November 27, 2015



New article by Dr. Malcolm Doupe
Mapping Nursing Home Inspections & Audits in Six Countries
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J. A. Choiniere, M. Doupe, M. Goldmann, et al.
Ageing Int 2015

International quality concerns regarding long-term residential care, home to many of the most vulnerable among us, prompted our examination of the audit and inspection processes in six different countries. Drawing on Donabedian’s (Evaluation & Health Professions, 6(3), 363–375, 1983) categorization of quality criteria into structural, process and outcome indicators, this paper compares how quality is understood and regulated in six countries occupying different categories according to Esping Andersen’s (1990) typology: Canada, England, and the United States (liberal welfare regimes); Germany (conservative welfare regime); Norway, and Sweden (social democratic welfare regimes). In general, our review finds that countries with higher rates of privatization (mostly the liberal welfare regimes) have more standardized, complex and deterrence-based regulatory approaches. We identify that even countries with the lowest rates of for profit ownership and more compliance-based regulatory approaches (Norway and Sweden) are witnessing an increased involvement of for-profit agencies in managing care in this sector. Our analysis suggests there is widespread concern about the incursion of market forces and logic into this sector, and about the persistent failure to regulate structural quality indicators, which in turn have important implications for process and outcome quality indicators.

New article by Dr. Lisa Cranley
Work-related factors influencing home care nurse intent to remain employed.
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A. E. Tourangeau, E. Patterson, M. Saari, H. Thomson and L. Cranley.
Health Care Manage Rev 2015 Nov 5

BACKGROUND: Health care is shifting out of hospitals into community settings. In Ontario, Canada, home care organizations continue to experience challenges recruiting and retaining nurses. However, factors influencing home care nurse retention that can be modified remain largely unexplored. Several groups of factors have been identified as influencing home care nurse intent to remain employed including job characteristics, work structures, relationships and communication, work environment, responses to work, and conditions of employment. PURPOSE: The aim of this study was to test and refine a model that identifies which factors are related to home care nurse intentions to remain employed for the next 5 years with their current home care employer organization. METHODOLOGY/APPROACH: A cross-sectional survey design was implemented to test and refine a hypothesized model of home care nurse intent to remain employed. Logistic regression was used to determine which factors influence home care nurse intent to remain employed. FINDINGS: Home care nurse intent to remain employed for the next 5 years was associated with increasing age, higher nurse-evaluated quality of care, having greater variety of patients, experiencing greater meaningfulness of work, having greater income stability, having greater continuity of client care, experiencing more positive relationships with supervisors, experiencing higher work-life balance, and being more satisfied with salary and benefits. PRACTICE IMPLICATIONS: Home care organizations can promote home care nurse intent to remain employed by (a) ensuring nurses have adequate training and resources to provide quality client care, (b) improving employment conditions to increase income stability and satisfaction with pay and benefits.

Dr. Carole Estabrooks convenes the 10th Annual Forum of the Canadian Academy of Health Sciences (CAHS) on the topic of dementia in Canada
The rising tide of dementia in Canada: Facing the critical challenge by 2025

On September 17, 2015, Drs. Carole Estabrooks and Howard Feldman convened the 10th Annual Forum of the Canadian Academy of Health Sciences (CAHS) on the topic of dementia in Canada. The Academy is a unique Canadian organization that brings together a breadth of expertise and scholarship across a broad view of health, including social scientists, biomedical researchers, health care practitioners, and technology experts. Fora and their follow-up activities often produce important outputs including publications that can serve to inform public policy.

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


The “evidence-based practice inventory”: reliability and validity was demonstrated for a novel instrument to identify barriers and facilitators for Evidence Based Practice in health care.
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N. M. Kaper, M. H. Swennen, A. J. van Wijk, et al.
J Clin Epidemiol 2015 Nov;68(11):1261-1269

OBJECTIVES: To design and validate a practical questionnaire for clinicians, to identify barriers and facilitators for evidence-based practice (EBP), that is, the use of research evidence in patient care. The inventory is ultimately intended for departments to assess local conditions for EBP, to aim and evaluate efforts at improving or maximizing EBP. STUDY DESIGN AND SETTING: We derived candidate items from existing EBP scales, psychology, and behavioral economics. In an online Delphi study, 537 international expert clinicians, researchers, teachers, and policymakers interested in EBP identified items with sufficient face and content validity. We piloted and validated the resulting draft inventory among 127 clinicians from various specialties and career stages. RESULTS: The Delphi study started with 114 items and resulted in a draft inventory with 29 items in five dimensions. During the pilot, the inventory was easy to complete within 15 minutes and the items showed sufficient response variation. In four of five dimensions, test-retest reliability was substantial to almost perfect and the power to discriminate between groups with different expertise was adequate, whereas internal consistency showed that the items generally measured the same construct. On the basis of internal consistency and factor analysis, we excluded three items. The final EBP inventory consists of 26 items in five dimensions: decision making, subjective norm, attitude, perceived behavior control, and intention and behavior. DISCUSSION AND CONCLUSION: The EBP inventory was developed with support of EBP experts and validated among various academic clinicians. It shows adequate face and content validity, internal consistency, test-retest reliability, discriminative power, and completion will take <15 minutes. We recommend further evaluation of its value in field trials.

Implementation of evidence-based practice and the PARIHS framework
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Zaheer S.
Healthcare Administration: Concepts, Methodologies, Tools, and Applications
2014. p. 323-340.

Patients receiving healthcare are commonly exposed to harm that is systematic and often severe. Clinical decisions based on inaccurate sources of information can lead to medical errors, high treatment costs, and poor patient outcomes. Evidence-based practice has the potential to overcome these problems by improving clinical decision-making processes. The PARIHS framework was developed to address the inability of traditional unidimensional models to successfully implement evidence-based practice. The PARIHS framework proposes that successful implementation of evidence into practice is a function of evidence, culture, and facilitation. The PARIHS framework can be used to design, implement, and evaluate knowledge translation projects at both acute and chronic care facilities. This chapter discusses the PARIHS framework as well as its advantages for implementing change at a healthcare setting compared to traditional models. The chapter also outlines a feasible knowledge translation project based on the principles of the PARIHS framework while highlighting health informatics and availability of easily accessible high quality patient outcome data as key enablers in designing and successfully implementing such a project at a healthcare setting. © 2015 by IGI Global.

From Research to a Web-Based Interactive Tool: Knowledge Transfer Within Social Services Organizations
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Nathalie Houlfort, Julie Descheneaux, Préscilla Labelle, Caroline Marion, Mathieu-Joël Gervais and Benoit Martel.
European Conference on Knowledge Management: Academic Conferences International Limited; 2015.

Despite growing scientific evidence on knowledge utilization and transfer, knowledge transfer remains a critical issue for organizations in the social services network. Among the underlying reasons behind this perpetual problem, according to organizational partners, are the difficulty of choosing the right knowledge transfer activity and a lack of understanding of how to implement a proper knowledge transfer process. Hence, based on their partners’ concerns and the principle that knowledge transfer activities should match the organizational context and goals, the authors, in partnership with a community of practice, worked for just over two years to co-construct a tool that would help organizations choose the right activity and implement a proper, comprehensive knowledge transfer process. They examined five knowledge transfer projects in four different social services organizations. Among the results, they found that organizations are likely to minimize the importance of analyzing their context, repeatedly choose the same familiar knowledge transfer activities and proceed following a one-time evaluation of the level of satisfaction with the activities.

Strategies to promote practice nurse capacity to deliver evidence-based care.
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A. Dadich, P. Abbott and H. Hosseinzadeh.
J Health Organ Manag 2015 Nov 16;29(7):988-1010

Purpose – Evidence-based practice is pivotal to effective patient care. However, its translation into practice remains limited. Given the central role of primary care in many healthcare systems, it is important to identify strategies that bolster clinician-capacity to promote evidence-based care. The purpose of this paper is to identify strategies to increase Practice Nurse capacity to promote evidence-based sexual healthcare within general practice. Design/methodology/approach – A survey of 217 Practice Nurses in an Australian state and ten respondent-interviews regarding two resources to promote evidence-based sexual healthcare – namely, a clinical aide and online training. Findings – The perceived impact of both resources was determined by views on relevance and design – particularly for the clinical aide. Resource-use was influenced by role and responsibilities within the workplace, accessibility, and support from patients and colleagues. Research limitations/implications – This is the first Australian study to reveal strategies to promote evidence-based sexual healthcare among Practice Nurses. The findings provide a platform for future research on knowledge translation processes, particularly among clinicians who might be disengaged from sexual healthcare. Practical implications – Given the benefits of evidence-based practices, it is important that managers recognize their role, and the role of their services, in promoting these. Without explicit support for evidence-based care and recognition of the Practice Nurse role in such care, knowledge translation is likely to be limited. Originality/value – Knowledge translation among Practice Nurses can be facilitated by: resources-deemed informative, relevant, and user-friendly, as well as support from patients, colleagues, and their workplace.

Evaluating factors associated with implementing of evidence-based practice in nursing.
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J. Farokhzadian, R. Khajouei and L. Ahmadian.
J Eval Clin Pract 2015 Nov 13

RATIONALE, AIMS AND OBJECTIVES: Evidence-based practice (EBP) has emerged as an innovation for quality improvement in health care. Nurses have important role in implementing EBP but they face many challenges in this context. Evaluation of factors influencing implementation of EBP seems necessary. The aims of this study were to examine nurses’ attitude towards EBP, their self-efficacy and training needs, as well as supporting factors and barriers for implementing EBP. METHODS: A cross-sectional study was conducted on 182 nurses from four teaching hospitals in Kerman, Iran. Data were collected using a questionnaire consisting of two main sections; a section to collect socio-demographic information of participants and a section collecting information on five topics (staff’s attitude, self-efficacy skills of EBP, supporting factors, barriers and training needs for implementing EBP). RESULTS: The majority (87.4%) of the nurses had not attended any formal training on EBP and 60% of them were not familiar with the concept of EBP. Nurses’ attitude towards EBP was unfavourable (2.57 +/- 0.99) and their self-efficacy skills of EBP were poor (2.93 +/- 1.06). The most important supporting factor was mentoring by nurses who have adequate EBP experience (3.65 +/- 1.17) and the biggest barrier was difficulty judging the quality of research papers and reports (2.46 +/- 0.95). There was a moderate demand for training in all areas of EBP (3.62 +/- 1.12). CONCLUSIONS: Nursing care needs to move towards quality improvement using EBP. It is necessary to equip nurses with knowledge and skills required for EBP. Managers should design an appropriate strategic plan by considering supporting factors and barriers for integrating EBP into clinical setting.

