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HAPPY NEW YEAR! Wishing you the best of 2017!
Announcements
New TREC Article!
Burnout in the nursing home health care aide: A systematic review
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Abstract Objective To systematically review the evidence on factors that influence burnout in health care aides working in nursing homes. Design Systematic literature review. Data Sources Two search engines (Google and EBSCO Discovery Service) and five databases (MEDLINE, Scopus, CINAHL, PsycINFO and Proquest Dissertations & Theses) through to August 2013. Keywords: nursing home, health care aide and burnout (all synonyms were included). Methods Two authors independently assessed methodological quality, data extraction, analysis and synthesis on the 10 included publications. 100% reliability was found between the first and second authors. Data extracted included precipitating and buffering factors related to burnout, interventions and demographic information for the health care aide population. Data were synthesized according to individual and organizational factors. Results Our search and screening yielded 2787 titles and abstracts resulting in 83 manuscripts for full manuscript review and 10 included publications. Methodological quality assessments revealed 3 (30%) rated as low quality, 7 (70%) rated as medium quality. Independent variables were categorized as either individual or organizational factors. Methodological problems and heterogeneity in independent and dependant variables yielded few significant results. Only personal life (attributes of provider) was found to significantly buffer burnout (depersonalization, emotional exhaustion and personal accomplishment). Equivocal evidence was found for many of the organizational factors (work environment, workload and facility) supporting the need for further robust studies in this field. Of the two intervention studies, only dementia care mapping, and training in organizational respect buffered burnout. Conclusion Factors associated with burnout in health care aides are similar to those reported among nurses, although the level of evidence and low methodological rigor of these studies suggest more robust study designs are warranted. Our findings suggest research focused on this important but largely invisible group of care providers could yield important advances in understanding burnout in this group and yield potential interventions to buffer burnout and its consequences. Without mitigating the effects of burnout on nursing home health care aides, vulnerable older adults in residential care are at risk.
New article by Dr. Susan Slaughter
Hearing Loss and Cognitive-Communication Test Performance of Long-Term Care Residents With Dementia: Effects of Amplification
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Purpose: The study aims were (a) to explore the relationship between hearing loss and cognitive-communication performance of individuals with dementia, and (b) to determine if hearing loss is accurately identified by long-term care (LTC) staff. The research questions were (a) What is the effect of amplification on cognitive-communication test performance of LTC residents with early- to middle-stage dementia and mild-to-moderate hearing loss? and (b) What is the relationship between measured hearing ability and hearing ability recorded by staff using the Resident Assessment Instrument-Minimum Data Set 2.0 (RAI-MDS; Hirdes et al., 1999)? Method: Thirty-one residents from 5 long-term care facilities participated in this quasiexperimental crossover study. Residents participated in cognitive-communication testing with and without amplification. RAI-MDS ratings of participants’ hearing were compared to audiological assessment results. Results: Participants’ speech intelligibility index scores significantly improved with amplification; however, participants did not demonstrate significant improvement in cognitive-communication test scores with amplification. A significant correlation was found between participants’ average pure-tone thresholds and RAI-MDS ratings of hearing, yet misclassification of hearing loss occurred for 44% of participants. Conclusions: Measuring short-term improvement of performance-based cognitive communication may not be the most effective means of assessing amplification for individuals with dementia. Hearing screenings and staff education remain necessary to promote hearing health for LTC residents.
New article by Dr. Jennifer Baumbusch
Factors influencing the decision of older adults to be assessed for transcatheter aortic valve implantation: An exploratory study
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BACKGROUND: Transcatheter aortic valve implantation (TAVI) is the recommended therapy for patients with severe symptomatic aortic stenosis at increased surgical risk and likely to derive benefit. Multimodality and multidisciplinary assessment is required for the heart team to determine eligibility for TAVI in a primarily older population. Little is known about patients’ motivation and perspectives on making the decision to undergo the complex assessment. AIMS: To explore factors influencing patients’ decision making to undergo TAVI eligibility assessment to inform practice, programme development, health policy and future research. METHODS: An exploratory qualitative approach was used. Semistructured interviews were conducted with 15 patients at the time of their referral for assessment to a quaternary cardiac and high volume TAVI centre. RESULTS: Multiple, intersecting factors that included biomedical, functional, social and environmental considerations influenced patients’ decision. The six distinct factors were symptom burden, participants’ perception as ‘experienced’ patients, expectations of benefit and risks, healthcare system and informal support, logistical barriers and facilitators, and obligations and responsibilities. CONCLUSIONS: The decision to undergo TAVI eligibility assessment is multifaceted and complex. Programmatic processes of care must be in place to facilitate appropriate and patient-centered decision making and access to TAVI. Strategies are required to mitigate the risks associated with the rapid deterioration of severe aortic stenosis, address patient and referring physicians’ education needs, and provide individualised care and equitable access. Future research must focus on patients’ experiences throughout the trajectory of TAVI care.
Advice Seeking Networks in LTC Newsletter
Long-Term Care Winter Newsletter 2016
Read the latest news from the Winter 2016 Edition!
New article by Dr. Kate Seers
Measuring compassionate care: views of healthcare staff
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Aim To explore healthcare professionals’ views of measuring compassionate care. Method As part of a grounded theory study participants, who were healthcare professionals involved in the care of patients with type 2 diabetes, were invited to discuss the topic of compassionate care measurement through semi-structured interviews and focus groups. Results Measuring compassionate care was regarded as problematic because of its complex nature. Categories identified in the data that reflect this difficulty include distinguishing compassionate care from other concepts, relying on informal indicators, making the subjective objective, incorporating external influences and putting a measurement tool to use. Conclusion Findings highlighted the complexities associated with measuring compassionate care, and how attempts to do this by managers could be problematic.
Calls for Abstracts
CALL FOR ABSTRACTS:
Late Breaker Abstracts Now Open for IAGG 2017
The IAGG 2017 World Congress Organizing Committee welcomes submissions that address the industry’s most-pressing challenges and generate actionable insights that drive strategic decisions, enhance efficiency, and create new forms of value in the field of aging.
Grants & Awards
CIHR Training Grant: Indigenous Mentorship Network Program
The Institute of Aboriginal Peoples’ Health (IAPH) is looking to support innovative mentoring proposals from researchers and leaders with a distinguished track record in successfully mentoring First Nations, Inuit and Métis trainees and New Investigators, and experience in community-based research. The participation of international Indigenous scholars and mentors in the Indigenous Mentorship Network Program (IMNP) is encouraged.
This is an upcoming funding opportunity from PCORI. Applying for funding from PCORI is a two-stage process. A Letter of Intent must be submitted and an organization must be invited to submit a full application. Specific requirements and guidance to complete a successful LOI and subsequent full application are found in the full funding announcement, application guidelines, and application checklist for each specific funding opportunity.
Dissemination And Implementation Research In Health (R01 Research Project Grant)
This Funding Opportunity Announcement (FOA) encourages investigators to submit research grant applications that will identify, develop, test, evaluate and/or refine strategies to disseminate and implement evidence-based practices (e.g. behavioral interventions; prevention, early detection, diagnostic, treatment and disease management interventions; quality improvement programs) into public health, clinical practice, and community settings. In addition, studies to advance dissemination and implementation research methods and measures are encouraged.
Dissemination And Implementation Research In Health (R03 Small Grant Program)
This Funding Opportunity Announcement (FOA) encourages investigators to submit research grant applications that will identify, develop, evaluate and refine effective and efficient methods, systems, infrastructures, and strategies to disseminate and implement evidence-based health behavior change interventions, evidence-based prevention, early detection, diagnostic, treatment and management, and quality of life improvement services into public health, clinical practice, and community settings.
Dissemination And Implementation Research In Health (R21 Exploratory Developmental Grant)
This Funding Opportunity Announcement (FOA) encourages investigators to submit research grant applications that will identify, develop, test, evaluate and/or refine strategies to disseminate and implement evidence-based practices (e.g. behavioral interventions; prevention, early detection, diagnostic, treatment and disease management interventions; quality improvement programs) into public health, clinical practice, and community settings. In addition, studies to advance dissemination and implementation research methods and measures are encouraged.
CIHR Team Grant Funding: Impact of Gender on Knowledge Translation Interventions
As with any funding opportunity relevant to knowledge translation, the Alberta SPOR KT Platform is happy to work with applicants for this competition to provide advice and assistance. Our services are currently available at no charge. Please contact our Program Coordinator of Knowledge Translation and Implementation Science, Dr. Gabrielle Zimmermann, to inquire about how to start the process. As we tend to get very busy in the period leading up to granting deadlines, please be aware that the earlier you contact us, the more help we will be able to provide. Please contact Dr. Gabrielle Zimmermann at Gabrielle.Zimmermann@ualberta.ca
NIH National Institute on Aging: Full list of funding opportunities available
Several funding opportunities available. Earliest deadlines close in January 2017.
