New Article by Dr. Greta Cummings
Poor Reliability between Cochrane Reviewers and Blinded External Reviewers When Applying the Cochrane Risk of Bias Tool in Physical Therapy Trials.
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Armijo-Olivo S, Ospina M, da Costa BR, Egger M, Saltaji H, Fuentes J, et al.
PloS one 2014 May 13;9(5):e96920
To test the inter-rater reliability of the RoB tool applied to Physical Therapy (PT) trials by comparing ratings from Cochrane review authors with those of blinded external reviewers. METHODS: Randomized controlled trials (RCTs) in PT were identified by searching the Cochrane Database of Systematic Reviews for meta-analysis of PT interventions. RoB assessments were conducted independently by 2 reviewers blinded to the RoB ratings reported in the Cochrane reviews. Data on RoB assessments from Cochrane reviews and other characteristics of reviews and trials were extracted. Consensus assessments between the two reviewers were then compared with the RoB ratings from the Cochrane reviews. Agreement between Cochrane and blinded external reviewers was assessed using weighted kappa (κ). RESULTS: In total, 109 trials included in 17 Cochrane reviews were assessed. Inter-rater reliability on the overall RoB assessment between Cochrane review authors and blinded external reviewers was poor (κ = 0.02, 95%CI: -0.06, 0.06]). Inter-rater reliability on individual domains of the RoB tool was poor (median κ = 0.19), ranging from κ = -0.04 (“Other bias”) to κ = 0.62 (“Sequence generation”). There was also no agreement (κ = -0.29, 95%CI: -0.81, 0.35]) in the overall RoB assessment at the meta-analysis level. CONCLUSIONS: Risk of bias assessments of RCTs using the RoB tool are not consistent across different research groups. Poor agreement was not only demonstrated at the trial level but also at the meta-analysis level. Results have implications for decision making since different recommendations can be reached depending on the group analyzing the evidence. Improved guidelines to consistently apply the RoB tool and revisions to the tool for different health areas are needed.
CALL FOR ABSTRACTS:
First International Conference on Systems and Complexity Sciences for Healthcare
13-14 November 2014 Washington, DC
DEADLINE 15 June
Hosted by Georgetown University Medical Center, we expect a very stimulating conference with a large number of opportunities to interact with groups interested in Systems Medicine and Complexity Sciences. This meeting will provide a forum for participants from academia, government, and industry interested in understanding the future of healthcare and complexity of diseases.
CALL FOR ABSTRACTS:
American Academy of Nursing’s 2014 Policy Conference
16-18 October Washington DC
DEADLINE 23 June
The American Academy of Nursing annual policy conference will identify ways nurses are transforming health and building a better care delivery system. This three day conference will showcase the extraordinary work nurses are undertaking to drive policy changes that meet the health needs of individuals and populations. Transforming Health: Driving Policy highlights nursing initiatives that are transforming health, leading change, and influencing policy and ultimately improving the nation’s health.
CALL FOR PAPERS:
Implementation Science in Pediatric Health Care
DEADLINE October 2014
JAMA Pediatrics will devote an entire issue in spring 2015 to implementation science research in child health, both in the United States and abroad. We are interested in rigorous studies that test hypotheses about methods to translate research in those steps between efficacy trials and population health. This will include studies on the most effective strategies to change professional behavior; create informed, activated consumers; and guide the behavior of administrators and health care organizations and policy makers.
CALL FOR ABSTRACTS:
International Association of Clinical Research Nurses 2014 Conference
Boston 5-7 November
DEADLINE 16 June
-To provide CRNs with resources to enhance the conduct of clinical research through the art and science of nursing.
-To describe strategies that support effective coping with ethical dilemmas and the resulting moral distress
-To identify strategies to successfully navigate and build relationships between institutions and individuals with shared interests.
-To provide innovative and effective mechanisms for the clinical research nurse (CRN) to support research compliance and patient adherence.
Scaling up evidence-based practices for children and families in New York State: toward evidence-based policies on implementation for state mental health systems.
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Hoagwood KE, Olin SS, Horwitz S, McKay M, Cleek A, Gleacher A, et al.
Journal of clinical child and adolescent psychology 2014;43(2):145-157
Dissemination of innovations is widely considered the sine qua non for system improvement. At least two dozen states are rolling out evidence-based mental health practices targeted at children and families using trainings, consultations, webinars, and learning collaboratives to improve quality and outcomes. In New York State (NYS) a group of researchers, policymakers, providers, and family support specialists have worked in partnership since 2002 to redesign and evaluate the children’s mental health system. Five system strategies driven by empirically based practices and organized within a state-supported infrastructure have been used in the child and family service system with more than 2,000 providers: (a) business practices, (b) use of health information technologies in quality improvement, (c) specific clinical interventions targeted at common childhood disorders, (d) parent activation, and (e) quality indicator development. The NYS system has provided a laboratory for naturalistic experiments. We describe these initiatives, key findings and challenges, lessons learned for scaling, and implications for creating evidence-based implementation policies in state systems.
Road map to scaling-up: translating operations research study’s results into actions for expanding medical abortion services in rural health facilities in Nepal
Puri M, Regmi S, Tamang A, Shrestha P.
Health Research Policy and Systems 2014;12(1):24
Identifying unsafe abortion among the major causes of maternal deaths and respecting the rights to health of women, in 2002, the Nepali parliament liberalized abortion up to 12 weeks of pregnancy on request. However, enhancing women?s awareness on and access to safe and legal abortion services, particularly in rural areas, remains a challenge in Nepal despite a decade of the initiation of safe abortion services. Methods Between January 2011 and December 2012, an operations research study was carried out using quasi-experimental design to determine the effectiveness of engaging female community health volunteers, auxiliary nurse midwives, and nurses to provide medical abortion services from outreach health facilities to increase the accessibility and acceptability of women to medical abortion. This paper describes key components of the operations research study, key research findings, and follow-up actions that contributed to create a conducive environment and evidence in scaling up medical abortion services in rural areas of Nepal. Results It was found that careful planning and implementation, continuous advocacy, and engagement of key stakeholders, including key government officials, from the planning stage of study is not only crucial for successful completion of the project but also instrumental for translating research results into action and policy change. While challenges remained at different levels, medical abortion services delivered by nurses and auxiliary nurse midwives working at rural outreach health facilities without oversight of physicians was perceived to be accessible, effective, and of good quality by the service providers and the women who received medical abortion services from these rural health facilities. Conclusions This research provided further evidence and a road-map for expanding medical abortion services to rural areas by mid-level service providers in minimum clinical settings without the oversight of physicians, thus reducing complications and deaths due to unsafe abortion.
