BACKGROUND: Despite substantial research on pediatric pain assessment and management, health care professionals do not adequately incorporate this knowledge into clinical practice. Organizational context (work environment) is a significant factor in influencing outcomes; however, the nature of the mechanisms are relatively unknown. The objective of this study was to assess how organizational context moderates the effect of research use and pain outcomes in hospitalized children. METHODS: A cross-sectional survey was undertaken with 779 nurses in 32 patient care units in 8 Canadian pediatric hospitals, following implementation of a multifaceted knowledge translation intervention, Evidence-based Practice for Improving Quality (EPIQ). The influence of organizational context was assessed in relation to pain process (assessment and management) and clinical (pain intensity) outcomes. Organizational context was measured using the Alberta Context Tool that includes: leadership, culture, evaluation, social capital, informal interactions, formal interactions, structural and electronic resources, and organizational slack (staff, space, and time). Marginal modeling estimated the effects of instrumental research use (direct use of research knowledge) and conceptual research use (indirect use of research knowledge) on pain outcomes while examining the effects of context. RESULTS: Six of the 10 organizational context factors (culture, social capital, informal interactions, resources, and organizational slack [space and time]) significantly moderated the effect of instrumental research use on pain assessment; four factors (culture, social capital, resources and organizational slack time) moderated the effect of conceptual research use and pain assessment. Only two factors (evaluation and formal interactions) moderated the effect of instrumental research use on pain management. All organizational factors except slack space significantly moderated the effect of instrumental research use on pain intensity; informal interactions and organizational slack space moderated the effect of conceptual research use and pain intensity. CONCLUSIONS: Many aspects of organizational context consistently moderated the effects of instrumental research use on pain assessment and pain intensity, while only a few influenced conceptual use of research on pain outcomes. Organizational context factors did not generally influence the effect of research use on pain management. Further research is required to further explore the relationships between organizational context and pain management outcomes.
New article by Dr. Anne-Marie Boström
Methods for objectively assessing clinical masticatory performance: protocol for a systematic review
Non UofA Access
BACKGROUND: Chewing and masticatory function constitutes one of the most important oral health factors that affect quality of life, especially in older individuals. Little consensus currently exists regarding ways to objectively assess clinical masticatory performance (in this context, performance refers an individual’s objective ability to mix or comminute food bolus). That said, many methods were developed to assess masticatory performance. Consequently, systematic review of the literature would be of great value when it comes to identifying various methods for objectively assessing clinical masticatory performance and for evaluating these methods. DESIGN: This study protocol describes a systematic review that intends to (i) identify methods to objectively assess clinical masticatory performance and (ii) evaluate psychometric properties (such as validity and reliability) of the identified methods. A systematic literature search is required to do so in these sources: MEDLINE (Ovid), Embase (embase.com), Web of Science Core Collection (Thomson Reuters), Cochrane (Wiley), and Cinahl (Ebsco). INCLUSION CRITERIA: studies in scientific, full-text articles; development articles; validation articles; studies of the general adult population, ages >/=18. EXCLUSION CRITERIA: topics and article types that cover interview methods and self-reported questionnaires; methods/instruments that measure subjective masticatory performance; qualitative studies and case studies; opinion and editorial pieces; animal studies; studies of humans with severe oral health complications. DISCUSSION: This systematic review will result in a comprehensive assessment of various methods designed to objectively measure clinical masticatory performance. This systematic review will rate these methods, assess their reliability and validity, and identify one or more methods that can be recommended for use in clinical and scientific environments. From what is currently known, no systematic evaluation of various methods for objectively assessing clinical masticatory performance has been published. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42016037700.
Grants & Awards
Canadian Frailty Network is providing up to 10 awards of up to $4,000 each, which must be matched by at least 100% funding guaranteed by the student’s supervisor, with all funds to be used for student salary and benefits only. Each student award covers up to 14 weeks of full-time participation from May 15 to August 17, 2017.
The Health System Impact Fellowship provides highly-qualified individuals with a doctorate degree in health services and policy research, or related fields, a unique opportunity to apply their research and analytic talents to critical challenges in health system and related organizations outside of the traditional scholarly setting (e.g., public, private for-profit, not-for-profit, and Indigenous health organizations that are not universities or research-focused institutes), and to develop professional experience, new skills, and networks. Fellows will be exposed to how the health system and related organizations work, how decisions are made, and how research and analytic skills can contribute to an organization’s performance.
The Emergency Strategic Clinical Network (ESCN) Scientific Office is pleased to announce the 2017 Systematic Review Grant Competition. The maximum amount for a single award will be $15,000, with a total of $45,000 available to applicants. This year’s systematic reviews competition will focus on Transitions in Care (TiC) involving the Emergency Department (ED). The definition of transitions in care refers to its usage by Coleman and Berenson “a set of actions designed to ensure the coordination and continuity of health care as patients transfer between different locations or different levels of care in the same location.”
The University of Alberta Libraries (UAL) and Faculty of Graduate Studies and Research (FGSR) are excited to announce that the Images of Research (IOR) Competition and Exhibition is returning for 2017! Images of Research is an opportunity for current University of Alberta graduate students from all disciplines (part-time or full-time) to capture, share, and present the essence of their research in one image.
Background: Dissemination is a principle within communitybased participatory research (CBPR); however, published research focuses on the dissemination of findings from CBPR projects but less on dissemination of interventions developed through CBPR approaches. To disseminate an evidencebased lifestyle intervention tailored for Native Hawaiians and other Pacific Islanders, the PILI ‘Ohana Project (POP), an 11-year CBPR initiative, developed an innovative dissemination model. Objectives: The community-to-community mentoring (CCM) model described in this paper extends the application of CBPR values and principles used in intervention development to intervention dissemination. Methods: The CCM model combines a CBPR orientation with the diffusion of innovation theory, the social cognitive theory, and key concepts from community organizing and community building to address the multilevel factors that influence uptake of an evidence-based intervention (EBI). Grounding the model in CBPR principles provides benefits for intervention dissemination and integrates a focus on community benefits and capacity building. Conclusions: By establishing co-equal, mutually beneficial relationships at the core of the CCM model, opportunities are created for building critical consciousness, community capacity, and social capital. More research is needed to determine the effectiveness of this model of intervention dissemination which may enhance diffusion of CBPR interventions and empower communities in the process.