Travel Awards: Summer Program in Aging – “Physical Activity and Aging”
The CIHR Institute of Aging (IA) has partnered with Concordia University’s PERFORM Centre to host an innovative five-day training program. The Summer Program in Aging (SPA) 2017 will provide graduate students and post-doctoral fellows interested in research on physical activity and aging an advanced training program that crosses disciplines, institutions and geographical boundaries. Trainees who are conducting, or who have an interest in learning about research in the area of physical activity and aging are encouraged to apply to this program.
The Project Grant program is designed to capture ideas with the greatest potential to advance health-related fundamental or applied knowledge, health research, health care, health systems, and/or health outcomes. It supports projects with a specific purpose and a defined endpoint. The best ideas may stem from new, incremental, innovative, and/or high-risk lines of inquiry or knowledge translation approaches.
Request for Proposals:
Environmental Scan and Software Development Recommendations
The Canadian Foundation for Healthcare Improvement (CFHI) released today a Request for Proposals (RFP) for applicant(s) to undertake an environmental scan of existing software applications used in residential care in British Columbia and Canada, along with a situational analysis of key Electronic Health Record providers working in residential care in Canada. Expressions of interest are due on or before January 13, 2017 and final proposals are due January 30, 2017. The primary deliverable is an environmental scan and situational analysis report on the use of computer-based applications in long term care (also known as nursing homes or residential homes). The report will summarize the key providers and current practices related to documentation, use of computer-based applications and Electronic Health Records in long term care across Canada. The report will identify emerging trends and challenges, outline unique long term care software applications and documentation specificities, and provide recommended strategic directions to advance development work in this area.
Publications
KT
Health Care Administration and Organization
Health Care Innovation and Quality Assurance
Research Practice and Methodology
Aging
KT
Implementation of the BETTER 2 program: a qualitative study exploring barriers and facilitators of a novel way to improve chronic disease prevention and screening in primary care 
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BACKGROUND: BETTER (Building on Existing Tools to Improve Chronic Disease Prevention and Screening in Primary Care) is a patient-based intervention to improve chronic disease prevention and screening (CDPS) for cardiovascular disease, diabetes, cancer, and associated lifestyle factors in patients aged 40 to 65. The key component of BETTER is a prevention practitioner (PP), a health care professional with specialized skills in CDPS who meets with patients to develop a personalized prevention prescription, using the BETTER toolkit and Brief Action Planning. The purpose of this qualitative study was to understand facilitators and barriers of the implementation of the BETTER 2 program among clinicians, patients, and stakeholders in three (urban, rural, and remote) primary care settings in Newfoundland and Labrador, Canada. METHODS: We collected and analyzed responses from 20 key informant interviews and 5 focus groups, as well as memos and field notes. Data were organized using Nvivo 10 software and coded using constant comparison methods. We then employed the Consolidated Framework for Implementation Research (CFIR) to focus our analysis on the domains most relevant for program implementation. RESULTS: The following key elements, within the five CFIR domains, were identified as impacting the implementation of BETTER 2: (1) intervention characteristics-complexity and cost of the intervention; (2) outer setting-perception of fit including lack of remuneration, lack of resources, and duplication of services, as well as patients’ needs as perceived by physicians and patients; (3) characteristics of prevention practitioners-interest in prevention and ability to support and motivate patients; (4) inner setting-the availability of a local champion and working in a team versus working as a team; and (5) process-planning and engaging, collaboration, and teamwork. CONCLUSIONS: The implementation of a novel CDPS program into new primary care settings is a complex, multi-level process. This study identified key elements that hindered or facilitated the implementation of the BETTER approach in three primary care settings in Newfoundland and Labrador. Employing the CFIR as an overarching typology allows for comparisons with other contexts and settings, and may be useful for practices, researchers, and policy-makers interested in the implementation of CDPS programs.
Forging a link between mentoring and collaboration: a new training model for implementation science
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BACKGROUND: Training investigators for the rapidly developing field of implementation science requires both mentoring and scientific collaboration. Using social network descriptive analyses, visualization, and modeling, this paper presents results of an evaluation of the mentoring and collaborations fostered over time through the National Institute of Mental Health (NIMH) supported by Implementation Research Institute (IRI). METHODS: Data were comprised of IRI participant self-reported collaborations and mentoring relationships, measured in three annual surveys from 2012 to 2014. Network descriptive statistics, visualizations, and network statistical modeling were conducted to examine patterns of mentoring and collaboration among IRI participants and to model the relationship between mentoring and subsequent collaboration. RESULTS: Findings suggest that IRI is successful in forming mentoring relationships among its participants, and that these mentoring relationships are related to future scientific collaborations. Exponential random graph network models demonstrated that mentoring received in 2012 was positively and significantly related to the likelihood of having a scientific collaboration 2 years later in 2014 (p = 0.001). More specifically, mentoring was significantly related to future collaborations focusing on new research (p = 0.009), grant submissions (p = 0.003), and publications (p = 0.017). Predictions based on the network model suggest that for every additional mentoring relationships established in 2012, the likelihood of a scientific collaboration 2 years later is increased by almost 7 %. CONCLUSIONS: These results support the importance of mentoring in implementation science specifically and team science more generally. Mentoring relationships were established quickly and early by the IRI core faculty. IRI fellows reported increasing scientific collaboration of all types over time, including starting new research, submitting new grants, presenting research results, and publishing peer-reviewed papers. Statistical network models demonstrated that mentoring was strongly and significantly related to subsequent scientific collaboration, which supported a core design principle of the IRI. Future work should establish the link between mentoring and scientific productivity. These results may be of interest to team science, as they suggest the importance of mentoring for future team collaborations, as well as illustrate the utility of network analysis for studying team characteristics and activities.
The role of embedded research in quality improvement: a narrative review
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The use of research evidence to facilitate improvements in healthcare quality continues to be a topic widely debated by scholars and practitioners. The concept of ‘knowledge mobilisation’ has been developed, with strategies to help bridge this gap. These strategies include the development of “a culture of partnership between academic researchers and decision-makers to assist in strengthening the development of policy, practice and social innovation, or the co-production of knowledge”. It is based on the premise that knowledge that is collected and created ‘on the ground’, through daily interaction and negotiation with practitioners, managers and service users,4 will provide better insight into the issues affecting these stakeholders, be more relevant to the local context and will, therefore, be more easily incorporated into changes in practice.
Helping staff to implement psychosocial interventions in care homes: augmenting existing practices and meeting needs for support
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OBJECTIVE: To contribute to an optimised training programme for care staff that supports the implementation of evidence-based psychosocial interventions in long-term care. METHODS: Qualitative study that involved focus group discussions with 119 care home staff within 16 care homes in the UK. Part of wider clinical trial aimed at developing and evaluating an effective and practical psychosocial intervention and implementation approach for people with dementia in long-term care. Inductive thematic analysis was used to identify themes and interpret the data. RESULTS: The findings highlighted that successful training and support interventions must acknowledge and respond to ‘whole home’ issues. Three overarching themes emerged as influential: the importance of contextual factors such as staff morale, interpersonal relationships within the home, and experience and perceived value of the proposed intervention. CONCLUSIONS: Priority must be given to obtain the commitment of all staff, management and relatives to the training programme and ensure that expectations regarding interaction with residents, participation in activities and the reduction of medication are shared across the care home.
Translating research findings to clinical nursing practice
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AIMS AND OBJECTIVES: To describe the importance of, and methods for, successfully conducting and translating research into clinical practice. BACKGROUND: There is universal acknowledgement that the clinical care provided to individuals should be informed on the best available evidence. Knowledge and evidence derived from robust scholarly methods should drive our clinical practice, decisions and change to improve the way we deliver care. Translating research evidence to clinical practice is essential to safe, transparent, effective and efficient healthcare provision and meeting the expectations of patients, families and society. Despite its importance, translating research into clinical practice is challenging. There are more nurses in the frontline of health care than any other healthcare profession. As such, nurse-led research is increasingly recognised as a critical pathway to practical and effective ways of improving patient outcomes. However, there are well-established barriers to the conduct and translation of research evidence into practice. DESIGN: This clinical practice discussion paper interprets the knowledge translation literature for clinicians interested in translating research into practice. METHODS: This paper is informed by the scientific literature around knowledge translation, implementation science and clinician behaviour change, and presented from the nurse clinician perspective. We provide practical, evidence-informed suggestions to overcome the barriers and facilitate enablers of knowledge translation. Examples of nurse-led research incorporating the principles of knowledge translation in their study design that have resulted in improvements in patient outcomes are presented in conjunction with supporting evidence. CONCLUSIONS: Translation should be considered in research design, including the end users and an evaluation of the research implementation. The success of research implementation in health care is dependent on clinician/consumer behaviour change and it is critical that implementation strategy includes this. RELEVANCE TO PRACTICE: Translating best research evidence can make for a more transparent and sustainable healthcare service, to which nurses are central.