Understanding factors associated with the translation of cardiovascular research: a multinational case study approach
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Wooding S, Hanney SR, Pollitt A, Grant J, Buxton MJ, Project Retrosight Team.
Implementation science 2014 Apr 21;9(1):47-5908-9-47
Funders of health research increasingly seek to understand how best to allocate resources in order to achieve maximum value from their funding. We built an international consortium and developed a multinational case study approach to assess benefits arising from health research. We used that to facilitate analysis of factors in the production of research that might be associated with translating research findings into wider impacts, and the complexities involved. METHODS: We built on the Payback Framework and expanded its application through conducting co-ordinated case studies on the payback from cardiovascular and stroke research in Australia, Canada and the United Kingdom. We selected a stratified random sample of projects from leading medical research funders. We devised a series of innovative steps to: minimize the effect of researcher bias; rate the level of impacts identified in the case studies; and interrogate case study narratives to identify factors that correlated with achieving high or low levels of impact. RESULTS: Twenty-nine detailed case studies produced many and diverse impacts. Over the 15 to 20 years examined, basic biomedical research has a greater impact than clinical research in terms of academic impacts such as knowledge production and research capacity building. Clinical research has greater levels of wider impact on health policies, practice, and generating health gains. There was no correlation between knowledge production and wider impacts. We identified various factors associated with high impact. Interaction between researchers and practitioners and the public is associated with achieving high academic impact and translation into wider impacts, as is basic research conducted with a clinical focus. Strategic thinking by clinical researchers, in terms of thinking through pathways by which research could potentially be translated into practice, is associated with high wider impact. Finally, we identified the complexity of factors behind research translation that can arise in a single case. CONCLUSIONS: We can systematically assess research impacts and use the findings to promote translation. Research funders can justify funding research of diverse types, but they should not assume academic impacts are proxies for wider impacts. They should encourage researchers to consider pathways towards impact and engage potential research users in research processes.
Challenges to using evidence from systematic reviews to stop ineffective practice: an interview study.
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Shepperd S, Adams R, Hill A, Garner S, Dopson S.
Journal of health services research & policy 2013 Jul;18(3):160-166
To examine the challenges to using systematic review evidence to develop guidance for decommissioning ineffective health services, and the problems experienced by clinicians and commissioners when they attempt to implement the evidence from this guidance. METHODS: Interviews with 23 clinicians and 15 commissioners from nine commissioning organizations (Primary Care Trusts) in the south of England. RESULTS: Participants identified generic and intervention-specific barriers to using systematic review evidence to develop and implement decommissioning. Generic barriers included: contradictions within the health care system arising from policy; managing a high volume of evidence; difficulty in applying the evidence to the local context; and patient or parent expectations. Intervention-specific factors included: the influence of industry; an absence of systems for monitoring local implementation of guidance; and the availability of different codes for the same procedure which made monitoring some practices unreliable. CONCLUSIONS: The micro practices of commissioners are shaped by the wider system of health policy, the knowledge producing and delivery agencies associated with health care, and power dynamics within the health care system. If decommissioning is to be guided by evidence, then adequate resources to support the process are necessary. This includes long-term engagement of clinicians, providing alternatives to the decommissioned activity and tackling perverse incentives. An important precursor to decommissioning is obtaining data on the nature and extent of current clinical practice and using these data to monitor variation in the implementation of guidance.
Health Care Administration and Organization
The burden of caring for people with dementia at the end of life in nursing homes: a postdeath study among nursing staff
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Albers G, Van den Block L, Vander Stichele R.
International journal of older people nursing 2014 May 10
To investigate how often nursing staff perceive caring for nursing home residents with dementia at the end of life as an emotional and/or physical burden, and to identify associated factors. DESIGN: Postdeath study conducted in 2010 in Flanders, Belgium. Nursing homes were selected through random clustersampling. METHODS: All residents who died with dementia in a three-month period were identified, and a structured questionnaire was completed by the nurse mostly involved. Nursing staff were asked to indicate how they perceived burden of caregiving for this resident on 10-point scale. RESULTS: Sixty-nine out of 120 nursing homes (response rate 58%) participated in the study. In 37% and 32% of cases, respectively, the nursing staff reported that they perceived themselves as experiencing a high emotional and physical burden. In cases where the resident had capacity for medical decision making during the last week of life and where the nurse had spoken with a relative about wishes for medical end-of-life treatments, they were more likely to report an emotional burden. A physical burden was more likely to be reported where the resident had decubitus ulcers or had developed pneumonia. CONCLUSION: In one-third of cases, nursing staff experienced a high emotional and/or physical burden. While experiencing a physical burden seems to be related to the poorer clinical status of the resident, an emotional burden was more likely to be related to greater and closer contact with the resident or a relative and to the nurse being involved in the process of care and decision making in the last phase of life. IMPLICATIONS FOR PRACTICE: This study highlights the need to support nursing home staff in providing compassionate end-of-life care for people with dementia and suggests that both the physical and emotional burdens in staff should be monitored regularly to achieve optimal working. © 2014 John Wiley & Sons Ltd.
Making tradeoffs between the reasons to leave and reasons to stay employed in long-term care homes: Perspectives of licensed nursing staff.
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McGilton KS, Boscart VM, Brown M, Bowers B.