BACKGROUND: Capacity building strategies are widely used to increase the use of research in policy development. However, a lack of well-validated measures for policy contexts has hampered efforts to identify priorities for capacity building and to evaluate the impact of strategies. We aimed to address this gap by developing SEER (Seeking, Engaging with and Evaluating Research), a self-report measure of individual policymakers’ capacity to engage with and use research. METHODS: We used the SPIRIT Action Framework to identify pertinent domains and guide development of items for measuring each domain. Scales covered (1) individual capacity to use research (confidence in using research, value placed on research, individual perceptions of the value their organisation places on research, supporting tools and systems), (2) actions taken to engage with research and researchers, and (3) use of research to inform policy (extent and type of research use). A sample of policymakers engaged in health policy development provided data to examine scale reliability (internal consistency, test-retest) and validity (relation to measures of similar concepts, relation to a measure of intention to use research, internal structure of the individual capacity scales). RESULTS: Response rates were 55% (150/272 people, 12 agencies) for the validity and internal consistency analyses, and 54% (57/105 people, 9 agencies) for test-retest reliability. The individual capacity scales demonstrated adequate internal consistency reliability (alpha coefficients > 0.7, all four scales) and test-retest reliability (intra-class correlation coefficients > 0.7 for three scales and 0.59 for fourth scale). Scores on individual capacity scales converged as predicted with measures of similar concepts (moderate correlations of > 0.4), and confirmatory factor analysis provided evidence that the scales measured related but distinct concepts. Items in each of these four scales related as predicted to concepts in the measurement model derived from the SPIRIT Action Framework. Evidence about the reliability and validity of the research engagement actions and research use scales was equivocal. CONCLUSIONS: Initial testing of SEER suggests that the four individual capacity scales may be used in policy settings to examine current capacity and identify areas for capacity building. The relation between capacity, research engagement actions and research use requires further investigation.
Background Research utilization is part of evidence-based practice referring to the process of reviewing and critiquing scientific research and applying the findings to one’s own clinical practice. Many studies on research utilization have been conducted with doctors and nurses, but to our knowledge, none have been investigated amongst pharmacists. Objective To assess research utilization and its barriers among pharmacists and identify potential influencing factors. Setting Malaysia. Methods This cross-sectional survey was administered online and by mail to a convenient sample of pharmacists working in hospitals, health clinics, and retail pharmacies in rural and urban areas. Main outcome measure Pharmacists’ research utilization knowledge, attitudes, and practices. Results Six hundred surveys were mailed to potential respondents, and 466 were returned (77.7% response rate). Twenty-eight respondents completed the survey online. The respondents’ research utilization knowledge, attitudes, and practices were found to be moderate. Research utilization was associated with respondents’ knowledge and attitude scores (P < 0.001). When factors related to research utilization were modelled, higher educational level was associated with higher level of research utilization (P < 0.001) while less involvement in journal clubs, more years of service (3-7 years and more than 7 years) were associated with low and moderate research utilization, respectively. The main reported barrier to research utilization was lack of sufficient authority to change patient care procedures. Conclusion Pharmacists’ research utilization knowledge, attitudes, and practices can be improved by encouraging pharmacists to pursue higher degrees, promoting active participation in institutions’ journal clubs, and introducing senior clinical pharmacist specialization.
An introduction is presented in which the editor discusses various reports within the issue on topics including moral economy of health technology assessment (HTA) professionals, strategies to increase evidence use and workplace programme to increase levels of employment.
Transferring knowledge into action is challenging. Ward et al (2009a) developed a framework for bridging this gap. This article describes what helps and hinders getting knowledge into action when using this approach in the field of mental health. Four areas of Scotland were selected which had used resources to inform local planning and participants were interviewed. The resources helped galvanise local action on outcomes and the transfer of evidence into policy. It also facilitated building stronger relationships. Using a knowledge-brokering approach to transfer knowledge into action yielded positive feedback from participants and may have mitigated some prior barriers and enhanced facilitators.
This study explored macro, meso and micro-level influences on the role of evidence in the development of six health policies in India and Nigeria. Macro-level influences included adoption of international agreements, movement towards evidence-informed policymaking, committed country leadership and resource environment. At meso level, national actors drove policy processes with support from the international actors. Micro-level influences included individual values, interests and evidence preferences. Factors at three levels are interrelated. Greater understanding of contextual influences can provide a platform for adapting to, or managing, these influences to improve the evidence-informed nature of health policymaking. ABSTRACT FROM AUTHOR]; Copyright of Evidence & Policy: A Journal of Research, Debate & Practice is the property of Policy Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder’s express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.