What we know about designing an effective improvement intervention (but too often fail to put into practice)
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It is temptingly easy to treat improvement interventions as if they are drugs—technical, stable and uninfluenced by the environment in which they work. Doing so makes life so much easier for everyone. It allows improvement practitioners to plan their work with a high degree of certainty, funders to be confident that they know what they are buying and evaluators to focus on what really matters—whether or not ‘it’ works.
Barriers, facilitators, strategies and outcomes to engaging policymakers, healthcare managers and policy analysts in knowledge synthesis: a scoping review protocol
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Introduction Engaging policymakers, healthcare managers and policy analysts in the conduct of knowledge synthesis can help increase its impact. This is particularly important for knowledge synthesis studies commissioned by decision-makers with limited timelines, as well as reviews of health policy and systems research. A scoping review will be conducted to assess barriers, facilitators, strategies and outcomes of engaging these individuals in the knowledge synthesis process.Methods and analysis We will follow the Joanna Briggs Institute guidance for scoping reviews. Literature searches of electronic databases (eg, MEDLINE, EMBASE, Cochrane Library, ERIC, PsycINFO) will be conducted from inception onwards. The electronic search will be supplemented by searching for sources that index unpublished/difficult to locate studies (eg, GreyNet International database), as well as through scanning of reference lists of reviews on related topics. All study designs using either qualitative or quantitative methodologies will be eligible if there is a description of the strategies, barriers or facilitators, and outcomes of engaging policymakers, healthcare managers and policy analysts in the knowledge synthesis process. Screening and data abstraction will be conducted by 2 team members independently after a calibration exercise across the team. A third team member will resolve all discrepancies. We will conduct frequency analysis and thematic analysis to chart and characterise the literature, identifying data gaps and opportunities for future research, as well as implications for policy.Ethics and dissemination This project was commissioned by the Alliance for Health Policy and Systems Research, WHO. The results will be used by Alliance Review Centers of health policy and systems research in low-income and middle-income countries that are conducting knowledge synthesis to inform health policymaking and decision-making. Our results will also be disseminated through conference presentations, train-the-trainer events, peer-reviewed publication and a 1-page policy brief that will be posted on the authors’ websites.
Facilitators’ delivery of a psychosocial intervention in a controlled trial for men with prostate cancer and their partners: a process evaluation
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AIM: The aim of this paper is to report the process evaluation of facilitators’ delivery of a psychosocial intervention (called CONNECT), in a randomised controlled trial, to men with prostate cancer and their partners. BACKGROUND: There is a lack of information on the process of implementing psychosocial interventions in controlled trials and, in particular, on the role and performance of facilitators who deliver them. Yet this information is crucial in assessing whether these interventions are effective or not and why. METHODS: Semi-structured qualitative interviews and diaries were used to collect data (January – October 2012) from four facilitators and a co-facilitator. Data were analysed using the Miles et al. FRAMEWORK: RESULTS: Five themes were discernible. These were ‘difficulties to keep to the structure of the intervention’, ‘selective coverage of topics’, ‘partner participation’, ‘overall impression of the group and telephone sessions’ and ‘perceived benefits to participants’. Issues such as not keeping to the aim of the intervention, deviating from the content and/or reluctance in discussing sensitive issues such as sexual health may mean that the psychosocial effects of the intervention may not have been fully realised. CONCLUSIONS: These findings will be useful for further development and evaluation of the intervention. A tentative conceptual framework of factors, related to facilitators, influencing the fidelity of interventions in the context of controlled trials, is offered. This model, which requires further development and testing, will be useful for researchers worldwide who are involved in developing interventions and training facilitators.
Transforming Evidence Generation to Support Health and Health Care Decisions
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Making better choices about health and health care requires the best possible evidence. Unfortunately, many of the decisions made today in our health care system are not supported by high-quality evidence1-4 derived from randomized, controlled trials or well-designed observational studies. But as rich, diverse sources of digital data become widely available for research and as analytical tools continue to grow in power and sophistication, the research and health care communities now have the opportunity to quickly and efficiently generate the scientific evidence needed to support improved decision making about health and health care.
Improving the Use of Evidence-Based Practice and Research Utilization Through the Identification of Barriers to Implementation in a Critical Access Hospital
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OBJECTIVE: This study explored the relationship between perceived barriers to research use and the implementation of evidence-based practice (EBP) among rural hospital nurses. BACKGROUND: The Institute of Medicine recommends that 90% of clinical decisions be evidence based by 2020. METHODS: This descriptive, quality improvement study used a convenience sampling of registered nurses (RNs). Participants completed multiple questionnaires. RESULTS: Overall the attitude toward EBP was positive. Nurses recognize the importance to their practice but identified a lack of educational preparation regarding the process of research utilization. CONCLUSION: Providing education on research process and supportive monitoring during implementation may increase compliance with EBP initiatives.
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Health Care Administration and Organization
The role of nursing staff in the activities of daily living of nursing home residents
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Abstract The aim of this cross-sectional study was to explore the role of nursing staff in residents’ activities. Nursing home residents (n = 723) were observed in their wards, randomly five times for one minute between 7 a.m. and 11 p.m. Resident’s (in)activity and the role of nursing staff or others in this activity were recorded. Roles were defined as ‘taking over the activity’, ‘giving support’, or ‘supervision’. Nurse observers were interviewed to obtain insight into their observation-experiences. Residents were observed in activities of daily living in 31% of all 3282 observations, and inactive in 57%. Nursing staff provided support in 51% of the observations and took over activities in 45%; supervision was rarely observed (4%). Nurse observers who knew the residents reported that a large part of activities were taken over unnecessarily. Based on these results, nursing staff are recommended to provide more supervision and support to optimize residents’ activities and independence.
Taking the lead: Supporting staff in coping with grief and loss in dementia care
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Healthcare providers working with people living with dementia often experience a profound sense of grief when the person they support dies or moves to an alternative level of care. Unattended staff grief can impact healthcare leaders by reducing quality of care, increasing staff turnover and absenteeism, lowering morale, and creating a greater risk of long-term staff health problems. Organizational and self-care strategies can mitigate these challenges.
Work environment characteristics associated with quality of care in Dutch nursing homes: A cross-sectional study
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BACKGROUND: A lack of relationship between direct care staffing levels and quality of care, as found in prior studies, underscores the importance of considering the quality of the work environment instead of only considering staff ratios. Only a few studies, however, have combined direct care staffing with work environment characteristics when assessing the relationship with quality of care in nursing homes. OBJECTIVES: To examine the relationship between direct care staffing levels, work environment characteristics and perceived quality of care in Dutch nursing homes. DESIGN: Cross-sectional, observational study in cooperation with the Dutch Prevalence Measurement of Care Problems. SETTINGS: Twenty-four somatic and 31 psychogeriatric wards from 21 nursing homes in the Netherlands. PARTICIPANTS: Forty-one ward managers and 274 staff members (registered nurses or certified nurse assistants) from the 55 participating wards. METHODS: Ward rosters were discussed with managers to obtain an insight into direct care staffing levels (i.e, total direct care staff hours per resident per day). Participating staff members completed a questionnaire on work environment characteristics (i.e., ward culture, team climate, communication and coordination, role model availability, and multidisciplinary collaboration) and they rated the quality of care in their ward. Data were analyzed using multilevel linear regression analyses (random intercept). Separate analyses were conducted for somatic and psychogeriatric wards. RESULTS: In general, staff members were satisfied with the quality of care in their wards. Staff members from psychogeriatric wards scored higher on the statement ‘In the event that a family member had to be admitted to a nursing home now, I would recommend this ward’. A better team climate was related to better perceived quality of care in both ward types (p</=0.020). In somatic wards, there was a positive association between multidisciplinary collaboration and agreement by staff of ward recommendation for a family member (p=0.028). In psychogeriatric wards, a lower score on market culture (p=0.019), better communication/coordination (p=0.018) and a higher rating for multidisciplinary collaboration (p=0.003) were significantly associated with a higher grade for overall quality of care. Total direct care staffing, adhocracy culture, hierarchy culture, as well as role model availability were not significantly related to quality of care. CONCLUSIONS: Our findings suggest that team climate may be an important factor to consider when trying to improve quality of care. Generating more evidence on which work environment characteristics actually lead to better quality of care is needed.
