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Advice Seeking Networks in LTC
Fall Newsletter 2016
Read the latest newsletter from Advice Seeking Networks in LTC!
New article by Dr. Jo Rycroft-Malone
Reducing repeat pregnancies in adolescence: applying realist principles as part of a mixed-methods systematic review to explore what works, for whom, how and under what circumstances
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Previous research has demonstrated emotional, psychological and educational harm to young mothers following unintended conceptions. The UK has one of the highest rates of pregnancies in adolescence in Western Europe with a high proportion of these being repeat pregnancies, making it a topic of interest for public health policy makers, and health and social care practitioners. As part of a wider mixed-methods systematic review, realist principles were applied to synthesise evidence about interventions aiming to reduce repeat pregnancies in adolescence.
New article by Dr. Kim Fraser
How Quality Improvement Practice Evidence Can Advance the Knowledge Base
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Recommendations for the evaluation of quality improvement interventions have been made in order to improve the evidence base of whether, to what extent, and why quality improvement interventions affect chosen outcomes. The purpose of this article is to articulate why these recommendations are appropriate to improve the rigor of quality improvement intervention evaluation as a research endeavor, but inappropriate for the purposes of everyday quality improvement practice. To support our claim, we describe the differences between quality improvement interventions that occur for the purpose of practice as compared to research. We then carefully consider how feasibility, ethics, and the aims of evaluation each impact how quality improvement interventions that occur in practice, as opposed to research, can or should be evaluated. Recommendations that fit the evaluative goals of practice-based quality improvement interventions are needed to support fair appraisal of the distinct evidence they produce. We describe a current debate on the nature of evidence to assist in reenvisioning how quality improvement evidence generated from practice might complement that generated from research, and contribute in a value-added way to the knowledge base.
Calls for Abstracts
RCN International Nursing Research conference and exhibition 2017 (Apr 5 – Apr 7, 2017)
The call for abstracts for Research 2017 is open
This is a leading international conference for health care professionals and academics involved in or interested in research relevant to nursing. Papers are presented using a variety of formats to: challenge participants to learn and update their research knowledge; advance nursing practice through evidence based research; stimulate discussion and debate on nursing related research and policy.
Publications
Health Care Administration and Organization
Health Care Innovation and Quality Assurance
Organizational Change
Research Practice and Methodology
Aging
Health Care Administration and Organization
Challenges for Nurses Caring for Individuals with Peripherally Inserted Central Catheters in Skilled Nursing Facilities
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OBJECTIVES: To understand the perceived preparedness of frontline nurses (registered nurses (RNs), licensed practical nurses (LPNs)), unit nurse managers, and skilled nursing facility (SNF) administrators in providing care for residents with peripherally inserted central catheters (PICCs) in SNFs. DESIGN: Exploratory, qualitative pilot study. SETTING: Two community based SNFs. PARTICIPANTS: Residents with PICCs, frontline nurses (RNs, LPNs), unit nurse managers, and SNF administrators. METHODS: Over 36 weeks, 56 residents with PICCs and their nurses were observed and informally interviewed, focusing on PICC care practices and documentation. In addition, baseline PICC data were collected on placement indication (e.g., antimicrobial administration), placement setting (hospital vs SNF), and dwell time. Focus groups were then conducted with frontline nurses and unit nurse managers, and semistructured interviews were conducted with SNF administrators to evaluate perceived preparedness for PICC care. Data were analyzed using a descriptive analysis approach. RESULTS: Variations in documentation were observed during weekly informal interviews and observations. Differences were noted between resident self-reported PICC concerns (quality of life) and those described by frontline nurses. Deficiencies in communication between hospitals and SNFs with respect to device care, date of last dressing change, and PICC removal time were also noted. During focus group sessions, perceived inadequacy of information at the time of care transitions, limited availability of resources to care for PICCs, and gaps in training and education were highlighted as barriers to improving practice and safety. CONCLUSION: Practices for PICC care in SNFs can be improved. Multimodal strategies that enhance staff education, improve information exchange during care transitions, and increase resource availability in SNFs appear necessary to enhance PICC care and safety.
Care Aides’ Relational Practices and Caring Contributions 
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The current study was a qualitative focused ethnography aimed at exploring the complexities of care; working environments; and knowledge, skills, and efforts of care aides who work in nursing homes. Over the past decade, dramatic shifts in staffing patterns in Canadian nursing homes have transformed care aides’ assistive and caring roles. Care aides are now the central and most accessible service providers to nursing home residents. In the current article, the authors (a) conceptualize care aide work as caring rather than caring activities, (b) explore relational care as a foundational and significant component of care aide work, (c) interpret care aides’ relational care practices through the lens of Swanson’s Middle Range Theory of Caring, and (d) describe how nursing home managers can empower care aides to do this work.
Negotiated risk and resident autonomy: Frontline care staff perspectives on culture change in long term care in Nova Scotia, Canada
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BACKGROUND: Regulating risk, freedom of action, and autonomy in decision making are problems shared by both caregivers and residents in long term care settings, and may become the subject of tension and constant negotiation. OBJECTIVE: This study focuses on long term care staff and management perceptions of day to day life in a care community which has gone through a culture change transition, where small residentially scaled households replace large instutional models of care. In each household, the setting is considered to be home for the 8-12 residents, creating a major shift of roles for the caregivers; they are, in essence, coming into a home rather than institutional environment as a place of work. This potentially changes the dynamics of both patterns of work for caregivers and patterns of daily living for residents. METHODS: Participant observations and care staff interviews. RESULTS: Several key themes emrged which include: teamwork; the culture of care; regulating risk; the physical environment and care staff empowerment. CONCLUSIONS: An unexpected outcome was the consensus among care staff that it is they who feel at home while working in the care households, leading to empowerment in their work roles and a deeper understanding of the importance of their role in the lives of the residents.
