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New article by Dr. Estabrooks
The Canadian dementia challenge: Ensuring optimal care and services for those at risk or with dementia throughout the country
Abstract: In the next 15 years, Canada is predicted to face a doubling in its population affected by dementia. By 2038, an estimated 1.1 million Canadians will be experiencing dementia, with unprecedented impact on social, economic and health landscapes. In September 2015, the Canadian Academy of Health Sciences convened a Forum, with the specific thematic goals of reviewing progress towards effective dementia treatment and prevention, improved systems of care, advanced living and built environments, and impactful technology developments. The orientation of the Forum was to focus on potential solutions and advances in these areas. These areas are integral to the goal of a national end-to-end program, where all affected Canadians can be optimally supported in their communities and receive quality of care – regardless of where they live or who they are.
New TREC Article
Development and Validation of A Scheduled Shifts Staffing (ASSiST) Measure of Unit-Level Staffing in Nursing Homes
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Purpose of the study: To (a) describe A Scheduled Shifts Staffing measure (ASSiST) to derive care aide worked hours per resident day (HCA WHRD) at facility and unit levels in nursing homes, (b) report reliability through comparisons to administrative staffing data; (c) report validity by examining associations between HCA WHRD, staff outcomes (job satisfaction, emotional exhaustion), and resident quality indicators (QIs) (e.g. falls, delirium, stage 2+ pressure ulcers), and (d) explore intrafacility variation in staffing intensity levels related to unit-level variation in resident and staff outcomes. Design and Methods: We used data from 40 care units in 12 Canadian nursing homes between 2007 and 2012. Descriptive statistics and tests of association and difference described relationships of two measures of staffing with resident and staff outcomes. Results: Annualized rates of HCA WHRD from both data sources compared well at the facility level (Pearson Product Correlation; R = 0.847, p < .001), and were correlated similarly to staff work life and many QIs. Using ASSiST data, we show that staffing levels can vary by up to 40% at the unit-level within nursing homes. Implications: ASSiST is easy to collect, more timely to retrieve than administrative data, has good criterion and construct validity, and reflects intrafacility variation in health care aide staffing levels.
CIHR Institute of Aging newsletter 
Calls for Abstracts
International Journal of Evidence-Based Healthcare (Official journal of the Joanna Briggs Institute) is calling for methodological papers addressing any aspects of systematic reviews and implementation science for a special issue. Interested authors should download and read the Instructions for Authors which are available online at http://www.editorialmanager.com/ijebh.
Articles should be submitted online at http://www.editorialmanager.com/ijebh no later than FRIDAY 11TH AUGUST 2017
Publications
KT
Health Care Administration and Organization
Health Care Innovation and Quality Assurance
Research Practice and Methodology
Aging
KT
Researcher readiness for participating in community-engaged dissemination and implementation research: a conceptual framework of core competencies
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Participating in community-engaged dissemination and implementation (CEDI) research is challenging for a variety of reasons. Currently, there is not specific guidance or a tool available for researchers to assess their readiness to conduct CEDI research. We propose a conceptual framework that identifies detailed competencies for researchers participating in CEDI and maps these competencies to domains. The framework is a necessary step toward developing a CEDI research readiness survey that measures a researcher’s attitudes, willingness, and self-reported ability for acquiring the knowledge and performing the behaviors necessary for effective community engagement. The conceptual framework for CEDI competencies was developed by a team of eight faculty and staff affiliated with a university’s Clinical and Translational Science Award (CTSA). The authors developed CEDI competencies by identifying the attitudes, knowledge, and behaviors necessary for carrying out commonly accepted CE principles. After collectively developing an initial list of competencies, team members individually mapped each competency to a single domain that provided the best fit. Following the individual mapping, the group held two sessions in which the sorting preferences were shared and discrepancies were discussed until consensus was reached. During this discussion, modifications to wording of competencies and domains were made as needed. The team then engaged five community stakeholders to review and modify the competencies and domains. The CEDI framework consists of 40 competencies organized into nine domains: perceived value of CE in D&I research, introspection and openness, knowledge of community characteristics, appreciation for stakeholder’s experience with and attitudes toward research, preparing the partnership for collaborative decision-making, collaborative planning for the research design and goals, communication effectiveness, equitable distribution of resources and credit, and sustaining the partnership. Delineation of CEDI competencies advances the broader CE principles and D&I research goals found in the literature and facilitates development of readiness assessments tied to specific training resources for researchers interested in conducting CEDI research.
Protocol of a scoping review on knowledge translation competencies
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BACKGROUND: Knowledge translation (KT) activities can reduce the gap between “what is known” and “what is done”. Several factors hinder or facilitate KT activities including individual characteristics and organizational attributes; we will focus on individual healthcare professional modifiable characteristics. The purpose of this scoping review is to summarize knowledge on KT competencies for knowledge users, knowledge brokers, and knowledge producers/researchers to support evidence-based practice (EBP) and inform policy and research in health. Our objectives are to explore the relevant theoretical and empirical literature; map the publications for key themes and research gaps of KT competencies, and interventions for enhancing KT competencies; summarize and disseminate findings; produce an action plan and research agenda; and develop self-assessment tools (the KT Pathways) for professional development for our three target audiences. METHODS: The scoping review method will guide our study by following six stages: formulating the research question; identifying relevant studies; selecting the literature; charting the data; collating, summarizing, and reporting the results; and developing a KT plan and consulting stakeholders involved in the fields of KT, EBP, evidence-informed policy-making, and/or research. We will include empirical and theoretical/conceptual peer-reviewed and grey literature in health that examine knowledge user, knowledge broker and knowledge producer KT competencies. Publications written in the English language and published after 2003 only will be considered. Our multidisciplinary research team will collaborate using technology (i.e., WebEx for discussions and a Web 2.0 website for storing documents). Our KT plan consists of an Advisory Group and dissemination plan of the findings. DISCUSSION: We expect the identified KT competencies to contribute to the KT science by providing positive outcomes in practice, policy, education, and future research. Incorporation of the core KT competencies may enhance safety, effectiveness of clinical care, and quality of health outcomes; contribute to and facilitate collaboration among practitioners, knowledge users, knowledge brokers, researchers, employers, and educators; improve education of healthcare professionals and inform policy-making process; benefit practitioners by guiding their KT professional development to become effective at moving evidence into practice and policy; guide suitable interventions and strategies to enhance KT activities in the health sector; and direct future research.