International journal of nursing studies 2014 Jun;51(6):917-926
Turnover of licensed nursing staff in long-term care (LTC) settings (e.g., nursing homes) is a mounting concern and is associated with poor quality of care and low staff morale. Retention and turnover research in LTC have focused primarily on direct care workers (i.e., nurse aides) leaving the issues largely unexplored for licensed nursing staff (i.e., registered nurses and licensed practical nurses). OBJECTIVE: The main objective of this study was to understand factors that influence nurses’ intentions to remain employed at their current job. DESIGN: Qualitative descriptive study. SETTINGS: Seven nursing homes in Ontario, Canada. PARTICIPANTS: A convenience sample of forty-one licensed LTC nurses. METHODS: Data were collected through focus groups conducted at each of the participating nursing homes. Focus group discussions were transcribed verbatim. Directed content analysis was used to identify and develop themes. RESULTS: Work conditions were a salient element affecting nurses’ intention to stay and included impact of regulations on nurse role flexibility and professional judgment, an underfunded system contributing to insufficient resources and staffing, and a lack of supportive leadership. Factors promoting nurses’ willingness to stay included the development of meaningful relationships with residents and staff and opportunities for learning and professional development. Nurses also considered personal and life circumstances (e.g., marital status and seniority) when discussing intention to stay. CONCLUSIONS: Nurses in this study weighed positive and negative work-related factors as well as personal circumstances to determine their intent to stay. Developing a more individualized approach to address attrition of licensed nurses in LTC may be the most successful strategy for improving retention of highly skilled staff in this sector. Copyright © 2013 Elsevier Ltd. All rights reserved.
Measuring direct nursing cost per patient in the acute care setting.
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Jenkins P, Welton J.
The Journal of nursing administration 2014 May;44(5):257-262
The objective of the study was to measure the variability of direct nursing cost for similar patients and to examine the characteristics of nurses assigned to different types of patients. BACKGROUND: There is no standard method for measuring direct nursing cost by patient. METHODS: Deidentified data were collected from 3 databases for patients admitted from January 2010 through December 2012 on 1 medical/surgical unit in a large Magnet hospital. Direct nursing care time and costs were calculated from the nurse-patient assignment. RESULTS: Variability in nursing intensity (0.36-13 hours) and cost per patient day ($132-$1,455) was significant for similar patients. Higher cost nurses were not assigned sicker patients (F3, 3029 = 87.09, P < .001, R = 0.124). Mean (SD) nursing direct cost per day was $96.48 ($55.73). CONCLUSIONS: Standard measurement of nursing cost per patient could be benchmarked across hospitals and inform nursing administration care delivery decisions.The objective of the study was to measure the variability of direct nursing cost for similar patients and to examine the characteristics of nurses assigned to different types of patients. BACKGROUND: There is no standard method for measuring direct nursing cost by patient. METHODS: Deidentified data were collected from 3 databases for patients admitted from January 2010 through December 2012 on 1 medical/surgical unit in a large Magnet hospital. Direct nursing care time and costs were calculated from the nurse-patient assignment. RESULTS: Variability in nursing intensity (0.36-13 hours) and cost per patient day ($132-$1,455) was significant for similar patients. Higher cost nurses were not assigned sicker patients (F3, 3029 = 87.09, P < .001, R = 0.124). Mean (SD) nursing direct cost per day was $96.48 ($55.73). CONCLUSIONS: Standard measurement of nursing cost per patient could be benchmarked across hospitals and inform nursing administration care delivery decisions.
Staffing and job satisfaction: nurses and nursing assistants.
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Kalisch B, Lee KH.
Journal of nursing management 2014 May;22(4):465-471
The aim of this study was to examine the relationship between staffing and job satisfaction of registered nurses (RNs) and nursing assistants (NAs). BACKGROUND: Although a number of previous studies have demonstrated the link between the numbers of patients cared for on the last shift and/or perceptions of staffing adequacy, we could find only one study that utilized a measure of actual staffing (opposed to perceptions of staffing adequacy) and correlated it with job satisfaction of registered nurses. METHODS: This cross-sectional study included 3523 RNs and 1012 NAs in 131 patient care units. Staff were surveyed to determine job satisfaction and demographic variables. In addition, actual staffing data were collected from each of the study units. RESULTS: Hours per patient day was a significant positive predictor for registered nurse job satisfaction after controlling for covariates. For NAs, a lower skill mix was marginally significant with higher job satisfaction. In addition, the more work experience the NAs reported, the lower their job satisfaction. CONCLUSION: Adequate staffing levels are essential for RN job satisfaction whereas NA job satisfaction depends on the number of assistive personnel in the mix of nursing staff. IMPLICATIONS FOR NURSING MANAGEMENT: Two implications are (1) providing adequate staffing is critical to maintain RN job satisfaction and (2) the NA job needs to be re-engineered to make it a more attractive and satisfying career. © 2012 John Wiley & Sons Ltd.
Health Care Innovation and Quality Assurance
Education to Reduce Potentially Harmful Medication Use Among Residents of Assisted Living Facilities: A Randomized Controlled Trial.
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Pitkala KH, Juola AL, Kautiainen H, Soini H, Finne-Soveri UH, Bell JS, et al.
Journal of the American Medical Directors Association 2014 May 8
The objectives of this study were (1) to investigate the effect of nurse training on the use of potentially harmful medications; and (2) to explore the effect of nurse training on residents’ health-related quality of life (HRQoL), health service utilization, and mortality. DESIGN: A randomized controlled trial. SETTING AND PARTICIPANTS: In total, 227 residents in 20 wards of assisted living facilities in Helsinki were recruited. The 20 wards were randomized into those in which (1) staff received two 4-hour training sessions on appropriate medication treatment (intervention group), and (2) staff received no additional training and continued to provide routine care (control group). INTERVENTION: Two 4-hour interactive training sessions for nursing staff based on constructive learning theory to recognize potentially harmful medications and corresponding adverse drug events. MEASUREMENTS: Use of potentially harmful medications, HRQoL assessed using the 15 dimensional instrument of health-related quality of life, health service utilization, and mortality assessed at baseline, and 6 and 12 months. RESULTS: During the 12-month follow-up, the mean number of potentially harmful medications decreased in the intervention wards [-0.43, 95% confidence interval (CI) -0.71 to -0.15] but remained constant in the control wards (+0.11, 95% CI -0.09 to +0.31) (P = .004, adjusted for age, sex, and comorbidities). HRQoL declined more slowly in the intervention wards (-0.038 (95% CI -0.054 to -0.022) than in the control wards (-0.072 (95% CI -0.089 to -0.055) (P = .005, adjusted for age, sex, and comorbidities). Residents of the intervention wards had significantly less hospital days (1.4 days/person/year, 95% CI 1.2-1.6) than in the control wards (2.3 days/person/year; 95% CI 2.1-2.7) (relative risk 0.60, 95% CI 0.49-0.75, P < .001, adjusted for age, sex, and comorbidities). CONCLUSIONS: Activating learning methods directed at nurses in charge of comprehensive care can reduce the use of harmful medications, maintain HRQoL, and reduce hospitalization in residents of assisted living facilities. Copyright © 2014 American Medical Directors Association, Inc. All rights reserved. Published by Elsevier Inc. All rights reserved.