Life story work with persons with dementia in nursing homes: A Grounded Theory study of the perspectives of care staff
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In Germany, the use of life story work as an approach to care in nursing homes has not been implemented successfully. Using Grounded Theory, we explored care staff’s understandings of life story work when caring for persons with dementia. Thirty-six staff from seven nursing homes participated in semi-structured interviews or group discussions. In this paper we discuss new aspects and theoretical connections between understandings and practices of life story work. For some participants, obtaining ‘true facts’ about a resident’s course of life was considered the most important topic. Others highlighted the importance of narratives as well as embodied stories told by persons with dementia, as aspects that generated emotionally meaningful situations. Delivering sound life story work can be challenging for care staff working with persons with dementia. To enhance care in nursing homes, the importance of life story work needs to be further developed.
Nurses’ use of computerised decision support systems affects drug monitoring in nursing homes
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AIM: To describe variations in nurses’ perceptions of using a computerised decision support system (CDSS) in drug monitoring. BACKGROUND: There is an increasing focus on incorporating informatics into registered nurses’ (RNs) clinical practice. Insight into RNs’ perceptions of using a CDSS in drug monitoring can provide a basis for further development of safer practices in drug management. METHOD: A qualitative interview study of 16 RNs. Data were analysed using a phenomenographic approach. RESULTS: The RNs perceived a variety of aspects of using a CDSS in drug monitoring. Aspects of ‘time’ were evident, as was giving a ‘standardisation’ to the clinical work. There were perceptions of effects of obtained knowledge and ‘evidence’ and the division of ‘responsibilities’ between RNs and physicians of using the CDSS. CONCLUSION: The RNs perceived a CDSS as supportive in drug monitoring, in terms of promoting standardised routines, team-collaboration and providing possibilities for evidence-based clinical practice. IMPLICATIONS: Implementing a CDSS seems to be one feasible strategy to improve RNs’ preconditions for safe drug management. Nurse managers’ engagement and support in this process are vital for a successful result.
Priorities for the professional development of registered nurses in nursing homes
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OBJECTIVE: to establish a consensus on the care and professional development needs of registered nurses (RNs) employed by UK care homes. DESIGN: two-stage, online modified Delphi study. SETTING AND PARTICIPANTS: a panel (n = 352) of individuals with experience, expertise or interest in care home nursing: (i) care home nurses and managers; (ii) community healthcare professionals (including general practitioners, geriatricians, specialist and district nurses); and (iii) nurse educators in higher education. RESULTS: RNs employed by nursing homes require particular skills, knowledge, competence and experience to provide high-quality care for older residents. The most important responsibilities for the nursing home nurse were: promoting dignity, personhood and wellbeing, ensuring resident safety and enhancing quality of life. Continuing professional development priorities included personal care, dementia care and managing long-term conditions. The main barrier to professional development was staff shortages. Nursing degree programmes were perceived as inadequately preparing nurses for a nursing home role. Nursing homes could improve by providing supportive learning opportunities for students and fostering challenging and rewarding careers for newly RNs. CONCLUSION: if nurses employed by nursing homes are not fit for purpose, the consequences for the wider health and social-care system are significant. Nursing homes, the NHS, educational and local authorities need to work together to provide challenging and rewarding career paths for RNs and evaluate them. Without well-trained, motivated staff, a high-quality care sector will remain merely an aspiration.
An Examination of Nursing Care Quality Efficiency in U.S. Nursing Homes Using Data Envelopment Analysis
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Adequate nurse staffing has been recognized as a required factor for improving quality of care in nursing homes. To manage costs and deliver efficient quality of nursing care for patients, it is necessary to evaluate the efficiency of nursing care. The purpose of this study was to evaluate relative nursing care quality efficiency in U.S. nursing homes and determine the organizational factors contributing to care quality efficiency across 50 states.
Utilization of palliative care principles in nursing home care: Educational interventions
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OBJECTIVE: This study is part of the overarching PVIS (Palliative Care in Nursing Homes) project aimed at building competence in palliative care for nursing home staff. Our objective was to describe nursing home staff’s attitudes to competence-building programs in palliative care. METHOD: Three different programs were developed by specialist staff from three local palliative care teams. In all, 852 staff at 37 nursing homes in the greater Stockholm area participated. Staff from 7 nursing homes participated in 11 focus-group discussions. Variation in size between the seven nursing homes initiated purposeful selection of staff to take part in the discussions, and descriptive content analysis was used. RESULTS: The results suggest that staff reported positive experiences as they gained new knowledge and insight into palliative care. The experiences seemed to be similar independent of the educational program design. Our results also show that staff experienced difficulties in talking about death. Enrolled nurses and care assistants felt that they carried out advanced care without the necessary theoretical and practical knowledge. Further, the results also suggest that lack of support from ward managers and insufficient collaboration and of a common language between different professions caused tension in situations involved in caring for dying people. SIGNIFICANCE OF RESULTS: Nursing home staff experienced competence-building programs in palliative care as useful. Even so, further competence is needed, as is long-term implementation strategies and development of broader communication skills among all professions working in nursing homes.