Pain in older adults: development of a tool for measuring knowledge of residential aged care staff
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OBJECTIVE: To develop a psychometrically sound tool for measuring the knowledge of nursing and care staff about the experience, assessment and management of pain in older people (including people with dementia) for use in the residential aged care setting. METHODS: The Pain in Older Adults Knowledge Survey (POAKS) was developed and tested in two phases. Phase 1 involved developing an initial item pool with good content validity based on a review of the research literature and a modified Delphi technique involving national and international experts. A pool of 24 items was developed for testing. Initial testing of the psychometric properties of the POAKS with 30 university employees led to refinement and final wording of items. Phase 2 involved testing of the psychometric properties of the POAKS with 279 respondents, including first year (n = 176) and third year (n = 70) nursing students and staff in a residential aged care service (n = 33). RESULTS: Results established the content validity and internal consistency of the POAKS and supported its use as an instrument to measure nursing staff knowledge about the experience, assessment and management of pain in older people. CONCLUSIONS: The POAKS will enable residential aged care facilities to measure the level of knowledge among nursing and care staff about pain in older people (including people with dementia). The measure provides a basis for the development and implementation of educational interventions to address knowledge gaps that may impact on the quality of care provided.
A survey of interprofessional activity of acute and long-term care employed nurse practitioners
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PURPOSE: To describe activities of interprofessional (IP) care, a key aspect of high-quality care, performed by nurse practitioners (NPs) employed in acute and long-term care institutions. DATA SOURCES: We developed and tested a new theory-driven process tool to quantify NP everyday activities of IP care. We then invited NPs in acute and long-term care to complete the IP self-assessment tool (IPSAT). CONCLUSIONS: The IPSAT is a validated tool shown to be reliable for use with NPs. Testing with other healthcare professionals is suggested. More than 50% of NPs engage in all activities of IP care. Many engage in shared decision making, professional relationship, communication, and partnership or collaboration activities on most work days. Less-common activities were interdependence and collective problem solving including efforts to create role clarity. IMPLICATIONS FOR PRACTICE: It is important to evaluate the everyday use of activities that enhance high-quality care. Awareness and enhanced knowledge of IP care activities such as promoting interdependence, collective problem solving, and ensuring role clarity will improve care quality. The tool results are valuable for practicing NPs and their educators to reflect on practice and advance knowledge to influence purposeful engagement in interprofessional care.
Nursing Home Manager’s Knowledge, Attitudes and Beliefs about Advance Care Planning for people with Dementia in Long-term Care Settings: A Cross-Sectional Survey
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AIM: To examine nursing home managers’ knowledge, attitudes, beliefs and current practice regarding advanced care planning for people with dementia in long term care settings informed by the Theory of Planned Behaviour. BACKGROUND: Internationally advance care planning is advocated for people with dementia. However, evidence suggests that discussions with people with dementia are rare, particularly in long-term care settings. Whilst nursing home managers can be considered central to implementation in this setting, there is a dearth of research that has examined their perspective. This study reports on their role with regards to advance care planning, and the perceived factors which influence this. DESIGN: A cross-sectional postal survey was carried out as part of a larger scale sequential explanatory mixed methods study between January-March 2015. SETTING AND PARTICIPANTS: Nursing home managers in a region in the UK (n=178). RESULTS: A response rate of 66% (n=116) was achieved. Nursing home managers demonstrated a lack of knowledge of advance care planning; with negative attitudes underpinned by concerns regarding the capacity and lack of perceived benefits to the person with dementia. Currently they do not view ACP as part of their role, with lack of ownership impacting upon current practice behaviours. CONCLUSIONS: Whilst nursing home managers recognise the potential benefits of advance care planning, barriers and challenges create a reluctance to facilitate. Targeted training to address the knowledge deficit is required, with the wider components of advance care planning promoted. There is a need for greater role clarification to ensure nurses in long-term care settings identify with the process in the future. A gap between rhetoric and reality of implementation is evident, therefore long-term care settings must critically examine system, organisational and individual factors for failure to implement advance care planning for people with dementia.
Supporting Staff to Identify Residents in Pain: A Controlled Pretest-Posttest Study in Residential Aged Care
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Practical strategies are needed to improve pain awareness among aged care staff and promote a systematic approach to pain identification using evidence-based tools. The purpose of this study was to evaluate a pain identification tool for use by nursing and nonprofessional staff in residential aged care facilities (RACFs). A controlled pretest-posttest intervention design was conducted in two RACFs in Brisbane, Australia. Completed surveys were returned by 216 staff and 74 residents at baseline and 218 staff and 94 residents at 3-month follow-up. Chart audits were conducted on 308 residents at baseline and 328 at follow-up. Groups were compared on: (1) staff knowledge and attitudes regarding pain, perceived confidence and skills for pain assessment, and perceived quality of pain management; (2) frequency of pain assessments and use of pain interventions; and (3) residents’ perceptions of the quality of pain management. Both groups had high knowledge scores and reported high levels of confidence, skills, and perceived quality of pain management at baseline and follow-up. The intervention group showed significant improvement in routine pain assessment and use of nonpharmacological pain interventions. However, due to unexpected changes in control group conditions, both groups increased episodic pain assessment. Overall, staff believed the intervention was clinically useful and fostered a team approach to pain assessment. We found the introduction of pain identification resources with implementation strategies to support frontline staff was partially effective in improving staff and resident outcomes. Nonetheless, our findings confirm the need for change and importance of translational pain research in RACFs.
Competence for older people nursing in care and nursing homes: An integrative review
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BACKGROUND: People living in care and nursing homes are vulnerable individuals with complex needs; therefore, a wide array of nursing competence is needed to ensure their well-being. When developing the quality of care in these units, it is essential to know what type of competence is required for older people nursing. AIMS AND OBJECTIVES: The aim of this integrative review was to identify the competence needed for older people nursing in licensed practical nurses’ and registered nurses’ work in care and nursing homes. DESIGN: Integrative literature review. METHODS: We performed an integrative review using Whittemore and Knafl’s method. The CINAHL, MEDLINE, PsycINFO, SocINDEX and Scopus databases were searched for studies published from 2006 to April 2016. We assessed the quality of the studies using Joanna Briggs Institute critical appraisal tools and analysed the data by applying qualitative content analysis. RESULTS: Ten articles were included in the review. Most of the studies focused on registered nurses’ work. We identified five competence areas that are needed for older people nursing in registered nurses’ work in care and nursing homes: attitudinal and ethical, interactional, evidence-based care, pedagogical, and leadership and development competence. Empirical evidence of competence requirements related to licensed practical nurses’ work in these facilities was scarce. CONCLUSIONS: The competence required for registered nurses and licensed practical nurses should be clearly identified to support competence management in the care and nursing home context. IMPLICATIONS FOR PRACTICE: Well-educated nursing staff are needed in care and nursing homes to provide high-quality care because comprehensive and advanced nurse competence is required to meet the needs of older people.
Job Satisfaction: Insights from Home Support Care Workers in Three Canadian Jurisdictions
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This mixed-methods study identified the personal and workplace characteristics that drive the job satisfaction of home support workers (HSWs) providing assistance to elderly clients. Data were based on a standardized measure of job satisfaction, along with in-depth qualitative interviews with 176 home support workers from three Canadian provincial jurisdictions (British Columbia, n = 108; Ontario, n = 28; Nova Scotia, n = 40). We anticipated that variability in demographic profiles between the three groups of workers and different job descriptions would be associated with differences in perceived job satisfaction. This was not the case. Results from the qualitative analysis highlight key areas that contributed to job satisfaction. These are job (scheduling, travel, and safety), economic (income security), and organizational (communication, support, and respect) factors. Given these findings, we recommend improvements to workplace communication, increased travel time allowance between clients, and wage parity with equivalent positions in long-term care facilities.
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Health Care Innovation and Quality Assurance
Medication management policy, practice and research in Australian residential aged care: current and future directions
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Eight percent of Australians aged 65 years and over receive residential aged care each year. Residents are increasingly older, frailer and have complex care needs on entry to residential aged care. Up to 63% of Australian residents of aged care facilities take nine or more medications regularly. Together, these factors place residents at high risk of adverse drug events. This paper reviews medication-related policies, practices and research in Australian residential aged care. Complex processes underpin prescribing, supply and administration of medications in aged care facilities. A broad range of policies and resources are available to assist health professionals, aged care facilities and residents to optimise medication management. These include national guiding principles, a standardised national medication chart, clinical medication reviews and facility accreditation standards. Recent Australian interventions have improved medication use in residential aged care facilities. Generating evidence for prescribing and deprescribing that is specific to residential aged care, health workforce reform, medication-related quality indicators and inter-professional education in aged care are important steps toward optimising medication use in this setting.