The inter-play between facilitation and context in the Promoting Action on Research Implementation in Health Services framework: a qualitative exploratory implementation study embedded in a cluster randomised controlled trial to reduce restraint in nursing homes
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Aim: To explore the inter-play between external facilitation and nursing home contexts relative to intervention outcomes.; Background: The Promoting Action on Research Implementation in Health Services framework is frequently used to theoretically inform implementation and research in nursing and recent reviews indicate high face validity for health services. However, the inter-play and relationship between framework sub- elements of evidence, context and facilitation and the prospective utility in non-English speaking contexts warrant further illumination.; Design: In an overarching single-blind cluster-randomised controlled trial, we applied participatory action research and ethnography from August 2011- June 2015 to evaluate a standardised education intervention to reduce restraint and agitation in nursing home residents living with dementia. The trial results are published elsewhere.; Methods: Prospectively informed by the framework, a research team and eight facilitators participating in dual roles as action researchers designed, implemented and evaluated the intervention. How contextual factors influenced the facilitation processes were explored in focus group interviews (1), reflection notes (84) written by the facilitators’ after each education session, ethnographic field studies (6 homes) and co-analysis workshops (5). Directed content analysis was used to analyse data.; Results: Clinical leaders taking roles of internal facilitator influenced the success of implementation, while complex and fluctuating context elements determined whether restraint use was reduced- or not. The framework was found to be relevant in a non-English nursing home setting, albeit some elements merit further conceptualization CONCLUSIONS: our findings confirm the prospective utility of the framework for implementation in a non-English context, particularly the notion of implementation processes as dynamic and multifaceted.
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Health Care Administration and Organization
Factors affecting nursing staff use of a communication tool to reduce potentially preventable acute care transfers in long-term care
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Although specialized communication tools can effectively reduce acute care transfers, few studies have assessed the factors that may influence the use of such tools by nursing staff at the individual level. We evaluated the associations between years of experience, tool-related training, nursing attitudes, and intensity of use of a communication tool developed to reduce transfers in a long-term care facility. We employed a mixed methods design using data from medical charts, electronic records, and semi-structured interviews. Experienced nurses used the tool significantly less than inexperienced nurses, and training had a significant positive impact on tool use. Nurses found the purpose of the tool to be confusing. No significant differences in attitude were observed based on years of experience or intensity of use. Project findings indicate that focused efforts to enrich training may increase intervention adherence. Experienced nurses in particular should be made aware of the benefits of utilizing communication tools.
How does burnout impact the three components of nursing professional commitment?
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BACKGROUND: While the impact of burnout on organisational commitment has been widely observed, its impact on nursing professional commitment has not previously been investigated. The literature has clarified that professional commitment has three distinct components: affective, continuance and normative. AIMS: This study aims to investigate the relationships between burnout and the three components of nursing professional commitment. METHODS: This was a cross-sectional study using questionnaires to collect data in one large medical centre. Responses from 571 nurses were used for regression analysis. Among the sampled nurses, 90.9% had 0.05). LINKING EVIDENCE TO ACTION: Nurse managers aiming to improve nurses’ professional commitment should consider reducing nurses’ burnout, for example improving nursing optimism and reducing administrative tasks, as suggested by the literature.
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Health Care Innovation and Quality Assurance
Disruptive cooperation: Innovation for health’s wicked problems (book chapter in Disruptive Cooperation in Digital Health)
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No abstract available
Individualized Music Program is Associated with Improved Outcomes for U.S. Nursing Home Residents with Dementia
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OBJECTIVES: The objective of this study was to compare resident outcomes before and after implementation of an individualized music program, MUSIC & MEMORY (M&M), designed to address the behavioral and psychological symptoms associated with dementia (BPSD). SETTING: 98 nursing homes trained in the M&M program during 2013 and 98 matched-pair comparisons. PARTICIPANTS: Long-stay residents with Alzheimer’s disease and related dementias (ADRD) residing in M&M participating facilities (N = 12,905) and comparison facilities (N = 12,811) during 2012-2013. INTERVENTION: M&M is a facility-level quality improvement program that provides residents with music specific to their personal histories and preferences. MEASUREMENTS: Discontinuation of anxiolytic and antipsychotic medications, and reductions in behavioral problems and depressed mood in 2012 (pre-intervention) and 2013 (intervention), calculated using Minimum Data Set (MDS) assessments. RESULTS: The proportion of residents who discontinued antipsychotic medication use over a 6-month period increased from 17.6% to 20.1% among M&M facilities, while remaining stable among comparison facilities (15.9% to 15.2%). The same trend was observed for anxiolytic medications: Discontinuation of anxiolytics increased in M&M facilities (23.5% to 24.4%), while decreasing among comparison facilities (24.8% to 20.0%). M&M facilities also demonstrated increased rates of reduction in behavioral problems (50.9% to 56.5%) versus comparison facilities (55.8% to 55.9%). No differences were observed for depressed mood. CONCLUSIONS: These results offer the first evidence that the M&M individualized music program is associated with reductions in antipsychotic medication use, anxiolytic medication use, and BPSD symptoms among long-stay nursing home residents with ADRD.