Reporting of context and implementation in studies of global health interventions: a pilot study
Luoto J, Shekelle P, Maglione M, Johnsen B, Perry T.
Implementation Science 2014;9(1):57
There is an increasing push for `evidence-based? decision making in global health policy circles. However, at present there are no agreed upon standards or guidelines for how to evaluate evidence in global health. Recent evaluations of existing evidence frameworks that could serve such a purpose have identified details of program context and project implementation as missing components needed to inform policy. We performed a pilot study to assess the current state of reporting of context and implementation in studies of global health interventions. Methods We identified three existing criteria sets for implementation reporting and selected from them 10 criteria potentially relevant to the needs of policy makers in global health contexts. We applied these 10 criteria to 15 articles included in the evidence base for three global health interventions chosen to represent a diverse set of advocated global health programs or interventions: household water chlorination, prevention of mother-to-child transmission of HIV, and lay community health workers to reduce child mortality. We used a good-fair-poor/none scale for the ratings. Results The proportion of criteria for which reporting was poor/none ranged from 11% to 54% with an average of 30%. Eight articles had `good? or `fair? documentation for greater than 75% of criteria, while five articles had `poor or none? documentation for 50% of criteria or more. Examples of good reporting were identified. Conclusions Reporting of context and implementation information in studies of global health interventions is mostly fair or poor, and highly variable. The idiosyncratic variability in reporting indicates that global health investigators need more guidance about what aspects of context and implementation to measure and how to report them. This lack of context and implementation information is a major gap in the evidence needed by global health policy makers to reach decisions.
Improving health status and reduction of institutionalization in long-term care-Effects of the Resident Assessment Instrument-Home Care by degree of implementation.
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Stolle C, Wolter A, Roth G, Rothgang H.
International journal of nursing practice 2014 Apr 28
A cluster randomized controlled trial showed that the Resident Assessment Instrument (RAI) could not improve or stabilize the health status of people in need of long-term care or reduce the rate of institutionalization in Germany among clients of home care agencies. The aim of this article is to investigate whether the effect of RAI depends on the degree of implementation. A factor analysis was used to distinguish between those agencies that implemented RAI intensively and those that did not. The clients of home care agencies working intensively with RAI were significantly less hospitalized (P = 0.0284) and fared slightly better according to activities of daily living (ADL, instrumental ADL (IADL)), cognitive skills (Mini-Mental Status Test (MMST)) and quality of life (EuroQol (EQ-5D)) compared with the control group. In contrast, those not working intensively with RAI had worse outcomes (IADL, MMST, EQ-5D) than the control group (not significant). It is important to guarantee a successful implementation of RAI. © 2014 Wiley Publishing Asia Pty Ltd.
U.S. Department of Health adverse event reporting policies for nursing homes.
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Wagner LM, Castle NG, Reid KC, Stone R.
Journal for healthcare quality 2013 May-Jun;35(3):9-14
The objectives of this study were to describe state policies for the frequency of adverse event reporting and follow-up that occurs in U.S. nursing homes, and to identify the health information technology used to facilitate these processes. The study was conducted using a mailed survey to the Departments of Health (DOH) in all 50 states, specifically the department that is responsible for the oversight and regulation of nursing home care. Thirty-two state DOH representatives participated. The primary variables examined were (1) which incidents were most commonly reported to state DOH and (2) whether or not they were followed up with a surveyor visit to the nursing home. There was wide variation in incident reporting processes across all states and lack of a standardized process. Abuse is the only adverse event that almost always is required to be reported to the state DOH and has the highest incidence of follow-up with a surveyor visit. Improving and standardizing adverse event reporting systems is a necessary strategy to enhance patient safety in nursing homes. This study provides an important step by increasing our knowledge base of the current state of adverse event reporting policies and processes at the state level. © 2011 National Association for Healthcare Quality.
The Effects of Regulation and Litigation on a Large For-Profit Nursing Home Chain.
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Harrington C, Stockton J, Hoopers S.
Journal of health politics, policy and law 2014 May 19
This article examined the effects of state regulation and civil class-action litigation on corporate compliance with nurse staffing and quality standards, corporate strategies to manage staffing and quality, and corporate financial status of a large for-profit nursing home chain. A historical case study was used to examine multiple public data sources, focusing on facilities in California from 2003 to 2011 during and after regulatory actions and litigation. The results showed that the state issued numerous deficiencies for violations of the nurse staffing and quality standards with minimal impact on quality compliance with state law. A class action jury trial found the chain violated the state’s minimum staffing standard on one-third of the total days during a six-year period and awarded a $677 million verdict. A court settlement and supervised injunction resulted in compliance with minimum staffing and some improvement in quality measures, but quality levels remained below the average California facilities. The litigation also had some negative financial impact on Skilled’s California facilities and parent company. Civil litigation had more impact on the chain than the regulatory oversight. Copyright © 2014 by Duke University Press.
Exploring factors influencing residents’ health outcomes in long-term care facilities: 1-year follow-up using latent growth curve model.
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Liu LF, Weng RH, Wu JY.
Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation 2014 May 17
This study explored the residents’ health outcomes of long-term care (LTC) facilities and examined the risk factors in individual and institutional levels during 1 year of admission. METHODS: The study included four stages of interviews with residents in 31 nursing homes and 64 residential care homes. Three hundred and twenty-five residents at baseline were interviewed, and 206 completed the interviews at follow-up. Five outcomes including residents’ physical/mental functional status and subjective health status in Short Form-36 were analyzed using latent growth curve models (LGCMs). RESULTS: Only the physical component summary (PCS) had increased significantly. The most influential risk factors to outcomes were the intra-individual-level time-varying variables, including self-rated health and with/without tubing care. Some predictive inter-individual-level factors were also found. For institutional characteristics, small-sized homes (<49 beds) with low occupancy rates showed a lower growth rate in residents’ mental component summary (MCS) and PCS over 1 year and private sector homes showed the most significant growth rates in MCS. CONCLUSIONS: The methodological strength using LGCMs provides a framework for systematically assessing the influence of risk factors from various levels on residents’ outcomes and follow-up change. It is evident that factors in various levels all influenced residents’ outcomes which support critical information for case mix and quality management in LTC facilities. Under the scenario of a surplus of institutional care in Taiwan, we suggest that institutions must focus more on residents’ psychological well-being and care quality, especially in small-sized homes in relation to the outcomes of its residents.