Carers’ education improves oral health of older people suffering from dementia – results of an intervention study
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AIM: The aim of this study was to evaluate the effectiveness of carers’ education on improvements in oral health and denture hygiene of care-dependent and cognitively impaired older people in nursing homes compared to those without intervention. METHODS: A total of 219 seniors living in 14 nursing homes in southwest Germany (intervention: n=144; control: n=75) were enrolled in this study. For each participant, Plaque Control Record (PCR), Gingival Bleeding Index (GBI), Denture Hygiene Index (DHI) and Community Periodontal Index of Treatment Needs (CPITN) were assessed at baseline and six months following the interventions. In addition, demographic parameters such as age, sex, chronic diseases, permanent medications, level of dependency and cognitive state were recorded. In the intervention homes, education for caregivers was provided and ultrasound baths for denture cleaning were implemented. Changes in the dental target variables PCR, GBI, CPITN and DHI during the six-month study period were compared between subjects in the intervention and the control groups as well as between subjects with and without dementia. Additionally, multivariate models were compiled for each dental index to evaluate possible confounders. RESULTS: In the intervention group, PCR and DHI significantly improved during the study period (P0.05). CONCLUSION: Carers’ education improves oral health of people in nursing homes over a clinically relevant period of time. Implementation of ultrasound baths is a simple and effective measure to improve denture hygiene of both institutionalized elderly people and seniors with dementia and in severe need of care. From a clinical standpoint, it is noteworthy that the respective interventions can be easily implemented in everyday care routine.
Improving pain assessment practices and outcomes in long-term care facilities: a mixed methods investigation
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An ongoing concern in long-term care (LTC) is that pain problems are often not identified correctly. There is also evidence that behavioral disturbance due to pain is misattributed to psychiatric conditions and consequently frequently treated with psychotropic rather than analgesic medication. This can result in unnecessary polypharmacy and ineffective pain management. In a previous study, implementation of a pain assessment protocol resulted in changes in administration of pro re nata (PRN) medications and positive outcomes. However, there were no changes in regularly scheduled medications suggesting that assessment results were either not communicated to the prescribing physicians or not taken into account. The goal of this study was to determine whether a pain assessment protocol, augmented with communication of the assessment results to the residents’ physicians, affects prescriptions of analgesic and psychotropic medication. Psychotropic medication reduction would help address the problem of polypharmacy frequently seen in LTC facilities. PRN medications were also examined. This investigation involved a two group design (control vs. assessment). A mixed methods analysis included both quantitative and qualitative procedures. At the end of the study, residents in the pain assessment group were administered fewer psychotropic medications than patients in the control group, helping address the problem of polypharmacy. Pain levels were comparable between the groups. Health care staff indicated that the protocol resulted in more careful evaluation of residents’ pain and greater appropriateness of prescriptions including reductions in polypharmacy.
A primer on PDSA: executing plan–do–study–act cycles in practice, not just in name
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Plan-do–study–act (PDSA) cycles are the building blocks of iterative healthcare improvement. Although frequently regarded as separate from research, this quality improvement method remains rooted in the scientific method. The P in PDSA usually stands for ‘plan’ but could just as easily refer to ‘predict’. Each cycle combines prediction with a test of change (in effect, hypothesis testing), analysis and a conclusion regarding the best step forward—usually a prediction of what to do for the next PDSA cycle.
What we know about designing an effective improvement intervention (but too often fail to put into practice)
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It is temptingly easy to treat improvement interventions as if they are drugs—technical, stable and uninfluenced by the environment in which they work. Doing so makes life so much easier for everyone. It allows improvement practitioners to plan their work with a high degree of certainty, funders to be confident that they know what they are buying and evaluators to focus on what really matters—whether or not ‘it’ works.
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Research Practice and Methodology
Making patient relevant clinical research a reality
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Clinical research aims to improve the knowledge base in the prevention, treatment, care, and cure of disease while delivering good value for money and avoiding research waste. However, a wide gap exists between what generally receives funding and what patients, carers, and the public would like to see examined.
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Aging
Patient safety in community dementia services: what can we learn from the experiences of caregivers and healthcare professionals?
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OBJECTIVES: this study aims to explore how patient safety in community dementia services is understood by caregivers, and healthcare professionals. METHODS: cross-sectional analysis of guided one-to-one interviews with 10 caregivers, and 10 healthcare professionals. RESULTS: caregivers and healthcare professionals identified a range of issues including medication errors, mis-communication between professionals, unclear service pathways and the effects of stress on caregivers’ behaviour. Caregivers and professionals differed in their attitudes to balancing safety with patient autonomy and who is responsible for managing safety. CONCLUSIONS: this article helps to define the nature of safety issues in the context of community care for people with dementia. In contrast to hospital medicine, where the ideal treatment world is safe with all risks managed or minimised, in dementia some risks are actively taken in the interests of promoting autonomy. Caregivers’ views differ from those of health professionals but both parties see potential for collaborative working to manage risk in this context, balancing the promotion of autonomy with the minimisation of potential harm.
Community Level Association between Home Health and Nursing Home Performance on Quality and Hospital 30-day Readmissions for Medicare Patients
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We evaluated whether community-level home health agencies and nursing home performance is associated with community-level hospital 30-day all-cause risk-standardized readmission rates for Medicare patients used data from the Centers for Medicare & Medicaid Service from 2010 to 2012. Our final sample included 2,855 communities that covered 4,140 hospitals with 6,751,713 patients, 13,060 nursing homes with 1,250,648 residents, and 7,613 home health agencies providing services to 35,660 zipcodes. Based on a mixed effect model, we found that increasing nursing home performance by one star for all of its 4 measures and home health performance by 10 points for all of its 6 measures is associated with decreases of 0.25% (95% CI 0.17-0.34) and 0.60% (95% CI 0.33-0.83), respectively, in community-level risk-standardized readmission rates.
Pain management intervention targeting nursing staff and general practitioners: Pain intensity, consequences and clinical relevance for nursing home residents
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AIM: Although chronic pain is common in older adults, its treatment is frequently inappropriate. This problem is particularly prevalent in nursing home residents. We therefore developed an intervention to optimize pain management and evaluated its effects on pain intensity and pain interference with function in nursing home residents in Germany. METHODS: In a cluster-randomized controlled intervention, 195 residents of 12 Berlin nursing homes who were affected by pain were surveyed at three points of measurement. A modified German version of the Brief Pain Inventory was used to assess pain sites, pain intensity and pain interference with function in various domains of life. The intervention consisted of separate training measures for nursing staff and treating physicians. RESULTS: The primary objective of reducing the mean pain intensity by 2 points was not achieved, partly because the mean pain intensity at baseline was relatively low. However, marginal reductions in pain were observed in the longitudinal assessment at 6-month follow up. The intervention and control groups differed significantly in the intensity sum score and in the domain of walking. Furthermore, the proportion of respondents with pain scores >0 on three pain intensity items decreased significantly. CONCLUSIONS: Given the multifocal nature of the pain experienced by nursing home residents, improving the pain situation of this vulnerable group is a major challenge. To achieve meaningful effects not only in pain intensity, but especially in pain interference with function, training measures for nursing staff and physicians need to be intensified, and long-term implementation appears necessary.
Trends in potentially inappropriate medication prescribing to nursing home patients: comparison of three cross-sectional studies
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PURPOSE: The aim of this study was to examine trends in potentially inappropriate medication (PIM) prescribing in Norwegian nursing homes. METHODS: Patients aged >/=70 years were included from three cross-sectional studies conducted in 1997, 2005 and 2011. PIMs were analyzed according to the Norwegian General Practice-Nursing Home criteria (NORGEP-NH), use of single substances to avoid, combinations to avoid, and deprescribing items. Associations between sample and use of PIMs were examined by logistic regression, adjusted for age, gender, and ward. We established Pearsons r for correlations between numbers of drugs and PIMs. RESULTS: Altogether, 4373 patients (mean age 85.7 years, 73.5% women) were included. The mean overall number of drugs per patient increased from 4.7 in 1997 to 6.9 in 2011 (p < 0.001). Use of any single substances to avoid increased from 36.8% in 1997 to 39.5% in 2011 (p = 0.002), use of any combinations to avoid from 16.3% to 27.0% (p < 0.001), and use of any deprescribing items from 46.0% to 55.3% (p < 0.001). Use of codeine-analgesics, nonsteroidal anti-inflammatory drugs, tricyclic antidepressants, long-acting benzodiazepines, and first generation antihistamines decreased significantly, while use of short-acting benzodiazepines, z-hypnotics, statins, and anti-dementia drugs increased significantly. A moderate strong correlation was detected between number of drugs and the three above-mentioned PIM categories, r = 0.34, r = 0.43, r = 0.37, respectively (all p < 0.001). CONCLUSIONS: Although several PIMs were less commonly prescribed in recent years, increased overall use of PIMs may suggests worsening of prescribing quality for nursing home patients in Norway.
