-centred, patient-centric and many other terms have been used to signal a change in how health services engage with people. This rapid review summarises research about measuring the extent to which care is person-centred.
Three key questions guided the review:
-How is person-centred care being measured in healthcare?
-What types of measures are used?
-Why and by whom is measurement taking place?
The review signposts to research about commonly used approaches and tools to help measure person-centred care. It aims to showcase the many tools available.
A spreadsheet listing 160 of the most commonly researched measurement tools accompanies the review. This allows users to search according to the type of tool, who it targets and the main contexts it has been tested in. Hyperlinks to the abstracts of examples of research using each tool are also provided.
Conference Board of Canada: Strong Learning Organizations, Strong Leadership
February 2014
This report provides an overview of the current state of learning and development (L&D) practices and programs across Canada, with particular attention paid to the impact of learning culture on organizational performance.
NESTA: Which doctors take up promising ideas? New insights from open data (UK)
January 2014
The report looks at early adoption of promising new ideas across primary care in England and argues that analysing open data can help public services gain a greater understanding of their take up of innovations.
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Research Practice & Methodology
Mapping patient safety: a large-scale literature review using bibliometric visualisation techniques
Rodrigues SP, van Eck NJ, Waltman L, Jansen FW.
BMJ Open 2014;4(3)
The amount of scientific literature available is often overwhelming, making it difficult for researchers to have a good overview of the literature and to see relations between different developments. Visualisation techniques based on bibliometric data are helpful in obtaining an overview of the literature on complex research topics, and have been applied here to the topic of patient safety (PS). Methods On the basis of title words and citation relations, publications in the period 2000–2010 related to PS were identified in the Scopus bibliographic database. A visualisation of the most frequently cited PS publications was produced based on direct and indirect citation relations between publications. Terms were extracted from titles and abstracts of the publications, and a visualisation of the most important terms was created. The main PS-related topics studied in the literature were identified using a technique for clustering publications and terms. Results A total of 8480 publications were identified, of which the 1462 most frequently cited ones were included in the visualisation. The publications were clustered into 19 clusters, which were grouped into three categories: (1) magnitude of PS problems (42% of all included publications); (2) PS risk factors (31%) and (3) implementation of solutions (19%). In the visualisation of PS-related terms, five clusters were identified: (1) medication; (2) measuring harm; (3) PS culture; (4) physician; (5) training, education and communication. Both analysis at publication and term level indicate an increasing focus on risk factors. Conclusions A bibliometric visualisation approach makes it possible to analyse large amounts of literature. This approach is very useful for improving one’s understanding of a complex research topic such as PS and for suggesting new research directions or alternative research priorities. For PS research, the approach suggests that more research on implementing PS improvement initiatives might be needed.
Gathering opinion leader data for a tailored implementation intervention in secondary healthcare: a randomised trial
Non UofA Access
Suehs BT, Shah SN, Davis CD, Alvir J, Faison WE, Patel NC, et al.
Journal of the American Geriatrics Society 2014 Feb 27
Health professionals’ behaviour is a key component in compliance with evidence-based recommendations. Opinion leaders are an oft-used method of influencing such behaviours in implementation studies, but reliably and cost effectively identifying them is not straightforward. Survey and questionnaire based data collection methods have potential and carefully chosen items can – in theory – both aid identification of opinion leaders and help in the design of an implementation strategy itself. This study compares two methods of identifying opinion leaders for behaviour-change interventions. Methods Healthcare professionals working in a single UK mental health NHS Foundation Trust were randomly allocated to one of two questionnaires. The first, slightly longer questionnaire, asked for multiple nominations of opinion leaders, with specific information about the nature of the relationship with each nominee. The second, shorter version, asked simply for a list of named “champions” but no more additional information. We compared, using Chi Square statistics, both the questionnaire response rates and the number of health professionals likely to be influenced by the opinion leaders (i.e. the “coverage” rates) for both questionnaire conditions. Results Both questionnaire versions had low response rates: only 15% of health professionals named colleagues in the longer questionnaire and 13% in the shorter version. The opinion leaders identified by both methods had a low number of contacts (range of coverage, 2–6 each). There were no significant differences in response rates or coverage between the two identification methods. Conclusions The low response and population coverage rates for both questionnaire versions suggest that alternative methods of identifying opinion leaders for implementation studies may be more effective. Future research should seek to identify and evaluate alternative, non-questionnaire based, methods of identifying opinion leaders in order to maximise their potential in organisational behaviour change interventions.