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Research Practice and Methodology
Graduate nurses’ evaluation of mentorship: Development of a new tool
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Aim Develop and test an instrument to measure graduate-nurses’ perceptions of a structured mentorship program. Background New graduate nurses may experience difficulties in the transition from student to practitioner. Mentoring is commonly used to support graduates. However, there is a lack of published tools measuring graduate nurses’ perceptions of mentorship. As mentoring is resource intensive, development and testing of a validated tool are important to assist in determining program effectiveness. Methods A pretest-posttest interventional design was used. Following a critical review of literature and content experts’ input, the 10-item National University Hospital Mentorship Evaluation (NUH ME) instrument was tested with a convenience sample of 83 graduate nurses. Psychometric tests included internal reliability, stability, content validity, and factor analysis. Changed scores were evaluated using paired samples t-test. Results Seventy-three graduates (88%) out of a possible 83 completed the pre-and post-program survey. Internal reliability was excellent with a Cronbach’s alpha of 0.92. Test-retest reliability was stable over time (ICC = 0.81). Exploratory factor analysis supported a 1-factor solution explaining 58.2% of variance. Paired samples t-test showed statistical significance between the pre- and post-program scores (p < 0.001). Conclusions The NUH-ME measure was found to be valid and reliable. Confirmatory Factor Analysis of the tool with different groups of nursing graduates is required. Mentorship programs can be an effective recruitment and retention strategy, but are also resource intensive. Measuring new graduates' perceptions of mentoring contributes to program relevance in addressing their personal, professional and clinical skill development needs. As mentoring engages a diverse range of mentors, feedback through measurement may also positively alter organizational learning culture.
Development and Evaluation of the Barriers to Nurses’ Participation in Research Questionnaire at a Large Academic Pediatric Hospital
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The purposes of this study were to survey nurses at a large pediatric hospital to examine barriers to nursing research and to develop the Barriers to Nurses’ Participation in Research Questionnaire (BNPRQ) in preparation for its use at other institutions. The BNPRQ was created and refined through iterative pilot testing. Exploratory factor analysis was applied, and composite scores were computed for the identified factors. The two latent factors “Research Resources” and “Personal Relevance of Research” were extracted. The independent item “lack of time to do research” represented the largest barrier to research. Factor and item scores differed according to subject characteristics. Findings from this study will be used to create targeted interventions to reduce barriers to research participation prevalent in specific groups of nurses. By using the BNPRQ developed in this study, researchers and administrators at other institutions can identify and address barriers to research among their nurses.
The politics of co-production: risks, limits and pollution
Abstract:
Co-production is a risky method of social inquiry. It is time-consuming, ethically complex, emotionally demanding, inherently unstable, vulnerable to external shocks, subject to competing demands and it challenges many disciplinary norms. This is what makes it so fresh and innovative. And yet these research-related risks are rarely discussed and, as a result, risk-reduction strategies remain under-developed within training and research processes. It is for exactly this reason that this article draws upon Mary Douglas’s notion of ‘social pollution’ in order to understand the tensions and challenges of co-production. It seeks to expose the generally hidden politics of co-production.
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Aging
Struggling to maintain individuality – Describing the experience of food in nursing homes for people with dementia
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AbstractPurpose of the study To describe the food and dining experience of people with cognitive impairment and their family members in nursing homes. Design and methods Interviews and focus groups with people with cognitive impairment and their family members (n = 19). Thematic analysis was undertaken using NVivo10 data analysis software package to determine key themes. Results The main themes identified tracked a journey for people with cognitive impairment in nursing homes, where they initially sought to have their individual needs and preferences recognised and heard, expressed frustration as they perceived growing barriers to receiving dietary care which met their preferences, and ultimately described a deterioration of the amount of control and choice available to the individual with loss of self-feeding ability and dysphagia. Implications Further consideration of how to incorporate individualised dietary care is needed to fully implement person-centred care and support the quality of life of those receiving nursing home care.
The Nursing Home Compare Report Card: Perceptions of Residents and Caregivers Regarding Quality Ratings and Nursing Home Choice
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OBJECTIVE: To evaluate the perceived usefulness of publicly reported nursing home quality indicators. STUDY SETTING: Primary data were collected from October 2013 to August 2014 among a convenience sample of persons (or family member) recently admitted or anticipating admission to a nursing home within 75 miles of the city of Philadelphia. STUDY DESIGN: Structured interviews were conducted to assess the salience of data on the Medicare Nursing Home Compare website, including star ratings, clinical quality measures, and benchmarking of individual nursing home quality with state and national data. DATA COLLECTION: Interviews were transcribed verbatim, independently coded by two reviewers, and agreement determined. A thematic analysis of transcripts was undertaken. PRINCIPAL FINDINGS: Thirty-five interviews were completed. Eighty-three percent (n = 29) were caregivers and 17 percent (n = 6) were residents. Star ratings, clinical quality measures, and benchmarking information were salient to decision making, with preferred formats varying across participants. Participants desired additional information on the source of quality data. Confusion was evident regarding the relationship between domain-specific and overall star quality ratings. CONCLUSIONS: The Nursing Home Compare website provides salient content and formats for consumers. Increased awareness of this resource and clarity regarding the definition of measures could further support informed decision making regarding nursing home choice.
How do levels of nursing home adjustment differ by length of stay
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The purpose of this study was to explore how residents’ adjustment is different depending on the length of stay in nursing homes. A total of 161 cognitively intact residents completed a survey questionnaire of the Nursing Home Adjustment Scale (NHAS) and demographic information. Controlling for activities of daily living function, a generalized linear model demonstrated that the levels of nursing home adjustment are different depending on the length of stay for nursing home residents. Residents who stayed 12 months or more (Groups 4 or 5) showed the highest NHAS scores, followed by the group who stayed under 3 months (Groups 1 or 2), and those who stayed 3 months or more but under 12 months (Group 3) had the lowest NHAS scores. Knowing that residents’ life adjustment might vary based on the length of stay, nursing home staff can identify residents’ level of adjustment, predict their needs and implement interventions in a timely manner.