Health Care Administration and Organization
BACKGROUND: Recent evidence suggests that an increase in baccalaureate-educated registered nurses (BRNs) leads to better quality of care in hospitals. For geriatric long-term care facilities such as nursing homes, this relationship is less clear. Most studies assessing the relationship between nurse staffing and quality of care in long-term care facilities are US-based, and only a few have focused on the unique contribution of registered nurses. In this study, we focus on BRNs, as they are expected to serve as role models and change agents, while little is known about their unique contribution to quality of care in long-term care facilities. METHODS: We conducted a cross-sectional study among 282 wards and 6,145 residents from 95 Dutch long-term care facilities. The relationship between the presence of BRNs in wards and quality of care was assessed, controlling for background characteristics, i.e. ward size, and residents’ age, gender, length of stay, comorbidities, and care dependency status. Multilevel logistic regression analyses, using a generalized estimating equation approach, were performed. RESULTS: 57% of the wards employed BRNs. In these wards, the BRNs delivered on average 4.8 min of care per resident per day. Among residents living in somatic wards that employed BRNs, the probability of experiencing a fall (odds ratio 1.44; 95% CI 1.06-1.96) and receiving antipsychotic drugs (odds ratio 2.15; 95% CI 1.66-2.78) was higher, whereas the probability of having an indwelling urinary catheter was lower (odds ratio 0.70; 95% CI 0.53-0.91). Among residents living in psychogeriatric wards that employed BRNs, the probability of experiencing a medication incident was lower (odds ratio 0.68; 95% CI 0.49-0.95). For residents from both ward types, the probability of suffering from nosocomial pressure ulcers did not significantly differ for residents in wards employing BRNs. CONCLUSIONS: In wards that employed BRNs, their mean amount of time spent per resident was low, while quality of care on most wards was acceptable. No consistent evidence was found for a relationship between the presence of BRNs in wards and quality of care outcomes, controlling for background characteristics. Future studies should consider the mediating and moderating role of staffing-related work processes and ward environment characteristics on quality of care.
BACKGROUND: Pain assessment and management are key aspects in the care of people with dementia approaching the end of life but become challenging when patient self-report is impaired or unavailable. Best practice recommends the use of observational pain assessments for these patients; however, difficulties have been documented with health professionals’ use of these tools in the absence of additional collateral patient knowledge. No studies have explored the role, perspectives and experiences of healthcare assistants in pain assessment and management in dementia; this study provides insight into this important area. METHODS: A qualitative approach was adopted, using key informant interviews with healthcare assistants caring for people with advanced dementia approaching the end of life in hospice, nursing home and acute care settings. Thematic analysis was the analytic approach taken to interpretation of interview data. Data were collected between June 2014 and September 2015. RESULTS: Fourteen participants took part in the study. Participants’ average length of caring experience was 15.4 years and most were female. Three key themes emerged: recognising pain, reporting pain, and upskilling. Participants were often the first to notice obvious causes of pain and to detect changes in patient norms which signified hidden causes of pain. Comprehensive knowledge of resident norms enabled participants to observe for behavioural and nonverbal indicators of pain and distinguish these from non-pain related behaviours. Pain reporting was heavily impacted by relationships with professional staff and the extent to which participants felt valued in their role. Positive relationships resulted in comprehensive pain reports; negative relationships led to perfunctory or ambiguous reporting. Participants emphasised a desire for further training and upskilling, including in the use and reporting of basic pain tools. CONCLUSIONS: Healthcare assistants are frontline staff who have a key role in direct patient care, spending a considerable amount of time with patients in comparison to other health professionals. These staff are often first to notice changes in patients that may signify pain and to alert professional staff. However, to ensure the quality of these reports, further efforts must be made in reversing stigma attached to this role and in upskilling these members of the healthcare team.
BACKGROUND: Workplace stress is a complex phenomenon that may often be dynamic and evolving over time. Traditional linear modeling does not allow representation of recursive feedback loops among the implicated factors. The objective of this study was to develop a multidimensional system dynamics model (SDM) of workplace stress among nursing aides and conduct simulations to illustrate how changes in psychosocial perceptions and workplace factors might influence workplace stress over time. METHODS: Eight key informants with prior experience in a large study of US nursing home workers participated in model building. Participants brainstormed the range of components related to workplace stress. Components were grouped together based on common themes and translated into feedback loops. The SDM was parameterized through key informant insight on the shape and magnitude of the relationship between model components. Model construction was also supported utilizing survey data collected as part of the larger study. All data was entered into the software program, Vensim. Simulations were conducted to examine how adaptations to model components would influence workplace stress. RESULTS: The SDM included perceptions of organizational conditions (e.g., job demands and job control), workplace social support (i.e., managerial and coworker social support), workplace safety, and demands outside of work (i.e. work-family conflict). Each component was part of a reinforcing feedback loop. Simulations exhibited that scenarios with increasing job control and decreasing job demands led to a decline in workplace stress. Within the context of the system, the effects of workplace social support, workplace safety, and work-family conflict were relatively minor. CONCLUSION: SDM methodology offers a unique perspective for researchers and practitioners to view workplace stress as a dynamic process. The portrayal of multiple recursive feedback loops can guide the development of policies and programs within complex organizational contexts with attention both to interactions among causes and avoidance of adverse unintended consequences. While additional research is needed to further test the modeling approach, findings might underscore the need to direct workplace interventions towards changing organizational conditions for nursing aides.
BACKGROUND: The growth in the number of older adults in the United States requires appropriately prepared health care providers at all levels who will be able to effectively care for this population. First-line caregivers such as certified nursing assistants (CNAs) need education and training in end-of-life care so they can provide high-quality care for residents and families in the long-term-care (LTC) setting. METHOD: CNAs were recruited from an LTC facility in western New York to attend an educational intervention consisting of six 45-minute sessions on various topics selected by the researchers using the curriculum from the Core Curriculum for the Hospice and Palliative Nursing Assistant. Pretests and posttests were administered to assess changes in knowledge, and a satisfaction survey was used for the CNAs to identify additional learning needs. RESULTS: Nineteen CNAs completed the six education and training sessions. Data analysis revealed a significant increase in knowledge for the participants. CNAs were also able to identify additional learning needs. CONCLUSION: Significant improvement in knowledge was seen after the CNAs attended the educational intervention. CNAs working in LTC facilities need education and training in end-of-life care so they can provide appropriate and effective care to residents and their families. Education and training for CNAs led to increased knowledge of end-of-life care and desire for more educational opportunities.