Nurses’ pressure ulcer related judgements and decisions in clinical practice: A systematic review.
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Samuriwo R, Dowding D.
International journal of nursing studies 2014 Apr 19
Pressure ulcers are considered to be an adverse outcome of care that should never occur in clinical practice. The formation of a pressure ulcer is also perceived to be an indicator of poor quality nursing care. Therefore, pressure ulcer prevention is a priority for nurses, healthcare professionals and healthcare organisations throughout the world. A key factor in pressure ulcer prevention and management is individual nurse decision making. OBJECTIVES: To synthesise the literature on the judgement and decision making of nurses in relation to the assessment, prevention, grading and management of pressure ulcers in all care settings (hospital and community). DESIGN: A systematic search of published literature relating to judgement and decision making in nurses, with a focus on the prevention and management of pressure ulcers. METHODS: A search of electronic databases from 1992 to present, together with hand searching of the reference lists of retrieved publications, to identify published papers that reported results of studies evaluating the decision making of nurses in relation to the prevention and management of pressure ulcers. Abstracts were independently reviewed by two authors and full text of potentially relevant articles retrieved. Each paper included in this systematic review was evaluated using recognised appraisal criteria relevant to the specific study design. Included papers provided empirical data on key aspects of nurses’ pressure ulcer related judgements and decision making. Data were synthesised into themes using narrative analysis. RESULTS: Sixteen studies and one systematic review were included in the review, focusing on pressure ulcer risk assessment, pressure ulcer prevention, grading of pressure ulcers and treatment decisions. The results indicated that assessment tools were not routinely used to identify pressure ulcer risk, and that nurses rely on their own knowledge and experience rather than research evidence to decide what skin care to deliver. CONCLUSIONS: Emphasising pressure ulcer risk assessment and pressure ulcer grading in clinical practice is unlikely to deliver improved outcomes. Further research into nurses’ pressure ulcer related judgements and decision making is needed and clinicians must focus on the consistent delivery of high quality care to prevent and mange pressure ulcers to all patients in clinical practice. Crown Copyright © 2014. Published by Elsevier Ltd. All rights reserved.
Combining Quality Improvement and Geriatrics Training: The Nursing Home Polypharmacy Outcomes Project.
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Kojima G, Bell CL, Tamura B, Davis J, Inaba M, Lorenzo P, et al.
Gerontology & geriatrics education 2014 May 14
To examine sustained effects of an educational intervention, we repeated a successful quality improvement (QI) project on medication safety and cost-effectiveness. In October 2007 and August 2008, facility leadership and geriatrics faculty identified all patients receiving ≥9 medications (polypharmacy cohort) in a 170-bed teaching nursing home and taught Geriatric Medicine fellows (n=12 in 2007, 11 in 2008) to: 1) systematically collect medication data; 2) generate medication recommendations (stop, taper, or continue) based on expert criteria (Beers Criteria) or drug-drug interaction programs; 3) discuss recommendations with patients’ attending physicians; and 4) implement approved recommendations. Over the two projects, the polypharmacy cohorts demonstrated decreased potentially inappropriate medications (odds ratio (OR) 0.78, 95% confidence interval (95%CI)0.69-0.88, p<0.001), contraindicated medications (OR=0.63, 95%CI=0.47-0.85, p=0.002) and medication costs (OR=0.97, 95%CI=0.96-0.99, p<0.001). Our findings suggest that programs planning educational QI projects for trainees may benefit from a multi-year approach to maximize both clinical and educational benefits.
A Proposal for an Austrian Nursing Minimum Data Set (NMDS): A Delphi Study.
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Ranegger R, Hackl WO, Ammenwerth E.
Studies in health technology and informatics 2014;198:253
Nursing Minimum Data Sets can be used to compare nursing care across clinical populations, settings, geographical areas, and time. NMDS can support nursing research, nursing management, and nursing politics. However, in contrast to other countries, Austria does not have a unified NMDS. The objective of this study is to identify possible data elements for an Austrian NMDS. A two-round Delphi survey was conducted, based on a review of available NMDS, 22 expert interviews, and a focus group discussion. After reaching consensus, the experts proposed the following 56 data elements for an NMDS: six data elements concerning patient demographics, four data elements concerning data of the healthcare institution, four data elements concerning patient’s medical condition, 20 data elements concerning patient problems (nursing assessment, nursing diagnoses, risk assessment), eight data elements concerning nursing outcomes, 14 data elements concerning nursing interventions, and no additional data elements concerning nursing intensity. The proposed NMDS focuses on the long-term and acute care setting. It must now be implemented and tested in the nursing practice.
The Health Foundation: Perspectives on context
Professor Paul Bate; Professor Glenn Robert and Professor Naomi Fulop; Professor John Øvretveit; Professor Mary Dixon-Woods
The Health Foundation has been eager to explore the role of context in improving the quality of patient care. In 2011, we invited leading academics in the field to discuss the following questions:
-How do you define and frame context?
-What do you see as the key conceptual and empirical literature in the field?
-How would you identify the main unanswered questions about context and improvement?
The essays they produced in response are presented in this report and provide a fascinating range of insights into the importance – and challenges – of context.
Development of online decision support tool for organizational readiness for change
Khan S, Timmings C, Moore J, Marquez C, Pyka K, Gheihman G, et al.