Micronutrients on the Menu: Enhancing the Quality of Food in Long-term Care for Regular, Nontherapeutic Menus
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Micronutrient (vitamin and mineral) deficiencies may exacerbate prevalent health conditions occurring in long-term care (LTC) residents, and current food provision may potentiate this problem. A micronutrient-focused, food-first approach to menu planning may address this gap by emphasizing nutrient-dense foods. The objectives were to determine if: (i) selected LTC menus met micronutrient and Canada’s Food Guide (CFG) recommendations, and (ii) recommendations can be met through food alone with strategic menu planning. Regular, nontherapeutic menus (week 1, all meals) from diverse LTC homes (n = 5) across Canada were analyzed for micronutrient content using Food Processor and CFG servings. Site dietitians confirmed menu analyses. Five super-menus were created and analyzed for comparison. The nutrient content of the menus varied significantly across homes. Micronutrients of greatest concern were (mean +/- SD) vitamin D (8.90 +/- 5.29 microg/d) and vitamin E (5.13 +/- 1.74 mg/d). Folate, magnesium, and potassium were also below recommendations. Super-menus of equal food volume met recommendations for all micronutrients except vitamin D (56%), vitamin E (84%), and potassium (85%). Meeting most micronutrient recommendations is possible with creative and deliberate menu planning. Knowledge translation of best practices is needed.
Characteristics of Activities for Persons With Dementia at the Mild, Moderate, and Severe Stages
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PURPOSE: To understand activity in dementia care, we examine relationships of disease stage with types and characteristics of meaningful activities (cueing needs, help with initiation, and recommended engagement time) provided in a home-based intervention trial designed to reduce behavioral symptoms. DESIGN AND METHODS: Data involved 158 activity prescriptions or written documents detailing prescribed activities, cueing needs, and engagement goals designed by occupational therapists for 56 families. Activities were categorized as arts and crafts, exercise/physical, cognitive, music/entertainment, manipulation/sensory/sorting, family/social/ reminiscence, and domestic/homemaking. Bivariate correlations examined relationships of activity categories and characteristics with disease stage (mild, moderate, or severe). Kruskal-Wallis H tests examined differences among disease stages and frequency of type of activities prescribed, recommended cues, and engagement time. For significant Kruskal-Wallis tests, pairwise comparisons utilized the Mann-Whitney U test. RESULTS: Activity categories and instructions for set up were significantly related to cognitive and functional levels. Persons with mild dementia were most often prescribed complex arts and crafts and cognitive activities. Persons with moderate dementia were most often prescribed music/entertainment. Persons with severe dementia were most often prescribed simple physical exercises and manipulation/sensory/sorting activities. Average time prescribed for activities was less for those in severe (15min) versus moderate (24min) and mild (28min) stages. The severe group required more assistance with activity initiation and cueing/redirection. IMPLICATIONS: Type of activity, recommended cueing, and engagement time differed by dementia stage. Findings provide guidance as to how to use and set up activities across the dementia trajectory.
Aggressive Behaviour Risk Assessment Tool for Newly-Admitted Residents of Long-Term Care Homes
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AIM: The aim of this study was to revise the 10-item Aggressive Behaviour Risk Assessment Tool for predicting aggressive events among residents newly admitted to long-term care homes. BACKGROUND: The original tool had acceptable sensitivity and specificity for identifying potentially aggressive patients in acute care medical-surgical units, but its usefulness in long-term care homes is unknown. DESIGN: A retrospective cohort study design was used. METHODS: All residents admitted to 25 long-term care homes in western Canada were assessed for the risk of aggression using the original tool within 24 hours of admission from January 2014 – December 2014 (n = 724). Incident reports of aggressive events occurring within 30 days of admission were collected. Multiple logistic regression and receiver operating characteristics analyses were performed. RESULTS: Fifty-three residents out of 724 exhibited aggressive behaviours. The demographic variable of age less than 85 years was found to be a positive predictor of aggressive events in multivariate logistic regression model and was added to the tool. The revised 6-item Aggressive Behaviour Risk Assessment Tool for Long-Term Care consists of one new item, age less than 85 years and five items from the original tool: History of physical aggression, physically aggressive/threatening, anxiety, confusion/cognitive impairment and threatening to leave. The receiver operating characteristics of the revised tool with weighted scoring showed a good discriminant ability with satisfactory sensitivity and specificity at the recommended cutoff score of 4. CONCLUSION: The revised 6-item tool may be useful in identifying potentially aggressive residents newly admitted to long-term care homes.
Green Care Farms as Innovative Nursing Homes, Promoting Activities and Social Interaction for People With Dementia
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Journal of the American Medical Directors Association 2016/12;18(1):40-46
Objectives: Innovative care environments are developed for people with dementia to encourage person-centered care. This study aims to investigate whether residents of green care farms that provide 24-hour nursing care participate more in (physical) activities and social interaction compared with residents of other nursing homes.
Preconditions for successful advance care planning in nursing homes: A systematic review
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OBJECTIVES: There is growing evidence of the potential effectiveness of advance care planning. Yet important knowledge gaps remain regarding the preconditions for successful implementation of advance care planning in the nursing home setting. We aim to identify the preconditions related to successful advance care planning in the nursing home setting. By specifying those, we would be able to make well-founded choices for the future design and planning of advance care planning intervention programs. DESIGN: A systematic review. DATA SOURCES: PubMed, PsycINFO, EMBASE and CINAHL. REVIEW METHODS: Two authors independently screened publications. One author assessed methodological quality and extracted textual data, which was double-checked for a random sample. We extracted textual data and used thematic synthesis to identify “preconditions”, defined as requirements, conditions and elements necessary to achieve the desired outcome of advance care planning, i.e. attaining concordance between residents’ preferences and actual care or treatment received at the end of life. MAIN FINDINGS: Based on 38 publications, we identified 17 preconditions at five different levels: resident, family, health-care professional, facility and community. Most preconditions were situated on multiple levels but the majority addressed professionals and the nursing home itself. We summarized preconditions in five domains: to have sufficient knowledge and skills, to be willing and able to participate in advance care planning, to have good relationships, to have an administrative system in place, and contextual factors supporting advance care planning within the nursing home. CONCLUSION: There are multiple preconditions related to successfully implementing advance care planning in the complex nursing home setting that operate at micro, meso and macro level. Future interventions need to address these multiple domains and levels in a whole-system approach in order to be better implementable and more sustainable, while simultaneously target the important role of the health-care professional and the facility itself.
The Effect of Laughter Therapy on the Quality of Life of Nursing Home Residents
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AIMS AND OBJECTIVES: To carry out laughter therapy and evaluate its effect on the quality of life of nursing home residents. BACKGROUND: By improving the quality of life of residents living in nursing homes and allowing them to have a healthier existence, their lives can be extended. Therefore, interventions impacting the quality of life of older adults are of critical importance. DESIGN: Quasi-experimental design. METHOD: The study was conducted between March 2 and May 25, 2015. The experimental group was composed of 32 nursing home residents from one nursing home while the control group consisted of 33 nursing home residents from another nursing home in the capital city of Turkey. Laughter therapy was applied with nursing home residents of the experimental group two days per week (21 sessions in total). A socio-demographic form and the Short-Form Health Survey (SF-36) were used for data collection. RESULTS: After the laughter therapy intervention, total and subscale (physical functioning, role-physical, bodily pain, general health, vitality, social functioning, role-emotional, and spiritual health) quality of life scores of residents in the experimental group significantly increased in comparison to the pretest. CONCLUSION: Laughter therapy improved the quality of life of nursing home residents. Therefore, nursing home management should integrate laughter therapy into health care and laughter therapy should be provided as a routine nursing intervention. RELEVANCE TO CLINICAL PRACTICE: The results indicated that the laughter therapy programme had a positive effect on the quality of life of nursing home residents. Nurses can use laughter therapy as an intervention to improve quality of life of nursing home residents.