Personalizing Nursing Home Compare and the Discharge from Hospitals to Nursing Homes
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OBJECTIVE: To test whether use of a personalized report card, Nursing Home Compare Plus (NHCPlus), embedded in a reengineered discharge process, can lead to better outcomes than the usual discharge process from hospitals to nursing homes. DATA SOURCES/SETTING: Primary data collected in the Departments of Medicine and Surgery at a University Medical Center between March 2014 and August 2015. STUDY DESIGN: A randomized controlled trial in which patients in the intervention group were given NHCPlus. Participants included 225 patients or their family members/surrogates. DATA COLLECTION: Key strokes of NHCPlus users were recorded to obtain information about usage. Users were surveyed about usability and satisfaction with NHCPlus. All participants were surveyed at discharge from the hospital. Survey data were merged with medical records. PRINCIPAL FINDINGS: About 85 percent of users indicated satisfaction with NHCPlus. Compared to controls, intervention patients were more satisfied with the choice process (by 40 percent of the standard deviation p < .01), more likely to go to higher ranked five-star nursing homes (OR = 1.8, p < .05), traveled to further nursing homes (IRR = 1.27, p < .10), and had shorter hospital stays (IRR = 0.84, p < .05). CONCLUSIONS: Personalizing report cards and reengineering the discharge process may improve quality and may lower costs compared to the usual discharge process.
Developing, implementing and evaluating an end of life care intervention
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Aim To develop, implement and evaluate a collaborative intervention in care homes seeking to increase the confidence and competence of staff in end of life care and enable more people to receive end of life care in their usual place of residence. Method A two-phase exploratory mixed methods design was used, evaluating the effect of an end of life care toolkit and associated training in care homes, facilitated by a specialist palliative care team. Six care homes in England were recruited to the intervention; 24 staff participated in discussion groups; 54 staff attended at least one training session; and pre- and post-intervention questionnaires were completed by 78 and 103 staff respectively. Results Staff confidence in receiving emotional and clinical support and managing end of life care symptoms increased post-intervention, but confidence in discussing death and dying with residents and relatives decreased. Audit data indicate greater reduction in the number of residents from participating care homes dying in hospital than those from comparison homes. Conclusion Collaborative end of life care interventions support care home staff to manage end of life and may enable residents to have choice about their place of death.
Development of a New Tool for Systematic Observation of Nursing Home Resident and Staff Engagement and Relationship
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Purpose of Study: To develop a structured observational tool, the Resident-centered Assessment of Interactions with Staff and Engagement tool (RAISE), to measure 2 critical, multi-faceted, organizational-level aspects of person-centered care (PCC) in nursing homes: (a) resident engagement and (b) the quality and frequency of staff-resident interactions. Design and Methods: In this multi-method psychometric development study, we conducted (a) 120 hr of ethnographic observations in one nursing home and (b) a targeted literature review to enable construct development. Two constructs for which no current structured observation measures existed emerged from this phase: nursing home resident-staff engagement and interaction. We developed the preliminary RAISE to measure these constructs and used the tool in 8 nursing homes at an average of 16 times. We conducted 8 iterative psychometric testing and refinement cycles with multi-disciplinary research team members. Each cycle consisted of observations using the draft tool, results review, and tool modification. Results: The final RAISE included a set of coding rules and procedures enabling simultaneously efficient, non-reactive, and representative quantitative measurement of the interaction and engagement components of nursing home life for staff and residents. It comprised 8 observational variables, each represented by extensive numeric codes. Raters achieved adequate to high reliability with all variables. There is preliminary evidence of face and construct validity via expert panel review. Implications: The RAISE represents a valuable step forward in the measurement of PCC, providing objective, reliable data based on systematic observation.
Exercise and Dementia in Nursing Homes: Views of Staff and Family Carers
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This paper reports the qualitative component of a randomized controlled trial which evaluated the impact and feasibility of a physical exercise intervention on individuals living with dementia in nursing homes. Interviews were conducted with 10 staff and nine family carers about their views and opinions of physical exercise (n=19). Thematic content analysis revealed both benefits and barriers to physical exercise for individuals living with dementia in nursing homes. Another theme was the influences of knowledge and understanding on individuals’ views of physical exercise. The involvement of staff and family carers in research encourage their involvement in the implementation of research into clinical practice. This can help to improve provisions of meaningful and beneficial activities for individuals living with dementia in nursing homes. The views and opinions of individuals living with dementia in nursing homes were not considered, though it would be beneficial to include them in future research.
Nursing home team-care deprescribing study: a stepped-wedge randomised controlled trial protocol
An ageing population has become an urgent concern for Asia in recent times. In nursing homes, polypharmacy has also become a compounding issue. Deprescribing practice is an evidence-based strategy to provide a better outcome in this group of patients; however, its implementation in nursing homes is often challenging, and prospective outcome data on deprescribing practice in the elderly is lacking. Our study assesses the implementation of team-care deprescribing to understand the benefits of this practice in geriatric setting and to explore the factors affecting deprescribing practice.