Do Policy Makers Use Academic Research? Reexamining the “Two Communities” Theory of Research Utilization
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J. Newman, A. Cherney and B. W. Head.
Public Adm Rev 2015

Academics and policy makers in many Western countries are perceived as occupying separate communities, with distinct languages, values, and reward systems. However, data from a survey of more than 2,000 policy officials and 126 in-depth interviews with public servants in Australia suggest that the “two communities” conceptualization may be misleading and flawed. More realistically, there is a range of interaction between policy and academia, with some individuals valuing and using academic research more than others. Furthermore, this relationship is complicated by the internal division between the political and administrative components of the public policy process. © 2015 by The American Society for Public Administration.

Using the Knowledge to Action Framework in practice: a citation analysis and systematic review.
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B. Field, A. Booth, I. Ilott and K. Gerrish.
Implement Sci 2014 Nov 23;9:172-014-0172-2

BACKGROUND: Conceptual frameworks are recommended as a way of applying theory to enhance implementation efforts. The Knowledge to Action (KTA) Framework was developed in Canada by Graham and colleagues in the 2000s, following a review of 31 planned action theories. The framework has two components: Knowledge Creation and an Action Cycle, each of which comprises multiple phases. This review sought to answer two questions: ‘Is the KTA Framework used in practice? And if so, how?’ METHODS: This study is a citation analysis and systematic review. The index citation for the original paper was identified on three databases-Web of Science, Scopus and Google Scholar-with the facility for citation searching. Limitations of English language and year of publication 2006-June 2013 were set. A taxonomy categorising the continuum of usage was developed. Only studies applying the framework to implementation projects were included. Data were extracted and mapped against each phase of the framework for studies where it was integral to the implementation project. RESULTS: The citation search yielded 1,787 records. A total of 1,057 titles and abstracts were screened. One hundred and forty-six studies described usage to varying degrees, ranging from referenced to integrated. In ten studies, the KTA Framework was integral to the design, delivery and evaluation of the implementation activities. All ten described using the Action Cycle and seven referred to Knowledge Creation. The KTA Framework was enacted in different health care and academic settings with projects targeted at patients, the public, and nursing and allied health professionals. CONCLUSIONS: The KTA Framework is being used in practice with varying degrees of completeness. It is frequently cited, with usage ranging from simple attribution via a reference, through informing planning, to making an intellectual contribution. When the framework was integral to knowledge translation, it guided action in idiosyncratic ways and there was theory fidelity. Prevailing wisdom encourages the use of theories, models and conceptual frameworks, yet their application is less evident in practice. This may be an artefact of reporting, indicating that prospective, primary research is needed to explore the real value of the KTA Framework and similar tools.

From knowledge transfer to innovation spreading: The use of networks in long-term care
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I. Bonacci and O. Tamburis.
Lecture Notes in Information Systems and Organisation 2015;5:135-148

The present work improves both the research hypotheses and the methodological study from the same authors, and aims at working out the connections between technology-driven needs and social-related patterns in the Long-Term Care (LTC) milieu, seen as a complex disease network, from which many classes of chronic pathologies (namely, Thalassemia, Cardiovascular diseases, Diabetes Mellitus type 2) can be identified as peculiar subnetworks. The adoption and implementation of the Social Network Analysis to study the dynamics concerning technology-assisted LTC emerges as feasible mean to strengthen the paradigm of patient-centered care, providing new perspectives for recognizing how the set of interactions and relationships within a “virtual team” (including formal and informal carers from different organizations) can bring to higher levels of knowledge transfer, organizational learning and innovation spreading. © Springer International Publishing Switzerland 2015.

Role of context in care transition interventions for medically complex older adults: a realist synthesis protocol. Canada-flat-icon
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K. B. Pitzul, N. E. Lane, T. Voruganti, et al.
BMJ Open 2015 Nov 19;5(11):e008686-2015-008686

INTRODUCTION: Approximately 30-50% of older adults have two or more conditions and are referred to as multimorbid or complex patients. These patients often require visits to various healthcare providers in a number of settings and are therefore susceptible to fragmented healthcare delivery while transitioning to receive care. Care transition interventions have been implemented to improve continuity of care, however, current evidence suggests that some interventions or components of interventions are only effective within certain contexts. There is therefore a need to unpack the mechanisms of how and within which contexts care transition interventions and their components are effective. Realist review is a synthesis method that explains how complex programmes work within various contexts. The purpose of this study is to explain the effect of context on the activities and mechanisms of care transition interventions in medically complex older adults using a realist review approach. METHODS AND ANALYSIS: This synthesis will be guided by Pawson and colleagues’ 2004 and 2005 protocols for conducting realist reviews. The underlying theories of care transition interventions were determined based on an initial literature search using relevant databases. English language peer-reviewed studies published after 1993 will be included. Several relevant databases will be searched using medical subject headings and text terms. A screening form will be piloted and titles, abstracts and full text of potentially relevant articles will be screened in duplicate. Abstracted data will include study characteristics, intervention type, contextual factors, intervention activities and underlying mechanisms. Patterns in Context-Activity-Mechanism-Outcome (CAMO) configurations will be reported. ETHICS AND DISSEMINATION: Internal knowledge translation activities will occur throughout the review and existing partnerships will be leveraged to disseminate findings to frontline staff, hospital administrators and policymakers. Finalised results will be presented at local, national and international conferences, and disseminated via peer-reviewed publications in relevant journals.

Exploring the function and effectiveness of knowledge brokers as facilitators of knowledge translation in health-related settings: a systematic review and thematic analysis Canada-flat-icon
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C. C. Bornbaum, K. Kornas, L. Peirson and L. C. Rosella.
Implement Sci 2015 Nov 20;10(1):162-015-0351-9

BACKGROUND: Knowledge brokers (KBs) work collaboratively with key stakeholders to facilitate the transfer and exchange of information in a given context. Currently, there is a perceived lack of evidence about the effectiveness of knowledge brokering and the factors that influence its success as a knowledge translation (KT) mechanism. Thus, the goal of this review was to systematically gather evidence regarding the nature of knowledge brokering in health-related settings and determine if KBs effectively contributed to KT in these settings. METHODS: A systematic review was conducted using a search strategy designed by a health research librarian. Eight electronic databases (MEDLINE, Embase, PsycINFO, CINAHL, ERIC, Scopus, SocINDEX, and Health Business Elite) and relevant grey literature sources were searched using English language restrictions. Two reviewers independently screened the abstracts, reviewed full-text articles, extracted data, and performed quality assessments. Analysis included a confirmatory thematic approach. To be included, studies must have occurred in a health-related setting, reported on an actual application of knowledge brokering, and be available in English. RESULTS: In total, 7935 records were located. Following removal of duplicates, 6936 abstracts were screened and 240 full-text articles were reviewed. Ultimately, 29 articles, representing 22 unique studies, were included in the thematic analysis. Qualitative (n = 18), quantitative (n = 1), and mixed methods (n = 6) designs were represented in addition to grey literature sources (n = 4). Findings indicated that KBs performed a diverse range of tasks across multiple health-related settings; results supported the KB role as a ‘knowledge manager’, ‘linkage agent’, and ‘capacity builder’. Our systematic review explored outcome data from a subset of studies (n = 8) for evidence of changes in knowledge, skills, and policies or practices related to knowledge brokering. Two studies met standards for acceptable methodological rigour; thus, findings were inconclusive regarding KB effectiveness. CONCLUSIONS: As knowledge managers, linkage agents, and capacity builders, KBs performed many and varied tasks to transfer and exchange information across health-related stakeholders, settings, and sectors. How effectively they fulfilled their role in facilitating KT processes is unclear; further rigourous research is required to answer this question and discern the potential impact of KBs on education, practice, and policy.

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Health Care Administration and Organization

Exploratory investigation of communication management in residential-aged care: a comparison of staff knowledge, documentation and observed resident-staff communication.
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M. K. Bennett, E. C. Ward and N. A. Scarinci.
Int J Lang Commun Disord 2015 Nov 17

BACKGROUND: There is a high prevalence of communication difficulty among older people living in residential-aged care. Such functional deficits can have a negative impact on resident quality of life, staff workplace satisfaction and the provision of quality care. Systematic research investigating the nature of communication management in residential-aged care and factors impacting optimal communication management is lacking. AIMS: To use data triangulation across multiple sources to describe resident-staff communication and communication management in residential-aged care. METHODS & PROCEDURE: Participants included a sample of 14 residents and 29 staff directly involved in communication interactions with residents. Data were obtained from: (1) resident file review (n = 14), (2) observation of resident-staff communication (n = 14), (3) resident surveys (n = 14) and (4) staff surveys (n = 29). Data from each source were examined separately then triangulated. OUTCOMES & RESULTS: All residents had limited opportunity for meaningful communication with staff. Documentation of residents’ communication needs and strategies to facilitate resident-staff communication was insufficient to provide individualized recommendations. Although staff were observed to use various strategies to facilitate communication with residents, staff agreement about the applicability of these strategies to individual residents was inconsistent. Differences in resident-staff communication for residents who experience nil/mild versus moderate/severe communication difficulty were also found. CONCLUSIONS & IMPLICATIONS: Resident-staff communication and communication management in residential-aged care is limited in scope and challenged in meeting residents’ individual communication needs. Improvements in both documentation and staff knowledge of residents’ communication needs are necessary. Strategies to facilitate communication with individual residents must be tailored, evidence based, documented in care plans and delivered to staff through ongoing education. Increased involvement of specialist providers such as speech pathologists to support better communication management in residential-aged care may provide one way of facilitating such change.