AHRQ: Assessment of a Method To Detect Signals for Updating Systematic Reviews
March 2014
The AHRQ Comparative Effectiveness Review (CER) program had produced 13 CERs by 2009, and 11 of these were assessed in 2009 using the surveillance system to produce determinations of the degree to which individual conclusions were out of date, along with a priority for updating each report. Four CERs were judged to be a high priority for updating, 4 CERs were judged to be medium priority for updating, and 3 CERs were judged to be low priority for updating. AHRQ then commissioned full updated reviews for 9 of these 11 CERs, including 4 high, 3 medium, and 2 low-priority reports. After all the updated reports were completed, we matched the original predictions about which conclusions in each CER were still valid, possibly out of date, probably out of date, and out of date, with the corresponding conclusions in the updated report, and then classified each pair as having good, fair or poor concordance. We also made a summary determination of the priority for updating each CER based on the actual changes in conclusions in the updated report, and compared these determinations with the earlier assessments of priority.
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Health Care in Canada
Setting Priorities for the B.C. Health System
BC Ministry of Health February 2014
Setting Priorities for the B.C. Health System presents the strategic and operational priorities for the delivery of health services across the province.
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Aging
Observer-rated depression in long-term care: Frequency and risk factors.
Non UofA Access
McCusker J, Cole MG, Voyer P, Monette J, Champoux N, Ciampi A, et al.
Archives of Gerontology and Geriatrics 2013 Dec 1
The objectives of this study were: (1) to describe the prevalence and 6-month incidence of observer-rated depression in residents age 65 and over of long-term care (LTC) facilities; (2) to describe risk factors for depression, at baseline and over time. A multisite, prospective observational study was conducted in residents aged 65 and over of 7 LTC facilities. The Cornell Scale for Depression in Dementia (CSDD) was completed by nurses monthly for 6 months. We measured demographic, medical, and functional factors at baseline and monthly intervals, using data from research assessments, nurse interviews, and chart reviews. 274 residents were recruited and completed baseline depression assessments. The prevalence of depression (CSDD score of 6+) was 19.0%. The incidence of depression among those without prevalent depression was 73.3 per 100 person-years. A delirium diagnosis, pain, and diabetes were independently associated with prevalent depression. CSDD score at baseline and development of severe cognitive impairment at follow-up were independent risk factors for incident depression. A diagnosis of delirium and uncorrected visual impairment at follow-up occurred concurrently with incident depression. The results of this study have implications for the detection and prevention of depression in LTC. Delirium diagnosis, pain and diabetes at baseline were associated with prevalent depression; depression symptoms at baseline and development of severe cognitive impairment at follow-up were risk factors for incident depression.
Variations in levels of care between nursing home patients in a public health care system
Dohl O, Garasen H, Kalseth J, Magnussen J.
BMC Health Services Research 2014;14(1):108
Within the setting of a public health service we analyse the distribution of resources between individuals in nursing homes funded by global budgets. Three questions are pursued. Firstly, whether there are systematic variations between nursing homes in the level of care given to patients. Secondly, whether such variations can be explained by nursing home characteristics. And thirdly, how individual need-related variables are associated with differences in the level of care given. Methods The study included 1204 residents in 35 nursing homes and extra care sheltered housing facilities. Direct time spent with patients was recorded. In average each patient received 14.8 hours direct care each week. Multilevel regression analysis is used to analyse the relationship between individual characteristics, nursing home characteristics and time spent with patients in nursing homes. The study setting is the city of Trondheim, with a population of approximately 180 000. Results There are large variations between nursing homes in the total amount of individual care given to patients. As much as 24 percent of the variation of individual care between patients could be explained by variation between nursing homes. Adjusting for structural nursing home characteristics did not substantially reduce the variation between nursing homes. As expected a negative association was found between individual care and case-mix, implying that at nursing home level a more resource demanding case-mix is compensated by lowering the average amount of care. At individual level ADL-disability is the strongest predictor for use of resources in nursing homes. For the average user one point increase in ADL-disability increases the use of resources with 27 percent.
Impact on hospital admissions of an integrated primary care model for very frail elderly patients.
Non UofA Access
de Stampa M, Vedel I, Buyck JF, Lapointe L, Bergman H, Beland F, et al.