Health Care Innovation and Quality Assurance
Should we educate care staff to improve the oral health and oral hygiene of people with intellectual disability in residential care? Real world lessons from a randomized controlled trial
Non UofA Access
This study assessed the impact of a multitiered oral health educational program on the oral health and oral hygiene of people with intellectual disabilities (ID). In a controlled pretest, posttest trial, with cluster randomization, a pyramidal training program was delivered to residential staff who cared for a randomly allocated, purposively stratified intervention group of people with ID living in community care homes. A control group lived in centers where staff received no training. Clinical measures were carried out pre- and posttest. Difference in Modified Gingival Index (MGI) and Plaque Index (PI) was measured posttest using ANCOVA. Seventy-six participants took part, representing 49.0% of the invited sample (n = 155). Fourteen did not receive clinical examination. There was one dropout 6-9 months later. A 10.5% and 8.5% reduction in mean MGI and PI was evident at posttest but did not show statistically significant difference, when controlling for baseline covariates (p > 0.05, ANCOVA). Mean MGI and PI scores were not significantly different among people with ID whose care staff had and had not received oral health training. Limitations are discussed. The results indicate that this program failed to significantly improve oral health or oral hygiene, despite the intervention being “educationally” successful. More research is needed.
A cluster randomized controlled trial showed that the Resident Assessment Instrument (RAI) could not improve or stabilize the health status of people in need of long-term care or reduce the rate of institutionalization in Germany among clients of home care agencies. The aim of this article is to investigate whether the effect of RAI depends on the degree of implementation. A factor analysis was used to distinguish between those agencies that implemented RAI intensively and those that did not. The clients of home care agencies working intensively with RAI were significantly less hospitalized (P = 0.0284) and fared slightly better according to activities of daily living (ADL, instrumental ADL (IADL)), cognitive skills (Mini-Mental Status Test (MMST)) and quality of life (EuroQol (EQ-5D)) compared with the control group. In contrast, those not working intensively with RAI had worse outcomes (IADL, MMST, EQ-5D) than the control group (not significant). It is important to guarantee a successful implementation of RAI.
BACKGROUND: The literature suggests that person-centred care can contribute to quality of life and wellbeing of nursing home residents, relatives and staff. However, there is sparse research evidence on how person-centred care can be operationalised and implemented in practice, and the extent to which it may promote wellbeing and satisfaction. Therefore, the U-Age nursing home study was initiated to deepen the understanding of how to integrate person-centred care into daily practice and to explore the effects and meanings of this. METHODS: The study aims to evaluate effects and meanings of a person-centred and thriving-promoting intervention in nursing homes through a multi-centre, non-equivalent controlled group before-after trial design. Three nursing homes across three international sites have been allocated to a person-centred and thriving-promoting intervention group, and three nursing homes have been allocated to an inert control group. Staff at intervention sites will participate in a 12-month interactive educational programme that operationalises thriving-promoting and person-centred care three dimensions: 1) Doing a little extra, 2) Developing a caring environment, and 3) Assessing and meeting highly prioritised psychosocial needs. A pedagogical framework will guide the intervention. The primary study endpoints are; residents’ thriving, relatives’ satisfaction with care and staff job satisfaction. Secondary endpoints are; resident, relative and staff experiences of the caring environment, relatives’ experience of visiting their relative and the nursing home, as well as staff stress of conscience and perceived person-centredness of care. Data on study endpoints will be collected pre-intervention, post-intervention, and at a six-month follow up. Interviews will be conducted with relatives and staff to explore experiences and meanings of the intervention. DISCUSSION: The study is expected to provide evidence that can inform further research, policy and practice development on if and how person-centred care may improve wellbeing, thriving and satisfaction for people who reside in, visit or work in nursing homes. The combination of quantitative and qualitative data will illuminate the operationalisation, effects and meaning of person-centred and thriving-promoting care. TRIAL REGISTRATION: The trial was registered at ClinicalTrials.gov March 19, 2016, identifier NCT02714452.
BACKGROUND: Physical activity (PA) levels of older adults living in a care setting are known to be very low. This is a significant health(care) problem, as regular PA has many health benefits also at advanced age. Research on automatic processes underlying PA behaviour in physically inactive older adults is yet non-existing. Since people are unconsciously influenced by people around them (i.e. by ‘social norms’) automatic processes could be used to promote PA. We developed an explorative intervention method to assess the effects of automatically processed (implicit) descriptive social norms (‘What most people do’) on behavioral intention and participation in PA offered in a local residential care setting. METHODS: Forty-seven care clients met the inclusion criteria. Participants (response 45%; unaware of the intention of the research) were randomly assigned to an experimental (N = 10) or a control group (N = 11). The experimental group was exposed to photos and text heading on active peers (physically active implicit descriptive norm) using a draft newsletter article they were asked to comment on, whereas the control group was exposed to a newsletter with photos and text heading of inactive peers (physically inactive implicit descriptive norm). Subsequently, we tested (Fishers exact p < 0.10) whether this unaware exposure predicted intention (implicit and explicit) to participate in PA offered and organized by the care center (e.g. walking, gymnastics) and self-reported participation in organised PA at three months follow-up. Participants were debriefed later. RESULTS: Mean age was 87 years (SD = 3.6; range 80-95) and 53% of the participants were male. At baseline, there were no significant differences in self-rated health and PA between the experimental and control group. Results indicated that implicit descriptive norm information was associated with implicit PA intention (p = .056, Fisher’s exact test). No significant effects were found on explicit intention. At 3 months follow-up the experimental group self-reported 80% participation in PA versus 22% in the control group (Fisher’s exact test p = 0.027). CONCLUSION: Implicit descriptive social norm information could indeed be a potentially effective way to encourage inactive older adults in residential care to engage in organized PA.
Institutionalization is generally a consequence of functional decline driven by physical limitations, cognitive impairments, and/or loss of social supports. At this stage, intervention to reverse functional losses is often too late. To be more effective, geriatric medicine must evolve to intervene at an earlier stage of the disability process. Could nursing homes (NHs) transform from settings in which many residents dwell to settings in which the NH residents and those living in neighboring communities benefit from staff expertise to enhance quality of life and maintain or slow functional decline? A task force of clinical researchers met in Toulouse on December 2, 2015, to address some of these challenges: how to prevent or slow functional decline and disabilities for NH residents and how NHs may promote the prevention of functional decline in community-dwelling frail elderly. The present article reports the main results of the Task Force discussions to generate a new paradigm.