24/7 Registered Nurse Staffing Coverage in Saskatchewan Nursing Homes and Acute Hospital Use. Canada-flat-icon
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M. J. McGregor, J. M. Murphy, J. W. Poss, et al.
Can J Aging 2015 Nov 16:1-14

In many jurisdictions, legislation requires long-term care (LTC) facilities to have a registered nurse on duty 24 hours a day, seven days per week. Although considerable research exists on LTC nurse staffing intensity, no empirical research on this requirement exists. Our retrospective observational study in Saskatchewan compared facilities with 24/7 RN coverage to facilities with less coverage supplemented with various night-shift staffing models. Adjusted for nurse staffing intensity and other potential confounders, risk ratios associated with less-than-24/7 RN coverage supplemented with licensed practical nurse night-shift staffing were 1.17, 95% CI [0.91, 1.50] and 1.00, 95% CI [0.72, 1.39]; and with less-than-24/7 RN coverage supplemented with care aide night-shift staffing, risk ratios were 1.46, 95% CI [1.11, 1.91] and 1.11, 95% CI [0.78, 1.58], for inpatient hospital admissions and Emergency Department visits respectively. Findings suggest that acute services utilization may be negatively influenced by the absence of 24/7 RN coverage.

Measuring nursing assistants’ knowledge, skills and attitudes in a palliative approach: A literature review.
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S. Karacsony, E. Chang, A. Johnson, A. Good and M. Edenborough.
Nurse Educ Today 2015 Dec;35(12):1232-1239

BACKGROUND: Nursing assistants are the largest aged care workforce providing care to older people in residential aged care facilities. Although studies have focused on their training and development needs when providing a palliative approach, a valid and reliable instrument to evaluate their knowledge, skills and attitudes is required. AIMS: To examine what instruments have been used to evaluate nursing assistants’ knowledge of, skills in and attitudes towards a palliative approach in residential aged care facilities, critically evaluate development processes, and discuss the strengths and limitations of existing instruments for this population. METHODS: CINAHL, the Cochrane Library, ERIC, MEDLINE, PubMed, Scopus and Web of Science were searched using key words. Selected articles were published in English in the period 2004-2014 and included instruments which evaluated nursing assistants and a palliative approach. RESULTS: Ten studies using seven instruments met the inclusion criteria. One of these instruments measured nursing assistants’ level of comfort in providing end-of-life care. The six remaining instruments measured palliative care knowledge, palliative care practice, self-efficacy, knowledge and attitudes towards people with advanced dementia, beliefs and attitudes to death, dying, palliative and interdisciplinary care across the aged care workforce. CONCLUSION: Seven instruments have been used to evaluate nursing assistants’ knowledge, skills and attitudes in a palliative approach. Instrument design and recommended psychometric processes for development limit specificity and usefulness of these instruments for nursing assistants’ scope of practice. Adhering to recommended psychometric processes will increase the validity and reliability of an instrument tailored to this population and a palliative approach.

Effects of Person-Centered Care Approaches to Dementia Care on Staff: A Systematic Review.
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A. Barbosa, L. Sousa, M. Nolan and D. Figueiredo.
Am J Alzheimers Dis Other Demen 2014 Jan 20

Person-centered care (PCC) has been the subject of several intervention studies reporting positive effects on people with dementia. However, its impact on staff remains unclear. The purpose of this systematic review was to assess the impact of PCC approaches on stress, burnout, and job satisfaction of staff caring for people with dementia in residential aged care facilities. Research articles published up to 2013 were searched on PubMed, Web of Knowledge, Scopus, and EBSCO and reference lists from relevant publications. The review was limited to experimental and quasi-experimental studies, published in English and involving direct care workers (DCWs). In all, 7 studies were included, addressing different PCC approaches: dementia care mapping (n = 1), stimulation-oriented approaches (n = 2), emotion-oriented approaches (n = 2), and behavioral-oriented approaches (n = 2). Methodological weaknesses and heterogeneity among studies make it difficult to draw firm conclusions. However, 5 studies reported benefits on DCWs, suggesting a tendency toward the effectiveness of PCC on staff.

Comparing Nursing Home Assistive Personnel in Five Countries Canada-flat-icon
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K. Laxer, F. F. Jacobsen, L. Lloyd, et al.
Ageing Int 2015

Assistive personnel are the primary caregivers in long-term residential care (LTRC) in industrialized countries. Our goal is to describe and compare the work-related characteristics of assistive personnel in LTRC in five countries (Canada, Germany, Norway, U.K., and U.S), which may reflect how various societies view their responsibility to aging populations and the workers who care for them. OECD and national statistical databases are used to assess and compare the work context for assistive personnel. Analysis of the statistical data is informed by on-site observations in nursing homes with reputations for high quality, close readings of these organizations’ documents and records, and interviews with LTRC staff. Pay is generally low and the work required of assistive personnel is often demanding in all countries studied. While most assistive personnel have completed high school, formal certification requirements vary considerably. Professionalization is increasing in Norway with its high school major in eldercare, and in Germany, which has a 2-year certificate program. Financial compensation for assistive personnel in Norway and Canada is greater than in the other countries. Union membership for assistive personnel ranges from very high in Canada to negligible in the U.S. Some countries studied have training programs of only a few months duration to prepare assistive personnel for highly demanding jobs. However, in Germany and Norway, training aims to professionalize the work of assistive personnel for the benefit of workers, employers, and residents. There are high rates of part-time and/or casual work among assistive personnel, associated with reduced employment-related benefits, except in Germany and Norway, where these benefits are statutory for all. Data suggest that unionization is protective for assistive personnel, however union coverage data were not available for all countries. The need to improve the qualifications and training of assistive personnel was observed to be a national priority everywhere except in the U.S. Compensation is relatively low in the U.K., the U.S. and Germany, despite the important jobs performed by assistive personnel. Finally, to improve future research, statistical mapping of this critical component of the labour force in LTRC should be a greater priority across high-income countries. © 2015 Springer Science+Business Media New York

Moved to care: the impact of migration on the adult social care workforce (UK)
International Longevity Centre UK and Independent Age

This report outlines key findings from new research, conducted by the International Longevity Centre UK and Independent Age, into the importance of migration to the adult social care workforce in England. Despite a growing body of literature and speculation about the future of adult social care on the one hand, and the socioeconomic implications of migration on the other, there has been little informed discussion about the role of migrants in the delivery of care and how this might evolve over future decades.

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Health Care Innovation and Quality Assurance

A Practice Improvement Education Program Using a Mentored Approach to Improve Nursing Facility Depression Care-Preliminary Data.
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J. Chodosh, R. M. Price, M. P. Cadogan, et al.
J Am Geriatr Soc 2015 Nov;63(11):2395-2399

Depression is common in nursing facility residents. Depression data obtained using the Minimum Data Set (MDS) 3.0 offer opportunities for improving diagnostic accuracy and care quality. How best to integrate MDS 3.0 and other data into quality improvement (QI) activity is untested. The objective was to increase nursing home (NH) capability in using QI processes and to improve depression assessment and management through focused mentorship and team building. This was a 6-month intervention with five components: facilitated collection of MDS 3.0 nine-item Patient Health Questionnaire (PHQ-9) and medication data for diagnostic interpretation; education and modeling on QI approaches, team building, and nonpharmacological depression care; mentored team meetings; educational webinars; and technical assistance. PHQ-9 and medication data were collected at baseline and 6 and 9 months. Progress was measured using team participation measures, attitude and care process self-appraisal, mentor assessments, and resident depression outcomes. Five NHs established interprofessional teams that included nursing (44.1%), social work (20.6%), physicians (8.8%), and other disciplines (26.5%). Members participated in 61% of eight offered educational meetings (three onsite mentored team meetings and five webinars). Competency self-ratings improved on four depression care measures (P = .05 to <.001). Mentors observed improvement in team process and enthusiasm during team meetings. For 336 residents with PHQ-9 and medication data, depression scores did not change while medication use declined, from 37.2% of residents at baseline to 31.0% at 9 months (P < .001). This structured mentoring program improved care processes, achieved medication reductions, and was well received. Application to other NH-prevalent syndromes is possible.

What are the reasons for clinical network success? A qualitative study.
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E. McInnes, M. Haines, A. Dominello, et al.
BMC Health Serv Res 2015 Nov 5;15(1):497-015-1096-5

BACKGROUND: Clinical networks have been established to improve patient outcomes and processes of care by implementing a range of innovations and undertaking projects based on the needs of local health services. Given the significant investment in clinical networks internationally, it is important to assess their effectiveness and sustainability. This qualitative study investigated the views of stakeholders on the factors they thought were influential in terms of overall network success. METHOD: Ten participants were interviewed using face-to-face, audio-recorded semi-structured interviews about critical factors for networks’ successes over the study period 2006-2008. Respondents were purposively selected from two stakeholder groups: i) chairs of networks during the study period of 2006-2008 from high- moderate- and low-impact networks (as previously determined by an independent review panel) and ii) experts in the clinical field of the network who had a connection to the network but who were not network members. Participants were blind to the performance of the network they were interviewed about. Transcribed data were coded and analysed to generate themes relating to the study aims. RESULTS: Themes relating to influential factors critical to network success were: network model principles; leadership; formal organisational structures and processes; nature of network projects; external relationships; profile and credibility of the network. CONCLUSIONS: This study provides clinical networks with guidance on essential factors for maximising optimal network outcomes and that may assist networks to move from being a ‘low-impact’ to ‘high-impact’ network. Important ingredients for successful clinical networks were visionary and strategic leadership with strong links to external stakeholders; and having formal infrastructure and processes to enable the development and management of work plans aligned with health priorities.