Archives of Gerontology and Geriatrics 2014 May-Jun;58(3):350-355
Very frail elderly patients living in the community, present complex needs and have a higher rate of hospital admissions with emergency department (ED) visits. Here, we evaluated the impact on hospital admissions of the COPA model (CO-ordination Personnes Agées), which provides integrated primary care with intensive case management for community-dwelling, very frail elderly patients. We used a quasi-experimental study in an urban district of Paris with four hundred twenty-eight very frail patients (105 in the intervention group and 323 in the control group) with one-year follow-up. The primary outcome measures were the presence of any unplanned hospitalization (via the ED), any planned hospitalizations (direct admission, no ED visit) and any hospitalization overall. Secondary outcome measures included health parameters assessed with the RAI-HC (Resident Assessment Instrument-Home Care). Comparing the intervention group with the control group, the risk of having at least one unplanned hospital admission decreased at one year and the planned hospital admissions rate increased, without a significant change in total hospital admissions. Among patients in the intervention group, there was less risk of depression and dyspnea. The COPA model improves the quality of care provided to very frail elderly patients by reducing unplanned hospitalizations and improving some health parameters.
Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
Contribution of Alzheimer disease to mortality in the United States.
Non UofA Access
James BD, Leurgans SE, Hebert LE, Scherr PA, Yaffe K, Bennett DA.
Neurology 2014 Mar 5
To assess the burden of mortality attributable to Alzheimer disease (AD) dementia in the United States. METHODS: Data came from 2,566 persons aged 65 years and older (mean 78.1 years) without dementia at baseline from 2 cohort studies of aging with identical annual diagnostic assessments of dementia. Because both studies require organ donation, ascertainment of mortality was complete and dates of death accurate. Mortality hazard ratios (HRs) after incident AD dementia were estimated per 10-year age strata from proportional hazards models. Population attributable risk percentage was derived to estimate excess mortality after a diagnosis of AD dementia. The number of excess deaths attributable to AD dementia in the United States was then estimated. RESULTS: Over an average of 8 years, 559 participants (21.8%) without dementia at baseline developed AD dementia and 1,090 (42.4%) died. Median time from AD dementia diagnosis to death was 3.8 years. The mortality HR for AD dementia was 4.30 (confidence interval = 3.33, 5.58) for ages 75-84 years and 2.77 (confidence interval = 2.37, 3.23) for ages 85 years and older (too few deaths after AD dementia in ages 65-74 were available to estimate HR). Population attributable risk percentage was 37.0% for ages 75-84 and 35.8% for ages 85 and older. An estimated 503,400 deaths in Americans aged 75 years and older were attributable to AD dementia in 2010. CONCLUSIONS: A larger number of deaths are attributable to AD dementia in the United States each year than the number (<84,000 in 2010) reported on death certificates.
Differential impacts of care-giving across three caregiver groups in Canada: end-of-life care, long-term care and short-term care.
Non UofA Access
Williams AM, Wang L, Kitchen P.
Health & social care in the community 2014 Mar;22(2):187-196
Using data from Statistic Canada’s General Social Survey Cycle 21 (GSS 2007), this study explores whether differences exist in the impacts of care-giving among three groups of caregivers providing informal care either in the caregiver’s or recipient’s home, or in other locations within the community: (i) those providing end-of-life (EOL) care (n = 471); (ii) those providing long-term care (more than 2 years) for someone with a chronic condition or long-term illness (n = 2722); and (iii) those providing short-term care (less than 2 years) for someone with a chronic condition or long-term illness (n = 2381). This study lays out the variation in sociodemographic characteristics across the three caregiver groups while also building on our understanding of the differential impacts of care-giving through an analysis of determinants. All three groups of caregivers shared a number of sociodemographic characteristics, including being female, married, employed and living in a Census Metropolitan Area (CMA). With respect to health, EOL caregivers were found to have significantly higher levels of ‘fair or poor’ self-assessed health than the other two groups. Overall, the findings suggest that EOL caregivers are negatively impacted by the often additional role of care-giving, more so than both short-term and long-term caregivers. EOL caregivers experienced a higher proportion of negative impacts on their social and activity patterns. Furthermore, EOL caregivers incurred greater financial costs than the other two types of informal caregivers. The impacts of EOL care-giving also negatively influence employment for caregivers when compared with the other caregiver groups. Consequently, EOL caregivers, overall, experienced greater negative impacts, including negative health outcomes, than did long-term or short-term caregivers. This provides the evidence for the assertion that EOL care-giving is the most intense type of care-giving, potentially causing the greatest caregiver burden; this is shown through the greater negative impacts experienced by the EOL caregivers when compared with the short-term and long-term caregivers. © 2013 The Authors. Health and Social Care in the Community published by John Wiley & Sons Ltd.
