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Factors associated with rushed and missed resident care in western Canadian nursing homes: a cross-sectional survey of health care aides.
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J. A. Knopp-Sihota, L. Niehaus, J. E. Squires, P. G. Norton and C. A. Estabrooks.
J Clin Nurs 2015 Jul 16.
AIMS AND OBJECTIVES: To describe the nature, frequency and factors associated with care that was rushed or missed by health care aides in western Canadian nursing homes. BACKGROUND: The growing number of nursing home residents with dementia has created job strain for frontline health care providers, the majority of whom are health care aides. Due to the associated complexity of care, health care aides are challenged to complete more care tasks in less time. Rushed or missed resident care are associated with adverse resident outcomes (e.g. falls) and poorer quality of staff work life (e.g. burnout) making this an important quality of care concern. DESIGN: Cross-sectional survey of health care aides (n = 583) working in a representative sample of nursing homes (30 urban, six rural) in western Canada. METHODS: Data were collected in 2010 as part of the Translating Research in Elder Care study. We collected data on individual health care aides (demographic characteristics, job and vocational satisfaction, physical and mental health, burnout), unit level characteristics associated with organisational context, facility characteristics (location, size, owner/operator model), and the outcome variables of rushed and missed resident care. RESULTS: Most health care aides (86%) reported being rushed. Due to lack of time, 75% left at least one care task missed during their previous shift. Tasks most frequently missed were talking with residents (52% of health care aides) and assisting with mobility (51%). Health care aides working on units with higher organisational context scores were less likely to report rushed and missed care. CONCLUSION: Health care aides frequently report care that is rushed and tasks omitted due to lack of time. RELEVANCE TO CLINICAL PRACTICE: Considering the resident population in nursing homes today-many with advanced dementia and all with complex care needs-health care aides having enough time to provide physical and psychosocial care of high quality is a critical concern.
New article by Dr. Greta Cummings
Invisible no more: a scoping review of the health care aide workforce literature
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S. J. Hewko, S. L. Cooper, H. Huynh, et al.
BMC Nurs 2015 Jul 22;14:38-015-0090-x. eCollection 2015
Healthcare aides (HCAs) are the primary caregivers for vulnerable older persons. They have many titles and are largely unregulated, which contributes to their relative invisibility. The objective of this scoping review was to evaluate the breadth and depth of the HCA workforce literature. Methods We conducted a search of seven online bibliographic databases. Studies were included if published since 1995 in English, peer-reviewed journals. Results were iteratively synthesized within and across the following five categories: education, supply, use, demand and injury and illness. Results Of 5,045 citations screened, 82 studies met inclusion criteria. Few examined HCA education; particularly trainee characteristics, program location, length and content. Results in supply indicated that the average HCA was female, 36–45 years and had an education level of high school or less. Home health HCAs were, on average, older and were more likely to be immigrants than those working in other settings. The review of studies exploring HCA use revealed that their role was unclear – variation in duties, level of autonomy and work setting make describing “the” role of an HCA near impossible. Projected increased demand for HCAs and high rates of turnover, both at the profession and facility-level, elicit predictions of future HCA shortages. Home health HCAs experienced comparatively lower job stability, earned less, worked the fewest hours and were less likely to have fringe benefits than HCAs employed in hospitals and nursing homes. The review of studies related to HCA illness and injury revealed that they were at comparatively higher risk of injury than registered nurses and licensed practical nurses. Conclusions This is the largest, most comprehensive scoping review of HCA workforce literature to date. Our results indicate that the HCA workforce is both invisible and ubiquitous; as long as this is the case, governments and healthcare organizations will be limited in their ability to develop and implement feasible, effective HCA workforce plans. The continued undervaluation of HCAs adversely impacts care providers, the institutions they work for and those who depend on their care. Future workforce planning and research necessitates national HCA registries, or at minimum, directories.
Important new report on healthcare innovation in Canada
Unleashing Innovation: Excellent Healthcare for Canada. 
Advisory panel on healthcare innovation, Health Canada
This panel recommends health care innovation fund to be administered by new agency. The federal government should invest in a new, arms-length health care innovation fund — with a budget that would grow to $1 billion a year by 2020 — that would finance high-impact initiatives, break down structural barriers and accelerate promising health care innovations, recommends the Advisory Panel on Healthcare Innovation in its new report, Unleashing Innovation: Excellent Healthcare for Canada.
Article recommended by Dr. Estabrooks
Can we model a cognitive footprint of interventions and policies to help to meet the global challenge of dementia?
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M Rossor, M Knapp
The Lancet 2015
The changing global demographic characteristics of dementia have led to worldwide predictions of unaffordable treatment and care costs over the coming decades. Recognition of the economic consequences has encouraged many countries to develop national dementia plans, as well as international actions such as the G8 Dementia Summit in London, UK, in 2013 and the WHO Ministerial Conference on Global Action Against Dementia in Geneva, Switzerland, in 2015.
Abstracts
CALL FOR ABSTRACTS:
AHS Quality Summit
DEADLINE 10 August
October 26 Edmonton
We invite you to share a profile of your innovative quality improvement story at the Quality Summit. The aim of the summit is to share and learn from each other. We want to hear about your priceless learning opportunities (mistakes and failures) and your successes. Our call to action at the summit will be to ignite change and positively impact the patient experience.
CALL FOR ABSTRACTS:
8th Annual Conference on the Science of Dissemination and Implementation: Optimizing Personal and Population Health
14-15 December Washington DC
DEADLINE 20 August
The conference seeks novel research or conceptual papers that address any of the topics included within the thematic tracks, with an emphasis on empirical findings for how best to integrate evidence-based interventions within clinical and community settings and/or how to recast the nature or conduct of the research itself to make it more relevant and actionable in those settings.
Grants & Awards
PHAC Evidence Review Synthesis Centres
DEADLINE 21 August
The objective of this competition is to identify two Evidence Review Synthesis Centres (ERSC) to produce systematic reviews in order to support the Canadian Task Force on Preventive Health Care (Task Force) guidelines and recommendations. The ERSCs will provide synthesized evidence to the Task Force experts and the Public Health Agency of Canada (PHAC). The Task Force is supported by the PHAC though the Prevention Guidelines Division in the Centre for Chronic Disease Prevention. The selected ERSCs will undertake evidence reviews and provide scientific support for the development of the Task Force’s clinical practice guidelines. In addition, the Task Force works with other health professional groups and organizations to support the development of prevention tools to aid implementation of their guideline recommendations.