The Professional Nurse Self-Assessment Scale: Psychometric testing in Norwegian long term and home care contexts.
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E. Finnbakk, S. Wangensteen, K. Skovdahl and L. Fagerstrom.
BMC Nurs 2015 Nov 16;14:59

BACKGROUND: Nurses’ clinical competence is vital to ensure safe and high quality care, and the continuous assessment of nurses’ clinical competence is of major concern. A validated instrument for the self-assessment of nurses’ clinical competence at different educational levels across specialties and countries is lacking. The aim of this study was to test the reliability and construct validity of the new Professional Nurse Self-Assessment Scale (ProffNurse SAS) questionnaire in long term and home care contexts in Norway. The questionnaire is based on the Nordic Advanced Practice Nursing model, in which the nurse-patient relationship is central. METHODS: The study has a cross-sectional survey design. A purposive sample of 357 registered nurses who worked in long term and home care contexts in two geographical regions encompassing eight municipalities and three counties was included. The respondents completed the 74-item ProffNurse SAS questionnaire and demographic background data was collected. Data collection was conducted in two phases: first region autumn 2011 and second region spring 2012. Exploratory factor analyses (EFA) were used to test the psychometric properties of the questionnaire and included the following steps: assessment of the factorality of the data, factor extraction by Principal Component Analysis (PCA), oblimin (oblique) factor rotation, and interpretation. Cronbach’s alpha was used to estimate the internal consistency. RESULTS: The PCA revealed a six-component structure, reducing the number of items in the questionnaire from 74 to 51. Based on the content of the highest-loading items, the six components were named: Direct Clinical Practice, Professional Development, Ethical Decision-Making, Clinical Leadership, Cooperation and Consultation, and Critical Thinking. The Cronbach’s alpha values ranged from 0.940 (highest; Direct Clinical Practice) to 0.737 (lowest; Critical Thinking), leading to the estimation that the ProffNurse SAS is reliable. CONCLUSIONS: The six components support the study’s theoretical framework. The ProffNurse SAS showed acceptable reliability and construct validity and may therefore be a promising instrument for the assessment of practicing nurses’ clinical competence. However, we recommend further psychometric testing in other countries and contexts and the inclusion of larger samples of nurses at various levels of education, particularly master’s level APNs.

Understanding organizational and cultural premises for quality of care in nursing homes: an ethnographic study.
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S. Nakrem.
BMC Health Serv Res 2015 Nov 13;15(1):508-015-1171-

yBACKGROUND: Internationally, there are concerns about the quality of care in nursing homes. The concept of ‘corporate culture’ as an internal variable could be seen as the means to improve quality of care and quality of life for the residents. The aim of this article was to describe the nursing home culture from the staff’s perspective and to include how the residents describe quality of care. METHODS: An ethnographic design was employed. A purposive sample of four municipal public nursing homes in Norway with long-term care residents was included in the study. Data were collected by participant observation including informal conversation with the staff, and in-depth interviews with 15 residents using a narrative approach. RESULTS: The main findings were that organizational cultures could be seen as relatively stable corporate cultures described as ‘personalities’ with characteristics that were common for all nursing homes (conformity) and typical traits that were present in some nursing homes, but that they were also like no other nursing home (distinctiveness). Conformity (‘Every nursing home is like all other nursing homes’) meant that nursing home organizations formed their services according to a perception of what residents in general need and expect. Trait (‘Every nursing home is like some other nursing homes’) expressed typologies of nursing homes: residency, medical, safeguard or family orientation. The distinctness of each nursing home (‘Every nursing home is like no other nursing home’) was expressed in unique features of the nursing home; the characteristics of the nursing home involved certain patterns of structure, cultural assumptions and interactions that were unique in each nursing home. Nursing home residents experienced quality of care as ‘The nursing home as my home’ and ‘Interpersonal care quality’. The resident group in the different types of nursing homes were unique, and the experience of quality of care seemed to depend on whether their unique needs and expectations were met or not. CONCLUSION: In order to create a sustainable nursing home service the service needs to be characterized by learning and openness to change and must actually implement practices that respond to the resident and his or her family’s values.

A Systematic Review of Interventions to Change Staff Care Practices in Order to Improve Resident Outcomes in Nursing Homes.
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L. F. Low, J. Fletcher, B. Goodenough, et al.
PLoS One 2015 Nov 11;10(11):e0140711

BACKGROUND: We systematically reviewed interventions that attempted to change staff practice to improve long-term care resident outcomes. METHODS: Studies met criteria if they used a control group, included 6 or more nursing home units and quantitatively assessed staff behavior or resident outcomes. Intervention components were coded as including education material, training, audit and feedback, monitoring, champions, team meetings, policy or procedures and organizational restructure. RESULTS: Sixty-three unique studies were broadly grouped according to clinical domain-oral health (3 studies), hygiene and infection control (3 studies), nutrition (2 studies), nursing home acquired pneumonia (2 studies), depression (2 studies) appropriate prescribing (7 studies), reduction of physical restraints (3 studies), management of behavioral and psychological symptoms of dementia (6 studies), falls reduction and prevention (11 studies), quality improvement (9 studies), philosophy of care (10 studies) and other (5 studies). No single intervention component, combination of, or increased number of components was associated with greater likelihood of positive outcomes. Studies with positive outcomes for residents also tended to change staff behavior, however changing staff behavior did not necessarily improve resident outcomes. Studies targeting specific care tasks (e.g. oral care, physical restraints) were more likely to produce positive outcomes than those requiring global practice changes (e.g. care philosophy). Studies using intervention theories were more likely to be successful. Program logic was rarely articulated, so it was often unclear whether there was a coherent connection between the intervention components and measured outcomes. Many studies reported barriers relating to staff (e.g. turnover, high workload, attitudes) or organizational factors (e.g. funding, resources, logistics). CONCLUSION: Changing staff practice in nursing homes is possible but complex. Interventionists should consider barriers and feasibility of program components to impact on each intended outcome.

Impact of medication aide use on skilled nursing facility quality.
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J. E. Walsh, S. J. Lane and J. L. Troyer.
Gerontologist 2014 Dec;54(6):976-988

PURPOSE OF THE STUDY: A number of states have begun to allow skilled nursing facilities to employ medication aides, who have less formal education than registered nurses (RNs) or licensed practical nurses (LPNs), to administer medications. If this results in fewer RNs or LPNs, quality degradation may occur. We evaluated the effect of regulations allowing for medication aides on subsequent medication aide use and the effect of changes in medication aide use on other nurse staffing, deficiencies, and Nursing Home Quality Initiative (NHQI) health outcome measures. DESIGN AND METHODS: Staffing levels and inspection deficiencies from the Online Survey and Certification and Reporting System and NHQI data from 2004 to 2010 for facilities from eight southeastern U.S. states are used in instrumental variables models with facility fixed effects. RESULTS: Facilities in states allowing for medication aide use increased medication aide use with no statistically significant reduction in RN or LPN use. Medication aide use decreased the probability that a facility received a deficiency citation for unnecessary drug use or having a medication error rate greater than or equal to 5% and had no effect on deficiencies for significant or harmful medication errors. Increased medication aide use was associated with fewer pharmacy and total deficiency citations and decreased use of physical restraints; in contrast, more use of medication aides was associated with an increase in the percentage of residents needing help with activities of daily living and losing continence. IMPLICATIONS: This study provides support for state policies that allow skilled nursing facilities to use medication aides.

Implementation of do not attempt resuscitate orders in a Japanese nursing home.
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N. Asai, Y. Ohkuni, L. Ashworth and N. Kaneko.
Am J Hosp Palliat Care 2014 Feb;31(1):27-32

OBJECTIVE: To investigate whether do not attempt resuscitation (DNAR) orders can be implemented in a standard nursing home in Japan, where routine DNAR orders are not yet common in many facilities including hospitals. METHOD: Ninety-eight residents in a 100-bed nursing home were evaluated. All of the eligible residents and/or their family members were asked whether they wanted to receive resuscitation, including mechanical ventilation. RESULT: The residents were 54 to 101 years of age (mean 83.3), with 27 males and 71 females. After administering the questionnaire, 92 (94%) patients did not want resuscitation and mechanical ventilation. CONCLUSION: In a nursing home, it was possible to obtain advance directives by which most residents/families rejected resuscitation and mechanical ventilation. This could avoid unnecessary and undesirable resuscitation procedures.

Influence of hospital and nursing home quality on hospital readmissions.
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K. S. Thomas, M. Rahman, V. Mor and O. Intrator.
Am J Manag Care 2014 Nov 1;20(11):e523-31

OBJECTIVES: To determine whether the quality of the hospital and of the nursing home (NH) to which a patient was discharged were related to the likelihood of rehospitalization. STUDY DESIGN: Retrospective cohort study of 1,382,477 individual hospitalizations discharged to 15,356 NHs from 3683 hospitals between 2006 and 2008. METHODS: Data come from Medicare claims and enrollment records, Minimum Data Set, Online Survey Certification and Reporting Dataset, Hospital Compare, and the American Hospital Association Database. Cross-classified random effects models were used to test the association of hospital and NH quality measures and the likelihood of 30-day rehospitalization. RESULTS: Patients discharged from higher-quality hospitals (as indicated by higher scores on their accountability process measures and high nurse staffing levels) and patients who received care in higher-quality NHs (as indicated by high nurse staffing levels and lower deficiency scores) were less likely to be rehospitalized within 30 days. CONCLUSIONS: The passage of the Affordable Care Act changed the accountability of hospitals for patients’ outcomes after discharge. This study highlights the joint accountability of hospitals and NHs for rehospitalization of patients.

Role of Case Conferences in Dementia-Specific vs Traditional Care Units in German Nursing Homes
Non UofA Access
S. M. Albert.
J Am Med Dir Assoc 2015 Nov 17.