This article outlines the development of a new way of working across a group of care homes in south east Wales, based on a philosophy of relationship-centred care and an ethos of empowerment for older people in the homes. The underpinning aim was to enable residents to have a good quality of life, reflecting recommendations made by the Older People’s Commissioner for Wales in a 2014 review into the quality of life and care of older people living in care homes in the country. After the introduction of the new way of working, the care home group were approached by a university to take part in a collaborative project offering nursing students clinical placements in the care homes, mentored by registered nurses employed there. The collaboration between the university and the care homes meant that nursing students became enveloped in the person-centred culture, receiving positive exposure to nursing older people early in their careers. It is hoped that the clinical placements may encourage them to consider careers in the specialty.
BACKGROUND AND OBJECTIVE: Although oral care may have salutary effects among frail elderly people, access to dental care is often limited in long-term care facilities. In 2009, the Japanese long-term care insurance system introduced an additional reimbursement scheme for enhanced oral care supervised by dentists in nursing facilities. The aim of this study was to examine whether enhanced oral care provided by trained nursing facility staff members is sufficient to improve health outcomes among nursing facility residents. DESIGN, SETTING, AND PARTICIPANTS: This was a quasi-experimental study using a nationwide long-term care database. Using facility-level propensity score matching, we identified 170,874 residents in 742 facilities that provided enhanced oral care and 167,546 residents in 742 control facilities that provided only standard care from 2009 to 2012. We used a resident-level difference-in-differences approach to analyze the impact of enhanced oral care on health outcomes among nursing facility residents. RESULTS: After controlling for resident characteristics and background time trends, no significant differences were found between residents admitted to the facilities with and without enhanced oral care in the incidence of critical illness, transfer to a hospital, mortality, or costs. Yearly change in the odds of discharge to home was significantly increased for residents with enhanced oral care (odds ratio = 1.07; 95% confidence interval: 1.02-1.12; P = .008). CONCLUSION: The results suggest that enhanced oral care provided by trained nursing facility staff members may improve the general condition of elderly residents in nursing facilities and promote their discharge to home.
OBJECTIVES: Physical activity may have positive effects on decreasing anxiety, stress and depression, maintaining mental health and ensuring psychological vitality.This study aimed to determine how a “Physical Activity Program” for elderly people in nursing homes affected their depressive symptoms and quality of life. METHODS: We included 80 individuals aged >65years (40 in the intervention group, 40 controls) in this experimental, randomized, controlled pretest-posttest study. Besides socio-demographic data, depressive symptoms and quality of life were assessed by standardized procedures (Beck Depression Scale [BDI], SF 36 Quality of Life Questionnaire) before and after a ten-weeks lasting “Physical Activity Program”, consisting of 10min warm-up activities, 20 minutes rhythmic exercices, 10min cool-down exercises and a 30 minutes free walking period on four days of the week. RESULTS: In contrast to controls, individuals of the intervention group presented with a significant decrease in the BDI after the “Physical Activity Program”. Likewise, eight-subscales and two sub-dimensions of the SF 36 Quality of Life Questionnaire significantly improved only in the experimental group (p<0.05). CONCLUSIONS: Our results suggest that a structured physical activity program positively impacts depressive symptoms and quality of life in elderly individuals.
Purpose The purpose of this paper is to explore potential differences in how nursing home residents rate care quality and to explore cluster characteristics. Design/methodology/approach A cross-sectional design was used, with one questionnaire including questions from quality from patients’ perspective and Big Five personality traits, together with questions related to socio-demographic aspects and health condition. Residents ( n=103) from four Norwegian nursing homes participated (74.1 per cent response rate). Hierarchical cluster analysis identified clusters with respect to care quality perceptions. chi2 tests and one-way between-groups ANOVA were performed to characterise the clusters ( p<0.05). Findings Two clusters were identified; Cluster 1 residents (28.2 per cent) had the best care quality perceptions and Cluster 2 (67.0 per cent) had the worst perceptions. The clusters were statistically significant and characterised by personal-related conditions: gender, psychological well-being, preferences, admission, satisfaction with staying in the nursing home, emotional stability and agreeableness, and by external objective care conditions: healthcare personnel and registered nurses. Research limitations/implications Residents assessed as having no cognitive impairments were included, thus excluding the largest group. By choosing questionnaire design and structured interviews, the number able to participate may increase. Practical implications Findings may provide healthcare personnel and managers with increased knowledge on which to develop strategies to improve specific care quality perceptions. Originality/value Cluster analysis can be an effective tool for differentiating between nursing homes residents’ care quality perceptions.
BACKGROUND: Reducing avoidable hospitialisation of aged care facility (ACF) residents can improve the resident experience and their health outcomes. Consequently many variations of hospital avoidance (HA) programs continue to evolve. Nurse practitioners (NP) with expertise in aged care have the potential to make a unique contribution to hospital avoidance programs. However, little attention has been dedicated to service evaluation of this model and the quality of care provided. The purpose of this study was to evaluate the quality of an aged care NP model of care situated within a HA service in a regional area of Australia. METHODS: Donabedian’s structure, process and outcome framework was applied to evaluate the quality of the NP model of care. The Australian Nurse Practitioner Study standardised interview schedules for evaluating NP models of care guided the semi-structured interviews of nine health professionals (including ACF nurses, medical doctors and allied health professionals), four ACF residents and their families and two NPs. Theory driven coding consistent with the Donabedian framework guided analysis of interview data and presentation of findings. RESULTS: Structural dimensions identified included the ‘in-reach’ nature of the HA service, distance, limitations of professional regulation and the residential care model. These dimensions influenced the process of referring the resident to the NP, the NPs timely response and interactions with other professionals. The processes where the NPs take time connecting with residents, initiating collaborative care plans, up-skilling aged care staff and function as intra and interprofessional boundary spanners all contributed to quality outcomes. Quality outcomes in this study were about timely intervention, HA, timely return home, partnering with residents and family (knowing what they want) and resident and health professional satisfaction. CONCLUSIONS: This study provides valuable insights into the contribution of the NP model of care within an aged care, HA service and how staff manipulated the process dimensions to improve referral to the NPs. NP service in this study was dynamic, flexible and responsive to both patient and organisational demands.