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Health Care Innovation and Quality Assurance
Fixing the broken image of care homes, could a ‘care home innovation centre’ be the answer?
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The UK has many excellent care homes that provide high-quality care for their residents; however, across the care home sector, there is a significant need for improvement. Even though the majority of care homes receive a rating of ‘good’ from regulators, still significant numbers are identified as requiring ‘improvement’ or are ‘inadequate’. Such findings resonate with the public perceptions of long-term care as a negative choice, to be avoided wherever possible-as well as impacting on the career choices of health and social care students. Projections of current demographics highlight that, within 10 years, the part of our population that will be growing the fastest will be those people older than 80 years old with the suggestion that spending on long-term care provision needs to rise from 0.6% of our Gross Domestic Product in 2002 to 0.96% by 2031. Teaching/research-based care homes have been developed in the USA, Canada, Norway, the Netherlands and Australia in response to scandals about care, and the shortage of trained geriatric healthcare staff. There is increasing evidence that such facilities help to reduce inappropriate hospital admissions, increase staff competency and bring increased enthusiasm about working in care homes and improve the quality of care. Is this something that the UK should think of developing? This commentary details the core goals of a Care Home Innovation Centre for training and research as a radical vision to change the culture and image of care homes, and help address this huge public health issue we face.
Appeals to evidence for the resolution of wicked problems: the origins and mechanisms of evidentiary bias
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Wicked policy problems are often said to be characterized by their ‘intractability’, whereby appeals to evidence are unable to provide policy resolution. Advocates for ‘Evidence Based Policy’ (EBP) often lament these situations as representing the misuse of evidence for strategic ends, while critical policy studies authors counter that policy decisions are fundamentally about competing values, with the (blind) embrace of technical evidence depoliticizing political decisions. This paper aims to help resolve these conflicts and, in doing so, consider how to address this particular feature of problem wickedness. Specifically the paper delineates two forms of evidentiary bias that drive intractability, each of which is reflected by contrasting positions in the EBP debates: ‘technical bias’—referring to invalid uses of evidence; and ‘issue bias’—referring to how pieces of evidence direct policy agendas to particular concerns. Drawing on the fields of policy studies and cognitive psychology, the paper explores the ways in which competing interests and values manifest in these forms of bias, and shape evidence utilization through different mechanisms. The paper presents a conceptual framework reflecting on how the nature of policy problems in terms of their complexity, contestation, and polarization can help identify the potential origins and mechanisms of evidentiary bias leading to intractability in some wicked policy debates. The discussion reflects on how a better understanding about such mechanisms could inform future work to mitigate or overcome such intractability
Does Nursing Facility Use of Habilitation Therapy Improve Performance on Quality Measures
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The purpose of the project, Centers for Medicare & Medicaid Services (CMS) Innovation study, was to evaluate the impact on 12 quality measures including 10 Minimum Data Set (MDS) publicly reported measures and 2 nursing home process measures using habilitation therapy techniques and a behavior team to manage dementia-related behaviors. A prospective design was used to assess the changes in the measures. A total of 30 Massachusetts nursing homes participated in the project over a 12-month period. Project participation required the creation of an interdisciplinary behavior team, habilitation therapy training, facility visit by the program coordinator, attendance at bimonthly support and sharing calls, and monthly collection of process measure data. Participating facilities showed improvement in 9 of the 12 reported measures. Findings indicate potential quality improvement in having nursing homes learn habilitation therapy techniques and know how to use the interdisciplinary team to manage problem behaviors.
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Research Practice and Methodology
The Mass Production of Redundant, Misleading, and Conflicted Systematic Reviews and Meta-analyses
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POLICY POINTS: Currently, there is massive production of unnecessary, misleading, and conflicted systematic reviews and meta-analyses. Instead of promoting evidence-based medicine and health care, these instruments often serve mostly as easily produced publishable units or marketing tools. Suboptimal systematic reviews and meta-analyses can be harmful given the major prestige and influence these types of studies have acquired. The publication of systematic reviews and meta-analyses should be realigned to remove biases and vested interests and to integrate them better with the primary production of evidence. CONTEXT: Currently, most systematic reviews and meta-analyses are done retrospectively with fragmented published information. This article aims to explore the growth of published systematic reviews and meta-analyses and to estimate how often they are redundant, misleading, or serving conflicted interests. METHODS: Data included information from PubMed surveys and from empirical evaluations of meta-analyses. FINDINGS: Publication of systematic reviews and meta-analyses has increased rapidly. In the period January 1, 1986, to December 4, 2015, PubMed tags 266,782 items as “systematic reviews” and 58,611 as “meta-analyses.” Annual publications between 1991 and 2014 increased 2,728% for systematic reviews and 2,635% for meta-analyses versus only 153% for all PubMed-indexed items. Currently, probably more systematic reviews of trials than new randomized trials are published annually. Most topics addressed by meta-analyses of randomized trials have overlapping, redundant meta-analyses; same-topic meta-analyses may exceed 20 sometimes. Some fields produce massive numbers of meta-analyses; for example, 185 meta-analyses of antidepressants for depression were published between 2007 and 2014. These meta-analyses are often produced either by industry employees or by authors with industry ties and results are aligned with sponsor interests. China has rapidly become the most prolific producer of English-language, PubMed-indexed meta-analyses. The most massive presence of Chinese meta-analyses is on genetic associations (63% of global production in 2014), where almost all results are misleading since they combine fragmented information from mostly abandoned era of candidate genes. Furthermore, many contracting companies working on evidence synthesis receive industry contracts to produce meta-analyses, many of which probably remain unpublished. Many other meta-analyses have serious flaws. Of the remaining, most have weak or insufficient evidence to inform decision making. Few systematic reviews and meta-analyses are both non-misleading and useful. CONCLUSIONS: The production of systematic reviews and meta-analyses has reached epidemic proportions. Possibly, the large majority of produced systematic reviews and meta-analyses are unnecessary, misleading, and/or conflicted.