The Effect of Cognitive Stimulation on Nursing Home Elders: A Randomized Controlled Trial.
Non UofA Access
Apostolo JL, Cardoso DF, Rosa AI, Paul C.
Journal of nursing scholarship 2014 Mar 5
This paper describes the effectiveness of cognitive stimulation therapy (CST) on cognition and depressive symptoms in older adults in nursing homes (NHs). DESIGN: A randomized controlled trial, carried out from 2012 to 2013, included 56 residents from four NHs, 36 women and 20 men (randomized into experimental and control groups). Eight participants dropped out. METHODS: Participants of the experimental group underwent 14 CST sessions (7 weeks) in groups of six to eight older adults, and participants of the control group received usual care. The Montreal Cognitive Assessment, the Geriatric Depression Scale-15, and the Barthel Index of activities of daily living (ADLs) were administered at baseline and postintervention. FINDINGS: Repeated measures revealed that CST increased cognition (F = 8.581; p = .005; partial η squared = 0.157; power = 0.82). There were no statistically significant differences in depressive symptoms (F = 1.090; p = .302). Baseline level of ADLs did not affect the outcomes. CONCLUSIONS: CST had significantly improved cognition, explaining the 15.7% variability, but there was no statistical evidence of its effectiveness on depressive symptoms. This improvement was not affected by the baseline level of dependence-independence in ADLs. CLINICAL RELEVANCE: CST offers a range of activities, providing general stimulation for thinking, concentration, and memory, usually in a social setting. These results will support implementation of CST in NHs. In addition to the impact on elderly independence and autonomy, CST may also have an economic impact by reducing the direct costs of the impact of elders’ cognitive frailty. © 2014 Sigma Theta Tau International.
Dementia As a Cultural Metaphor.
Non UofA Access
Zeilig H.
The Gerontologist 2013 Feb 13
This article contributes to debates about the category “dementia,” which until recently has been dominated by biomedical models. The perspectives of critical gerontology are pertinent for extending knowledge about dementia and guiding this analysis. These perspectives encourage examination of cultural and historical influences and thus question how societies have constructed and defined dementia. This article queries the stories told about dementia and the language that we use to tell these stories. Central to the article is an analysis of some of the stories about dementia that are contained within and framed by contemporary culture. A number of films, TV documentaries, news reports, theatre, memoirs, novels, and poems that portray some of the experiences associated with dementia are interrogated. These representations are examined as they either perpetrate or challenge stereotypes about living with dementia. Analysis of these representations demonstrates the sociocultural construction of dementia and the extent to which dementia is a diachronic phenomenon. Above all, the article considers (a) the social and political dimensions of dementia, (b) the ways in which the metaphors persistently used to explain dementia shape our consciousness about this condition, and (c) the extent to which dementia is an inherent part of contemporary life.
Perceptions of Cause and Control in People With Alzheimer’s Disease
Non UofA Access
Matchwick C, Domone R, Leroi I, Simpson J.
The Gerontologist 2013 Mar 19
Purpose of the Study:To explore cause and control illness representations in older adults with Alzheimer’s disease (AD). DESIGN AND METHODS: Six older adults living in the North West of England completed semi-structured interviews that were subject to an interpretative phenomenological analysis. RESULTS: Three main themes emerged indicating that participants were trying to make sense of their AD by comparing it with their previous experience of physical health illnesses. All participants acknowledged their diagnosis of AD but engaged with it in a graded way because of a lack of tangible diagnostic evidence. Participants developed pragmatic emotional responses to their situation. IMPLICATIONS: One of the main implications of the results is that caution needs to be exercised within clinical practice so that the pragmatic responses of individuals with AD are not pathologized.
Household Members of Persons with Alzheimer’s Disease: Health Conditions, Healthcare Resource Use, and Healthcare Costs
Non UofA Access
Suehs BT, Shah SN, Davis CD, Alvir J, Faison WE, Patel NC, et al.