Publications
KT
Health Care Administration and Organization
Health Care Innovation and Quality Assurance
Research Practice and Methodology
Aging
KT
Dissemination of Evidence-Based Antipsychotic Prescribing Guidelines to Nursing Homes: A Cluster Randomized Trial.
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J. Tjia, T. Field, K. Mazor, et al.
J Am Geriatr Soc 2015 Jul;63(7):1289-1298.
OBJECTIVES: To evaluate the effectiveness of efforts to translate and disseminate evidence-based guidelines about atypical antipsychotic use to nursing homes (NHs). DESIGN: Three-arm, cluster randomized trial. SETTING: NHs. PARTICIPANTS: NHs in the state of Connecticut. MEASUREMENTS: Evidence-based guidelines for atypical antipsychotic prescribing were translated into a toolkit targeting NH stakeholders, and 42 NHs were recruited and randomized to one of three toolkit dissemination strategies: mailed toolkit delivery (minimal intensity); mailed toolkit delivery with quarterly audit and feedback reports about facility-level antipsychotic prescribing (moderate intensity); and in-person toolkit delivery with academic detailing, on-site behavioral management training, and quarterly audit and feedback reports (high intensity). Outcomes were evaluated using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. RESULTS: Toolkit awareness of 30% (7/23) of leadership of low-intensity NHs, 54% (19/35) of moderate-intensity NHs, and 82% (18/22) of high-intensity NHs reflected adoption and implementation of the intervention. Highest levels of use and knowledge among direct care staff were reported in high-intensity NHs. Antipsychotic prescribing levels declined during the study period, but there were no statistically significant differences between study arms or from secular trends. CONCLUSION: RE-AIM indicators suggest some success in disseminating the toolkit and differences in reach, adoption, and implementation according to dissemination strategy but no measurable effect on antipsychotic prescribing trends. Further dissemination to external stakeholders such as psychiatry consultants and hospitals may be needed to influence antipsychotic prescribing for NH residents.
A mixed methods study of the factors that influence whether intervention research has policy and practice impacts: perceptions of Australian researchers
Robyn Newson, Lesley King, Lucie Rychetnik, et al.
BMJ Open 2015 07/01;5(7).
To investigate researchers’ perceptions about the factors that influenced the policy and practice impacts (or lack of impact) of one of their own funded intervention research studies. Design Mixed method, cross-sectional study. Setting Intervention research conducted in Australia and funded by Australia’s National Health and Medical Research Council between 2003 and 2007. Participants The chief investigators from 50 funded intervention research studies were interviewed to determine if their study had achieved policy and practice impacts, how and why these impacts had (or had not) occurred and the approach to dissemination they had employed. Results We found that statistically significant intervention effects and publication of results influenced whether there were policy and practice impacts, along with factors related to the nature of the intervention itself, the researchers’ experience and connections, their dissemination and translation efforts, and the postresearch context. Conclusions This study indicates that sophisticated approaches to intervention development, dissemination actions and translational efforts are actually widespread among experienced researches, and can achieve policy and practice impacts. However, it was the links between the intervention results, further dissemination actions by researchers and a variety of postresearch contextual factors that ultimately determined whether a study had policy and practice impacts. Given the complicated interplay between the various factors, there appears to be no simple formula for determining which intervention studies should be funded in order to achieve optimal policy and practice impacts.
Advancing implementation science through measure development and evaluation: a study protocol.
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C. C. Lewis, B. J. Weiner, C. Stanick and S. M. Fischer.
Implement Sci 2015 Jul 22;10(1):102-015-0287-0
Significant gaps related to measurement issues are among the most critical barriers to advancing implementation science. Three issues motivated the study aims: (a) the lack of stakeholder involvement in defining pragmatic measure qualities; (b) the dearth of measures, particularly for implementation outcomes; and (c) unknown psychometric and pragmatic strength of existing measures. Aim 1: Establish a stakeholder-driven operationalization of pragmatic measures and develop reliable, valid rating criteria for assessing the construct. Aim 2: Develop reliable, valid, and pragmatic measures of three critical implementation outcomes, acceptability, appropriateness, and feasibility. Aim 3: Identify Consolidated Framework for Implementation Research and Implementation Outcome Framework-linked measures that demonstrate both psychometric and pragmatic strength. METHODS/DESIGN: For Aim 1, we will conduct (a) interviews with stakeholder panelists (N = 7) and complete a literature review to populate pragmatic measure construct criteria, (b) Q-sort activities (N = 20) to clarify the internal structure of the definition, (c) Delphi activities (N = 20) to achieve consensus on the dimension priorities, (d) test-retest and inter-rater reliability assessments of the emergent rating system, and (e) known-groups validity testing of the top three prioritized pragmatic criteria. For Aim 2, our systematic development process involves domain delineation, item generation, substantive validity assessment, structural validity assessment, reliability assessment, and predictive validity assessment. We will also assess discriminant validity, known-groups validity, structural invariance, sensitivity to change, and other pragmatic features. For Aim 3, we will refine our established evidence-based assessment (EBA) criteria, extract the relevant data from the literature, rate each measure using the EBA criteria, and summarize the data. DISCUSSION: The study outputs of each aim are expected to have a positive impact as they will establish and guide a comprehensive measurement-focused research agenda for implementation science and provide empirically supported measures, tools, and methods for accomplishing this work.
Communities of practice for supporting health systems change: a missed opportunity.
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A. Kothari, J. A. Boyko, J. Conklin, P. Stolee and S. L. Sibbald.