Exposing the Backstage Critical Reflections on a Longitudinal Qualitative Study of Residents’ Care Networks in Assisted Living
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In this article, we analyze the research experiences associated with a longitudinal qualitative study of residents’ care networks in assisted living. Using data from researcher meetings, field notes, and memos, we critically examine our design and decision making and accompanying methodological implications. We focus on one complete wave of data collection involving 28 residents and 114 care network members in four diverse settings followed for 2 years. We identify study features that make our research innovative, but that also represent significant challenges. They include the focus and topic; settings and participants; scope and design complexity; nature, modes, frequency, and duration of data collection; and analytic approach. Each feature has methodological implications, including benefits and challenges pertaining to recruitment, retention, data collection, quality, and management, research team work, researcher roles, ethics, and dissemination. Our analysis demonstrates the value of our approach and of reflecting on and sharing methodological processes for cumulative knowledge building.
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Aging
End-of-life care preferences of nursing home residents: Results of a cross-sectional study
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BACKGROUND: Palliative care services were not available in nursing homes in Singapore. Project CARE (Care At the end-of-life for Residents in homes for the Elderly) was a pilot programme that aimed to promote advance care planning and improve end-of-life care in nursing homes. AIM: We aimed to examine end-of-life care preferences among nursing home residents, and identify factors associated with preference for medical intervention, cardiopulmonary resuscitation and place of death. DESIGN AND SETTING/PARTICIPANTS: A cross-sectional study using data from advance care planning discussions was conducted from September 2009 to April 2012 across seven nursing homes. The advance care planning discussion was conducted with the resident (with a prognosis of 6 months or 1 year), their families and staff from the nursing home and hospital. RESULTS: A total of 600 residents and their families completed the advance care planning discussion. Majority (93.2%) preferred not to proceed with cardiopulmonary resuscitation, 52.3% opted for limited additional intervention at the nursing home with escalation to the hospital if necessary and 77.0% preferred to die at the nursing home. Residents 85+ years (relative risk ratio: 3.34, 95% confidence interval: 1.13-9.93, p = 0.030) were more likely to prefer medical intervention at the nursing home only. No associations were found with the preference for cardiopulmonary resuscitation. Residents who were single, or who were Christians or Catholics (adjusted odds ratio: 2.09, 95% confidence interval: 1.04-4.19, p = 0.039), were more likely to prefer to die at the nursing home. CONCLUSION: Preferences for medical interventions in nursing homes provide support to extend palliative care services to nursing homes, which may benefit residents who are older, single, or Christians or Catholics.
Residents’ Positive and Negative Relationship Networks in a Nursing Home
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Person-centered care involves consideration of long-term care residents’ lived experience, including social relationships. The current cross-sectional study investigated co-resident social networks in three units of a 94-bed Australian nursing home, including an 18-bed dementia-specific unit (DSU). Six care staff were interviewed. Chart, self-reported social isolation, and staff-reported social engagement data were collected for 36 residents ages 63 to 94 who consented to full participation. Fifty-five additional residents were included in observations. Median positive-to-negative network size ratios within units were 1.5:1 (Unit 1), 0.7:1 (Unit 3), and 0:1 (DSU). Moderate positive correlations existed between: perceived social support and total positive relationships [rho(25) = 0.44, p = 0.03]; social withdrawal and total negative relationships [rho(36) = 0.51, p = 0.002]; and objective social isolation and total negative relationships [rho(22) = -0.44, p = 0.042]. Number and quality of relationships were associated with resident social withdrawal, perceived support, and isolation. High prevalence of isolation and negative relationships demonstrate the need for interventions.
Stability of Geriatric Syndromes in Hospitalized Medicare Beneficiaries Discharged to Skilled Nursing Facilities
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OBJECTIVES: To assess multiple geriatric syndromes in a sample of older hospitalized adults discharged to skilled nursing facilities (SNFs) and subsequently to home to determine the prevalence and stability of each geriatric syndrome at the point of these care transitions. DESIGN: Descriptive, prospective study. SETTING: One large university-affiliated hospital and four area SNFs. PARTICIPANTS: Fifty-eight hospitalized Medicare beneficiaries discharged to SNFs (N = 58). MEASUREMENTS: Research personnel conducted standardized assessments of the following geriatric syndromes at hospital discharge and 2 weeks after SNF discharge to home: cognitive impairment, depression, incontinence, unintentional weight loss, loss of appetite, pain, pressure ulcers, history of falls, mobility impairment, and polypharmacy. RESULTS: The average number of geriatric syndromes per participant was 4.4 +/- 1.2 at hospital discharge and 3.8 +/- 1.5 after SNF discharge. There was low to moderate stability for most syndromes. On average, participants had 2.9 syndromes that persisted across both care settings, 1.4 syndromes that resolved, and 0.7 new syndromes that developed between hospital and SNF discharge. CONCLUSION: Geriatric syndromes were prevalent at the point of each care transition but also reflected significant within-individual variability. These findings suggest that multiple geriatric syndromes present during a hospital stay are not transient and that most syndromes are not resolved before SNF discharge. These results underscore the importance of conducting standardized screening assessments at the point of each care transition and effectively communicating this information to the next provider to support the management of geriatric conditions.