Implementation Science 2014;9(1):56
Much importance has been placed on assessing readiness for change as one of the earliest steps of implementation, but measuring it can be a complex and daunting task. Organizations and individuals struggle with how to reliably and accurately measure readiness for change. Several measures have been developed to help organizations assess readiness, but these are often underused due to the difficulty of selecting the right measure. In response to this challenge, we will develop and test a prototype of a decision support tool that is designed to guide individuals interested in implementation in the selection of an appropriate readiness assessment measure for their setting. Methods A multi-component approach will be used to develop the decision support tool. First, we will identify key measures for assessing organizational readiness for change from a recently completed systematic review. Included measures will be those developed for healthcare settings (e.g., acute care, public health, mental health) and that have been deemed valid and reliable. Second, study investigators and field experts will engage in a mapping exercise to categorize individual items of included measures according to key readiness constructs from an existing framework. Third, a stakeholder panel will be recruited and consulted to determine the feasibility and relevance of the selected measures using a modified Delphi process. Fourth, findings from the mapping exercise and stakeholder consultation will inform the development of a decision support tool that will guide users in appropriately selecting change readiness measures. Fifth, the tool will undergo usability testing. Discussion Our proposed decision support tool will address current challenges in the field of organizational change readiness by aiding individuals in selecting a valid and reliable assessment measure that is relevant to user needs and practice settings. We anticipate that implementers and researchers who use our tool will be more likely to conduct readiness for change assessments in their settings when planning for implementation. This, in turn, may contribute to more successful implementation outcomes. We will test this tool in a future study to determine its efficacy and impact on implementation processes.
Research Practice & Methodology
Using logic model methods in systematic review synthesis: describing complex pathways in referral management interventions
Baxter S, Blank L, Woods H, Payne N, Rimmer M, Goyder E.
BMC Medical Research Methodology 2014;14(1):62
There is increasing interest in innovative methods to carry out systematic reviews of complex interventions. Theory-based approaches, such as logic models, have been suggested as a means of providing additional insights beyond that obtained via conventional review methods. Methods This paper reports the use of an innovative method which combines systematic review processes with logic model techniques to synthesise a broad range of literature. The potential value of the model produced was explored with stakeholders. Results The review identified 295 papers that met the inclusion criteria. The papers consisted of 141 intervention studies and 154 non-intervention quantitative and qualitative articles. A logic model was systematically built from these studies. The model outlines interventions, short term outcomes, moderating and mediating factors and long term demand management outcomes and impacts. Interventions were grouped into typologies of practitioner education, process change, system change, and patient intervention. Short-term outcomes identified that may result from these interventions were changed physician or patient knowledge, beliefs or attitudes and also interventions related to changed doctor-patient interaction. A range of factors which may influence whether these outcomes lead to long term change were detailed. Demand management outcomes and intended impacts included content of referral, rate of referral, and doctor or patient satisfaction. Conclusions The logic model details evidence and assumptions underpinning the complex pathway from interventions to demand management impact. The method offers a useful addition to systematic review methodologies. Trial registration number PROSPERO registration number: CRD42013004037.
Core principles for involving people with dementia in research: Innovative practice
Non UofA Access
Scottish Dementia Working Group Research Sub-Group,UK.
Dementia 2014 May 22
The Scottish Dementia Working Group Research Sub-group is part of the Scottish Dementia Working Group, an internationally renowned campaigning group of people with dementia. We co-created our core principles for involving people with dementia in research between September and December 2013. The principles address six areas: (i) how people with dementia are valued and involved in research, (ii) lived experience as valid knowledge, (iii) physical and emotional safety, (iv) accessibility of all aspects of research, (v) training for researchers and (vi) the impact of our experiences of time on research processes. Through our core principles, we challenge researchers across all disciplines to re-consider how we and other people with dementia are involved in research as well as how knowledge in dementia research is created.
Activities of daily living and quality of life across different stages of dementia: a UK study.
Non UofA Access
Giebel CM, Sutcliffe C, Challis D.
Aging & mental health 2014 May 15:1-9
People with dementia (PwD) require an increasing degree of assistance with activities of daily living (ADLs), and dependency may negatively impact on their well-being. However, it remains unclear which activities are impaired at each stage of dementia and to what extent this is associated with variations in quality of life (QoL) across the different stages, which were the two objectives of this study. Methods: The sample comprised 122 PwD, and their carers, either living at home or recently admitted to long-term care. Measures of cognition and QoL were completed by the PwD and proxy measures of psychopathology, depression, ADLs and QoL were recorded. Using frequency, correlation and multiple regression analysis, data were analysed for the number of ADL impairments across mild, moderate and severe dementia and for the factors impacting on QoL. Results: ADL performance deteriorates differently for individual activities, with some ADLs showing impairment in mild dementia, including dressing, whereas others only deteriorate later on, including feeding. This decline may be seen in the degree to which carers perceive ADLs to explain the QoL of the PwD, with more ADLs associated with QoL in severe dementia. Results of the regression analysis showed that total ADL performance however was only impacting on QoL in moderate dementia. Conclusion: Knowledge about performance deterioration in different ADLs has implications for designing interventions to address specific activities at different stages of the disease. Furthermore, findings suggest that different factors are important to consider when trying to improve or maintain QoL at different stages.
Geriatric Depression and its relation with Cognitive Impairment and Dementia
Non UofA Access
Dillon C, Tartaglini F, Stefani D, Salgado P, Taragano FE, Allegri RF.
Archives of Gerontology and Geriatrics
Different subtypes of depressive syndromes exist in late life; many of them have cognitive impairment and sometimes it is difficult to differentiate them from dementia. This research aimed to investigate subtypes of geriatric depression associated with cognitive impairment, searched for differential variables and tried to propose a study model. A hundred and eighteen depressive patients and forty normal subjects matched by age and educational level were evaluated with an extensive neuropsychological battery, scales to evaluate neuropsychiatric symptoms and daily life activities (DLA). Depressive patients were classified in groups by SCAN 2.1: Major Depression Disorder (MDD) (n: 31), Dysthymia Disorder (DD) (n: 31), Subsyndromal Depression Disorder (SSD) (n: 29), Depression due to Dementia (n: 27) (DdD). Neuropsychological significant differences (p < 0.05) were observed between depressive groups, demonstrating distinctive cognitive profiles. Moreover, significant differences (p < 0.05) were found in daily life activities between DdD vs all groups and MDD vs controls and vs SSD. Age of onset varied in the different subtypes of depression. Beck Depression Inventory (BDI) and MMSE were significant variables that helped to differentiate depressive groups. Significant correlations between BDI and Neuropsychological tests were found in MDD and DD groups. Depressive symptoms and its relation with neuropsychological variables, MMSE, cognitive profiles, daily life activities and age of onset of depression should be taken into consideration for the study of subtypes of geriatric depression.