Journal of the American Geriatrics Society 2014 Feb 27
To compare medical condition burden, healthcare resource use, and healthcare costs of household members (HHMs) of individuals diagnosed with Alzheimer’s disease (AD) with those of HHMs of matched individuals without AD. Design Retrospective cohort study based on administrative claims data collected between January 1, 2007, and December 31, 2011. Setting Medicare Advantage Prescription Drug (MAPD) plan. Participants MAPD plan members with a diagnosis of AD (International Classification of Disease Ninth Revision, Clinical Modification, code 331.0) were selected and linked to a HHM to form patient-HHM dyads. AD dyads were matched to non-AD dyads. Measurements Health-related endpoints, including medical condition burden, healthcare resource use, and direct healthcare costs, were measured during 36 months of continuous health plan enrollment. Results Individuals with AD (n = 1,861) were linked to HHMs (n = 1,861), and these AD dyads were matched to 1,861 non-AD patient–HHM dyads. AD HHMs had greater medical condition burden scores than non-AD HHMs, with mood disorders, anxiety disorders, insomnia, substance abuse or dependence, cardiovascular disease, and rheumatoid arthritis being more prevalent in AD HHMs. Emergency department and outpatient service use were more common in AD HHMs than in non-AD HHMs, and AD HHMs had greater healthcare costs. Conclusion HHMs of individuals diagnosed with AD demonstrated greater medical condition burden, healthcare resource use, and direct healthcare costs than non-AD HHMs. These findings demonstrate the significant clinical and financial impact of AD on HHMs of individuals with AD.
Adverse events in skilled nursing facilities: national incidence among Medicare beneficiaries (US)
Department of Health and Human Services February 2014
An estimated 22 percent of Medicare beneficiaries experienced adverse events during their SNF stays. An additional 11 percent of Medicare beneficiaries experienced temporary harm events during their SNF stays. Physician reviewers determined that 59 percent of these adverse events and temporary harm events were clearly or likely preventable. They attributed much of the preventable harm to substandard treatment, inadequate resident monitoring, and failure or delay of necessary care. Over half of the residents who experienced harm returned to a hospital for treatment, with an estimated cost to Medicare of $208 million in August 2011. This equates to $2.8 billion spent on hospital treatment for harm caused in SNFs in FY 2011.
The King’s Fund: Making our health and care systems fit for an ageing population (UK)
2014
This King’s Fund report presents a framework and tools to help local service leaders improve the care provided for older people. The focus is on improving the integration of care and the reduction of delays in transitions between different services. Whole-system changes are needed, and this report addresses the nine underlying components of care.
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Events
UofA
Dancing to Death: Mass Psychogenic Illness in History
Classroom D (2F1.04 W Mackenzie Health Sciences Centre), 08:00-09:00 Friday 28 March 28
This Grand Rounds presentation examines several striking episodes of Mass Psychogenic Illness in European history, from medieval dancing plagues and outbreaks of apparent demonic possession to modern cases of paralysis and compulsive laughter in schools and factories. It will explore the preconditions for these incidents and reflect on what they tell us about the role of cultural factors in the expression of psychological distress.
Darwin’s Angst: Medical Genetics before Mendel
1-490 ECHA 12:00-13:00 Friday 28 March 28
This presentation will examine how physicians and patients used the concept of heredity prior to the twentieth century. Starting with the classical tradition, it traces the development of the idea of inherited malady through the medieval period and into the modern age, showing how and why medicine came to place more and more importance on the idea that diseases can pass from parents to their children. It will also show how beliefs about disease and heredity were driving eugenic thinking long before the twentieth century and the advent of formal eugenics movements.
Making Biological Hierarchies: Patterns in the History of ‘Them-and-Us’ Distinctions
Classroom D (2F1.04 W Mackenzie Health Sciences Centre) 11:30-12:30 Saturday 29 March
This talk draws widely on the history of interactions among the diverse peoples of Europe and the Americas to explore how certain groups have come to conceptualize others. What are the key factors in leading one group to consider itself to be innately superior to another? How important are cultural and religious divergences, relative military power, economic interests, and ideological traditions in deciding whether another group is regarded as inherently inferior, assimilable given the ‘right’ influences, or different but equal? I will argue that by drawing on evidence from very different historical periods and places, from classical Greece and Rome to twentieth century Europe, we can discern broad patterns in how groups respond to human differences. This talk offers a contextual understanding of the long history of regarding certain social classes and ethnicities as genetically distinct.