Geriatric Syndromes in Hospitalized Older Adults Discharged to Skilled Nursing Facilities
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OBJECTIVES: To determine the prevalence, recognition, co-occurrence, and recent onset of geriatric syndromes in individuals transferred from the hospital to a skilled nursing facility (SNF). DESIGN: Quality improvement project. SETTING: Acute care academic medical center and 23 regional partner SNFs. PARTICIPANTS: Medicare beneficiaries hospitalized between January 2013 and April 2014 and referred to SNFs (N = 686). MEASUREMENTS: Project staff measured nine geriatric syndromes: weight loss, lack of appetite, incontinence, and pain (standardized interview); depression (Geriatric Depression Scale); delirium (Brief Confusion Assessment Method); cognitive impairment (Brief Interview for Mental Status); and falls and pressure ulcers (hospital medical record using hospital-implemented screening tools). Estimated prevalence, new-onset prevalence, and common coexisting clusters were determined. The extent to which treating physicians commonly recognized syndromes and communicated them to SNFs in hospital discharge documentation was evaluated. RESULTS: Geriatric syndromes were prevalent in more than 90% of hospitalized adults referred to SNFs; 55% met criteria for three or more coexisting syndromes. The most-prevalent syndromes were falls (39%), incontinence (39%), loss of appetite (37%), and weight loss (33%). In individuals who met criteria for three or more syndromes, the most common triad clusters were nutritional syndromes (weight loss, loss of appetite), incontinence, and depression. Treating hospital physicians commonly did not recognize and document geriatric syndromes in discharge summaries, missing 33% to 95% of syndromes present according to research personnel. CONCLUSION: Geriatric syndromes in hospitalized older adults transferred to SNFs are prevalent and commonly coexist, with the most frequent clusters including nutritional syndromes, depression, and incontinence. Despite the high prevalence, this clinical information is rarely communicated to SNFs on discharge.
Safeness and Treatment Mitigate the Effect of Loneliness on Satisfaction With Elderly Care
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Maximizing satisfaction among the older persons is the goal of modern individualized elderly care and how to best achieve this is of relevance for people involved in planning and providing elderly care services. PURPOSE OF THE STUDY: What predicts satisfaction with care among older persons can be conceived as a function of process (how care is performed) and the older person. Inspired by the long-standing person versus situation debate, the present research investigated the interplay between person- and process-related factors in predicting satisfaction with elderly care. DESIGN AND METHODS: A nationwide sample was analyzed, based on a questionnaire with 95,000 individuals using elderly care services. RESULTS: The results showed that person-related factors (i.e., anxiety, health, and loneliness) were significant predictors of satisfaction with care, although less strongly than process-related factors (i.e., treatment, safeness, and perceived staff and time availability). Among the person-related factors, loneliness was the strongest predictor of satisfaction among older persons in nursing homes. Interestingly, a path analysis revealed that safeness and treatment function as mediators in linking loneliness to satisfaction. IMPLICATIONS: The results based on a large national sample demonstrate that the individual aging condition to a significant degree can be countered by a well-functioning care process, resulting in higher satisfaction with care among older persons.
Residents Perceptions of Friendship and Positive Social Networks Within a Nursing Home
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PURPOSE OF THE STUDY: (i) To describe nursing home residents’ perceptions of their friendship networks using social network analysis (SNA) and (ii) to contribute to theory regarding resident friendship schema, network structure, and connections between network ties and social support. DESIGN AND METHODS: Cross-sectional interviews, standardized assessments, and observational data were collected in three care units, including a Dementia Specific Unit (DSU), of a 94-bed Sydney nursing home. Full participation consent was obtained for 36 residents aged 63-94 years. Able residents answered open-ended questions about friendship, identified friendship ties, and completed measures of nonfamily social support. RESULTS: Residents retained clear concepts of friendship and reported small, sparse networks. Nonparametric pairwise comparisons indicated that DSU residents reported less perceived social support (median = 7) than residents from the other units (median = 17; U = 10.0, p = .034, r = -.51), (median = 14; U = 0.0, p = .003, r = -.82). Greater perceived social support was moderately associated with higher number of reciprocated ties [rho(25) = .49, p = .013]. IMPLICATIONS: Though some residents had friendships, many reported that nursing home social opportunities did not align with their expectations of friendship. Relationships with coresidents were associated with perceptions of social support. SNA’s relational perspective elucidated network size, tie direction, and density, advancing understanding of the structure of residents’ networks and flow of subjective social support through that structure. Understanding resident expectations and perceptions of their social networks is important for care providers wishing to improve quality of life in nursing homes.
Learning and knowing technology as lived experience in people with Alzheimer’s disease: a phenomenological study
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OBJECTIVES: Most research on learning in the field of dementia has studied teaching approaches, while little is known about learning as experienced and enacted by the people with dementia. The aim was to explore the lived experience of learning and maintaining knowledge related to technology among people with mild to moderate stage dementia. METHOD: Seven persons with dementia were interviewed in-depth, and data were analyzed with a phenomenological approach. RESULTS: The participants positioned themselves on a continuum from ‘Updating and expanding is not for me’ to ‘Updating and expanding is really for me’. They used different ways of learning in their everyday life – relying on one’s habituated repertoire of actions, on other people or on technology itself, or belonging to a learning context. CONCLUSIONS: We have much to gain from better understanding of how people with dementia strive to learn and maintain their skills and knowledge related to technology. This is particularly important as they seem to use other approaches than those employed in current teaching methods. The necessity of learning stands out particularly when it comes to the interaction with the current multitude and ever-changing designs of technologies, including assistive technologies developed specifically to support people with dementia.