Delirium During Postacute Nursing Home Admission and Risk for Adverse Outcomes
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Objectives: To identify the rate of delirium present during admission to postacute care (PAC) in the nursing home setting and to determine whether patients with delirium had higher risk for adverse outcomes.; Design: Retrospective cohort study.; Setting: US Medicare- and Medicaid-certified nursing homes, 2011 to 2014.; Participants: Individuals admitted to all US nursing homes for PAC, aged =65 years, and without prior history of nursing home residence (n = 5,588,702).; Measurements: Minimum Data Set (MDS) 3.0 admission assessments identified delirium based upon Confusion Assessment Method (CAM) items. Robust Poisson regression was used to calculate adjusted relative risks (aRRs) with 95% confidence intervals (CIs) for death following PAC admission, and for 30-day discharge outcomes including re-hospitalization from PAC, discharge home, and functional improvement.; Results: Delirium was identified in 4.3% of new postacute nursing home admissions. Mortality within 30 days of PAC admission was observed in 16.3% of patients with delirium and 5.8% of patients without delirium (aRR = 2.27, CI = 2.24-2.30). The rate of 30-day readmission from PAC was 21.3% for patients with delirium compared with 15.1% among patients without delirium (aRR = 1.42, 95% CI = 1.40, 1.43). 26.9% of patients with delirium were discharged home within 30 days of admission compared to 52.5% of patients without delirium (aRR = 0.57, 95% CI = 0.57, 0.58). 48.9% of patients with delirium showed functional improvement at discharge compared to 59.9% of patients without delirium (aRR = 0.83, 95% CI = 0.82, 0.83).; Conclusions: Patients with delirium present upon PAC admission were at high risk for mortality and 30-day re-hospitalization and were less likely to have timely discharge to home or to improve in physical function at discharge. Early identification and care planning for individuals with delirium at PAC admission may be essential to improve outcomes.
Aggression, Older People and Care Workers
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No abstract available
Identifying models of delivery, care domains and quality indicators relevant to palliative day services: a scoping review protocol
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BACKGROUND: With an ageing population and increasing numbers of people with life-limiting illness, there is a growing demand for palliative day services. There is a need to measure and demonstrate the quality of these services, but there is currently little agreement on which aspects of care should be used to do this. The aim of the scoping review will be to map the extent, range and nature of the evidence around models of delivery, care domains and existing quality indicators used to evaluate palliative day services. METHODS: Electronic databases (MEDLINE, EMBASE, CINAHL, PsycINFO, Cochrane Central Register of Controlled Trials) will be searched for evidence using consensus development methods; randomised or quasi-randomised controlled trials; mixed methods; and prospective, longitudinal or retrospective case-control studies to develop or test quality indicators for evaluating palliative care within non-residential settings, including day hospices and community or primary care settings. At least two researchers will independently conduct all searches, study selection and data abstraction procedures. Meta-analyses and statistical methods of synthesis are not planned as part of the review. Results will be reported using numerical counts, including number of indicators in each care domain and by using qualitative approach to describe important indicator characteristics. A conceptual model will also be developed to summarise the impact of different aspects of quality in a palliative day service context. Methodological quality relating to indicator development will be assessed using the Appraisal of Indicators through Research and Evaluation (AIRE) tool. Overall strength of evidence will be assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. Final decisions on quality assessment will be made via consensus between review authors. DISCUSSION: Identifying, developing and implementing evidence-based quality indicators is critical to the evaluation and continued improvement of palliative care. Review findings will be used to support clinicians and policymakers make decisions on which quality indicators are most appropriate for evaluating day services at the patient and service level, and to identify areas for further research.
Polypharmacy in multimorbid older adults: protocol for a systematic review
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BACKGROUND: Polypharmacy, the concurrent use of multiple medications, consistently evokes a negative connotation, notably because it is associated with a plethora of adverse events. Nonetheless, the number of individuals exposed to polypharmacy is increasing steeply, especially for older people with multiple diseases. There is a need to carefully study the phenomenon at the population scale to full assess the associated health outcomes. Yet, this reveals a complex task because there exists no consensus indicator of polypharmacy. In fact, the definitions of polypharmacy are heterogeneous and its predisposing factors and associated outcomes are not well defined. The goal of this systematic review is to summarize the literature on polypharmacy in multimorbid individuals aged 65 years and over, targeting three objectives: (1) to identify the definitions of polypharmacy that are used in the context of multimorbidity among older individuals (>/=65 years); (2) to ascertain predisposing and concurrent factors associated with polypharmacy; and (3) to describe positive and negative outcomes of polypharmacy among older individuals, including hospitalizations, mortality and costs. METHODS: We will include publications from 2004 to 2016 that target four concepts: polypharmacy, older individuals, multimorbidity and positive/negative outcomes. The search will be performed using EBM Reviews, Embase, Global Health, MEDLINE, AgeLine, CINAHL, Health Policy Reference Center, Public Affairs Index, SocINDEX and Google Scholar. Two independent reviewers will screen the articles, extract the information and evaluate the methodological quality of included studies. The results will be presented in tables and narrative summaries will be performed. We will perform meta-analyses (objective 3) if the heterogeneity is not important. DISCUSSION: This review will help describe the various ways of conceptualizing polypharmacy and how it is associated with health outcomes. We have selected outcomes most relevant for public surveillance performed with administrative databases. Other positive and negative outcomes have been associated with polypharmacy but may not be included in the review. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42014014989. FAU – Sirois, Caroline.
Keep in Touch (KIT): feasibility of using internet-based communication and information technology in palliative care
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Background: Confinement to an in-patient hospital ward impairs patients’ sense of social support and connectedness. Providing the means, through communication technology, for patients to maintain contact with friends and family can potentially improve well-being at the end of life by minimizing social isolation and facilitating social connection. This study aimed to explore the feasibility of introducing internet-based communication and information technologies for in-patients and their families and to describe their experience in using this technology. Methods: A cross-sectional survey design was used to describe patient and family member experiences in using internet-based communication technology and health care provider views of using such technology in palliative care. Participants included 13 palliative in-patients, 38 family members, and 14 health care providers. An iPad or a laptop computer with password-protected internet access was loaned to each patient and family member for about two weeks or they used their own electronic devices for the duration of the patient’s stay. Quantitative and qualitative data were collected from patients, families, and health care providers to discern how patients and families used the technology, its ease of use and its impact. Descriptive statistics and paired sample t-tests were used to analyze quantitative data; qualitative data were analyzed using constant comparative techniques. Results: Palliative patients and family members used the technology to keep in touch with family and friends, entertain themselves, look up information, or accomplish tasks. Most participants found the technology easy to use and reported that it helped them feel better overall, connected to others and calm. The availability of competent, respectful, and caring technical support personnel was highly valued by patients and families. Health care providers identified that computer technology helped patients and families keep others informed about the patient’s condition, enabled sharing of important decisions and facilitated access to the outside world. Conclusions: This study confirmed the feasibility of offering internet-based communication and information technologies on palliative care in-patient units. Patients and families need to be provided appropriate technical support to ensure that the technology is used optimally to help them accomplish their goals.