Do resident case conferences in nursing homes improve care for people with dementia? Do these conferences provide support to care staff engaged in dementia care? What is the most effective organization for such conferences? Does use of structured assessments in case conferences improve care planning? Are nursing homes with dementia-specific care units more likely to use case conferences or use them more effectively than other skilled nursing facilities?

Designing a Quality and Safety Organizational Structure
Non UofA Access
C. Douma.
Newborn and Infant Nursing Reviews 2015;15(2):53-56

Creating a culture and organizational structure that promotes patient safety and achieves quality outcomes requires a shared accountability and teamwork within organizations. A framework designed to align quality and safety initiatives, provides the structure to achieve sustainable change. The aim of the study is to achieve the safest possible clinical outcomes by eliminating patient harm and integrating high-reliability behaviors into the work habits of employees and physicians through the development of a high performing, coordinated quality and safety collaborative in alignment with organizational strategies and existing infrastructure. A quality and safety collaborative committee was established to create shared accountability for clinical outcomes and develop a new framework for improvement. The collaborative undertook a full assessment of the current state utilizing a microsystem assessment model. Ongoing assessment, prioritization and aligned initiatives resulted in the creation of a shared vision between the medical school and hospital teams and clinical outcomes exceeding targets. © 2015 Elsevier Inc.

A quality improvement project to decrease emergency department and medical intensive care unit transfer times.
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R. I. Cohen, H. Kennedy, B. Amitrano, M. Dillon, S. Guigui and A. Kanner.
J Crit Care 2015 Dec;30(6):1331-1337

OBJECTIVE: To reduce transfer time of critically ill patients from the emergency department (ED) to the medical intensive care unit (MICU). DESIGN: A prospective, observational study assessing preimplementation and postimplementation of quality improvement interventions in a tertiary academic medical center. INTERVENTIONS: A team of frontline health care professional including ED, MICU, and supporting services using the clinical microsystems approach mapped out existing practice patterns, determined causes for delays, and used the Plan-Do-Study-Act to test changes. Measurements and Main Results The team identified multiple issues that contributed to delays. These included poor coordination between transport services, respiratory therapy, and nursing in transferring patients from the ED as well delays in identification and transfer of stable MICU patients. These interventions reduced transfer time from 4.2 (3.4-5.7) hours to 2.2 (1.4-3.1) hours (median [interquartile range]; P < .001). Hospital length of stay decreased from 9.9 +/- 9 to 8.3 +/- 7 days (P < .03). CONCLUSION: A team made up of frontline health care professionals using a structured quality improvement process and implementing multifaceted, multistage interventions, reduced transfer delays, and length of stay. Added benefits included engagement among members of the 2 microsystems and a more cohesive approach to patient care.

What methods are used to apply positive deviance within healthcare organisations? A systematic review.
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R. Baxter, N. Taylor, I. Kellar and R. Lawton.
BMJ Qual Saf 2015 Nov 20

BACKGROUND: The positive deviance approach focuses on those who demonstrate exceptional performance, despite facing the same constraints as others. ‘Positive deviants’ are identified and hypotheses about how they succeed are generated. These hypotheses are tested and then disseminated within the wider community. The positive deviance approach is being increasingly applied within healthcare organisations, although limited guidance exists and different methods, of varying quality, are used. This paper systematically reviews healthcare applications of the positive deviance approach to explore how positive deviance is defined, the quality of existing applications and the methods used within them, including the extent to which staff and patients are involved. METHODS: Peer-reviewed articles, published prior to September 2014, reporting empirical research on the use of the positive deviance approach within healthcare, were identified from seven electronic databases. A previously defined four-stage process for positive deviance in healthcare was used as the basis for data extraction. Quality assessments were conducted using a validated tool, and a narrative synthesis approach was followed. RESULTS: 37 of 818 articles met the inclusion criteria. The positive deviance approach was most frequently applied within North America, in secondary care, and to address healthcare-associated infections. Research predominantly identified positive deviants and generated hypotheses about how they succeeded. The approach and processes followed were poorly defined. Research quality was low, articles lacked detail and comparison groups were rarely included. Applications of positive deviance typically lacked staff and/or patient involvement, and the methods used often required extensive resources. CONCLUSION: Further research is required to develop high quality yet practical methods which involve staff and patients in all stages of the positive deviance approach. The efficacy and efficiency of positive deviance must be assessed and compared with other quality improvement approaches. PROSPERO REGISTRATION NUMBER: CRD42014009365.

Intentional whole health system redesign Southcentral Foundation’s ‘Nuka’ system of care (UK)
The King’s Fund, November 2015

Southcentral Foundation in Alaska is widely regarded as one of the best examples of health system redesign in the United States and internationally. It delivers state-funded health care to a minority population with high levels of need, with funding and responsibility for services resting with local people. Southcentral is a working example of a ‘multispecialty community provider’ offering expanded and integrated primary and community services. The case study, with a foreword by Don Berwick, aims to inspire commissioners and providers in the English NHS embarking on whole-system redesign. It analyses the factors behind Southcentral’s achievements and draws lessons for the NHS, focusing on issues with relevance to our system.

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Research Practice and Methodology

Statistical process control and interrupted time series: a golden opportunity for impact evaluation in quality improvement
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A. Fretheim and O. Tomic.
BMJ Qual Saf 2015 Dec;24(12):748-752.

Time series plots are widely used, across sectors and media, probably because many find them easy to understand. Statistical process control (SPC) and interrupted time series (ITS) designs are two closely related methodologies in the field of quality improvement. In both approaches, data are organised in time series and presented using time series plots. Both SPC and ITS use data to assess whether observed changes reflect random variation or ‘real’ change.

The SQUIRE Guidelines: an evaluation from the field, 5 years post release.
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L. Davies, P. Batalden, F. Davidoff, D. Stevens and G. Ogrinc.
BMJ Qual Saf 2015 Dec;24(12):769-775

BACKGROUND: The Standards for Quality Improvement Reporting Excellence (SQUIRE) Guidelines were published in 2008 to increase the completeness, precision and accuracy of published reports of systematic efforts to improve the quality, value and safety of healthcare. Since that time, the field has expanded. We asked people from the field to evaluate the Guidelines, a novel approach to a first step in revision. METHODS: Evaluative design using focus groups and semi-structured interviews with 29 end users and an advisory group of 18 thinkers in the field. Sampling of end users was purposive to achieve variation in work setting, geographic location, area of expertise, manuscript writing experience, healthcare improvement and research experience. RESULTS: Study participants reported that SQUIRE was useful in planning a healthcare improvement project, but not as helpful during writing because of redundancies, uncertainty about what was important to include and lack of clarity in items. The concept “planning the study of the intervention” (item 10) was hard for many participants to understand. Participants varied in their interpretation of the meaning of item 10b “the concept of the mechanism by which changes were expected to occur”. Participants disagreed about whether iterations of an intervention should be reported. Level of experience in writing, knowledge of the science of improvement and the evolving meaning of some terms in the field are hypothesised as the reasons for these findings. CONCLUSIONS: The original SQUIRE Guidelines help with planning healthcare improvement work, but are perceived as complicated and unclear during writing. Key goals of the revision will be to clarify items where conflict was identified and outline the key components necessary for complete reporting of improvement work.

Development of the Quality Improvement Minimum Quality Criteria Set (QI-MQCS): a tool for critical appraisal of quality improvement intervention publications.
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S. Hempel, P. G. Shekelle, J. L. Liu, et al.
BMJ Qual Saf 2015 Dec;24(12):796-804

OBJECTIVE: Valid, reliable critical appraisal tools advance quality improvement (QI) intervention impacts by helping stakeholders identify higher quality studies. QI approaches are diverse and differ from clinical interventions. Widely used critical appraisal instruments do not take unique QI features into account and existing QI tools (eg, Standards for QI Reporting Excellence) are intended for publication guidance rather than critical appraisal. This study developed and psychometrically tested a critical appraisal instrument, the QI Minimum Quality Criteria Set (QI-MQCS) for assessing QI-specific features of QI publications. METHODS: Approaches to developing the tool and ensuring validity included a literature review, in-person and online survey expert panel input, and application to empirical examples. We investigated psychometric properties in a set of diverse QI publications (N=54) by analysing reliability measures and item endorsement rates and explored sources of disagreement between reviewers. RESULTS: The QI-MQCS includes 16 content domains to evaluate QI intervention publications: Organisational Motivation, Intervention Rationale, Intervention Description, Organisational Characteristics, Implementation, Study Design, Comparator Description, Data Sources, Timing, Adherence/Fidelity, Health Outcomes, Organisational Readiness, Penetration/Reach, Sustainability, Spread and Limitations. Median inter-rater agreement for QI-MQCS items was kappa 0.57 (83% agreement). Item statistics indicated sufficient ability to differentiate between publications (median quality criteria met 67%). Internal consistency measures indicated coherence without excessive conceptual overlap (absolute mean interitem correlation=0.19). The critical appraisal instrument is accompanied by a user manual detailing What to consider, Where to look and How to rate. CONCLUSIONS: We developed a ready-to-use, valid and reliable critical appraisal instrument applicable to healthcare QI intervention publications, but recognise scope for continuing refinement.

Concocting that Magic Elixir: Successful Grant Application Writing in Dissemination and Implementation Research
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R. C. Brownson, G. A. Colditz, M. Dobbins, et al.
Clin Transl Sci 2015 Nov 18

BACKGROUND: This paper reports core competencies for dissemination and implementation (D&I) grant application writing and provides tips for writing a successful proposal. METHODS: Two related phases were used to collect the data: a card sorting process among D&I researchers and an expert review among a smaller set of researchers. Card sorting was completed by 123 respondents. In the second phase, a series of grant application writing tips were developed based on the combined 170 years of grant review experience of the writing team. RESULTS: The card sorting resulted in 12 core competencies for D&I grant application writing that covered the main sections in a grant application to the US National Institutes of Health: (a) specific aims that provide clear rationale, objectives, and an overview of the research plan; (b) significance that frames and justifies the importance of a D&I question; (c) innovation that articulates novel products and new knowledge; and (d) approach that uses a relevant D&I model, addresses measurement and the D&I context, and includes an analysis plan well-tied to the aims and measures. CONCLUSIONS: Writing a successful D&I grant application is a skill that can be learned with experience and attention to the core competencies articulated in this paper.