The relation between mood, activity, and interaction in long-term dementia care
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OBJECTIVE: The aim of the study is to identify the degree of association between mood, activity engagement, activity location, and social interaction during everyday life of people with dementia (PwD) living in long-term care facilities. METHOD: An observational study using momentary assessments was conducted. For all 115 participants, 84 momentary assessments of mood, engagement in activity, location during activity, and social interaction were carried out by a researcher using the tablet-based Maastricht Electronic Daily Life Observation-tool. RESULTS: A total of 9660 momentary assessments were completed. The mean age of the 115 participants was 84 and most (75%) were women. A negative, neutral, or positive mood was recorded during 2%, 25%, and 73% of the observations, respectively. Positive mood was associated with engagement in activities, doing activities outside, and social interaction. The type of activity was less important for mood than the fact that PwD were engaged in an activity. Low mood was evident when PwD attempted to have social interaction but received no response. CONCLUSION: Fulfilling PwD’s need for occupation and social interaction is consistent with a person-centred dementia care focus and should have priority in dementia care.
Reporting of clinically diagnosed dementia on death certificates: retrospective cohort study
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BACKGROUND: mortality statistics are a frequently used source of information on deaths in dementia but are limited by concerns over accuracy. OBJECTIVE: to investigate the frequency with which clinically diagnosed dementia is recorded on death certificates, including predictive factors. METHODS: a retrospective cohort study assembled using a large mental healthcare database in South London, linked to Office for National Statistics mortality data. People with a clinical diagnosis of dementia, aged 65 or older, who died between 2006 and 2013 were included. The main outcome was death certificate recording of dementia. RESULTS: in total, 7,115 people were identified. Dementia was recorded on 3,815 (53.6%) death certificates. Frequency of dementia recording increased from 39.9% (2006) to 63.0% (2013) (odds ratio (OR) per year increment 1.11, 95% CI 1.07-1.15). Recording of dementia was more likely if people were older (OR per year increment 1.02, 95% CI 1.01-1.03), and for those who died in care homes (OR 1.89, 95% CI 1.50-2.40) or hospitals (OR 1.14, 95% CI 1.03-1.46) compared with home, and less likely for people with less severe cognitive impairment (OR 0.95, 95% CI 0.94-0.96), and if the diagnosis was Lewy body (OR 0.30, 95% CI 0.15-0.62) or vascular dementia (OR 0.79, 95% CI 0.68-0.93) compared with Alzheimer’s disease. CONCLUSIONS: changes in certification practices may have contributed to the rise in recorded prevalence of dementia from mortality data. However, mortality data still considerably underestimate the population burden of dementia. Potential biases affecting recording of dementia need to be taken into account when interpreting mortality data.
Feeling lonely in an unfamiliar place: older people’s experiences of life close to death in a nursing home
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AIM: The aim of the study was to deepen the understanding of how older persons living in a nursing home experience life close to death. BACKGROUND: A move to and a life in a nursing home while being close to death is a reality for many older people in Sweden. Being able to express thoughts and feelings about death has been described as both crucial for sustaining personhood as well as for establishing a meaningful existence at the end of life. Important are the experiences of older people living in nursing homes who are approaching death. METHOD: Six older people were interviewed on one to four occasions. A total of 16 interviews were conducted with the participants. An interpretative approach was chosen. FINDINGS: The main interpretation, Feeling lonely in an unfamiliar place, is based on three themes (i) Waiting for death, with the subthemes death as a release and thinking of oneself as dead; (ii) Subordinate oneself to values and norms of the staff, with the subthemes feeling offended and feeling trapped; and (iii) Keep the courage up. The older people’s lives were characterised by feelings of aloneness in an unfamiliar place which contributed to a sense of existential loneliness. They experienced few opportunities to discuss their thoughts of life and death, including preparations for passing away. CONCLUSION AND IMPLICATION FOR PRACTICE: It is of importance for professionals to be able to meet older people as they are and respect them as human beings in their transitions, before, during and after the move to a nursing home. It is important to find ways to support older people’s wellbeing and identity near death.
Antibiotic Misuse in Hospital, Outpatient, and Long-Term Care Settings
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Antibiotic misuse is common in the United States, but the causes of antibiotic misuse may differ from one health care setting to another. In this commentary, we describe the factors associated with inappropriate antibiotic prescriptions in hospital, outpatient, and long-term care settings, along with specific measures that can help prevent antibiotic misuse.
Active ageing within the nursing home: a study in Flanders, Belgium
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Nursing homes should support residents’ quality of life (QoL). It remains vague, however, how these facilities can create a QoL enhancing environment. Active ageing (AA) is a useful framework in this context, since it provides a multidimensional set of determinants that enhance QoL. This study examined the current status of AA in nursing homes in Flanders, Belgium. A sample of 383 randomly recruited residents was surveyed on the subjective importance and experienced reality of the AA determinants as well as on QoL. Based on descriptive analyses, residents appeared to have a positive QoL and a moderately positive appraisal of the extent to which nursing homes provide a multidimensional environment to enhance their QoL. Multivariate analyses showed that residents’ nursing home active ageing (NHAA) experience was positively related to their QoL and explained 20 % of its variance. Specifically, psychological factors and participation related positively to QoL. Demographic variables showed no relationships with QoL, while educational level related negatively to the NHAA experience. Currently, in Flanders, nursing homes are on their way to working according to the AA vision, but further efforts are still needed.