Patients’ knowledge of and participation in preventing pressure ulcers-an intervention study
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The aim of this study was to evaluate a patient information pamphlet on pressure ulcer ( PU) prevention using a descriptive, comparative pre- and post-test study design. The patient information pamphlet ‘How can you help to stop pressure ulcers?’ developed by the European PU Advisory Panel in 2012 was implemented in two surgical wards in a university hospital. A total of 61 patients answered pre- and post-test questionnaires. Patients assessed their knowledge of the risks, causes and ways to prevent PUs significantly higher after the intervention than before. Twenty-eight patients (46%) reported that they had participated in PU prevention during the last 24 hours. The patients assessed the content of the PU pamphlet as useful, its language as quite easy to understand and its layout as good. Patients with a PU pamphlet during their hospital stay were more knowledgeable about and more active in their own care. It is important that nurses invite patients to be active partners in preventing PUs but also that they identify patients who need to have a more passive role. The PU pamphlet could be updated to increase its comprehensibility, meaningfulness and manageability for patients.
Linking Spiritual and Religious Coping With the Quality of Life of Community-Dwelling Older Adults and Nursing Home Residents
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Objective: This study examined the effect of Positive and Negative Spiritual and Religious Coping (SRC) upon older Brazilian’s quality of life (QOL). Method: A secondary analysis of data collected from 77 nursing home residents (NHRs; M age = 76.56) and 326 community-dwelling residents (CDRs; M age = 67.22 years) was conducted. Participants had completed the Brief SRC, and the World Health Organization Quality of Life-BREF (WHOQOL-BREF) and World Health Organization Quality of Life-OLD (WHOQOL-OLD). A General Linear Model regression analysis was undertaken to assess the effects of SRC upon 10 aspects of participants’ QOL. Results: Positive (F = 6.714, df = 10, p < .001) as opposed to Negative (F = 1.194, df = 10, p = .294) SRC was significantly associated with QOL. Positive SRC was more strongly associated with NHR's physical, psychological, and environmental QOL, and their perceived sensory abilities, autonomy, and opportunities for intimacy. Conclusion: Positive SRC behaviors per se were significantly associated with QOL ratings across both study samples. The effect size of Positive SRC was much larger among NHRs across six aspects of QOL. Place of residence (POR) in relation to SRC and QOL in older age warrants further study.
Validity of Total Kihon Checklist Score for Predicting the Incidence of 3-Year Dependency and Mortality in a Community-Dwelling Older Population
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BACKGROUND: Knowledge translation (KT) activities can reduce the gap between “what is known” and “what is done”. Several factors hinder or facilitate KT activities including individual characteristics and organizational attributes; we will focus on individual healthcare professional modifiable characteristics. The purpose of this scoping review is to summarize knowledge on KT competencies for knowledge users, knowledge brokers, and knowledge producers/researchers to support evidence-based practice (EBP) and inform policy and research in health. Our objectives are to explore the relevant theoretical and empirical literature; map the publications for key themes and research gaps of KT competencies, and interventions for enhancing KT competencies; summarize and disseminate findings; produce an action plan and research agenda; and develop self-assessment tools (the KT Pathways) for professional development for our three target audiences. METHODS: The scoping review method will guide our study by following six stages: formulating the research question; identifying relevant studies; selecting the literature; charting the data; collating, summarizing, and reporting the results; and developing a KT plan and consulting stakeholders involved in the fields of KT, EBP, evidence-informed policy-making, and/or research. We will include empirical and theoretical/conceptual peer-reviewed and grey literature in health that examine knowledge user, knowledge broker and knowledge producer KT competencies. Publications written in the English language and published after 2003 only will be considered. Our multidisciplinary research team will collaborate using technology (i.e., WebEx for discussions and a Web 2.0 website for storing documents). Our KT plan consists of an Advisory Group and dissemination plan of the findings. DISCUSSION: We expect the identified KT competencies to contribute to the KT science by providing positive outcomes in practice, policy, education, and future research. Incorporation of the core KT competencies may enhance safety, effectiveness of clinical care, and quality of health outcomes; contribute to and facilitate collaboration among practitioners, knowledge users, knowledge brokers, researchers, employers, and educators; improve education of healthcare professionals and inform policy-making process; benefit practitioners by guiding their KT professional development to become effective at moving evidence into practice and policy; guide suitable interventions and strategies to enhance KT activities in the health sector; and direct future research.