Health Res Policy Syst 2015 Jul 25;13(1):33
Communities of practice (CoPs) have been used in the health sector to support professional practice change. However, little is known about how CoPs might be used to influence a system that requires change at and across various levels (i.e. front line care, organizational, governmental). In this paper we examine the experience of a CoP in the Canadian province of Ontario as it engages in improving the care of seniors. Our aim is to shed light on using CoPs to facilitate systems change. METHODS: This paper draws on year one findings of a larger multiple case study that is aiming to increase understanding of knowledge translation processes mobilized through CoPs. In this paper we strategically report on one case to illustrate a critical example of a CoP trying to effect systems change. Primary data included semi-structured interviews with CoP members (n = 8), field notes from five planning meetings, and relevant background documents. Data analysis included deductive coding (i.e. pre-determined codes aligned with the larger project) and inductive coding which allowed codes and themes to emerge. A thorough description of the case was prepared using all the coded data. RESULTS: The CoP recognized a need to support health professionals (nurses, dentists) and related paraprofessionals with knowledge, experience, and resources to appropriately address their clients’ oral health care needs. Accordingly, the CoP led a knowledge-to-action initiative that involved a seven-part webinar series meant to transfer step-by-step, skill-based knowledge through live and archived webinars. Although the core planning team functioned effectively to develop the webinars, the CoP was challenged by organizational and long-term care sector cultures, as well as governmental structures within the broader health context. CONCLUSION: The provincial CoP functioned as an incubator that brought together best practices, research, experiences, a reflective learning cycle, and passionate champions. Nevertheless, the CoP’s efforts to stimulate practice changes were met with broader resistance. Research about how to use CoPs to influence health systems change is needed given that CoPs are being tasked with this goal.
The evolution of knowledge exchanges enabling successful practice change in two intensive care units.
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P. Rangachari, M. Madaio, R. K. Rethemeyer, et al.
Health Care Manage Rev 2015 Jan-Mar;40(1):65-78
Many hospitals are unable to consistently implement evidence-based practices. For example, implementation of the central line bundle (CLB), known to prevent catheter-related bloodstream infections (CRBSIs), is often challenging. This problem is broadly characterized as “change implementation failure.” PURPOSE: The theoretical literature on organizational change has suggested that periodic top-down communications promoting tacit knowledge exchanges across professional subgroups may be effective for enabling learning and change in health care organizations. However, gaps remain in understanding the mechanisms by which top-down communications enable practice change at the unit level. Addressing these gaps could help identify evidence-based management strategies for successful practice change at the unit level. Our study sought to address this gap. METHODS: A prospective study was conducted in two intensive care units within an academic health center. Both units had low baseline adherence to CLB and higher-than-expected CRBSIs. Periodic top-down quality improvement communications were conducted over a 52-week period to promote CLB implementation in both units. Simultaneously, the study examined (a) the content and frequency of communication related to CLB through weekly “communication logs” completed by unit physicians, nurses, and managers and (b) unit outcomes, that is, CLB adherence rates through weekly chart reviews. FINDINGS: Both units experienced substantially improved outcomes, including increased adherence to CLB and statistically significant (sustained) declines in both CRBSIs and catheter days (i.e., central line use). Concurrently, both units indicated a statistically significant increase in “proactive” communications-that is, communications intended to reduce infection risk-between physicians and nurses over time. Further analysis revealed that, during the early phase of the study, “champions” emerged within each unit to initiate process improvements. PRACTICE IMPLICATIONS: The study helps identify evidence-based management strategies for successful practice change at the unit level. For example, it underscores the importance of (a) screening each unit for change champions and (b) enabling champions to emerge from within the unit to foster change implementation.
Collective Intelligence in Patient Organisations (UK)
Nesta 2015
This report examines patient organisations’ ever more critical role as knowledge brokers in an increasingly complex, data-rich healthcare system. Key findings
-Patient organisations are important examples of collective intelligence practiced in challenging conditions with the aim of tackling complex problems. -With more long term conditions and multimorbidities, more data, more available options in diagnostics, treatments, and care, knowledge is becoming one of the most critical assets of patients seeking optimal care.
-Patient organisations, working as collectives, are in an excellent position to support the work of translating, assembling and analysing the information involved in healthcare.
-Innovative patient organisations are already supporting the development of peer relationships, driving ambitious research programmes, sharing skills and unlocking the energy and expertise of patients. But they need support from better tools to extend this critical work.
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Health Care Administration and Organization
Safety culture in long-term care: a cross-sectional analysis of the Safety Attitudes Questionnaire in nursing and residential homes in the Netherlands.
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M. Buljac-Samardzic, J. D. van Wijngaarden and C. M. Dekker-van Doorn.
BMJ Qual Saf 2015 Jul 24
The first objective was to investigate if the Safety Attitudes Questionnaire (SAQ) is appropriate to measure the safety attitude of caregivers in nursing and residential homes, and second, to compare safety attitude of these caregivers with available data of caregivers in other settings (ie, inpatients, intensive care unit (ICU) and ambulatory care). METHODS: Using a cross-sectional survey methodology, we obtained completed SAQ surveys from 521 caregivers (response rate of 53%) working in nine units in nine different nursing and residential homes in The Netherlands. Exploratory factor and Cronbach’s alpha measures were used to analyse the psychometric properties of the SAQ. A correlation matrix was performed to study the relationship among the SAQ dimensions. A t test was performed to test significant differences between our sample and the benchmark settings. RESULTS: The factor analyses and calculated Cronbach’s alphas (alpha=0.56-0.80) for this sample confirmed the robustness of the SAQ scales. There was a high positive correlation between teamwork climate, job satisfaction, perceptions of management, safety climate and working conditions (r=0.31 to 63), but stress recognition had a negative correlation with each of the other dimensions (r=-0.13 to -0.18). Overall, the scores from the nursing and residential homes differed significantly from the benchmark settings. CONCLUSIONS: The findings in this study confirmed that the SAQ could also be used in the nursing and residential homes setting. However, stress recognition in nursing and residential homes setting does not seem to be one of the dimensions of the safety attitude construct. Furthermore, Dutch nursing and residential homes have significantly higher scores on most dimensions of the SAQ compared with US inpatient units and comparable scores to ICUs (Dutch and US) and ambulatory services.
Personal care workers in Australian aged care: retention and turnover intentions.
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K. Radford, K. Shacklock and G. Bradley.