Dosseter Center: End of life decision-making & physician-assisted death: Recent developments
Friday 21 March Dvorkin Centre, 2G2.07 WMC
Recent developments are influencing end-of-life decision-making. The Supreme Court of Canada recently released its decision in Cuthbertson v. Rasouli , where it set out a legal requirement for consent prior to the withdrawal of non-beneficial life support in the ICU in Ontario. While the SCC attempted to limit the implications of its decision, what are the potential repercussions? And will it impact provinces beyond Ontario? Meanwhile, physician assisted suicide and euthanasia are heading back to the Supreme Court of Canada following decisions made by the courts in B.C. in Carter v. Attorney General of Canada. As a result, the Rodriguez decision, which upheld the Criminal Code prohibitions as constitutional, will be revisited. Additionally, Quebec has introduced a Bill which, if passed, will legalize euthanasia in Quebec, though this is sure to be challenged by the federal government. As a result, we could see changes in the law. Will we? Should we? Come for a discussion of end-of-life decision making in flux and the legal, ethical and professional considerations
Non UofA
E-Merge 2014
SFU Vancouver 9-12 June
E-Merge 2014! is ideal for those who want to advance their ideas for improving health and healthcare. You could be from a number of sectors (e.g., healthcare, social, medical device, digital, IT, education, lifestyle and fitness), a company or a not-for profit. You may be a healthcare professional, a patient or advocate, a university researcher/student. You may be interested in innovating within your current organization or creating a new healthcare venture. You are passionate about improving some aspect of health(-care).
North American DDI (NADDI) Users Group meeting
Vancouver 31 March-2 April
Research data management has become an important global issue as funding agencies, publishers, and disciplines increasingly require the sharing of publicly funded data. The Open Data movement treats curated data as a valuable resource available to support new research with the potential for new discoveries. Furthermore, the expectation that research findings can be replicated is pressuring researchers to make their data understandable and usable by others. Both the replication and reuse of research data are highly dependent on properly documented data. The Data Documentation Initiative (DDI) provides two structured metadata specifications for describing the content and context of data about individuals or organizations (microdata) in the health, social, and behavioural sciences. This community-maintained standard for microdata is internationally recognized as a best practice in preparing, sharing, and preserving data.
Annual international conference of Alzheimer’s Disease International
1-4 May 2014 San Juan, Puerto Rico
This year is set to be more exciting than ever with a growing number of delegates year on year and an unforgettable location: Puerto Rico. The unique conference has something to offer everyone. If you are a professional in the field of Alzheimer’s, an individual living with the disease or a carer you will no doubt benefit from attending ADI’s 2014 conference.
Online
NICHE: A Pilot Program Engaging Families to Collaborate in Delirium Recognition
Wednesday 19 March 11:00 MT Costs Free/NICHE Site, $99/non-NICHE Site
Patient care staff often cannot recognize delirium because patient baselines are not always known on admission. Families can be a resource in recognizing a family member’s change from baseline but are unfamiliar with the concept of delirium and are not empowered to report changes. The NICHE coordinators at Strong Memorial Hospital developed an educational video designed to arm family members with better knowledge about delirium and how to recognize and report changes in behavior to staff. Learn the details and results of this effort by attending this important NICHE webinar.
Equator Network & PAHO The STROBE Statement: reporting observational studies
19 March 09:00 MT
Sponsored by the Equator Network and the Pan American Health Organization (PAHO) under their agreement of collaboration to improve research for health reporting in the Americas through the use of guidelines that promote greater accuracy and transparency.
IIQM: “Troubling Qualitative Inquiry: Accounts as data and as product”
Thursday 20 March 13:00 MT
In this session Martyn Hammersley wants to share some concerns he has about the current state of qualitative research, and to outline his attempts to explore these and resolve them. The broad context for these concerns is the division between qualitative and quantitative inquiry, and the multiplicity of qualitative approaches now promoted.
Courses
2014 Training Institute for Dissemination and Implementation Research in Health
21-25 July 21 Harvard University
DEADLINE TO APPLY 6 April
This 5-day training institute provides participants with a thorough grounding in conducting dissemination and implementation research in health. Faculty and guest lecturers will consist of leading experts (practitioners and teachers) in theory, implementation and evaluation approaches to D&I, creating partnerships and multi-level, transdisciplinary research teams, research design, methods and analyses appropriate for D&I investigations and conducting research at different and multiple levels of interventions (e.g., clinical, community, policy).
Evidence-Informed Decision Making Workshop
May 5-9, Hamilton ON
This course is offered by the Canadian Centre for Evidence Based Nursing. Decisions about practice, program development, and policy making confront those involved with health care on a daily bases. Such decisions may include interpreting diagnostic tests, identifying the harm associated with a particular treatment, understanding the course of a disease in a specific patient, determining the effectiveness of interventions, or establishing the cost and consequences many other clinical decision. The EIDM Workshop focuses on helping participants to engage in decision making that is informed by the purposeful and systematic use of the best available evidence.