Antibiotic Stewardship in Long-Term Care: A Call to Action
Non UofA Access
The Centers for Medicare & Medicaid Services and the Centers for Disease Control and Prevention are focused heavily on curbing the misuse of antibiotics in health care facilities. Regulations governing the management of antibiotics in the nursing facility will likely be changing in the near future, which will put the pharmacist at the forefront of a clinical team that is dedicated to proper antibiotic utilization. Savvy pharmacists are embracing this opportunity to engage long-term care facility staff to improve the care of their residents.
Investing in Post-Acute Care Transitions: Electronic Information Exchange Between Hospitals and Long-Term Care Facilities
Non UofA Access
BACKGROUND: Electronic health information exchange (HIE) is expected to help improve care transitions from hospitals to long-term care (LTC) facilities. We know little about the prevalence of hospital LTC HIE in the United States and what contextual factors may motivate or constrain this activity. RESEARCH DESIGN: Cross-sectional analysis of U.S. acute-care hospitals responding to the 2014 AHA IT Supplement survey and with available readmissions data (n = 1,991). We conducted multivariate logistic regression to explore the relationship between hospital LTC HIE and selected IT and policy characteristics. RESULTS: Over half of the hospitals in our study (57.2%) reported engaging in some form of HIE with LTC providers: 33.9% send-only, 0.5% receive-only, and 22.8% send and receive. Hospitals that engaged in some form of LTC HIE were more likely than those that did not engage to have attested to meaningful use (odds ratio [OR], 1.87; P = .01 for stage 1 and OR, 2.05; P < .01 for stage 2), participate in a regional HIE effort (OR, 1.34; P = .021), and exchange information electronically with other hospitals or ambulatory providers (OR, 4.54; P < .01). Organizational affiliation with a skilled nursing facility (OR, 1.29; P = .041) and higher 30-day readmission rates (OR, 1.19; P = .016) were also associated with LTC HIE, but not accountable care organization nor bundled payment participation. CONCLUSIONS: As payment to LTC providers and hospitals increasingly emphasizes total patient care and paying for value, those leading these organizations have new incentives to pursue collaborative relationships. Hospitals appear to be investing in electronic information exchange with LTCs as part of a general strategy to adopt EHRs and engage in HIE, but also potentially to strengthen ties to LTC providers and to reduce readmissions. To achieve widespread connectivity, continued focus on adoption of related health IT infrastructure and greater emphasis on aligning incentives for hospital-LTC care transitions would be valuable.
Cross-Cultural Comparison of Long-Term Care in the U.S. and Finland: Research Done through a Short-Term Study Abroad Experience
Non UofA Access
In May of 2014 a short-term study abroad experience was conducted in Finland through a course offered at Indiana State University (ISU). Students and faculty from ISU and Eastern Illinois University participated in the experience, which was created to facilitate a cross-cultural comparison of long-term care settings in the U.S. and Finland. With its outstanding system of caring for the health and social needs of its aging populace, Finland is a logical model to examine when considering ways to improve the quality of life for older adults in the U.S. who require care. Those participating in the course visited a series of long-term care facilities in the region surrounding Terre Haute, Indiana, then travelled to Lappeenranta, Finland to visit parallel sites. Through limited-participation observation and semi-structured interviews, similarities and differences in experiences, educations, and policies affecting long-term care workers in the U.S. and Finland were identified and are described here.
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Events
Non UofA
We are pleased to offer our End of Grant Knowledge Translation (KT) Course on November 15th, 2016 (9am – 4:00pm) at the Li Ka Shing Knowledge Institute of St. Michael’s Hospital in Toronto. This course is designed to provide grant writers with the needed tools to write the KT portion of their grant applications. Course attendees will use their own grants to develop an end of grant KT plan. Topics include: A framework for end of grant KT; Assessing impact of research – how to use and interpret bibliometrics and altmetrics; and Approach to media and social media.
For interested individual policymakers, stakeholders and researchers, the McMaster Health Forum is offering regular in-person training workshops twice per year, in April and in October. Each workshop consists of a combination of online instruction and five days of in-person workshop in Hamilton, Ontario, Canada.
Online
2016 Online KT Conference: Communication Tools for Moving Research to Practice
Register today for the 2016 Online KT Conference! The online conference is designed for researchers and others to learn about current and innovative communication tools, including social media, in order to increase the use of evidence-based research findings though knowledge translation (KT) activities.
NCCMT Spotlight on Methods & Tools: McMaster Optimal Aging Portal
Interested in easy-to-understand, evidence-based information on healthy aging? Do you promote healthy aging or advocate for seniors’ issues in your work? Are you involved in developing legislation, policies, programs or services for older adults? Are you looking for evidence-based health information for self-management in older patients? The webinar to learn how the McMaster Optimal Aging Portal can help you.
NCCMT Spotlight on Methods & Tools: Quality Assessment Tool for Quantitative Studies
Are you engaged in utilizing sources of high quality literature to support your decision-making process? Are you interested in learning about critical appraisal of interventions studies? Join us for a webinar to learn how the Quality Assessment Tool for Quantitative Studies can help you.