OBJECTIVE: We quantified transdermal fentanyl prescribing in elderly nursing home residents without prior opioid use or persistent pain, and the association of individual and facility traits with opioid-naive prescribing. DESIGN: Cross-sectional study. SETTING: Linked Minimum Data Set (MDS) assessments; Online Survey, Certification and Reporting (OSCAR) records; and Medicare Part D claims. PARTICIPANTS: From a cross-section of all long-stay US nursing home residents in 2008 with an MDS assessment and Medicare Part D enrollment, we identified individuals (>/=65 years old) who initiated transdermal fentanyl, excluding those with Alzheimer disease, severe cognitive impairment, cancer, or receipt of hospice care. MEASUREMENTS: We used Medicare Part D to select beneficiaries initiating transdermal fentanyl in 2008 and determined whether they were “opioid-naive,” defined as no opioid dispensing during the previous 60 days. We obtained resident and facility characteristics from MDS and OSCAR records and defined persistent pain as moderate-to-severe, daily pain on consecutive MDS assessments at least 90 days apart. We estimated associations of patient and facility attributes and opioid-naive fentanyl initiation using multilevel mixed effects logistic regression modeling. RESULTS: Among 17,052 residents initiating transdermal fentanyl, 6190 (36.3%) were opioid-naive and 15,659 (91.8%) did not have persistent pain. In the regression analysis with adjustments, residents who were older (ages >/=95 odds ratio [OR] 1.69, 95% confidence interval [CI] 1.46-1.95) or more cognitively impaired (moderate-to-severe cognitive impairment, OR 1.99, 95% CI 1.73-2.29) were more likely to initiate transdermal fentanyl without prior opioid use. CONCLUSION: Most nursing home residents initiating transdermal fentanyl did not have persistent pain and many were opioid-naive. Changes in prescribing practices may be necessary to ensure Food and Drug Administration warnings are followed, particularly for vulnerable subgroups, such as the cognitively impaired.
OBJECTIVES: Malnutrition in older persons is associated with an increased risk of mortality. Useful strategies to counteract malnutrition are nutritional interventions, such as fortified diets, oral nutritional supplements (ONS), tube feeding, and parenteral nutrition. Presently, it is not known if these strategies can reduce mortality risk of nursing home (NH) residents who are malnourished or at risk of malnutrition. Thus, the aim of this study was to investigate if nutritional intake and interventions are associated with mortality in this specific population. DESIGN: One-day cross-sectional study with outcome evaluation after 6 months, repeated in yearly intervals since 2007. SETTING: A total of 507 NH units from 15 countries. PARTICIPANTS: NH residents participating in the nutritionDay between 2007 and 2014, aged 65 years or older with a poor nutritional status (body mass index 5 kg in the last year or at risk of malnutrition or malnourished according to NH staff). MEASUREMENTS: Data on resident and unit level were collected on nutritionDay and mortality status was assessed 6 months later. Residents’ nutrition (intake at lunch on nutritionDay) and nutritional interventions (diet, use of ONS, supplementary tube feeding, supplementary parenteral nutrition) were of interest as influencing factors of 6-month mortality, adjusted for 23 potential confounders (residents’ nutritional status, general residents’ characteristics, and unit characteristics). Univariate generalized estimating equations were performed for all variables and significant predictors (P 5 kg in the last year or at risk of malnutrition or malnourished according to NH staff). MEASUREMENTS: Data on resident and unit level were collected on nutritionDay and mortality status was assessed 6 months later. Residents’ nutrition (intake at lunch on nutritionDay) and nutritional interventions (diet, use of ONS, supplementary tube feeding, supplementary parenteral nutrition) were of interest as influencing factors of 6-month mortality, adjusted for 23 potential confounders (residents’ nutritional status, general residents’ characteristics, and unit characteristics). Univariate generalized estimating equations were performed for all variables and significant predictors (P 5 kg in the last year, body mass index <20 kg/m2, residents’ country region, and increasing age were also associated with a higher mortality risk. CONCLUSIONS: Poor intake at lunch on nutritionDay was a strong predictor of mortality, whereas the use of nutritional interventions was not associated with 6-month mortality in NH residents who are malnourished or at risk of malnutrition. The reasons for these findings need to be clarified.
BACKGROUND: Persons with dementia have described life in nursing home as difficult and lonely. Persons with dementia often reside in nursing homes for several years; therefore, knowledge is needed about how quality of life is affected in the nursing-home setting in order to be able to provide the best possible care. The aim of this study was to investigate the personal experience of living in a nursing home over time from the perspective of the person with dementia and to learn what makes life better or worse in the nursing home. METHODS: A phenomenological hermeneutic research design was applied. Unstructured, face-to-face interviews and field observations were conducted twice, three months apart. RESULTS: Twelve persons residing in three different nursing homes were included. The analysis revealed four themes: “Being in the nursing home is okay, but you must take things as they are”; “Everything is gone”; “Things that make it better and things that make it worse”; and “Persons – for better or worse? Staff, family, and co-residents”. CONCLUSIONS: Persons with dementia are able to communicate their feelings and thoughts about their lives in the nursing home and can name several factors that have impacts on their quality of life. They differentiate between members of the staff, and they prefer their primary nurse. They are content with life in general, but everyday life is boring, and their sense of contentment is based on acceptance of certain facts of reality and their ability to adjust their expectations.