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A Systematic Review of Montessori-Based Activities for Persons With Dementia. Canada-flat-icon
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C. L. Sheppard, C. McArthur and S. L. Hitzig.
J Am Med Dir Assoc 2015 Nov 14

OBJECTIVES: Montessori-based activities are becoming a popular approach for the care of older adults living with dementia. The aim of this study was to systematically assess the quality of the research examining the benefits of Montessori-based activities for persons with dementia. METHODS: Six peer-reviewed databases were systematically searched for all relevant articles published until April 2015. Included articles were peer-reviewed studies published in English that employed Montessori-based activities with persons with dementia. Methodological quality was assessed by 2 independent raters using the Physiotherapy Evidence Database Scale or the Downs and Black evaluation tool. Levels of evidence were assigned to the study design using a modified Sackett scale. RESULTS: One hundred fifty articles were identified, and 14 were selected for inclusion. Level-2 evidence examining the impact of Montessori-based activities on eating behaviors suggested that difficulties with eating could be reduced with Montessori training. There was limited level-4 evidence for the benefits of Montessori-based activities on cognition, wherein benefits appeared to be specific to lower-level cognitive abilities including memory and attention. Finally, there is level-1 (n = 1), level-2 (n = 3), and level-4 (n = 6) evidence for the benefits of Montessori-based activities on engagement and affect, whereby constructive engagement and positive affect were heightened. DISCUSSION: Overall, there is a strong level of evidence for the benefits of Montessori-based activities on eating behaviors and weak evidence for the benefits on cognition. Evidence for the benefits of Montessori-based activities on engagement and affect are mixed. Future research is needed to examine the long-term benefits of Montessori-based activities.

Challenges in the Pharmacological Management of Nursing Home Residents with Overactive Bladder or Urinary Incontinence.
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B. J. Zarowitz, C. Allen, T. O’Shea, E. G. Tangalos, T. Berner and J. G. Ouslander.
J Am Geriatr Soc 2015 Nov;63(11):2298-2307

OBJECTIVES: To determine the proportion of nursing home (NH) residents (NHR) with overactive bladder (OAB) or urinary incontinence (UI) with potential pharmacodynamic contraindications to antimuscarinic treatment because of concomitant anticholinergic medications or acetylcholinesterase inhibitors (AChEIs) and nonpharmacological limitations to antimuscarinic treatment. DESIGN: Cross-sectional retrospective analysis. SETTING: U.S. skilled nursing facilities. PARTICIPANTS: Nursing home residents with a diagnosis of OAB or UI. MEASUREMENTS: Linked and deidentified pharmacy claims and Minimum Data Set (MDS) 3.0 records (October 1, 2010 to September 30, 2012). RESULTS: Of NHRs, 71.3% received at least one anticholinergic medication. Medications that can cause or worsen UI were used commonly. AChEIs and antimuscarinic treatment were prescribed concurrently in 24% of NHRs with OAB or UI. NHRs with OAB or UI were more likely to have concurrent moderate to severe cognitive impairment (MSCI) (70.1%) than those without (29.9%) (P < .001). NHRs with or without OAB or UI and with MSCI were more likely to be treated with an anticholinergic medication than those without MSCI (P = .001). When NHRs with MSCI, severe mobility impairment (SMI), and anticholinergic medication and AChEI use were excluded, only a small proportion of NHRs were potential candidates for antimuscarinic treatment (6.6% with OAB or UI, 6.2% with UI). CONCLUSIONS: This study advances understanding of the challenges in prescribing antimuscarinic treatment safely and appropriately in elderly NHRs with a high prevalence of drug interactions, underlying MSCI, and SMI.

Being in a Bubble: the experience of loneliness among frail older people.
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E. Taube, U. Jakobsson, P. Midlov and J. Kristensson.
J Adv Nurs 2015 Nov 16

AIM: The aim of this study was to explore the experience of loneliness among frail older people living at home. BACKGROUND: Loneliness is a threat to the physical and psychological well-being with serious consequences if left unattended. There are associations between frailty and poor psychological well-being, implying that frail older people who experience loneliness are vulnerable. DESIGN: Qualitative content analysis, focusing on both latent and manifest content. METHOD: Frail older people (65+ years), living at home and who have experienced various levels in intensity of loneliness, were purposively selected from a larger interventional study (N = 12). For this study, ‘frail’ means being dependent in activities of daily life and having repeated contacts with healthcare services. Data were collected between December 2009-August 2011. Semi-structured interviews were performed, audio recorded and transcribed verbatim. FINDINGS: The analysis resulted in the overall theme ‘Being in a Bubble’, which illustrates an experience of living in an ongoing world, but excluded because of the participants’ social surroundings and the impossibility to regain losses. The theme ‘Barriers’ was interpreted as facing physical, psychological and social barriers for overcoming loneliness. The theme ‘Hopelessness’ reveals the experience when not succeeding in overcoming these barriers, including seeing loneliness as a constant state. A positive co-existing dimension of loneliness, offering independence, was reflected in the theme ‘Freedom’. CONCLUSION: The findings suggest that future strategies for intervening should target the frail older persons’ individual barriers and promoting the positive co-existing dimension of loneliness. When caring, a person centred approach, encompassing knowledge regarding physical and psychological aspects, including loneliness, is recommended.

The need for a social revolution in residential care. Canada-flat-icon
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K. Theurer, W. B. Mortenson, R. Stone, M. Suto, V. Timonen and J. Rozanova.
J Aging Stud 2015 Dec;35:201-210

Loneliness and depression are serious mental health concerns across the spectrum of residential care, from nursing homes to assisted and retirement living. Psychosocial care provided to residents to address these concerns is typically based on a long-standing tradition of ‘light’ social events, such as games, trips, and social gatherings, planned and implemented by staff. Although these activities provide enjoyment for some, loneliness and depression persist and the lack of resident input perpetuates the stereotype of residents as passive recipients of care. Residents continue to report lack of meaning in their lives, limited opportunities for contribution and frustration with paternalistic communication with staff. Those living with dementia face additional discrimination resulting in a range of unmet needs including lack of autonomy and belonging-both of which are linked with interpersonal violence. Research suggests, however, that programs fostering engagement and peer support provide opportunities for residents to be socially productive and to develop a valued social identity. The purpose of this paper is to offer a re-conceptualization of current practices. We argue that residents represent a largely untapped resource in our attempts to advance the quality of psychosocial care. We propose overturning practices that focus on entertainment and distraction by introducing a new approach that centers on resident contributions and peer support. We offer a model-Resident Engagement and Peer Support (REAP)-for designing interventions that advance residents’ social identity, enhance reciprocal relationships and increase social productivity. This model has the potential to revolutionize current psychosocial practice by moving from resident care to resident engagement.

Advance care planning for nursing home residents with dementia: policy vs. practice.
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S. Ampe, A. Sevenants, T. Smets, A. Declercq and C. Van Audenhove.
J Adv Nurs 2015 Nov 12

AIMS: The aims of this study were: to evaluate the advance care planning policy for people with dementia in nursing homes; to gain insight in the involvement of residents with dementia and their families in advance care planning, and in the relationship between the policy and the actual practice of advance care planning. BACKGROUND: Through advance care planning, nursing home residents with dementia are involved in care decisions, anticipating their reduced decision-making capacity. However, advance care planning is rarely realized for this group. Prevalence and outcomes have been researched, but hardly any research has focused on the involvement of residents/families in advance care planning. DESIGN: Observational cross-sectional study in 20 nursing homes. METHODS: The ACP audit assessed the views of the nursing homes’ staff on the advance care planning policy. In addition, individual conversations were analysed with ‘ACP criteria’ (realization of advance care planning) and the ‘OPTION’ instrument (involvement of residents/families). DATA COLLECTION: June 2013-September 2013. RESULTS: Nursing homes generally met three quarters of the pre-defined criteria for advance care planning policy. In almost half of the conversations, advance care planning was explained and discussed substantively. Generally, healthcare professionals only managed to involve residents/families on a baseline skill level. There were no statistically significant correlations between policy and practice. CONCLUSION: The evaluations of the policy were promising, but the actual practice needs improvement. Future assessment of both policy and practice is recommended. Further research should focus on communication interventions for implementing advance care planning in the daily practice.

Living in uncertain times: trajectories to death in residential care homes.
Non UofA Access
S. Barclay, K. Froggatt, C. Crang, et al.
Br J Gen Pract 2014 Sep;64(626):e576-83

BACKGROUND: Older people living in care homes often have limited life expectancy. Practitioners and policymakers are increasingly questioning the appropriateness of many acute hospital admissions and the quality of end-of-life care provided in care homes. AIM: To describe care home residents’ trajectories to death and care provision in their final weeks of life. DESIGN AND SETTING: Prospective study of residents in six residential care homes in three sociodemographically varied English localities: Hertfordshire, Essex, and Cambridgeshire. METHOD: Case note reviews and interviews with residents, care home staff, and healthcare professionals. RESULTS: Twenty-three out of 121 recruited residents died during the study period. Four trajectories to death were identified: ‘anticipated dying’ with an identifiable end-of-life care period and death in the care home (n = 9); ‘unexpected dying’ with death in the care home that was not anticipated and often sudden (n = 3); ‘uncertain dying’ with a period of diagnostic uncertainty or difficult symptom management leading to hospital admission and inpatient death (n = 7); and ‘unpredictable dying’ with an unexpected event leading to hospital admission and inpatient death (n = 4). End-of-life care tools were rarely used. Most residents who had had one or more acute hospital admission were still alive at the end of the study. CONCLUSION: For some care home residents there was an identifiable period when they were approaching the end-of-life and planned care was put in place. For others, death came unexpectedly or during a period of considerable uncertainty, with care largely unplanned and reactive to events.