Nursing Home Physicians’ Assessments of Barriers and Strategies for End-of-Life Care in Norway and The Netherlands
Non UofA Access
OBJECTIVES: Working conditions in nursing homes (NHs) may hamper teamwork in providing quality end-of-life (EOL) care, especially the participation of NH physicians. Dutch NH physicians are specialists or trainees in elderly care medicine with NHs as the main workplace, whereas in Norway, family physicians usually work part time in NHs. Thus, we aimed at assessing and comparing NH physicians’ perspectives on barriers and strategies for providing EOL care in NHs in Norway and in The Netherlands. DESIGN: A cross-sectional study using an electronic questionnaire was conducted in 2015. SETTING AND PARTICIPANTS: All NH physicians in Norway (approximately 1200-1300) were invited to participate; 435 participated (response rate approximately 35%). Of the total 1664 members of the Dutch association of elderly care physicians approached, 244 participated (response rate 15%). MEASUREMENTS: We explored NH physicians’ perceptions of organizational, educational, financial, legal, and personal prerequisites for quality EOL care. Differences between the countries were compared using chi2 test and t-test. RESULTS: Most respondents in both countries reported inadequate staffing, lack of skills among nursing personnel, and heavy time commitment for physicians as important barriers; this was more pronounced among Dutch respondents. Approximately 30% of the respondents in both countries reported their own lack of interest in EOL care as an important barrier. Suggested improvement strategies were routines for involvement of patients’ family, pain- and symptom assessment protocols, EOL care guidelines, routines for advance care planning, and education in EOL care for physicians and nursing staff. CONCLUSIONS: Inadequate staffing levels, as well as lack of competence, time, and interest emerge as important barriers to quality EOL care according to Dutch and Norwegian NH physicians. Their perspectives were mostly similar, despite large educational and organizational differences. Key strategies for improving EOL care in their facilities comprise education and incorporating available palliative care tools and systems.
Dementia Care, Women’s Health, and Gender Equity – The Value of Well-Timed Caregiver Support
Non UofA Access
Although encouraging evidence shows a decline in dementia prevalence, the percentage of the US population aged 65 years and older is predicted to rise to 20% by 2030 (from 13% in 2010). Age is the greatest risk factor for dementia, and the number of cases of dementia will continue to rise as a function of an aging population (approximately 8.4 million by 2030). The mainstay of treatment is functional support, and 83% of caregiving comes from unpaid sources: family.
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Events
UofA
University of Alberta Grant Assist Program – Meet the Canadian Institutes of Health Research (CIHR) President
You are invited to an open session to meet the Canadian Institutes of Health Research (CIHR) Acting President, Dr. Roderick McInnes. Dr. McInnes will be visiting the University of Alberta to discuss recent changes at CIHR, share his priorities, and answer your questions. The meeting will take place Tuesday, June 6, 2017 from 10:30 am to 12:00 pm in room L1-490 (basement) Edmonton Clinic Health Academy (ECHA). All health researchers, research grants facilitators, and graduate students are invited to join.
Dr. McInnes’ talk will be video-conferenced from L1-490 in the Edmonton Clinic Health Academy (ECHA) from the following link https://connect.srv.ualberta.ca/meet-the-president/ If you are not automatically logged in with your CCID, please fill in your name as a guest and select “enter the room”. Videoconference attendees will be able to enter questions through the chat box, and they will be relayed during the presentation. Please ensure your Java is up-to-date and check that you are able to access this videoconference in advance of the meeting.
The meeting will be recorded and available for viewing later via the Grant Assist Program (Health Sciences) website.
Constructive Feedback for CIHR:
In preparation for the President’s visit, we are requesting constructive feedback from the University of Alberta community. The feedback provided will be compiled and provided to the President.
We are also interested in hearing from those involved in the review process (SO, chair, reviewer) so please identify your role at the start of your comments.
Please provide your written feedback to cihrgrants@ualberta.ca by Sunday, May 28, 2017. All feedback will be kept anonymous. We would prefer feedback meet the following criteria:
– Up to 5 bulleted talking points of constructive feedback.
– Each talking point to include both the issue and one or more potential solutions.
– Up to 3/4 page in length.
If you have additional questions, please call Joanne Simala-Grant [Director, Grant Assist Program (Health Sciences)] at 780-492-1566 or email jls24@ualberta.ca.
Non UofA
10th Annual Conference on the Science of Dissemination and Implementation in Health
This year’s theme, A Decade of Progress and the Path Forward, will reflect on the accomplishments of and challenges to the field, and will focus on opportunities ahead. To make large-scale gains in health at a population level, we must consider the application of scientific discoveries to diverse contexts and populations, the power of partnerships, the value of engagement, and the complex fit between evidence and evidence-based interventions and the diversity of community and clinical settings where health and health care is delivered. This conference intends to support collective understanding of the research agenda to incorporate these challenges into D&I research through a combination of plenaries, concurrent and poster sessions that will present research findings and identify the next set of research priorities, setting the field up for the next decade.
As the largest, and growing focus for adult nursing in the UK, caring for older people requires diverse expertise from a wide range of healthcare professionals. Nurses, AHPs and social care all working together with doctors. As such the RCN Older People’s forum and British Geriatrics Society (BGS) would like to hear from you. This is your opportunity to take part by submitting an abstract for presentation. Make your voice heard and share new solutions to older people’s care whilst inspiring attendees to achieve personal excellence in the care of older people.
This year’s conference themes include:
– innovative services led by nurses and medics relating to the care of older people
– the interface between medicine and nursing
– multi-disciplinary team working leading teams
News
Alzheimer’s Association created care-planning toolkit for clinician
After Medicare began covering care-planning visits for patients with cognitive impairment, the Alzheimer’s Association developed a toolkit to help clinicians provide better care.
Study Shows 54 Percent Drop in Infections Among Nursing Home Patients
Rates of catheter-associated urinary tract infections (CAUTIs) dropped by 54 percent across more than 400 long-term care facilities that participated in a patient safety project funded by the Agency for Healthcare Research and Quality (AHRQ), according to a study published today in JAMA Internal Medicine.
Loneliness in seniors: A medical problem this provider thinks it can solve
Clinicians are starting to look at the role that poverty, race, and other social determinants play in a person’s health, but what about social connectedness — how do friendship, family, and loneliness play into a person’s medical needs?
Health Care? Daughters Know All About It
As Washington debates the relative merits of health care legislation, many families have already come up with what is arguably the most reliable form of care in America: It’s called daughter care.
A national seniors strategy means better health-care for all Canadians
Helping create the conditions whereby Canadians have the ability to live successful, healthy and long lives must be one of the most important jobs of policy makers. Judging by a new census showing our country now has more seniors than children, we have indeed created conditions for seniors to live a longer life. While this is welcome news for all Canadians, it does create added challenges that are best addressed by the creation of a national seniors strategy.