AIM: In Western countries, older adults’ needs are often managed through institutionalization. Based on the assumption that quality of life, particularly social relationships, may be perceived differently according to residential setting, the aims of this study were to compare World Health Organization Quality of Life brief version (WHOQOL-BREF) scores of elderly community-dwelling residents and nursing home residents. METHODS: A sample of 207 older adults (135 community-dwelling residents, 72 nursing home residents) was evaluated with Mini-Mental State Examination (MMSE), WHOQOL-BREF, and Geriatric Depression Scale (GDS). RESULTS: Nursing home residents achieved lower WHOQOL-BREF scores on the physical health scale only (P = 0.002). In a linear regression model, physical score correlated negatively with GDS score (P = 0.0001) and Mini-Mental State Examination score (P = 0.04), but positively with male gender (P = 0.02) and community-dwelling residence (P = 0.001); psychological score correlated negatively with GDS score (P = 0.0001) and being married (P = 0.03), but positively with male gender (P = 0.009) and being unmarried (P = 0.03). The social relationships score correlated negatively with the GDS score (P = 0.0001) and male gender (P = 0.02), but positively with high education level (P = 0.04). The environment score negatively correlated with GDS score (P = 0.0001). In a logistic regression model, living in a nursing home correlated with female gender (P = 0.001), age (P = 0.0001), a lower physical score (P = 0.0001), and a higher social relationships score (P = 0.02). CONCLUSION: Depressive symptoms correlated with low scores in all WHOQOL-BREF domains. The variables that correlated with living conditions in a nursing home were older age, male gender, lower physical domain scores, and higher social relationship scores. Opportunities for socialization in nursing homes may thus improve perception of quality of life in this domain.
Join us to hear Drs. Christian Beaulieu (Foundation recipient), Tania Bubela (Stage 3 Scientific Officer), and Matthias Götte (Stage 2 Reviewer) share their insights on preparing a Stage 2 Foundation application and the associated Stage 2/3 peer review process.
The program is designed to build the capacity of policymakers, stakeholders and researchers who are interested in developing a range of skills including: 1) finding and using research evidence to inform their work related to prioritizing problems to address, and developing and implementing policies and programs; and 2) understanding the political factors that shape the processes underlying the prioritization of problems and the development and implementation of policies and programs.
CADTH is pleased to present a two-day introductory workshop on network meta-analysis (NMA) — the statistical method used to compare multiple treatments and their alternatives simultaneously. Led by Dr. George Wells, a world-renowned methodologist and international expert in NMA, the workshop will provide an overview of NMA and its applications, including demonstrations of worked examples and hands-on sessions in which participants will work through real-world examples. An optional third day will cover integrating NMA findings into health economics evaluations and other advanced concepts.
Want to be at the leading edge of the fast paced field of how to bring the best evidence to bear on pressing policy issues in support of health system strengthening? Don’t miss your chance to attend this two-day workshop organized and sponsored by the Alberta SPOR Support Unit in collaboration with the McMaster Health Forum.
Presenters from the American Association for the Advancement of Science (AAAS) will lead an interactive session focusing on researcher involvement in public communication of science and how to connect with specific audiences. The workshop will close with a special one-hour session focusing on strategic social media and online science communication. Workshop registration questions – Please contact Tracy Bauman: firstname.lastname@example.org
A leading international conference for health care professionals and academics involved in or interested in research relevant to nursing.
Be part of the conversation! Session 3: Tools & Resources to Improve Prescribing – Canadian and International Perspectives. This interactive On Call session will be presented by experts who are leading efforts to improve prescribing in the elderly across Canada and hosted by Kaye Phillips, Senior Director, CFHI, and Jennifer Major, Senior Improvement Lead, CFHI.
Learn about CFHI’s open call for innovations to identify high-impact models and practices in palliative and end-of-life care in Canada.
Learning Objectives: 1) Understand the substantive role middle managers play in implementation processes, 2) Identify factors influencing their commitment to innovation implementation, 3) Consider potential strategies to optimize their role in innovation implementation. This session is offered by WebEx from St. Michael’s Hospital in Toronto. All registration requests should be sent to Gail Klein: email@example.com by Wednesday, February 8th at 12:00 PM ET.
On behalf of the Institute for Continuing Care Education and Research, please join us as we explore various approaches to communicating with individuals with responsive behaviours and other communication barriers. Communication, both verbal and non-verbal, is critical when caring for people with dementia and other complex conditions. Communication is where the clinical aspects and the supportive aspects of everyday lives meet. ICCER wants to help support person and family-centred care by encouraging a mindful approach to communication. Our speakers for the day include Mark Marcynuk and Dr. Jeff Small. Registration available via videoconference.
Dr. Lori Wozney, Research Associate at the Centre for Research in Family Health (www.crfh.ca) and human performance technologist. She completed her PhD in Educational Technology at Concordia University, will be presenting on the topic of Realist Reviews.
Dr. Cheryl Currie, AIHS Translational Chair in Aboriginal Health & Wellness and Assistant Professor of Public Health in the Faculty of Health Sciences at the University of Lethbridge will be presenting on the topic of Translational Research.
The 3-Part Webcast Series: Essential Practices to Facilitate Implementation of WIOA archive is now available. Presenters in this series focus on the essential practices for VR professionals to facilitate the implementation of the Workforce Innovation and Opportunity Act (WIOA).
This section of the Expo features archived presentations and files from the 2016 KT Conference. These include captioned YouTube videos, edited transcripts, and downloadable copies of presentation files (PDF and text versions).
In the maturing world of knowledge translation, community organizations are key research users who have a lot to offer. Integrated knowledge translation (iKT) takes full advantage of their potential by engaging research users as equal partners alongside researchers throughout the entire research process, resulting in research that is applicable, useful, and translatable to end-users. However, how to engage community organizations in this process remains a mystery to many researchers. In attempt to demystify this process, this presentation explores a community organization’s tips on how to successfully (and unsuccessfully) engage them as research users in iKT partnerships.