Effectiveness of meaningful occupation interventions for people living with dementia in residential aged care: a systematic review
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BACKGROUND: The ability to participate in valued activities, whether for work, leisure or family, is an important aspect of personal identity. In dementia, progressive memory loss means that abilities developed over a lifetime begin to be lost as well, contributing to the loss of self and identity. Some studies have reported that activities or interventions tailored to be meaningful to the person with dementia (defined as any activity important to the individual) are more effective in addressing behavioral and psychological symptoms of dementia (BPSD) and improving quality of life (QoL) than those that are not so tailored. However, the effectiveness of individualizing interventions or activities for this population is not known. OBJECTIVES: In response to consumer feedback by the Consumer Dementia Research Network that this question ought to be addressed, this review was undertaken, the aim of which was to determine the effectiveness of meaningful occupation interventions for people living with dementia in residential aged care facilities (RACFs). INCLUSION CRITERIA: People living with dementia in RACFs (nursing homes).Any intervention that was individualized to be meaningful to the participant, versus any active control condition or usual care.Experimental and observational studies. TYPES OF OUTCOMES: Quality of life, BPSD (such as agitation, aggression, depression, wandering and apathy), mood, function, cognition and sleep. SEARCH STRATEGY: The search strategy aimed to identify both published and unpublished studies, with the following 12 databases extensively searched: PubMed, CINAHL, PsycINFO, ISI Web of Science, OTSeeker, Embase, Cochrane CENTRAL, clinicaltrials.gov, Mednar, OpenSIGLE, New York Academy of Medicine Library Gray Literature Report, ProQuest Dissertations and Theses. The search strategy was limited to papers published in English between 2004 and January 31, 2015. METHODOLOGICAL QUALITY: All studies were assessed independently by two reviewers for relevance, eligibility and methodological quality. DATA EXTRACTION: Data from included papers were extracted using a standard data extraction tool. DATA SYNTHESIS: Where possible, study results were pooled in statistical meta-analysis. Alternatively, results are presented in narrative and tabular form. RESULTS: A total of 5274 citations were identified; after removal of duplicates, assessment for relevance and eligibility, 61 studies underwent critical appraisal. Thirty-four studies met the quality criteria and were included in a quantitative synthesis. A wide range of interventions were evaluated including individualized recreational activities (13 studies), reminiscence therapy (RT) (seven studies), music therapy interventions (six studies), training staff to develop individual care plans using person-centered care (PCC) or similar approaches (three studies), animal-assisted therapy (two studies), multi-sensory interventions (MSIs) (two studies) and social interaction (one study), all of which measured a number of different outcomes. Overall, and in spite of most studies being small-scale and of relatively brief duration, all interventions with the exception of Snoezelen therapy (a MSI) reported some benefits for people with dementia living in RACFs. The most frequently reported benefits were reductions in agitation (the most frequently assessed outcome), passivity and depression, improved QoL and increases in pleasure and interest. However, the majority of studies generally implemented the intervention, whether it was individualized activities, music or RT or other, in conjunction with one-to-one social interaction, and the relative importance of the intervention in comparison to one-to-one social contact for effectiveness cannot be determined from this review. CONCLUSION: Providing meaningful or individualized tailored activities for people with dementia living in RACFs appears to be effective for a range of behavioral and psychological symptoms. The strongest evidence was for individualized activities/recreational interventions for a range of BPSD; preferred music for agitation, depression and anxiety; and RT for mood and cognitive functioning. Insufficient evidence precluded making recommendations regarding animal-assisted (dog) therapy and training staff to develop individual care plans using PCC or similar approaches, while there was no good quality evidence to show that Snoezelen was effective for any outcome. What remains unclear, however, is whether any of these interventions is more effective than the provision of one-to-one social interaction.
Palliative care during the final week of life of older people in nursing homes: A register-based study
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OBJECTIVE: Our aim was to explore the presence of symptoms, symptom relief, and other key aspects of palliative care during the final week of life among older people residing in nursing homes. METHOD: Our study employed data from the Swedish Palliative Care Register on all registered individuals aged 60 and older who had died in nursing homes during the years 2011 and 2012. Variables pertaining to monitoring and treatment of symptoms, end-of-life discussions, circumstances around the death, and the individual characteristics of deceased individuals were explored using descriptive statistics. RESULTS: The most common underlying causes of death among the 49,172 deceased nursing home residents were circulatory diseases (42.2%) and dementia (22.7%). The most prevalent symptom was pain (58.7%), followed by rattles (42.4%), anxiety (33.0%), confusion (21.8%), shortness of breath (14.0%), and nausea (11.1%). Pain was the symptom with the highest degree of total relief (46.3%), whereas shortness of breath and confusion were totally relieved in 6.1 and 4.3% of all individuals, respectively. The use of valid instruments for symptom assessment was reported for pain in 12.3% and for other symptoms in 7.8% of subjects. The most prevalent individual prescriptions for injection PRN (pro re nata, according to circumstances) were for pain treatment (79.5%) and rattles (72.8%). End-of-life discussions were performed with 27.3% of all the deceased individuals and with 53.9% of their relatives. Of all individuals, 82.1% had someone present at death, and 15.8% died alone. Of all the nursing home resident deaths recorded, 45.3% died in their preferred place. SIGNIFICANCE OF RESULTS: There were large variations in degree of relief from different symptoms during the final week of life. Pain was the most prevalent symptom, and it was also the symptom with the highest proportion of total/partial relief. Other symptoms were less prevalent but also less well-relieved. Our results indicate a need for improvement of palliative care in nursing home settings, focusing on management of distressing symptoms and promotion of end-of-life discussions.
A qualitative study investigating training requirements of nurses working with people with dementia in nursing homes
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BACKGROUND: The care home workforce (over half a million people in the UK) has a pivotal role in the quality of care provided to the residents. Much care in this setting is inadequate, lacks a person-centred focus and neglects the dignity of residents. A combination of factors leads to burnout in nurses working in nursing homes, contributing to poor quality care. Recent reports have indicated that cultures of care need to be addressed through training, improved workforce support and supervision and that improving the quality of care for people with dementia can be achieved by the development of leadership in nursing and clarifying professional values. Addressing burnout through an educational intervention should improve quality of care and nurses’ experiences. OBJECTIVES: The study aimed to explore the training needs of nurses working with people with dementia in nursing homes with a view to developing an educational intervention to reduce nurses’ burnout and improve person-centred care. DESIGN: Four focus groups were conducted with 11 qualified nurses working in nursing homes; data was analysed using thematic analysis. RESULTS: Four themes emerged through the analysis of the transcripts. Participants reported that their work responsibilities revolved mainly around directing others, day to day care, paper work and supporting family carers. Nurses identified the importance of person-centred ways of being, communication and clinical skills when working in nursing home setting. They expressed their frustrations associated with managing staff levels, responding to behaviour that challenges and lack of time. CONCLUSIONS: The barriers to learning, experience of previous training and gaps in knowledge identified could inform the design of future training and support programmes.
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Events
UofA
Patient-Oriented Research Training Program: Foundations of patient-oriented research
The Training Program is open to anyone who is collaborating, or planning to collaborate, in POR. It is intended for graduate students, trainees, community and academic researchers, patients and family members, health care professionals, decision-makers, and industry and community stakeholders who are interested in learning about, or contributing to, POR in Alberta.
Clinical Research Seminar Series: SPOR Platform Discussion
Join us this January to learn more about the Strategy for Patient-Oriented Research (SPOR) as Platform Leads discuss what SPOR can do for clinical and health services researchers at the University of Alberta. Dr. Lisa Hartling, the Lead for the Knowledge Translation Platform will be presenting alongside Dr. Finlay McAlister, the Data Platform Lead, and Dr, Ross Tsuyuki, the Lead of the Consultation and Research Services Platform.
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Finding and Using Research Evidence to Inform Decision-Making in Health Systems and Organizations
Don’t miss your chance to attend this two-day workshop organized by the Alberta SPOR Support Unit in collaboration with the McMaster Health Forum.
IAGG 2017: Early Bird Registration
Early Bird Registration is now open for IAGG 2017 in San Francisco. From July 23 through July 27, you will have the opportunity to connect with more than 6,000 of your peers. Learn the latest trends and issues in aging from thought leaders, industry pioneers, expert researchers and practitioners from around the world, and return home inspired to put what you learned into practice. Register today to take advantage of the early bird rate and save up to $150.
KT Canada Summer Institute – Patient Oriented Research
Save the date! Applications open in January.
The Training Program is open to anyone who is collaborating, or planning to collaborate, in POR. It is intended for graduate students, trainees, community and academic researchers, patients and family members, health care professionals, decision-makers, and industry and community stakeholders who are interested in learning about, or contributing to, POR in Alberta.
