Canadian Foundation for Healthcare Innovation (CFHI)
June 2017 Newsletter
Read the latest news from CFHI
Post-conference KT is a term coined by the Child Development and Rehabilitation Evidence Centre to describe the process of documenting and prioritizing actionable key messages from professional development events, creating a KT plan, and sharing, adapting and integrating this new learning into practice, policy or research. For many occupational therapists, professional development opportunities, including scientific conferences, are common sources of new knowledge and skills, innovative ideas and potential collaborators. Because conference-based learning may differ from research syntheses with respect to level and guality of evidence, the effort invested in and the expected outcomes of post-conference KT often also differ. Outside of immediate widespread implementation, post-conference KT may be used to increase awareness of evidence or innovation; to enhance the attitudes, knowledge or skills of stakeholders (e.g. colleagues); to bring forward innovation or evidence that reguires further exploration; to pilot test or adapt new resources or approaches; to develop partnerships; to inform research design or to inspire efforts to maintain current directions. Barriers such as lack of resources, insufficient competencies and limited organizational supports limit health professionals’ and leaders’ capacity to apply KT best practices to implement change.
Co-developing a knowledge exchange network to facilitate access to clinical best practices during care transitions of patients with chronic diseases: An example in oncology (book chapter in Knowledge Creation and Transfer: New Research)
Despite numerous Quebec initiatives to improve transitional care for patients with chronic diseases such as cancer, clinical teams and patients still encounter some difficulties during these transitions. This article presents a review of the literature on the involvement of clinical teams and patient-as-partners in the changes made to clinical practices. It also highlights the main issues that arise during the implementation of a knowledge exchange strategy with a Forum for Knowledge Exchange (FKE) that aims to guide clinical teams and patients to improve the continuum of care in oncology. The FKE is an interactive space for researchers, nurses, other healthcare professionals, and patient-as-partners where they can share their knowledge, both tacit and scientific. This study uses a participative methodology and is conducted in six clinical settings that span the continuum of care in oncology. Patients-as-partners are an integral part of the implementation process, as active participants rather than in a simply advisory role. This strategy should help improve transitions between the different phases of the care continuum. The coconstruction of knowledge stemming from this clinical research study should lead to a renewal of clinical practices and thus guide clinical decision-making in multidisciplinary teams and patients.
BACKGROUND: Accompanying the unprecedented growth in the older adult population worldwide is an increase in the prevalence of frailty, an age-related clinical state of increased vulnerability to stressor events. This increased vulnerability results in lower social engagement and quality of life, increased dependency, and higher rates of morbidity, health service utilization and mortality. Early identification of frailty is necessary to guide implementation of interventions to prevent associated functional decline. Consensus is lacking on how to clinically recognize and manage frailty. It is unknown how healthcare providers and healthcare consumers understand and perceive frailty, whether or not they regard frailty as a public health concern; and information on the indirect and direct experiences of consumer and healthcare provider groups towards frailty are markedly limited.
BACKGROUND: Integrated knowledge translation has risen in popularity as a solution to the underuse of research in policy and practice settings. It engages knowledge users-policymakers, practitioners, patients/consumers or their advocates, and members of the wider public-in mutually beneficial research that can involve the joint development of research questions, data collection, analysis and dissemination of findings. Knowledge that is co-produced has a better chance of being implemented.
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.
Abstract: Despite a burgeoning literature and the development of new theories about knowledge mobilisation in the past 15 years, findings from this online survey in 2014 of over 100 research agencies (n=106; response rate 57%) show the challenges of making effective use of formal and informal learning. Many agencies rely on traditional knowledge ‘push’ activities; formal use of theoretical models and frameworks is patchy; and knowledge-sharing between agencies and the comprehensive evaluation of knowledge mobilisation programmes are limited. Closer links between research agencies, and between these and knowledge mobilisation researchers, could enhance future knowledge mobilisation practice and theory.
Health Care Administration and Organization
•Myanmar nurses working in the long-term care setting reported the highest job satisfaction level.
•Job satisfaction among international nursing staff in the long-term care setting was negatively correlated with all domains from the demands for immigration scale.
•Predictors for job satisfaction include age, English being taught in native country together with novelty, occupational demands and not being at home.