Many physicians interested in research will go on to become authors, peer reviewers, and scientific editors of research journals. However, the literature indicates that they are likely to be unprepared for any of these roles. The Introduction to Publication Science course adopts a comprehensive, evidence-based approach to the publication process by introducing participants to the principles of publication science (i.e., Journalology).
A shocking claim, based on figures from the Office of National Statistics. The data for England and Wales shows that in 2015, hunger and/or dehydration were a factor in 828 patient deaths in hospitals and care homes.
Welcome to the Green House, a reimagined nursing home near Hershey, Pennsylvania. Williard and her nine elderly housemates are beneficiaries of a growing movement to transform nursing homes from medicalized institutions to places that feel much more like home.
Current healthcare reform efforts promote the related ideas that patients ought to be involved in their own care, and that patient satisfaction is a key measure of healthcare quality. U.S. primary care practices have clearly gotten the message: A recent survey by the New Medical Group Management Association found that 85% of practices conduct patient satisfaction surveys.
Decades of underfunding has seen dementia research lagging more than 20 years behind the progress seen in cancer research, which sees more than six times more funding than dementia. David Cameron’s new role as President of Alzheimer’s Research UK will help to keep the spotlight on dementia at a time when we’re all putting the foot on the gas to accelerate dementia research.
Common viruses pose a serious threat in nursing homes, often sabotaging standard infection control measures, a new case study suggests.
Hospitalization-related delirium may speed mental decline in patients with dementia, a new study suggests.
We talked about how good writers will show in the first paragraph — sometimes in the first sentence — what’s at stake and how that can set up the rest of the book for the reader. They will pose an interesting question. They will know what their authority is to speak about their topic and bring passion to the page. In good essays and articles, they will work against a commonly held stereotype or misconception. They’ll focus on a controversy, and the reader will understand immediately why it matters.
Don’t expect vast riches. Across academe, there is a lot of variation in the amount academics are compensated to speak — depending on the prestige of the speaker, the nature of the invitation, the type of institution, and the size of the audience. Some academics earn speaking fees of $1,000 or more. Some have never received more than $500 as an honorarium. And still others have given plenty of talks yet never been paid. (Based on a nonscientific Twitter poll I conducted, very few academics have ever received more than $2,000 as an honorarium, and many have never been compensated.)
Mistakes happen in science, as they do in all professions. But owning up to scientific mistakes can be particularly difficult given the job description (to describe the world accurately), the extent to which professional prestige is often bound up with a researcher’s sense of self-worth, the key role that papers play in building scientific reputations and the enormous difficulty, from the outside, of distinguishing cock-up from something more sinister.
When I interview faculty job candidates, I always point out that their department will want to own them, and keep them focused on the departmental curriculum and major. As dean, my job is to remind faculty https://chroniclevitae.com/news/1671-get-out-of-your-departmentmembers that outside their department lies a big university that needs them, too. The business of my college and the larger university can only get done if professors take an interest in campus governance and in (with apologies to those who are allergic to corporate language) innovation.
When I read these drafts I quite often see a paper that doesn’t have a clear warrant. The writer hasn’t yet established the need for the research that the paper reports. It’s not that they don’t know it, they just haven’t communicated it in ways that will make sense to, and connect with, their readers. And that means – in paper writing terms – that the introduction and the conclusion in particular aren’t doing their job.
Researchers of all ilk care about bias and how it may creep into their research designs resulting in measurement error. This is true among quantitative researchers as well as among qualitative researchers who routinely demonstrate their sensitivity to potential bias in their data by way of building interviewer training, careful recruitment screening, and appropriate modes into their research designs. It is these types of measures that acknowledge qualitative researchers’ concerns about quality data; and yet, there are many other ways to mitigate bias in qualitative research that are often overlooked.
Dementia is a complex condition and every person’s experience is different. However, many people living with dementia do face similar challenges with communication. Often the small changes we make in our approach can make a big difference in avoiding communication difficulties or frustration, and can also help build and maintain good relationships.
Dr. Cory Ingram, MD, Medical Director of Palliative Medicine – Andreas Cancer Center, Mayo Clinic Health System, in conversation with Virtual Hospice about the impact that a diagnosis of dementia has on family caregivers.
Care UK developed a booklet that includes advice and tips on how to improve verbal and nonverbal communication between caregivers, families and friends of people living with dementia.
The Alberta Clinical Research Roadmap is an interactive navigator outlining the steps to setting up and conducting a clinical health research study within Alberta.
This tool is intended to assist in the assessment of infection control programs and practices in nursing homes and other long-term care facilities. If feasible, direct observations of infection control practices are encouraged. To facilitate the assessment, health departments are encouraged to share this tool with facilities in advance of their visit.
The Framework for Safe, Reliable, and Effective Care provides clarity and direction to health care organizations on the key strategic, clinical, and operational components involved in achieving safe and reliable operational excellence — a “system of safety,” not just a collection of stand-alone safety improvement projects.
This book summarises the main challenges and good practices to support improvements in health care quality, and to help ensure that the substantial resources devoted to health are being used effectively in supporting people to live healthier lives.
Canada’s Strategy for Patient-Oriented Research (SPOR) is about ensuring that the right patient receives the right intervention at the right time. The objective of SPOR is to foster evidence-informed health care by bringing innovative diagnostic and therapeutic approaches to the point of care, so as to ensure greater quality, accountability, and accessibility of care. Under direction from the Assistant Director, Knowledge Translation (KT) Platform, Alberta SPOR SUPPORT unit, the Program Coordinator – Training and Professional Development will lead the Training and Professional Development program within the SPOR KT Platform, addressing the areas of knowledge synthesis, knowledge translation and implementation science.
This opportunity will allow the fellow to develop a program of research in the area of the health of the Francophone population in the minority context, with a focus that can be tailored to interest and opportunities for funding that arise. Topics may include: measuring health determinants and status, health care system performance measurement, health care access, quality and safety, health care costs and efficiency, care transitions, language barriers, and data quality of the linguistic variables.