Multidisciplinary nutritional support for undernutrition in nursing home and home-care: A cluster randomized controlled trial.
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A. M. Beck, A. G. Christensen, B. S. Hansen, S. Damsbo-Svendsen and T. Kreinfeldt Skovgaard Moller.
Nutrition 2015 Sep 3

OBJECTIVE: To assess the effect of multidisciplinary nutritional support for undernutrition in older adults in nursing home and home-care identified with the validated Eating Validation Scheme (EVS). METHODS: An 11 wk cluster randomized trial with a home-care (3 clusters) or nursing home (3 clusters) setting as the unit of randomization. Before starting the study, a train-the-trainer course was performed to educate the nutrition coordinators. In addition to the nutrition coordinator, the participants assigned to the intervention group strategy received multidisciplinary nutrition support. Focus was on treatment of the potentially modifiable nutritional risk factors identified with the EVS, by involving the physiotherapist, registered dietitian, and occupational therapist, as relevant and independent of the municipality’s ordinary assessment and referral system. Outcome parameters were quality of life (by means of EuroQol-5D-3L), physical performance (30-seconds chair stand), nutritional status (weight and hand-grip strength), oral care, fall incidents, hospital admissions, rehabilitation stay, moving to nursing homes (participants from home-care), and mortality. RESULTS: Respectively, 55 (46 from 2 home-care clusters) and 40 (18 from 1 home-care cluster) were identified with the EVS and comprised the intervention and control group. A difference after 11 wk in quality of life (0.758 [0.222] versus 0.534 [0.355], P = 0.001), 30-seconds chair stand (47% versus 17% improved, P = 0.005) and oral care (1.1 [0.3] versus 1.3 [0.5], P = 0.021) was observed. There was a almost significant difference in mortality (2% versus 13%, P = 0.079). CONCLUSIONS: Multidisciplinary nutritional support in older adults in nursing home and home-care could have a positive effect on quality of life, muscle strength, and oral care.

The prevalence of anxiety among older adults in nursing homes and other residential aged care facilities: a systematic review.
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A. S. Creighton, T. E. Davison and D. W. Kissane.
Int J Geriatr Psychiatry 2015 Nov 9

OBJECTIVES: To synthesize and summarize the studies examining the prevalence rate of anxiety disorders and symptoms in older adults living in residential aged care. METHODS: Using the PRISMA guidelines, five electronic databases were searched using key terms and subject headings, as well as reference lists of relevant papers. The search was limited to literature published in English. Eligible studies examined the prevalence of anxiety disorders or symptoms in aged care residents aged 50+ years. RESULTS: A total of 2249 articles were identified, of which 18 studies (with a total of 5927 participants) were included in this review. The rate of overall anxiety disorders ranged from 3.2% to 20%, with the highest quality studies estimating a prevalence rate of 5% to 5.7%. Generalized anxiety disorder and specific phobias were found to be the most common anxiety disorders among aged care residents, while clinically significant anxiety symptoms were found to be more frequent (6.5% to 58.4%) than threshold disorders. CONCLUSIONS: Anxiety disorders and anxiety symptoms are common in older aged care residents. Given the paucity and overall quality of research examining anxiety within this population and the heterogeneity found in studies, further research is needed to help clarify this issue. Copyright (c) 2015 John Wiley & Sons, Ltd.

Factors associated with eating performance for long-term care residents with moderate-to-severe cognitive impairment.
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W. Liu, E. Galik, M. Boltz, E. S. Nahm, N. Lerner and B. Resnick.
J Adv Nurs 2015 Nov 9

AIMS: The aim of this study was to examine the association of specific personal and environmental factors with eating performance among long-term care residents with moderate-to-severe cognitive impairment. BACKGROUND: Eating is the one of the most basic and easiest activities of daily living to perform. While multilevel factors can be associated with eating performance, the evidence among those with dementia was insufficient. DESIGN: A secondary analysis of baseline data collected between March and September in 2012 from 199 residents in eight long-term care facilities. METHODS: Eating performance was conceptualized using the single self-care ‘feeding’ item in the Barthel Index and was scored based on four levels of dependence and assistance required. Binary logistic regression was used to examine the adjusted association of specific factors with eating performance. RESULTS: Almost one-third of the residents needed help with eating. After adjusting the type of facility, number of comorbidities, chair-sitting balance, agitation and depression, compromised eating performance was associated with severe cognitive impairment and low physical capability. CONCLUSION: This study supported the association of eating performance with cognitive impairment and physical capability among long-term care residents with moderate-to-severe cognitive impairment. Targeted interventions should be implemented to reduce the impact of cognitive decline on eating performance and promote physical capability to optimize eating performance. Future work need to use validated multiple-item measures for eating performance and test the association of personal and environmental factors with eating performance among a larger heterogeneous group of long-term care residents to enhance understanding of the factors.

Exploring Innovative Solutions for Quality of Life and Care of Bed-Ridden Nursing Home Residents through Codesign Sessions.
Non UofA Access
J. van Hoof, M. H. Wetzels, A. M. Dooremalen, et al.
J Aging Res 2015;2015:185054

Bed-ridden nursing home residents are in need of environments which are homelike and facilitate the provision of care. Design guidance for this group of older people is limited. This study concerned the exploration and generation of innovative environmental enrichment scenarios for bed-ridden residents. This exploration was conducted through a combination of participatory action research with user-centred design involving 56 professional stakeholders in interactive work sessions. This study identified numerous design solutions, both concepts and products that are available on the marketplace and that on a higher level relate to improvements in resident autonomy and the supply of technological items and architectural features. The methodology chosen can be used to explore the creative potential of stakeholders from the domain of healthcare in product innovation.

Family perceptions of quality of hospice care in the nursing home.
Non UofA Access
D. Hwang, J. M. Teno, M. Clark, et al.
J Pain Symptom Manage 2014 Dec;48(6):1100-1107

CONTEXT: Nursing homes (NHs) are increasingly the site of hospice care. High quality of care is dependent on successful NH-hospice collaboration. OBJECTIVES: To examine bereaved family members’ perceptions of NH-hospice collaborations in terms of what they believe went well or could have been improved. METHODS: Focus groups were conducted with bereaved family members from five diverse geographic regions, and included participants from inner city and rural settings, with oversampling of African Americans. RESULTS: A total of 28 participants (14.8% African American, mean age 61.4 years) identified three major aspects of collaboration as important to care delivery. First, most (67.9%) voiced concerns with knowing who (NH or hospice) is responsible for which aspects of patient care. Second, nearly half (42.9%) stated concern about information coordination between the NH and hospice. Finally, 67.9% of the participants mentioned the need for hospice to advocate for high-quality care rather than their having to directly do so on behalf of their family members. CONCLUSION: The important concerns raised by bereaved family members about NH-hospice collaboration have been incorporated into the revised Family Evaluation of Hospice Care, a post-death survey used to evaluate quality of hospice care.

Frailty, Frailty Components, and Oral Health: A Systematic Review.
Non UofA Access
L. H. Torres, M. Tellez, J. B. Hilgert, F. N. Hugo, M. D. de Sousa and A. I. Ismail.
J Am Geriatr Soc 2015 Nov 13

A systematic review was conducted to assess the relationship between frailty or one of its components and poor oral health. A search strategy was developed to identify articles related to the research question in the PubMed, EMBASE, Cochrane, LILACS, and SciELO databases that were published in English, Spanish, or Brazilian Portuguese from 1991 to July 2013. Thirty-five studies were identified, and 12 met the inclusion criteria, seven of which were cross-sectional and five were cohort studies. Of the 12 articles, five (41.7%) were rated good and seven (58.3%) as fair quality. The published studies applied different oral health and frailty criteria measures. Variations in definitions of outcome measures and study designs limited the ability to draw strong conclusions about the relationship between frailty or prefrailty and poor oral health. None of the studies that were evaluated longitudinally showed whether poor oral health increases the likelihood of developing signs of frailty, although the studies suggest that there may be an association between frailty and oral health. More longitudinal studies are needed to better understand the relationship between frailty and oral health.

Evaluating Nonverbal Behavior of Individuals with Dementia During Feeding: A Survey of the Nursing Staff in Residential Care Homes for Elderly Adults.
Non UofA Access
K. Kuehlmeyer, A. F. Schuler, C. Kolb, G. D. Borasio and R. J. Jox.
J Am Geriatr Soc 2015 Nov 14

OBJECTIVES: To determine how nursing staff evaluate nonverbal behavior related to hand and tube feeding of residents with dementia. DESIGN: Cross-sectional survey. SETTING: A stratified sample of nurses and nursing assistants in residential nursing homes in a major German city. PARTICIPANTS: Nursing staff members (N = 131) in 12 nursing homes. MEASUREMENTS: Nursing staff perception of nonverbal behavior of residents with dementia in response to hand and tube feeding. RESULTS: Ninety-three percent of survey participants considered the nonverbal behavior of residents with advanced dementia crucial for decisions about artificial nutrition and hydration (ANH). The same percentage had at some point encountered residents who did not open their mouths when feeding was attempted. Fifty-three percent of the participants interpreted residents’ expressions of pleasure while eating as a will to live. The most frequent interpretation of residents’ aversive behavior was discomfort. When residents did not open their mouth during nurse’s hand feeding, 41% of the participants inferred a will to die. CONCLUSION: Most nurses and nursing assistants consider residents’ behavior during hand or tube feeding to be important, but their interpretations are heterogeneous. Various professional caregivers assume a will to live or die. Further reflection is necessary to determine how behavioral expressions should be factored into treatment decisions.