INTRODUCTION: In developed countries, substituting physicians with nurse practitioners, physician assistants and nurses (physician substitution) occurs in nursing homes as an answer to the challenges related to the ageing population and the shortage of staff, as well as to guarantee the quality of nursing home care. However, there is great diversity in how physician substitution in nursing homes is modelled and it is unknown how it can best contribute to the quality of healthcare. This study aims to gain insight into how physician substitution is modelled and whether it contributes to perceived quality of healthcare. Second, this study aims to provide insight into the elements of physician substitution that contribute to quality of healthcare.
To describe (a) the unlicensed staff time necessary to provide quality activities of daily living (ADL) care to residents receiving dementia care within an assisted living facility and (b) a staff management approach to maintain quality ADL care.
Background: Healthcare organisations are facing large demands in recruiting employees with adequate competency to care for the increasing numbers of elderly. High degrees of turnover and dissatisfaction with working conditions are common. The gendered notion of care work as ‘women’s work’, in combination with low salaries and status, may contribute to negative work experiences. There is abundant information about the negative aspects of elderly care health services, but little is known about positive aspects of this work. The study aim was to investigate work satisfaction from a gender perspective among Swedish registered nurses, physiotherapists, and occupational therapists, focusing specifically on healthcare services for the elderly. Methods: A mixed methods approach was adopted in which we combined statistics and open-ended responses from a national survey with qualitative research interviews with healthcare professionals in elderly care organisations. The survey was administered to a random sample of 1578 registered nurses, physiotherapists, and occupational therapists. Qualitative interviews with 17 professionals were conducted in six elderly care facilities. Qualitative and quantitative content analyses, chi2 and constructivist grounded theory were used to analyse the data. Results: There was a statistically significant difference in overall work satisfaction between those who worked in elderly care and those who did not (64 and 74,4% respectively, p <0.001). Nine themes were derived from open-ended responses in the questionnaire. The qualitative interviews revealed four prominent storylines: ‘Team social cohesion’, ‘Career development and autonomy’, ‘Client-centeredness’, and ‘Invisible and ignored power structures’. Conclusions: The results show the complexity of elderly care work and describe several aspects that are important for work satisfaction among health professionals. The results reveal that work satisfaction is dependent on social interrelations and cohesion in the work team, in possibilities to use humour and to have fun together, and in the ability to work as professionals to provide client-centered elderly care. Power relations such as gendered hierarchies were less visible or even ignored aspects of work satisfaction. The storylines are clearly linked to the two central discourses of professionalism and gender equality.
BACKGROUND AND OBJECTIVES: This article describes nursing home (NH) leaders’ involvement in quality improvement (QI) decisions, with an emphasis on the concept of alignment in QI decisions across leaders.
The practicality of applying evidence to healthcare systems with the aim of implementing change is an ongoing challenge for practitioners, policy makers, and academics. Shared decision- making (SDM), a method of medical decision-making that allows a balanced relationship between patients, physicians, and other key players in the medical decision process, is purported to improve patient and system outcomes. Despite the oft-mentioned benefits, there are gaps in the current literature between theory and implementation that would benefit from a realist approach given the value of this methodology to analyze complex interventions. In this protocol, we outline a study that will explore: “In which situations, how, why, and for whom does SDM between patients and health care providers contribute to improved decision making?”
Abstract: Understanding the relationship between emergent social phenomena and the stabilizing mechanisms that make collective action possible is a long-standing concern in social science, but remains an inadequately theorized area. This article sets out a middle range theory—translational mobilization theory—to address this challenge. Adopting a practice-based approach, we connect interactionist perspectives on social order, analyses of sociotechnical networks, and theories of strategic action fields, to describe and explain how projects of institutionally sanctioned collective action are progressed by actors interacting with and through socially constructed objects. Investigating these mechanisms is a prerequisite to advancing empirical and theoretical understanding of the complex organizational processes and structures that characterize contemporary society.