J Nurs Manag 2015 Jul;23(5):557-566
This study examined factors influencing personal care workers’ intentions to stay or leave Australian aged care employment – especially for older workers. BACKGROUND: Retention of personal care workers is particularly important in aged care as they provide the majority of the direct care via community aged care or long-term aged care environments. However, there is limited research on what drives their turnover and retention. METHOD: A survey was conducted during 2012 collecting 206 responses from workers within community and long-term aged care in four organisations in Australia. RESULT: Perceived supervisor support, on-the-job embeddedness and area of employment were identified as predictors of both intention to stay and to leave, although the relationship strength differed. Community care workers were more likely to stay and reported more supervisor support than long-term care workers. Unexpectedly, age and health status were not predictors of staying or leaving. CONCLUSION: While there are similarities between retention and turnover motivators, there are also differences. Within a global context of health worker shortages, such new knowledge is keenly sought to enhance organisational effectiveness and sustain the provision of quality aged care. IMPLICATIONS FOR NURSING MANAGEMENT: Retention strategies for older workers should involve increasing supervisor support, and seeking to embed workers more fully within their organisation.
Home Help Service Staffs’ Descriptions of Their Role in Promoting Everyday Activities Among Older People in Sweden Who Are Dependent on Formal Care.
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S. Cederbom, C. Thunborg, E. Denison, A. Soderlund and P. von Heideken Wagert.
J Appl Gerontol 2015 Jul 24
The study aimed to explore how home help service staff described their role in improving the abilities of older people, in particular, older women with chronic pain who are dependent on formal care, to perform everyday activities. Three focus group interviews were conducted, and a qualitative inductive thematic content analysis was used. The analysis resulted in one theme: struggling to improve the care recipients’ opportunities for independence but being inhibited by complex environmental factors. By encouraging the care recipients to perform everyday activities, the staff perceived themselves to both maintain and improve their care recipients’ independence and quality of life. An important goal for society and health care professionals is to improve older people’s abilities to “age in place” and to enable them to age independently while maintaining their quality of life. A key resource is home help service staff, and this resource should be utilized in the best possible way.
Discrepancies in assessing home care workers’ working conditions in a Norwegian home care service: differing views of stakeholders at three organizational levels.
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G. R. Andersen and R. H. Westgaard.
BMC Health Serv Res 2015 Jul 25;15:286-015-0945-6
The present study is a follow-up study of factors contributing to an undesirable quality of work environment and sick leave rate in the home care services in a Norwegian municipality. The underlying assumption is that organizational discrepancies in the perceptions and appraisals of significant factors and processes in an organization have detrimental effects on the management of the organization and on work environment conditions. Thus, the study aim is to explore potential organizational discrepancies in the appraisals of factors relating to home care workers’ working conditions. METHODS: The study, using a mixed-methods design, comprised six home care units. It included survey responses of home care workers (80 respondents, response rate 54 %) and qualitative descriptions of stakeholders’ appraisals of organizational issues gathered through semi-structured interviews (33 interviews with stakeholders at three organizational levels). RESULTS: Employees at different organizational levels in the home care services expressed divergent appraisals of factors related to the working conditions of home care workers, including impact of organizational measures (i.e. time pressure, work tasks, a new work program, organizational changes, budget model, budget allocation and coping strategies). Survey responses supported interview descriptions by home care workers. Results suggest that organizational discrepancy serve as an important barrier to a sustainable, well-functioning organization in general and to quality-enhancing changes to work procedures in particular. CONCLUSIONS: It is recommended to improve communication channels and facilitate the exchange of information across levels to ensure a common understanding of matters significant to the organization of the home care services and to the work environment of home care workers. The prevalence and impact of organizational discrepancy should be included in organization research, particularly when exploring explanatory factors of an unhealthy organization.
Nurses in independent care homes: issues, challenges and potential.
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T. Morris-Thompson and D. Marks-Maran.
Br J Nurs 2015 Jul 23;24(14):734-737
Many registered nurses in the UK work in the social care sector in independent care homes and nursing homes. This article explores the challenges related to providing nursing care for adults in care homes, issues arising for nurses and nursing in the social care sector, and providing a career pathway for nurses in the social care sector. Steps need to be taken to ensure that cooperation, collaboration and leadership in nursing in the social care sector is recognised and that appropriate representation of nurses in social care takes place at national level.
Certified Nursing Assistants Balancing Family Caregiving Roles: Health Care Utilization Among Double- and Triple-Duty Caregivers.
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N. DePasquale, L. R. Bangerter, J. Williams and D. M. Almeida.
Gerontologist 2015 Jul 29
This study examines how certified nursing assistants (CNAs) balancing family caregiving roles-child care (double-duty child caregivers), elder care (double-duty elder caregivers), and both child and elder care (triple-duty caregivers)-utilize health care services relative to nonfamily caregiving counterparts (formal-only caregivers). DESIGN AND METHODS: A sample of 884 CNAs from the Work, Family and Health Study was drawn on to assess the number of acute care (i.e., emergency room or urgent care facility) and other health care (i.e., outpatient treatment or counseling) visits made during the past 6 months. RESULTS: Double-duty elder and triple-duty caregivers had higher acute care utilization rates than formal-only caregivers. CNAs with and without family caregiving roles had similar rates of other health care visits. IMPLICATIONS: CNAs providing informal care for older adults have higher acute care visit rates. Given the increasing need for family caregivers and the vital importance of the health of the nursing workforce for the health of others, future research on how double- and triple-duty caregivers maintain their health amidst constant caregiving should be a priority.
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Health Care Innovation and Quality Assurance
Beyond metrics? Utilizing ‘soft intelligence’ for healthcare quality and safety
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Graham P. Martin, Lorna McKee and Mary Dixon-Woods.