Social engagement in older residents of assisted living facilities
Non UofA Access
Jang Y, Park NS, Dominguez DD, Molinari V.
Aging & mental health 2014 Jul;18(5):642-647
As a core component of successful aging, social engagement is widely known to play an important role in promoting the health and well-being of older populations. Given the unique nature of assisted living facility (ALF) settings, the present study made a distinction between social engagement within and outside the facility and explored how these two types of social engagement would interact with functional disability in predicting depressive symptoms of older residents in ALFs. We hypothesized that the positive impact of social engagement within the facility would be greater among residents with higher levels of functional disability.Method: Using data from 150 ALF residents in Florida (Mage = 82.8, SD = 9.41), the direct and moderating effects of functional disability and the two types of social engagement on depressive symptoms were assessed.Results: Supporting the hypothesis, the interaction between functional disability and social engagement within the facility was found to be significant. The finding demonstrates the particular importance of social engagement within the facility for those with reduced physical function. For them, the limited but available opportunities for social activities and interpersonal contacts within the facility seem to bring substantial psychological benefits.Conclusion: The findings call attention to efforts to promote social activities and interpersonal contacts within ALFs.
‘It’s the little things that count’. Families’ experience of roles, relationships and quality of care in rural nursing homes.
Non UofA Access
Ryan AA, McKenna H.
International journal of older people nursing 2014 May 10
Entry to long-term care is an emotional time for older people and their families. Poor communication and uncertainty about roles and responsibilities in the post-placement period can cause distress for families and staff, further exacerbating an already difficult situation. However, there are limited studies that specifically address roles and relationships between families and care home staff in the post-placement period. AIM: The aim of this study was to explore the experiences of families following the nursing home placement of an older relative. DESIGN: A qualitative approach using grounded theory methodology was used to conduct the study. METHOD: Semi structured interviews were conducted with 29 relatives of nursing home residents in a region of the UK. Consistent with grounded theory methodology, data collection and analysis occurred simultaneously. FINDINGS: Data analysis revealed five distinct categories that captured the experience of families in the post-placement period. These were: communication with staff, involvement in relative’s care, the importance of ‘the little things’, quality of care and areas for improvement. CONCLUSIONS: Developing caring partnership is crucial if the resources of care home staff and families are to be maximised for the benefit of all concerned. IMPLICATIONS FOR PRACTICE: A number of programmes and initiatives already exist to enhance the quality of life of older people in care homes and their families. Serious consideration should be given to more widespread uptake of these initiatives. © 2014 John Wiley & Sons Ltd.
‘You can’t be forcing food down ’em’: Nursing home carers’ perceptions of residents’ dining needs.
Non UofA Access
Dunn H, Moore T.
Journal of health psychology 2014 May 13
Malnutrition is a life-threatening condition among older people living in nursing care homes. This qualitative analysis of interview data from five care staff aimed to understand their perceptions of ‘caring for’ residents’ nutritional needs. Tensions in the delivery of care and institutionalisation and disempowerment were identified. Despite carers’ good intentions, they often failed to recognise the importance of the psychosocial aspects of mealtimes. Staff shortages, routine-driven, medically based working practices and residents’ resistance to institutionalisation emerged as barriers to quality caregiving. The findings indicate that the relational aspects of care are constrained by social, structural and ideological contexts. © The Author(s) 2014.
Long-Term Care in America: Expectations and Reality
Associated Press-NORC Center for Public Affairs Research, 2014
The aim of this study is to understand better who is providing and receiving care, how caregiving impacts family relationships and personal experience, how Americans 40 or older use information on long-term care, and which policy measures they think would improve long-term care.
This report sets out what is known about dementia care, support and research. It highlights where improvements are being made and where progress can be seen – it also shows where improvements are needed, including where better data is necessary. It assesses the scale of the challenge of dementia and also looks at:
-living with dementia
-dementia education and training
-dementia friendly communities
The Future Economic, Health and Social Care Costs of Dementia (UK)
International Longevity Centre-UK 2011
This report launched by ILC-UK, highlights the growing cost of dementia and posits that with the predicted rise in the number of people with dementia, the current level of investment into dementia research, treatment and care is unsustainable
Hospital and emergency department use by people with Alzheimer’s disease and related disorders : final report (US)
U.S. Department of Health and Human Services 2013
One significant burden results from frequent, and often potentially avoidable, hospitalizations and emergency department (ED) visits, which have important implications for the quality of care and quality of life for people with ADRD or cognitive impairments. Understanding the patterns of hospital and ED use by people with ADRD or cognitive impairments relative to others without these conditions is crucial for developing appropriate policies to better address the care needs of this vulnerable population.
The Programme for Government gives a commitment to develop a National Strategy on Dementia by 2013 which will increase awareness, ensure early diagnosis and intervention, and enhance community based services for people living with this condition. During 2012, following the completion of the Research Review in preparation for the National Strategy, the Department carried out a public consultation to inform its development. This report is a summary of the responses and submissions received.
The Review of Assisted Living Options for Veterans is the third in a series of three papers produced by the Office of the Veterans Ombudsman (OVO) that examines the provision of health benefits by VAC to our Veterans, family members, survivors and caregivers. This review explores the diverse range of health care and housing options available for seniors and Veterans in the country, both in the publicly funded and client-paid sectors.
Health Data Research Symposium: An Alberta Perspective on Access, Management, Linkage
Thursday 29 May, Lister Centre Cost $50
here’s still time to register for this one-day symposium that explores and discusses issues, challenges and opportunities around health research data access, management and linkage in Alberta. Plenary and panel sessions include: privacy issues in health research data; provincial perspectives on how data is currently being managed and how it will be managed in the future; innovative health research projects in Alberta using data linkage; and Alberta projects using administrative data. Ample time will be provided for questions and group discussions.