King’s Fund: Designing Care Environments for People with Dementia Workshops
3 – 4 June Cheshire UK
15 – 16 October Swindon UK
There is increasing evidence that the environment of care, particularly in acute hospitals, can have a significant and detrimental effect on people who have dementia. The King’s Fund’s award-winning Enhancing the Healing Environment programme proves that straightforward and inexpensive changes to the design and fabric of the care environment can have a considerable impact on the well-being of people with dementia by easing decision-making, reducing agitation and distress, supporting independence and promoting safety, all of which can contribute to a reduction in overall service costs.
Online
Using Observational Data in Research: Using the Propensity Score to Adjust for Bias
19 March 19 11:30–14:00 PM MT
Observational data are data that were not originally collected for research purposes. This presentation will focus on the data contained in anonymized versions of the databases used to administer Ontario’s health care system. The timing of this webinar is fortuitous: this spring the Institute for Clinical Evaluative Sciences (ICES) will launch a program that will make the data in these databases available, at marginal cost, to Canadian researchers. The ICES program is part of CIHR’s SPOR (Strategy for Patient-Oriented Research) initiative.
News
Elderly profit from group meetings and home visits
Group meetings and preventive home visits helped octogenarians maintain their health, independence and a positive outlook, according to a first-of-its-kind study in Sweden.
Link your ORCID record to your funding
It goes without saying that funding is essential for research. Perhaps less well-recognized is that funding awards are an important component of a researcher’s record of contributions. ORCID now provides researchers the tools to link their ORCID iD to their funding awards. Together with efforts by funding organizations to integrate ORCID identifiers into grants application and post-award reporting workflows, these tools will support the claiming of existing and new funded awards.
ICES launches new website; new mission, vision and values statements; & new tagline
Follow the link to check out all this new stuff.
For-profit hospices more likely to bounce patients before death than nonprofits
A study published recently in JAMA Internal Medicine has found that for-profit hospices have significantly higher disenrollment rates than nonprofits, among other disparities.
Ontario seniors’ homes to get more nurse practitioners
Health Minister Deb Matthews says the province will fund 75 new positions for higher-level nursing in long-term care homes and promises more to come.
You’ve heard of seniors’ discounts and seniors movie passes. But how about an ER built for the aging demographic? In the U.S., they’re the latest trend in health care. But here in Canada, geriatric ERs are seen as little more than a marketing gimmick.
Quebec ruling supports confidentiality of researchers’ interviews
A recent ruling by a Quebec superior court has major ramifications for researchers who offer confidentiality to people they interview for their research.
Alberta government considers offering public land to private companies for long-term-facilities
The Redford government is proposing to offer public lands to private and non-profit companies to leverage more long-term-care facilities and affordable housing for seniors.
Dennis Gillings appointed World Dementia Envoy
Dr Dennis Gillings, consultant to the pharmaceutical industry and founder of Quintiles, has been appointed by the UK Prime Minister as the World Dementia Envoy. The creation of this role was agreed at the G8 dementia summit in December 2013. The envoy plans to create a World Dementia Council to stimulate innovation, development and commercialisation of life enhancing drugs, treatments and care for people with dementia, and to protect those at risk of dementia, within a generation. The council will be independent of government and will have expertise in pharmaceuticals, research, investment and civic society. The first members of the council will be announced shortly.
Latest IHSPR Newsletter available
Contains funding opportunities, upcoming conferences, and lots of other news about health services and health policy research in Canada.
T-AP is a three-year initiative funded by the European Union, and is a global first among national humanities and social science research agencies. It brings together key partners from the Americas and Europe to identify best practices and priorities for future collaboration to enhance the quality, quantity and visibility of future actions, including possible joint research agendas.
Five Questions to Identify Key Stakeholders
These questions will help you direct your organization’s energy and resources to the right relationships and activities.
Palliative care training gets $3M in federal money
Rona Ambrose said the money will help train frontline healthcare workers and is “critical to ease the strain on families.”
Use of surveillance tech to monitor seniors at home on rise
Many senior citizens are voluntarily being tracked by their caregivers so they can stay in their homes longer. The alternative is often a nursing home, which in terms of surveillance and loss of privacy can be a lot worse. Some seniors are prepared to compromise their privacy by allowing monitoring technology in their homes if it means staying at home.