Soc Sci Med
Formal metrics for monitoring the quality and safety of healthcare have a valuable role, but may not, by themselves, yield full insight into the range of fallibilities in organizations. ‘Soft intelligence’ is usefully understood as the processes and behaviours associated with seeking and interpreting soft data—of the kind that evade easy capture, straightforward classification and simple quantification—to produce forms of knowledge that can provide the basis for intervention. With the aim of examining current and potential practice in relation to soft intelligence, we conducted and analysed 107 in-depth qualitative interviews with senior leaders, including managers and clinicians, involved in healthcare quality and safety in the English National Health Service. We found that participants were in little doubt about the value of softer forms of data, especially for their role in revealing troubling issues that might be obscured by conventional metrics. Their struggles lay in how to access softer data and turn them into a useful form of knowing. Some of the dominant approaches they used risked replicating the limitations of hard, quantitative data. They relied on processes of aggregation and triangulation that prioritised reliability, or on instrumental use of soft data to animate the metrics. The unpredictable, untameable, spontaneous quality of soft data could be lost in efforts to systematize their collection and interpretation to render them more tractable. A more challenging but potentially rewarding approach involved processes and behaviours aimed at disrupting taken-for-granted assumptions about quality, safety, and organizational performance. This approach, which explicitly values the seeking out and the hearing of multiple voices, is consistent with conceptual frameworks of organizational sensemaking and dialogical understandings of knowledge. Using soft intelligence this way can be challenging and discomfiting, but may offer a critical defence against the complacency that can precede crisis.
Implementation of improvement strategies in palliative care: an integrative review
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J. van Riet Paap, M. Vernooij-Dassen, R. Sommerbakk, et al.
Implement Sci 2015 Jul 26;10(1):103
The European population is ageing, and as a consequence, an increasing number of patients are in need of palliative care, including those with dementia. Although a growing number of new insights and best practices in palliative care have been published, they are often not implemented in daily practice. The aim of this integrative review is to provide an overview of implementation strategies that have been used to improve the organisation of palliative care. METHODS: Using an integrative literature review, we evaluated publications with strategies to improve the organisation of palliative care. Qualitative analysis of the included studies involved categorisation of the implementation strategies into subgroups, according to the type of implementation strategy. RESULTS: From the 2379 publications identified, 68 studies with an experimental or quasi-experimental design were included. These studies described improvements using educational strategies (n = 14), process mapping (n = 1), feedback (n = 1), multidisciplinary meetings (n = 1) and multi-faceted implementation strategies (n = 51). Fifty-three studies reported positive outcomes, 11 studies reported mixed effects and four studies showed a limited effect (two educational and two multi-faceted strategies). CONCLUSIONS: This review is one of the first to provide an overview of the available literature in relation to strategies used to improve the organisation of palliative care. Since most studies reported positive results, further research is needed to identify and improve the effects of strategies aiming to improve the organisation of palliative care.
Participant experience of a Care Quality Commission inspection.
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J. Oates.
Nurs Stand 2015 Jul 29;29(48):42-46
The Care Quality Commission (CQC) is the regulator for health and social care in England. It sets and monitors standards of care and has legal powers to take action when those standards are not met. The CQC now regulates primary care as well as hospital, community and social care, with significant influence on nursing practice and the conduct of care. This article explains the role and function of the CQC and the circumstances in which its current model was devised. It discusses the commission’s comprehensive inspection approach, with particular reference to mental health settings. The article aims to demystify the inspection process and put it into context, drawing on the experiences of a director of nursing, an expert by experience and a nursing specialist adviser who participated in a comprehensive inspection.
Tailored e-Health services for the dementia care setting: a pilot study of ‘eHealthMonitor’.
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S. Schaller, V. Marinova-Schmidt, J. Gobin, et al.
BMC Med Inform Decis Mak 2015 Jul 28;15(1):58-015-0182-2
The European eHealthMonitor project (eHM) developed a user-sensitive and interactive web portal for dementia care: the eHM Dementia Portal (eHM-DP). It aims to provide targeted and personalized support for informal caregivers of people with dementia in a home-based care setting. The objective of the pilot study was to obtain feedback on the eHM-DP from two user perspectives (caregivers and medical professionals), focusing on caregiver empowerment, decision aid, and the perceived benefits of the eHM-DP. METHODS: The study on the eHM-DP was conducted from March 2014 to June 2014. The methodological approach followed a user-participatory design with a total number of 42 participants. The study included caregivers of people with dementia and medical professionals (MPs) from the metropolitan region of Erlangen-Nurnberg (Bavaria, Germany). Study participants were interviewed face-to-face with semi-structured, written interviews. RESULTS: Caregivers indicated a high degree of perceived support by the eHM-DP and of provided decision aid. In total, 89 % of caregivers and 54 % of MPs would use the eHM-DP if access were provided. The primary benefits participants perceived were the acquisition of individualized information, computerized interaction between caregivers and MPs, empowerment in health-related decisions and comprehensive insights into the progress of the disease. Major recommendations for improving the eHM-DP encompassed: an active search functionality based on predefined terms, the implementation of a chatroom for caregivers, an upload function and alerts for MPs, as well as the overall design. CONCLUSIONS: Our study is the first to have provided new insights and results on an interactive and needs-oriented web portal, endeavouring towards empowerment and assistance in decision making for caregivers as well as MPs within the realm of caring for patients with dementia. The acceptance and willingness to use the eHM-DP emphasizes the potential of eHealth services for community-based dementia care settings.
Comparison of practice based research network based quality improvement technical assistance and evaluation to other ongoing quality improvement efforts for changes in agency culture.
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W. C. Livingood, A. H. Peden, G. H. Shah, et al.
BMC Health Serv Res 2015 Jul 31;15(1):300
Public health agencies in the USA are increasingly challenged to adopt Quality Improvement (QI) strategies to enhance performance. Many of the functional and structural barriers to effective use of QI can be found in the organizational culture of public health agencies. The purpose of this study was to assess the impact of public health practice based research network (PBRN) evaluation and technical assistance for QI interventions on the organizational culture of public health agencies in Georgia, USA. METHODS: An online survey of key informants in Georgia’s districts and county health departments was used to compare perceptions of characteristics of organizational QI culture between PBRN supported QI districts and non-PBRN supported districts before and after the QI interventions. The primary outcomes of concern were number and percentage of reported increases in characteristics of QI culture as measured by key informant responses to items assessing organizational QI practices from a validated instrument on QI Collaboratives. Survey results were analyzed using Multi-level Mixed Effects Logistic Model, which accounts for clustering/nesting. RESULTS: Increases in QI organizational culture were consistent for all 10- items on a QI organizational culture survey related to: leadership support, use of data, on-going QI, and team collaboration. Statistically significant odds ratios were calculated for differences in increased QI organizational culture between PBRN-QI supported districts compared to Non-PBRN supported districts for 5 of the 10 items, after adjusting for District clustering of county health departments. CONCLUSIONS: Agency culture, considered by many QI experts as the main goal of QI, is different than use of specific QI methods, such as Plan-Do-Study-Act (PDSA) cycles or root-cause analyses. The specific use of a QI method does not necessarily reflect culture change. Attempts to measure QI culture are newly emerging. This study documented significant improvements in characteristics of organizational culture and demonstrated the potential of PBRNs to support agency QI activities.