Measuring Frailty in Older Canadians: An Analysis of the Canadian Longitudinal Study on Aging
The objective of this thesis was to evaluate the frailty of participants in the Canadian Longitudinal Study on Aging (CLSA). A Frailty Index (FI) was constructed for CLSA participants based on the cumulative deficit model of frailty. Exploratory factor analysis and structural equation modelling were conducted to study the underlying constructs of frailty and identify key factors. A new frailty measurement tool was created and its construct validity evaluated.
Adventures in KT: Travel tips for researchers and trainees
Webinars are hosted using WebEx and will be recorded and archived below. Supplemental resources are provided with each recording to support your continued learning of each topic area. The inaugural webinar entitled “Adventures in KT: Travel tips for researchers and trainees: features Drs. Bev Holmes and Marla Steinberg and is scheduled for October 14, 2016.
Almost 50% of older adults moving into long-term care will have depression and show symptoms of depression. The transition to long-term care is an important intervention point to address their unique mental health needs. In addition, older adults are more at risk to experience delirium in later life whether they are living in the community or long-term care.
This session is offered by WebEx from St. Michael’s Hospital in Toronto. All registration requests should be sent to Gail Klein: kleing@smh.ca by Wednesday, October 12th at 12:00 PM ET. Learning Objectives: Understand how the perspectives of researchers as stakeholders in the knowledge-to-action process have been examined in KT and implementation science to date; Consider the implications of new research exploring how researchers across health research pillars conceptualize and practice KT; Identify opportunities to support researcher stakeholders in engaging in integrated, theory-based, and evidence-informed knowledge-to-action processes.
Finding and Using International Research Resources
This webcast will guide users through the expanded REHABDATA database, highlighting new features with the integration of resources originally identified through the Center for International Rehabilitation Research Information and Exchange (CIRRIE). The collection of international research abstracts from CIRRIE included more than 115,000 citations of research in disability and rehabilitation. NARIC’s Media and Information Services Manager, Jessica Chaiken, will also cover how the collection will grow moving forward and demonstrate how to stay up to date on new additions.
News
Building a quality improvement (QI) system across a whole organisation (UK)
Dr Amar Shah, Associate Medical Director & Consultant forensic psychiatrist for East London NHS Foundation Trust, talks about his experience of building a QI system at his trust and shares his advice for other providers who are looking to do the same.
Keeping the conversation on the right track (UK)
It can be frustrating dealing with someone with dementia, and do not feel you are somehow to blame. Never let it show as they will pick it up and the rapport can be lost. Grit your teeth, take a deep breath and carry on. Remember someone with a communication problem, can also get frustrated if their views are not understood or if their speech comes out muddled.
B.C. nursing home review likely to lead to mandatory minimum staffing
The B.C. government appears to be seriously considering setting mandatory minimum staff levels for nursing homes. Plecas has been reviewing residential care for seniors B.C., at the request of Health Minister Terry Lake. That after a report from the B.C. seniors advocate, Isobel Mackenzie, said that 232 of B.C.’s 292 residential care homes for seniors did not meet the non-mandatory staffing targets.
Feds Target ‘Predatory’ Publishers (US)
“The Federal Trade Commission on Friday filed a complaint against the academic journal publisher OMICS Group and two of its subsidiaries, saying the publisher deceives scholars and misrepresents the editorial rigor of its journals.”
Resources
Families Caring for an Aging America
At least 17.7 million individuals in the United States are providing care and support to an older parent, spouse, friend, or neighbor who needs help because of a limitation in their physical, mental, or cognitive functioning. The circumstances of individual caregivers are extremely varied. They may live with, nearby, or far away from the person receiving care. The care they provide may be episodic, daily, occasional, or of short or long duration. The caregiver may help with household tasks or self-care activities, such as getting in and out of bed, bathing, dressing, eating, or toileting, or may provide complex medical care tasks, such as managing medications and giving injections. The older adult may have dementia and require a caregiver’s constant supervision. Or, the caregiver may be responsible for all of these activities. With support from 15 sponsors, the National Academies of Sciences, Engineering, and Medicine convened an expert committee to examine what is known about the nation’s family caregivers of older adults and to recommend policies to address their needs and help to minimize the barriers they encounter in acting on behalf of an older adult. The resulting report, Families Caring for an Aging America, provides an overview of the prevalence and nature of family caregiving of older adults as well as its personal impact on caregivers’ health, economic security, and overall well-being. The report also examines the available evidence on the effectiveness of programs and interventions designed to support family caregivers. It concludes with recommendations for developing a national strategy to effectively engage and support them.
Delirium in older adults often goes unrecognised by health care professionals and can be poorly managed. This video was produced with the aim of improving recognition and management of delirium in any healthcare setting.
Opportunities
Call for Expert Faculty in the areas of Knowledge – Translation and Implementation Science
This new Faculty of experts will collaborate on developing ideas, solutions, and strategies to implement patient safety practices, strengthen teamwork, communications and leadership targeted at reducing patient harm.
The Postgraduate Fellowship provides a stipend of $50,000 per year and a research and career development allowance of $5,000 per year. The Postgraduate Fellowship will provide up to a maximum of three years of support for postgraduate training. AIHS recognizes the institutional limitations on the period of expected postgraduate training and will not provide support beyond 5 years of postgraduate training at the same institution.
Alberta SPOR Graduate Studentship
$30,000 stipend for one year, and training opportunities in patient-oriented research. The Alberta SPOR Graduate Studentship provides opportunities for individuals enrolled in a thesis-based Master’s or PhD program at an Alberta university to undertake health-related research with a patient-oriented approach.