The Impact of Enhanced Programming on Aging in Place for People With Dementia in Assisted Living.
Non UofA Access
J. Hyde, R. Perez, P. J. Doyle, B. P. Forester and T. H. Whitfield.
Am J Alzheimers Dis Other Demen 2015 Dec;30(8):733-737

BACKGROUND: Assisted living (AL) is a growing and operationally diverse option in our nation’s long-term care system. Many consumers view AL communities as a viable option to receive needed services and age in place. However, little is known about the factors that influence residents’ ability to age in place when experiencing cognitive decline. OBJECTIVE: To estimate the association of resident and site characteristics to length of stay, reason for leaving and destination for residents with dementia in assisted living. In particular, this study sought to assess the impact of an ‘Enhanced’ Program intended to facilitate aging in place. METHOD: Data were gathered from a retrospective evaluation of residents’ clinical records (N = 312) in five dementia-specific ALs (3 with robust enhanced programs) in the Northeastern United States. RESULTS: The time to 50% survival for the full cohort (N = 312) was 20.2 months. Both age at move-in and gender were statistically significant predictors of length of stay. Sites with robust support for aging in place exhibited a statistically significant longer length of stay compared to sites with limited support. Of the residents who left or died (N = 165) nearly one quarter (24%) were able to stay until the end of their lives, while 52% moved to a nursing home, primarily because of family, financial, or medical concerns. Few residents left these settings because of behavioral problems. CONCLUSION: AL sites with a more robust commitment to an aging in place model and a willingness to provide palliative care demonstrated a significantly longer length of stay.

Future Care for Canadian Seniors: A Status Quo Forecast Canada-flat-icon
Conference Board of Canada, 2015

By 2026, over 2.4 million Canadians age 65+ will require paid and unpaid continuing care supports—up 71 per cent from 2011. By 2046, this number will reach nearly 3.3 million. Spending on continuing care for seniors will increase from $29.3 billion in 2011 to $184.2 billion in 2046. With nearly two-thirds of this spending provided by governments, spending growth will significantly outpace revenue growth for most provinces. Labour demand growth for the continuing care sector will also far exceed general labour force growth. The reliance on unpaid caregivers and volunteers to provide continuing care supports will grow dramatically and could compound the perceived level of unmet or under-met needs of seniors. Responding to these needs in an efficient and sustainable manner will require collaboration among the diverse mix of public and private stakeholders that make up the continuing care sector.

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KT Canada: Developing a research agenda for feedback: 389 hypotheses and counting
Thursday 10 December 10:00-11:00 MT online or ECHA 5-099

Learning Objectives:
-Identify different kinds of feedback available to health providers
-Identify a variety of factors thought to be related to more effective feedback
-Consider approaches for prioritizing research hypotheses

Knowledge Synthesis as a KT tool
Wednesday 2 December 14:00 MT

Knowledge synthesis is a fundamental aspect of knowledge translation, as its goal is to summarize and critically appraise the best available research evidence to inform decision-making. This webinar will begin with a review of established and emerging methods of synthesizing research evidence. We will then introduce the work of The Cochrane Collaboration and describe how this international group organizes the production of systematic reviews. The webinar will conclude with a presentation on overviews of reviews, an emerging method for analyzing and presenting pre-synthesized evidence.

TVN Research Webinar: Antipsychotics for management of delirium: a systemic review
Wednesday 2 December 10:00-11:00 MT

Join Dr. Lisa Burry, a Clinical Scientist and Clinical Pharmacy Specialist at Mount Sinai Hospital and the University of Toronto, as she discusses the Cochrane Collaboration to determine the efficacy and safety of antipsychotics for the treatment of delirium in hospitalized, elderly patients.

CFHI Webinar: Towards Cultural Competency, Safety and Humility to Improve Health and Healthcare for First Nations
Tuesday 1 December 10:00-11:00 MT

Find out more about:
-What cultural competency, safety and humility in health services means;
-The process undertaken to develop the Declaration of Commitment and the core components of that document;
-The ongoing development of a Guiding Framework for Action and the potential next steps for spreading this work within and beyond BC; and
-Considerations for how cultural competency, safety and humility can be integrated or help re-design how we deliver care for all Canadians

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Patients’ needs addressed in ‘person-centered health care’ (US)

The Comprehensive Care Program, funded with a $6.1 million federal grant, is an example of a new model of care aimed at changing the culture of America’s health care system to one where doctors treat people rather than symptoms.

Challenging aspects of peer reviewing in 2015

What aspects of peer review do you find the most challenging? When we asked individuals from around the globe this question, their answers ranged from balancing support and criticism, to accepting the feedback, to finding the time.

Look to home care to help aging Sask. population, says analyst Canada-flat-icon

Steven Lewis says Canada should help seniors stay in their homes for longer

How iPods are used to help dementia patients at long-term care homes Canada-flat-icon

Eastern Health expands Music & Memory therapy program for long-term care residents.

Social care: Crisis talks with homes ‘on brink’ (UK)

Economic analysis of the financial sustainability of residential care home services in England suggests that care homes could – within five years – be underfunded by £1.1 billion per year. This raises worrying implications for future capacity relative to demand from an ageing population, and predictable knock-on consequences for the NHS.

Weighing the Value of Qualitative Research Outcomes

Is all qualitative research of equal value? Are the findings derived from one focus group study just as useful as those obtained from another focus group study? Are the outcomes from observational research or in-depth interviews (IDIs) valuable regardless of the design peculiarities (i.e., how the research was conducted)?

Blast through writer’s block

Here’s how to break through the barriers that keep you from doing your best work.

Six things to consider when reviewing clinically-focused manuscripts

Journals in clinically related disciplines may feature manuscripts with a clinical focus, yet much of the guidance about reviewing manuscripts is focused on the research manuscript For reviewers accustomed to doing research or reviewing research manuscripts, the switch to reviewing clinically focused work can be difficult. Additionally, clinicians not experienced in scholarly writing might be reluctant to even agree to review a submitted manuscript.

Choosing the right journal for your manuscript: 4 steps to finding the right “fit”

For a new prospective author, selecting which journal to publish in can be a bit like my process of selecting an outfit in the morning- and if your research is anything like my wardrobe, this can be a difficult task. Questions running through your mind probably mirror mine every day- What do I want to communicate to the world? How exactly do I want to do that?

My Elderly Parents Have Been Separated By Health Care

The author describes her parents’ experience in Calgary’s long-term care system and the issue of spousal reunification. The article also contains suggestions for better long-term delivery in Alberta.

The growing impact of dementia — are we ready?

Rapidly rising dementia rates mean the disease will touch more and more people. But there is still time to act.

The academic job search – getting your foot in the door

When you decide to launch your career search, it is important that you make it a concerted effort. The predominant questions you should be asking yourself is what you want and need from you career, and why? Experiences will vary and I can only speak to mine.

Government directs AHS to develop policy on banning
visitors at long-term care facilities

Alberta’s health minister has ordered Alberta Health Services to create a clear, consistent policy when it comes to restricting or banning visitors at long-term care facilities in the province.

Report urges Ontario to take action on violence at long-term care homes Canada-flat-icon

Resident-on-resident assaults are all too common in long-term care facilities, according to a report to Ontario’s chief coroner that calls on the province to take immediate action.

Health region CEO reports on Saskatchewan’s long-term care facilities released Canada-flat-icon

Health Minister Dustin Duncan said more money is only part of the solution to improve the province’s long-term care facilities. “That’s why we’re trying to address the problem on multiple fronts,” the Sask. Party MLA told reporters Wednesday at the Legislative Building after the 2015 CEO tour reports on the province’s long-term care facilities were released.

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Stop The Pressure
NHS England

Stop The Pressure is an NHS England programme which aims to eliminate all avoidable pressure ulcers. Visit the website for information on pressure ulcer prevention including videos, webinars, patient stories and step by step guides. You can also follow Stop the pressure on Twitter: @STPressure

A brief guide to research collaboration for the young scholar

Working with other scholars can boost your profile, but some arrangements are more likely to lead to publication.

Reporting for reproducibility: best practices for reporting methods and results
Available on demand Wiley

All too often authors have their research rejected because of the reporting of their statistical methods. Our aim, as always, is to help you gain an insight in to what you can do to increase your chances of having your article accepted. Rachel Zawada of Wiley’s Author Marketing Team was joined by four experts who provided recommendations, best practices, and real-life examples for presenting research that is transparent, robust, and most importantly, reproducible.

Long-Term Care Home Design Manual 2015 Canada-flat-icon
Ministry of Health and Long-Term Care, Ontario February 2015

Attention to interior design in health care settings is always important because of how the design and layout of a space can influence efficiency and safety as well as affect the comfort level of an individual in need of care. In long-term care facilities there is the added challenge for interior designers to make these spaces be both effective health care environments and feel like home to the residents that live there. The Ministry of Health and Long-term Care in Ontario created a Long-term Care Home Design Manual in February 2015 which discusses and makes recommendations regarding all areas of a long-term care facility from personal spaces to nursing work spaces to dining areas and bathrooms.

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Research Scientist Position-Dissemination and Implementation Science
Kaiser Permanente, Oakland CA

The Division of Research of The Permanente Medical Group (Kaiser Permanente Northern California) seeks a mid-career or senior investigator with a focus in dissemination and implementation science. This individual will be expected to develop an independently-funded research program, conduct scholarly research that is recognized nationally and internationally, and collaborate with other Division of Research investigators and Kaiser Permanente clinicians and operational leadership to lead research regarding the adoption of evidence-based approaches to implementation in clinical and health system operations.

Tenure Track Faculty Positions in Health Management and Policy (4 positions)
University of Michigan, Ann Arbor
DEADLINE 30 December

he Department of Health Management and Policy (HMP) at the University of Michigan is hiring four tenure track faculty at any rank. We seek researchers with strong scholarly credentials and a record or promise of external research funding. HMP values diversity as a necessary part of success in any aspect of health teaching, research, and leadership and encourages candidates to share their personal experiences of diversity with the committee.

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