Common Sense for Caring Organizations Results from a Study of High-Performing Home Care Agencies and Nursing Homes (US)
Scripps Gerontology Center, Miami University
February 2013
Ohio’s population is aging, and with increasing age comes an increased likelihood of disability and an accompanying need for assistance with activities of daily living (Mehdizadeh, 2010). While the majority of daily assistance is provided informally by family and friends, paid direct care workers are an integral part of the system of long-term services and supports. For many individuals needing long-term services, the personal care or nursing home aide may be the person providing the most assistance in their daily lives. These direct care workers receive the lowest wages and the least amount of training of all long-term care workers. This study focuses on the best practice strategies used by high-performing organizations to support their direct care workforce.
Making change possible: a Transformation Fund for the NHS (UK)
2015
Making change possible: a Transformation Fund for the NHS draws on analysis conducted by the two organisations, in particular six case studies of funding transformation, in the health sector and beyond, along with examples of local NHS initiatives. We also captured the experience of NHS leaders and some of those organisations across the NHS that have been at the forefront of efforts to implement changes in the delivery of care.
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Research Practice and Methodology
Making randomised trials more efficient: report of the first meeting to discuss the Trial Forge platform.
Non UofA Access
S. Treweek, D. G. Altman, P. Bower, et al.
Trials 2015 Jun 5;16:261-015-0776-0
Randomised trials are at the heart of evidence-based healthcare, but the methods and infrastructure for conducting these sometimes complex studies are largely evidence free. Trial Forge ( http://www.trialforge.org ) is an initiative that aims to increase the evidence base for trial decision making and, in doing so, to improve trial efficiency.This paper summarises a one-day workshop held in Edinburgh on 10 July 2014 to discuss Trial Forge and how to advance this initiative. We first outline the problem of inefficiency in randomised trials and go on to describe Trial Forge. We present participants’ views on the processes in the life of a randomised trial that should be covered by Trial Forge.General support existed at the workshop for the Trial Forge approach to increase the evidence base for making randomised trial decisions and for improving trial efficiency. Agreed upon key processes included choosing the right research question; logistical planning for delivery, training of staff, recruitment, and retention; data management and dissemination; and close down. The process of linking to existing initiatives where possible was considered crucial. Trial Forge will not be a guideline or a checklist but a ‘go to’ website for research on randomised trials methods, with a linked programme of applied methodology research, coupled to an effective evidence-dissemination process. Moreover, it will support an informal network of interested trialists who meet virtually (online) and occasionally in person to build capacity and knowledge in the design and conduct of efficient randomised trials.Some of the resources invested in randomised trials are wasted because of limited evidence upon which to base many aspects of design, conduct, analysis, and reporting of clinical trials. Trial Forge will help to address this lack of evidence.
Handling trial participants with missing outcome data when conducting a meta-analysis: a systematic survey of proposed approaches
Non UofA Access
E. A. Akl, L. A. Kahale, T. Agoritsas, et al.
Syst Rev 2015 Jul 23;4(1):98
When potentially associated with the likelihood of outcome, missing participant data represents a serious potential source of bias in randomized trials. Authors of systematic reviews frequently face this problem when conducting meta-analyses. The objective of this study is to conduct a systematic survey of the relevant literature to identify proposed approaches for how systematic review authors should handle missing participant data when conducting a meta-analysis. METHODS: We searched MEDLINE and the Cochrane Methodology register from inception to August 2014. We included papers that devoted at least two paragraphs to discuss a relevant approach for missing data. Five pairs of reviewers, working independently and in duplicate, selected relevant papers. One reviewer abstracted data from included papers and a second reviewer verified them. We summarized the results narratively. RESULTS: Of 9,138 identified citations, we included 11 eligible papers. Four proposed general approaches for handling dichotomous outcomes, and all recommended a complete case analysis as the primary analysis and additional sensitivity analyses using the following imputation methods: based on reasons for missingness (n = 3), relative to risk among followed up (n = 3), best-case scenario (n = 2), and worst-case scenario (n = 3). Three of these approaches suggested taking uncertainty into account. Two papers proposed general approaches for handling continuous outcomes, and both proposed a complete case analysis as the reference analysis and the following imputation methods as sensitivity analyses: based on reasons for missingness (n = 2), based on the mean observed in the same trial or other trials (n = 1), and based on informative missingness differences in means (n = 1). The remaining eligible papers did not propose general approaches but addressed specific statistical issues. CONCLUSIONS: All proposed approaches for handling missing participant data recommend conducting a complete case analysis for the primary analysis and some form of sensitivity analysis to evaluate robustness of results. Although these approaches require further testing, they may guide review authors in addressing missing participant data.
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Aging
Measuring social integration among residents in a dementia special care unit versus traditional nursing home: A pilot study.
Non UofA Access
K. M. Abbott, J. S. Sefcik and K. Van Haitsma.
Dementia (London) 2015 Jul 22
The physical and mental health of older adults with dementia is affected by levels of social integration. The development of dementia special care units (D-SCU) arose, in part, to facilitate more meaningful social interactions among residents implying greater social integration of D-SCU residents as compared to residents in a traditional nursing home (TNH). But, it is unknown whether D-SCU residents are receiving equal or greater benefits from living on a segregated unit intended to enhance their social environment and integration through both design and staff involvement. The purpose of this study was to pilot test a comprehensive objective assessment to measure social integration among nursing home residents with dementia and to compare levels of integration of residents living on a D-SCU to those living in a TNH. A total of 29 residents participated (15 D-SCU and 14 TNH) and data were gathered from medical charts, visitor logs, and through direct observations. Over 1700 interactions were recorded during 143 h of observation. Specifically, the location, context, type, quantity, and quality of residents’ interactions were recorded. Overall, the majority of resident interactions were verbal and initiated by staff. Interactions were social in context, and occurred in public areas, such as the common room with a large screen TV. Average interactions lasted less than 1 min and did not change the resident’s affect. Residents spent between 10% and 17% of their time interacting with other people on average. D-SCU staff were significantly more likely to initiate interactions with residents than TNH staff. D-SCU residents also experienced more interactions in the afternoons and expressed more pleasure and anxiety than residents in the TNH. This study helps to lay the groundwork necessary to comprehensively and objectively measure social integration among people with dementia in order to evaluate care environments.