Canadian Frailty Network 2017 National Conference
Save the date!
Online
The Use of Facilitation as an Implementation Strategy
This presentation will review the conceptual underpinnings that support implementation facilitation, describe one study that established implementation facilitation as an evidence based strategy, frame implementation facilitation within the context of other implementation strategies and describe upcoming products that will support the application of implementation facilitation by implementation researchers as well as clinical managers and policymakers.
Knowledge Translation Canada National Seminar Series
Please join us for the Knowledge Translation Canada National Seminar Series session with Dr. Sophie Desroches and Audrée-Anne Dumas. Title: Using social media to improve dietary behaviors. 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, January 11th at 12:00 PM ET.
Knowledge Translation Webinar Series
The next webinar “Patient-Oriented Research: The intersection between patient engagement and knowledge translation” features Colleen McGavin (Patient Engagement Lead, BC SUPPORT Unit) and is co-presented with the BC SUPPORT Unit.
3rd Biennial Australasian Implementation Conference – Archives are now available!
Presentations, programs, and webinar recordings from the conference held October 5-6, 2016 are now available online.
Courses
UCSF Summer Institute: Research in Implementation Science for Equity (RISE)
The UCSF Research in Implementation Science for Equity (RISE) program is part of the National Heart, Lung, and Blood Institute’s Program to Increase Diversity among Individuals Engaged in Health-Related Research (PRIDE). The goal of the PRIDE program is to enhance the diversity of the biomedical research workforce for junior faculty and transitioning post-doctorates from diverse backgrounds to enable them to become competitive independent scientists.
Realist methodology assists us in understanding the observable and ‘hidden’ forces that produce outcomes in complex health and social interventions. In this 1.5 day workshop, participants will explore the advantages and challenges of using this methodology in evaluating or synthesizing evidence – to move past the question of ‘was it successful?’ to better understanding how, for whom, and under what circumstances interventions produce their particular outcomes. This workshop is suitable for those new to the methodology, as well as those who are currently working on realist projects.
The ambition for this advanced realist methodology workshop is to move toward a collective ‘crossing of the boundary’ of common ideation, using realism as a starting point to advance and optimize concepts in diverse fields. Realist methodology (evaluation and synthesis) has been developed to help us understand how interventions, programmes, policies function given the interaction between underpinning programme mechanisms and corresponding implementation contexts. Using examples and metaphors to understand what it means to analyse this interaction, the intellectual trajectory should take us from “flat” conceptualizations of ontology to what could be called “complexity-mindedness”.
Online
Online Introductory Course on Systematic Reviews and Meta-Analysis
This is an introductory course on systematic reviews and meta-analyses and will be delivered online. It is co-taught by Andrea Tricco (MSc, PhD) and Sharon Straus (MD, MSc). The overall course objective is to teach about systematic reviews in general, as well as how to go about doing a systematic review. This information will be used by the students to conduct a systematic review on the topic of their choice, with guidance from the course instructors.
News
Pressure injuries the ‘scarlet letter’ of patient care
“It’s the scarlet letter,” says Heather Orsted, director of education and professional development at the Canadian Association of Wound Care, noting that pressure injuries most often strike the healthcare system’s most vulnerable: people who are the sickest, most frail or immobilized.
Canadian Frailty Network: December 2016 Issue
Read the latest news and recently published papers from Network Investigators.
Therapy Cats for Dementia Patients, Batteries Included
On this recent Thursday morning, five cats circulated through the room, handed off by therapists from one resident to the next. “We’re using them to warm up the group space,” said Mary Farkas, the director of therapeutic activities at Hebrew Home.
Algonquin College living lab provides respite for dementia patients
Students in health care programs learn from dementia patients in a new daycare setting
Test Predicting Alzheimer’s Would Be Welcome, Survey Finds (US)
If a test could tell them they were going to develop Alzheimer’s disease, most American seniors would take it, a new study finds.
New rules give nursing home residents more power
About 1.4 million people living in nursing homes across the country can now be more involved in their care under the most wide-ranging revision of federal rules for such facilities in 25 years.
Thousands of Canadians languish in limbo as they wait for long-term care
According to the Canadian Institute for Health Information, there were, at last count, 6,671 patients in Canada listed as “alternate level of care,” or ALC, an Orwellian euphemism used to describe patients stuck in this care limbo – too well to be in hospital, not well enough to be at home alone, and no place at the long-term care inn.
My Visit to Cleveland Clinic: Seeing Leaders Engaging Staff in Meaningful Improvement
I had a chance to visit one of their community hospitals, Hillcrest Hospital, as well as the main campus. It was a very stimulating visit and it was great to see the progress they were making in building a “culture of improvement.”
Academics need to make sure their evidence matters
An average paper in a peer-reviewed academic journal is read by no more than 10 people, according to Singapore-based academic, Asit Biswas, and Oxford-researcher, Julian Kirchherr, in their controversial commentary, “Prof, no one is reading you,” which went viral last year. They cite some remarkable statistics – as many as 1.5 million peer-reviewed articles are published annually with as many as 82 percent never cited once, not even by other academics.
Resources
KT Encounters: Challenging Perspectives In Knowledge Translation
KT Encounters is a video series designed to engage people in conversation, to challenge conventions and to deepen understanding about knowledge translation (KT). KT is the broad range of activities meant to improve the use of research evidence in practice, policy and further research. Known by many names (e.g. knowledge mobilization; research to action; knowledge exchange), KT is ultimately about using health research to improve health.
Alzheimer Society Resource to help with a move to Long Term Care
Alzheimer Society of Canada has just launched a new resource to help you, individuals with dementia and their families through the many complex issues in moving to a Long Term Care (LTC) home. All of our resources are available in both English and French. What is the resource? : A four piece set of evidence based resources to support families and individuals with dementia as they: i) Consider a Move to Long Term Care (LTC), ii) Prepare for a Move iii) Handle Moving Day, and iv) Adjust after a Move.
This free interactive and informative e-learning module will be valuable for anyone preparing to move someone into a Long Term Care home. Created by the Alzheimer Society of Ottawa and Renfrew County, the modules are designed to follow the transition process: Preparing for the Move, Day of the Move, and After the Move.
The Playbook: Better Care for People with Complex Needs
This collaborative aims to help health care organizations participating in value-based payment models and adopting evidence-based interventions improve outcomes and lower overall costs of care. As an initial step, they have partnered with the Institute for Healthcare Improvement to create a dynamic website that highlights the challenges facing adults with complex health and social needs and provides direction on how to meet those needs through a variety of resources that detail care models, policies, and more.
AHRQ Develops New Safety Program for Healing Pressure Ulcers (US)
A new training guide has been added to AHRQ’s online resources for helping nursing homes manage pressure ulcers. The guide, part of AHRQ’s Safety Program for Nursing Homes: On-Time Pressure Ulcer Healing, includes videos and exercises for training facilitators to show nursing home staff how on-time reports can track pressure ulcers that are healing too slowly or are at risk for slow healing.
Engaging with Patients and Caregivers about Quality Improvement: A Guide for Health Care Providers
Patient engagement is an essential way of incorporating the voices of patients and caregivers (including family members) into decisions that will affect the care that patients receive. In particular, engaging patients and caregivers in the quality improvement process makes them active participants in improving the health care system and supports the transition to truly patient-centred care.
Opportunities
Implementation Research Institute (IRI) Fellowship
If you wish to join a challenging collaborative of implementation researchers, we invite you to apply to the Implementation Research Institute (IRI). This unique interdisciplinary training program will help you launch a research career in implementation science and will provide: experiential learning, didactic training, and faculty mentoring.
Under the direction of the Platform Lead and Assistant Director of the Alberta SPOR SUPPORT Unit (AbSPORU) Knowledge Translation (KT) Platform, the SPOR KT Project Coordinator is responsible for leading high-level, complex research activities specific to knowledge translation (KT) and evidence synthesis projects. The Project Coordinator will be responsible for the overall management and coordination of Knowledge Translation (KT) projects undertaken by the AbSPORU KT Platform. The individual will work with stakeholders to identify and develop KT plans (End-of-Grant KT or Integrated KT) and coordinate research activities and analysis specific to KT.
Researcher Competition: Integrated Knowledge Translation Cases
We invite researchers to tell us about their experiences using an integrated knowledge translation approach in their work. The most interesting and well-told examples will compiled into a CHIPS (CAHSPR) IKT Casebook that will be published for wider distribution. We also intend to host a session at the 2017 CAHSPR meeting and invite the authors of the chosen cases to present them (if they plan to attend).