Against the Odds: the Creation of National Institute of Health Research and the Impact on Front-Line Health Workers
Professor Dame Sally Davies
Tuesday 10 June Westin Hotel Edmonton 07:30-09:00
Presented by the Institute of Health Economics and Alberta Innovates Health Solutions.
AHRQ: Patient Engagement in Primary Care
Wednesday 4 June 11:30-13:00 MT
The presenters will discuss the engagement of patients and families in the medical home (including the pediatric medical home), the development of the Patient Voices Network, and the impact that activated patients can have on research, quality improvement efforts, and the delivery of primary care.
CDRAKE: Cerebrovascular Disease and Cognitive Decline/Pathologie Vasculaire Cérébrale et Déclin Cognitif
Webinar is in French
18 June 10:00-11:00 MT
La présentation portera sur le rôle de la pathologie cérébro-vasculaire dans le développement de troubles de mémoire. Particulièrement, le Dr Hamel fournira des exemples provenant de ses recherches sur le rôle facilitateur des vaisseaux cérébraux dysfonctionnels dans l’apparition des troubles de mémoire en conditions de comorbidité avec des facteurs de risque comme l’hypercholestérolémie.
The Critical Appraisal Skills Programme (CASP) ‘Train the Trainer’ Course
13-15 October 2014 Kellogg College, Oxford
A 3 day training programme designed for people who want to be more confident in teaching critical appraisal skills to others & critically appraising research evidence. Aim:
By the end of this course, participants will feel confident about:
-Teaching critical appraisal skills to others
-Critically appraising research evidence
-Enhance their understanding of evidence-based practice in health and social care
-Develop their critical appraisal skills
-Develop their critical appraisal facilitation and teaching skills
-Appreciate how to plan and run critical appraisal workshops and cascade learning
Participants in this training will benefit from having experienced critical appraisal training previously, either from CASP or other training providers.
With an aging Canadian population and the increasing cost of nursing homes, the number of Canadian seniors providing at-home care to elderly patients has increased in recent years.
NDP MP Claude Gravelle’s private member’s bill would require the feds to collaborate with provinces on a coordinated response to rapidly growing health crisis.
Members of an advisory committee have been chosen to help develop the province’s first comprehensive strategy for people with dementia and their families. The members include a Nova Scotian who is living with dementia, a family caregiver, service providers, and health-care professionals.
There will be more guaranteed disposable income supports for seniors in continuing care facilities as inflationary increases to accommodation charges come into effect.
he legislation will seek out and fix disparities in critical services to older individuals, and is the result of AARP’s ongoing advocacy work against Illinois’ well-documented history of racial and ethnic disparities in quality services. The legislation passed both chambers of the General Assembly unanimously and is on its way to the Governor’s desk. AARP is urging Governor Quinn to sign it into law.
Home First is designed to enhance healthy aging and care in New Brunswick. It will support seniors to maintain health and independence as well as continue to live at home for as long as possible.
Interdisciplinary team training (IDT) is an important component of ensuring quality geriatric care delivery, which can be complex and time intensive, requiring coordination of many medical, psychosocial, and therapeutic interventions and professionals.
Alzheimer’s Disease International, Alzheimer’s Society and the Department of Health (UK) have launched a Global Alzheimer’s and Dementia Action Alliance at the World Health Assembly in Geneva. The Assembly is the annual meeting of the World Health Organization.
A three per cent increase on accommodation fees for those in seniors residences is welcomed locally by operators but it does not reflect the significantly increased costs in utilities and food, says a local operator in Medicine Hat.
Better designed, better equipped and better staffed nursing homes are what the elderly need.
Government welcomes commitments from the Care Quality Commission to improve regulatory enforcement in partnership with the adult care sector.
In the midst of the province’s election, the Ontario Long Term Care Association (OLTCA) warns that the aging population and the growing medical needs of seniors require urgent action by the next government to ensure that Ontario’s long term care homes can provide the care seniors deserve.
The John A. Hartford Foundation and the Patient-Centered Outcomes Research Institute (PCORI) have joined together to invest nearly $750,000 in CaRe-Align, an initiative to develop a new model of care that could better meet the complex needs of older patients with multiple chronic conditions.
The Honourable Alice Wong, Minister of State (Seniors), highlighted today the Government of Canada’s new direction in tackling certain issues facing seniors using a social innovation approach. Her comments were part of a speech delivered to participants at a conference focused on sharing knowledge in the field of aging, hosted by the National Initiative for the Care of the Elderly.
The Dementia Roadmap provides high quality information about the dementia journey alongside local information about services, support groups and care pathways to assist primary care staff to more effectively support people with dementia and cognitive impairment, their families and carers.
There is a strong connection between hearing loss and cognitive health, particularly in older adults. Prevalence rates of hearing loss and cognitive loss, such as mild cognitive impairment and dementia, both increase with age. Recent large-scale epidemiological research has suggested higher rates of cognitive impairment in individuals with greater degrees of hearing loss.
From the Eldercare Workforce Alliance, this toolkit is a list of resources designed for people working with older people. It includes resources that support and promote the health, safety, and well-being of older adults (and not just older Americans).
Quality improvement – the role of context and how to manage it
Recorded webinar from The Health Foundation
This webinar – with Naomi Fulop, John Gabbay and Andrée le May, chaired by Bill Lucas – explores why context needs to be taken into consideration when attempting improvement, and what skills best help professionals to manage context effectively.
Associate Editor sought for the Journal of Pediatric Nursing:
DEADLINE 21 June
Applications are invited for the position of Associate Editor of The Journal of Pediatric Nursing: Nursing Care of Children and Families (JPN) publishes evidence-based practice, quality improvement, theory, and research papers on a variety of topics from US and international authors. JPN is the official journal of the Society of Pediatric Nurses and the Pediatric Endocrinology Nursing Society. Cecily L. Betz, PhD, RN, FAAN is the Editor in Chief. The successful candidate for the position of Associate Editor will be recognized for his or her academic and research achievements and will have an impressive track record of publications or presentations.
International Journal of Mental Health Nursing – Editor-in-Chief
DEADLINE 28 July 2014
The International Journal of Mental Health Nursing (IJMHN) is the key publication of the Australian College of Mental Health Nurses (ACMHN). The IJMHN aims to promote mental health nursing and inform the mental health nursing community of trends in clinical practice, research and education.