Atypical antipsychotic drug use and falls among nursing home residents in Winnipeg, Canada.
Non UofA Access
S. Bozat-Emre, M. Doupe, A. L. Kozyrskyj, R. Grymonpre and S. M. Mahmud.
Int J Geriatr Psychiatry 2015 Aug;30(8):842-850
The purpose of this study is to assess whether atypical antipsychotic drug (AAD) use is associated with increased risk of falling among older (>/=65 years) nursing home (NH) residents. METHODS: We conducted a nested case-control study using Resident Assessment Instrument Minimum Data Set 2.0 (RAI-MDS((c)) ) for NHs to identify falls, and population-based administrative healthcare databases to measure drug use and other study covariates. Cases (n = 626) were NH residents in Winnipeg, Canada, who had a fall between 1 April 2005 and 31 March 2007, and were matched to four controls on age, sex, and length of NH stay (n = 2388). RESULTS: While the odds of falling were statistically greater for AAD users versus nonusers (OR = 1.6, 95% CI 1.1-2.3), this association was type and dose dependent. Compared to nonusers, the odds of falling were greater for high-dose (>150 mg/day) quetiapine users and for high-dose (>2 mg/day) risperidone users. On the other hand, olanzapine (regardless of dose), low-dose quetiapine, and low-dose risperidone use were not associated with increased fall risk. Furthermore, the effect of AAD use, in general, on the risk of falling was significantly greater for people with wandering problems (OR = 1.8, 95% CI 1.1-3.1). CONCLUSIONS: Our findings suggest greater risk of falling with high-dose quetiapine use and with high-dose risperidone use among NH residents. In addition, the effect of AAD use was greater for people who frequently wander. Further research is needed to confirm these findings, and to address other important unanswered questions about the safest dose and duration of AAD use. Copyright (c) 2014 John Wiley & Sons, Ltd.
Transitions in Care in a Nationally Representative Sample of Older Americans with Dementia.
Non UofA Access
C. M. Callahan, W. Tu, K. T. Unroe, M. A. LaMantia, T. E. Stump and D. O. Clark.
J Am Geriatr Soc 2015 Jul 22
To describe transitions in care for older adults with dementia identified from a nationally representative cohort and to describe transition rates in those with more-severe levels of cognitive and functional impairment. DESIGN: Longitudinal cohort study. SETTING: Health and Retirement Study (HRS). PARTICIPANTS: HRS respondents aged 65 and older whose survey data were linked with Medicare claims from 1999 to 2008 (N = 16,186). MEASUREMENTS: Transitions in care between home, home with formal services, hospital, and nursing facility care; cognitive function; activities of daily living; and mortality. RESULTS: The 3,447 (21.3%) HRS subjects who were ever diagnosed with dementia experienced frequent transitions. Of subjects transitioning from a hospital stay, 52.2% returned home without home care services, and 33.8% transitioned to a nursing facility. Of subjects transitioning from a nursing facility, 59.2% transitioned to the hospital, and 25.3% returned home without services. There were 2,139 transitions to death, and 58.7% of HRS subjects with dementia died at home. Even in persons with moderate to severe dementia, multiple transitions in care were documented, including transitions from the hospital to home and back to the hospital. CONCLUSION: In this nationally representative sample of older adults, subjects diagnosed with dementia experience frequent transitions. Persons with dementia who are cared for at home and who transition back to home often have moderate to severe impairments in function and cognition.
Randomized controlled resistance training based physical activity trial for central European nursing home residing older adults.
Non UofA Access
I. Barthalos, S. Dorgo, J. Kopkane Plachy, et al.
J Sports Med Phys Fitness 2015 Jul 24
AIM: Nursing home residing older adults often experience fear of sickness or death, functional impairment and pain. It is difficult for these older adults to maintain a physically active lifestyle and to keep a positive outlook on life. This study evaluated the changes in quality of life, attitude to aging, assertiveness, physical fitness and body composition of nursing home residing elderly through a 15-week organized resistance training based physical activity program. METHODS: Inactive older adults living in a state financed nursing home (N=45) were randomly divided into two intervention groups and a control group. Both intervention groups were assigned to two physical activity sessions a week, but one of these groups also had weekly discussions on health and quality of life (MENTAL group). Data on anthropometric measures, fitness performance, as well as quality of life and attitudes to aging survey data were collected. Due to low attendance rate 12 subjects were excluded from the analyses. Statistical analysis included Paired Samples t-tests and Repeated Measures Analysis of Variance. RESULTS: Both intervention groups significantly improved their social participation, and their upper- and lower-body strength scores. Also, subjects in the MENTAL group showed improvement in agility fitness test and certain survey scales. No positive changes were detected in attitude towards aging and body composition measures in any groups. The post hoc results suggest that MENTAL group improved significantly more than the CONTROL group. CONCLUSIONS: Regular physical activity with discussions on health and quality of life made a more meaningful difference for the older adults living in nursing home than physical activity alone. Due to the fact that all participants were influenced by the program, it is suggested to further explore this area for better understanding of enhanced quality of life.
Individual and contextual determinants of resident-on-resident abuse in nursing homes: A random sample telephone survey of adults with an older family member in a nursing home.