Worrying shortage of senior NHS nurses
The NHS has lost nearly 4,000 senior nursing posts since 2010, putting patient care at risk, warns the Royal College of Nursing (RCN). The void includes ward sisters, community matrons and specialist nurses and has been brought about by cost saving reorganisation, it says.
Lesbian seniors turn to friends for care and support
Many LGBT seniors remain fearful of moving into seniors’ facilities because they distrust the care system. “Unfortunately, needing to go into some kind of long-term care facility will result in requiring them to be more hidden,” said Shari Brotman, a researcher in social work at McGill University.
Why are family members being banned from visiting their relatives in nursing homes?
From CBC’s The Current. Families of seniors in some care homes in Alberta have been banned from seeing their loved ones and say – short of going to court – which some are now doing, there is no way to appeal decisions made by staff at those homes. Huguette Hebert visited her husband in an Alberta nursing home and asked to watch while his diaper was changed. She was concerned about bedsores. Not only was she told she couldn’t watch — she was made to leave
Emergency Rooms Are No Place for the Elderly
Given longstanding trends in American medicine, it’s hard to imagine a health care setting more ill suited for the elderly than today’s emergency rooms.
Why Interdisciplinary Health Care Teams Are Better for Canadians & Health System
From the Conference Board of Canada. Interprofessional primary care (IPC) teams are groups of professionals from different disciplines who work and communicate together to care for a patient community within a primary care setting. Team members may include physicians, nurses, pharmacists, social workers, mental health counselors or psychiatrists, physiotherapists, midwives, and others. Other essential team members include administrative personnel and the patients themselves.
Vickie Kaminski accepts Alberta health authority’s top job
Kaminski has been appointed president and CEO of Alberta Health Services, the provincial health authority responsible for planning and delivering health supports and services to nearly four million people living in Alberta. The appointment takes effect June 1.
Resources
Series on Integrated Impact Assessment: Part 1 Overall Situation and Clarification of Concepts
From the National Collaborating Centre for Health Public Policy. Integrated impact assessment (IIA) is a prospective analytical tool intended to support governmental decision-making processes. This first note in a series of 6 briefly defines IIA and describes its origins. It then provides an overview of the current state of practice, and presents the main findings that emerge from this overview. In addition, it clarifies certain concepts related to the practice of IIA.
How to help people with dementia: A guide for customer-facing staff
This publication from the Alzheimer’s Society explains how small actions can make a big difference when you are serving customers with dementia. By recognising symptoms and demonstrating understanding to someone who may be having problems, you can make their day-to-day life much better.
AHRQ: TeamSTEPPS® Long-Term Care Version
The Long-Term Care version of TeamSTEPPS adapts the core concepts of the TeamSTEPPS program to reflect the environment of nursing homes and other other long-term care settings such as assisted living and continuing care retirement communities. The examples, discussions, and exercises below are tailored to the long-term care environment. Keys to success at each phase include involvement of the right people, use of information-driven decision making, and careful planning before acting. The following paragraphs provide an overview of each of the phases including goals and objectives, key actions, and recommended tools and resources.
AHRQ: Communication Climate Assessment Toolkit
The Communication Climate Assessment Toolkit (C-CAT) is an organizational performance assessment toolkit from the Ethical Force Program® at the American Medical Association designed to assist organizations in meeting the needs of a diverse patient population. This one-of-a-kind resource can help organizations assess how effectively they communicate, so they can target resources for improvement exactly where they are needed.
NCCMT: Critical Appraisal of Qualitative Studies
Critical Appraisal of Qualitative Studies will help you develop and practice critical appraisal skills you need to assess qualitative studies relevant to public health. With this knowledge, you will know whether the findings of the qualitative study can be applied to your public health decisions. After completing this module you will be able to answer: Is this study well done? Can you trust the conclusions? Can the findings be applied to your own population? How do the different kinds of qualitative research designs compare?
A conference poster session can be a golden opportunity to network one-on-one with the scientific bigwigs in your field—assuming, that is, that you can get them to notice your poster in the first place.
Opportunities
Associate Professor or Professor in Evidence-Based Social Intervention and Policy Evaluation
Centre for Evidence-Based Intervention, Oxford University Oxford UK
DEADLINE 28 March
The Department of Social Policy and Intervention proposes to appoint an Associate Professor of Evidence-Based Social Intervention and Policy Evaluation. This full-time, permanent post, based at the Department of Social Policy and Intervention, Oxford, is available from 1 September 2014. The appointment will be made in association with a Non-Tutorial Fellowship at Green Templeton College.