More Support for People Living with Dementia, and Their Families
Ontario Investing More Than $100 Million to Expand Dementia Care Through 2017 Budget
New unit aims to improve life for dementia patients in north and central Saskatchewan”
A new five-bed unit in Saskatoon will help improve the lives of people living with dementia in central and Northern Saskatchewan, staff of the province’s dementia assessment program say.
A New Approach to Alzheimer’s Treatment
The disease’s complexity and multiple contributing factors suggest that combinations of drugs could be more effective than single medications.
Resources
Training Institute for Dissemination and Implementation Research in Health (TIDIRH) 2017
In 2017, the institute will utilize a combination of a 3-month online course (six webinar sessions with related assignments) between mid-August and mid-November, and a 2-day in-person training to be held November 30 and December 1, 2017, in North Bethesda, MD. Faculty and guest lecturers will consist of leading experts (practitioners and teachers) in theory, implementation, and evaluation approaches to D&I; creating partnerships and multilevel, transdisciplinary research teams; research design, methods, and analyses appropriate for D&I investigations; and conducting research at different and multiple levels of intervention (e.g., clinical, community, policy). The training is open to researchers with interests in studying D&I across health care, public health, and community settings.
Toolkit To Reduce CAUTI and Other HAIs in Long-Term Care Facilities
The Toolkit To Reduce CAUTI and other HAIs in Long-Term Care Facilities helps long-term care (LTC) facilities reduce catheter-associated urinary tract infection (CAUTI) and improve practices to prevent healthcare-associated infections (HAIs).
SHIFT: Nova Scotia’s Action Plan for an Aging Population
In Nova Scotia, older adults help to support families, workplaces, communities and the province as a whole. With this action plan, the Nova Scotia government is launching a major effort to ensure that older Nova Scotians can stay connected and involved in the social, economic and cultural lives of our provinces. The commitments range from investments in transportation and housing, to promoting healthy living and the participation of older adults in the economy.
Spare a Thought for Dementia raises youth awareness of dementia and how it impacts communities. Founded by Dr. Kristine Newman at the Daphne Cockwell School of Nursing at Ryerson University, Spare a Thought for Dementia aims to inspire youth to become more involved in their communities and become advocates for persons living with dementia.
Improving Prescription Drug Safety for Canadian Seniors
Seniors are the heaviest users of prescriptions medicines in Canada. Yet it is estimated that as much as half of the medications given to seniors are taken incorrectly or overprescribed, increasing the likelihood of adverse drug reactions and interactions. Moreover, many drugs prescribed to seniors either have not been adequately studied for this age group or have not been formally approved for the conditions they are being prescribed to treat. What are the principal causes and what is the extent of the problem? What more can be done to address this serious health issue for our aging population? We invite you to take part in this webinar discussion with Nicole F. Bernier, former director of the IRPP’s Faces of Aging program, Isobel Mackenzie, BC Seniors Advocate, and Dr. Joel Lexchin, Professor Emeritus at York University. The moderator will be France St-Hilaire (IRPP).
For more information, please contact Suzanne Lambert at (514) 787-0746 or slambert@irpp.org.
Opportunities
Postdoctoral Fellowship At The University Of Texas Southwestern Medical Center
A postdoctoral fellowship is available to enhance research capacity in interventional healthcare delivery research, with an emphasis on multiple chronic conditions. Fellowship will provide the successful candidate with opportunity to engage in mentored research. Fellow will gain research experience in recruitment of research participants, primary data collection, integrative data analysis, and implementation science and evaluation.
Realist Reviewer – Systematic Review Fellowship
The Fellowship may be undertaken full or part-time and focuses on building capacity in realist reviews. During the Fellowship the applicant will undertake a realist review. The realist review will preferably be on one or more aspect of overdiagnosis and overtreatment. The successful applicant will be provided with in-depth training, support and supervision when working on the realist review by leaders in the field – Professor Trish Greenhalgh and Dr Geoff Wong.
Applicants will be funded and expected to complete the MSc in Evidence Based Healthcare Systematic Reviews at Oxford during the Fellowship. The successful applicant will also be provided with personal development support and have the opportunity to engage with the diverse and world-class research teams in the department as well as the wider training, academic and social programmes across the University.
AANP is seeking an Associate Editor who will train to assume the role of Editor in Chief (EIC) upon her retirement, transitioning into the EIC role at an appropriate time in 2018. The Associate Editor (AE) position will require approximately 20 hours per week, with variability depending on the time of year. The work schedule can be flexible aside from scheduled conference calls. Applications should be sent to Jobs@AANP.org and should include the following:
– Letter of interest and vision for the Journal, addressed to Associate Editor – – Search Committee
– Curriculum Vitae
– Two of your peer reviewed and published articles
– Names and contact information for three professional references
Letters should include a statement of the strengths you would bring to this position. Please describe your long-term goals for NP scholarly publishing, including your assessment of how your qualifications contribute to your vision for JAANP as a leader in the NP publication arena. Shortlisted candidates will be notified of the next steps in the process, which may include telephone or face-to-face interviews. Application deadline is May 31, 2017
The Research and Expertise Centre for Survey Methodology (RECSM) of the Pompeu Fabra University (Barcelona, Spain) seeks to fill a 2-year post-doctoral position linked to a international research project titled “Care, Retirement & Wellbeing of Older People Across Different Welfare Regimes (CREW)”.
The post-doctoral fellow will undertake research on ageing, care and wellbeing using longitudinal and cross-national datasets. The selected applicant will investigate how multiple roles influence health and wellbeing of older people and the moderator effects of policies and other contextual factors. More information on the CREW project can be found at: https://crew-more-years-better-lives.org/
The complete text of the call can be found here.