Non UofA Access
L. B. Schiamberg, L. von Heydrich, G. Chee and L. A. Post.
Arch Gerontol Geriatr 2015 May 12
Few empirical investigations of elder abuse in nursing homes address the frequency and determinants of resident-on-resident abuse (RRA). A random sample of 452 adults with an older adult relative, >/=65 years of age, in a nursing home completed a telephone survey regarding elder abuse experienced by that elder family member. Using a Linear Structural Relations (LISREL) modeling design, the study examined the association of nursing home resident demographic characteristics (e.g., age, gender), health and behavioral characteristics (e.g., diagnosis of Alzheimer’s Disease, Activities of Daily Living (ADLs), Instrumental Activities of Daily Living (IADLs), types of staff abuse (e.g., physical, emotional), and factors beyond the immediate nursing home setting (e.g., emotional closeness of resident with family members) with RRA. Mplus statistical software was used for structural equation modeling. Main findings indicated that resident-on-resident mistreatment of elderly nursing home residents is associated with the age of the nursing home resident, all forms of staff abuse, all ADLs and IADLs, and emotional closeness of the older adult to the family.
Reasons why people with dementia are admitted to a general hospital in an emergency (UK)
Public Health England 2015
This Public Health England (PHE) document summarises national data about why people with dementia made use of inpatient general hospital services during the financial year 2012/13. It includes data on short stay emergency admissions, increases in hospital admissions and preventable emergency hospital admissions.
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Events
Online
Conducting Culturally Humble Rehabilitation Research
Wednesday 19 August 13:00-14:00
Researchers from the Rehabilitation Research and Training Center on Developing Strategies to Foster Community Integration and Participation for Individuals with Traumatic Brain Injury discuss important issues related to conducting research with ethnic and racial minorities and the medically underserved.
Public Health Ethics in Practice: Applying Frameworks to Cases
National Collaborating Centre for Healthy Public Policy
Presenters: Michael Keeling and Olivier Bellefleur (NCCHPP)
1 October 12:00-13:00 MT
During this webinar, we will introduce participants to:
-The general nature and role of ethics frameworks in public health,
-Summary versions of two public health ethics frameworks, and
-Cases (drawn from public health and related to healthy public policy) for deliberation using those frameworks.
A big part of this webinar will be focused on a more in-depth application of a framework to a case. Participants will be able to both see and contribute to applying a framework to identify the ethical implications that arise, and to deliberate towards a decision about what to do.
News
How to get ahead in … nursing leadership (UK)
After the Mid Staffs hospital scandal, David Cameron called for a new style of leadership from nurses. Now a new development programme has been launched.
Respecting the needs and wants of the elderly and the frail
Globe and Mail Editorial by Duncan Sinclair
While not yet frail, I am elderly. While I am doing everything I can to avoid becoming somebody’s patient, my wife’s recent end-of-life struggle has made me think long and hard about what my needs will be, if and when I become frail.
According to new research commissioned by Age UK and the British Geriatrics Society, using the medical term ‘frailty’ can provoke a strongly negative reaction from older people, because of its associations with loss of independence and end of life.
Changing the culture of long term care in Spruce Grove
On July 22, Copper Sky Lodge in Spruce Grove became the first supported living facility in Canada to partner with Dementia Care Matters as a Butterfly Care Home. Dementia Care Matters, founded by Dr. David Sheard (from the U.K.), is an organization that strives to change the culture of care for residents with dementia. The goal is to no longer see residents as a series of symptoms but to provide “emotion-based” care, recognizing that feelings matter most.
The Secret to Hitting Your Writing Goals May Be Simple: Peer Pressure
It’s summertime, when scholars dream of doing all the writing they didn’t find time for during the academic year. But some have found a year-round, low-budget solution to the academic writer’s time crunch: Schedule a meeting.
PenCLAHRC dementia education principles set standard for national education (UK)
A set of standards and criteria for dementia education, developed by a team at PenCLAHRC, are being rolled out to all educational courses for health professionals across England.
Dying care: ‘Improved’ guidelines proposed (UK)
England’s health watchdog has put forward new draft guidance to improve the care of adults in their last few days of life. It comes after concerns that misuse of the previous system – the Liverpool Care Pathway – led to some patients being deprived of water and food.
Nova Scotia Government Seeks Input on Continuing Care Plan
Nova Scotians can provide feedback via the Department of Health and Wellness website. Input will help shape the final document, which will be released in the fall.
Health spending won’t meet needs of aging Canadians, report warns
The fiscal sustainability report released on Tuesday by the Parliamentary Budget Officer (PBO) looks at whether spending policies of the various levels of government will be viable 75 years into the future, given current economic and demographic predictions.
A research study has shown that the use of the medication AVP-923 could be useful in the treatment of agitation for people who have Alzheimer’s disease
The Art of Science Communication: William Zinsser on How to Write Well About Science
Few writers have articulated the philosophies and practicalities behind this artful organization with more clarity and conviction than William Zinsser.
Resources
A guide to quality improvement methods
Health Quality Improvement Partnership (HQIP)
The guide brings together twelve quality improvement (QI) methods, providing an overview of each and practical advice on how and when to implement them, with illustrative case examples. QI methods covered include clinical audit; Plan, Do, Study, Act; model for improvement; LEAN/Six Sigma; performance benchmarking, process mapping and statistical process control and it is aimed at all professionals with an interest in QI.
How to deal with reviewer comments
For any author, a request for revisions should be considered an opportunity and it ought to be taken. If a colleague has received a manuscript from a journal with a request for revisions and they ask me if they should revise and re-submit or send it elsewhere, I always advise them to revise and re-submit.
OECD releases Health Statistics 2015, includes updated estimates on long-term care
The following long-term care statistics are available for OECD countries (Cdn data source is Statistics Canada):
-Beds in nursing and residential care facilities;
-Long-term care recipients;
-Long-term care workers;
-Long-term care workers: formal sector; and,
-Long-term care workers: informal sector.
Prevention and Treatment of Pressure Ulcers: Quick Reference Guide
The National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel and Pan Pacific Pressure Injury Alliance have worked together to develop clinical practice guidelines for the prevention and treatment of pressure ulcers.
Opportunities
Call for Editor-in-Chief: Perspectives in Psychiatric Care
DEADLINE 1 September
Perspectives in Psychiatric Care is an established quarterly, peer-reviewed psychiatric nursing journal for advanced practice nurses. It is listed in 25 medical and scientific indexes, including Journal Citation Reports, MEDLINE, and SCOPUS.