Abstract: The Responsive Leadership Intervention (RLI) is a multi-faceted intervention. We evaluated the influence of the RLI on i) responsive leadership practices by team leaders; ii) health care aides’ (HCAs) self-determination; iii) HCAs’ perceived ability to provide individualized care. A quasi-experimental repeated measures non-equivalent control group design was used to assess participant outcomes in four long-term care facilities (two control, two intervention) across four time periods. Change from baseline to 1-month post-intervention was greater in the intervention group than control group for Individualized Care (IC) (p = 0.001), but not for Self Determination (p = 0.26). Perceived levels of responsive leadership was greater following the intervention among participants with baseline measures that were less than the median (p = 0.007), but not if greater. At 3-months post-intervention, the intervention group retained 32% of the difference from control in IC, and 49% of the difference from control in responsive leadership; at 6-months post-intervention, 35% and 28%, respectively. The RLI is a feasible method for improving responsive leadership practices and individualized care.
AIMS AND OBJECTIVES: Our objectives were a) to assess the level of burnout in nursing home caregivers within a unique healthcare network in France and b) to evaluate potential risk factors in this population.
Abstract: This pilot study analyzes interview research with long-term residential care nursing staff in four Canadian provinces, revealing relationships between workers’ psychological health and well-being and working conditions that include work overload, low worker control, disrespect and discrimination. Further, individual workers are often required to cope with these working conditions on their own. The findings suggest that these psychological health and safety hazards can be addressed by both individual workplaces and government regulation, but are currently ignored or mis-recognized by many employers and even by workers themselves. These findings indicate opportunities for improving psychological health and safety in long-term residential care work.
BACKGROUND AND OBJECTIVES: To examine the association between supervisory support and intent to turn over among personal support workers (PSWs) employed in long-term care (LTC) homes in Ontario, Canada, by assessing whether the association is mediated by job satisfaction and the potential confounding effect of happiness.
Health Care Innovation and Quality Assurance
Background and Objectives: This study describes the program requirements, workforce competencies, and barriers for dementia capable care coordination within health plans from seven states participating in the Center for Medicare and Medicaid Services demonstration programs for dually-eligible Medicare and Medicaid beneficiaries.
Abstract: Disturbances of circadian rest-activity rhythms in demented patients often culminate in the clinical problem of evening and nighttime agitation. The aim of the current study was to test the impact of a dynamic lighting system on agitation and rest-activity cycles. From midwinter on, a ceiling mounted dynamic lighting system was installed in the common room of a nursing home and programmed to produce high illuminance with higher blue light proportions during the day and lower illuminance without blue light in the evening. Fifteen residents with dementia were regularly assessed with the Cohen Mansfield Agitation Index (CMAI) before and after the intervention. Additionally rest-activity cycles were continuously monitored for 6 months by a wrist worn activity watch. Analysis of CMAI data was performed by using the Wilcoxon-Test for matched pairs (before vs. after the lighting installation). Rest-activity data was compared with t-tests for dependent samples. The dynamic lighting significantly reduced the CMAI sum-scores from 30.2±5.1 to 27.9±2.6 (mean ± SD; N = 12; p<0.05). Analysis of the CMAI subscores revealed that under the dynamic lighting mainly non-physically aggressive behaviors were reduced. Results from the rest-activity analysis did not show differences of circadian amplitude and other circadian variables before and after the lighting installation. The dynamic lighting in the living room significantly reduced agitated behavior in demented patients, indicating short-term benefits from higher daily light exposures. Whether such lighting also impacts long-term (circadian) rest-activity cycles needs to be further investigated.
To summarize the knowledge about the aftermath of adverse events (AEs) and develop a recommendation set to reduce their negative impact in patients, health professionals and organizations in contexts where there is no previous experiences and apology laws are not present.
Background: There is an increased demand for nursing homes (NHs) in middle-income countries such as Brazil. To monitor the quality of NHs, there is a need for reliable instruments to assess the extent to which the care provided meets the expectations and rights of residents and their families.
Purpose There is an increasing interest in understanding how innovation processes can address current challenges in healthcare. The purpose of this paper is to analyze the wider socio-economic context and conditions for such innovation processes in the Stockholm region, using the functional dynamics approach to innovation systems (ISs). Design/methodology/approach The analysis is based on triangulation using data from 16 in-depth interviews, two workshops, and additional documents. Using the functional dynamics approach, critical structural and functional components of the healthcare IS were analyzed. Findings The analysis revealed several mechanisms blocking innovation processes such as fragmentation, lack of clear leadership, as well as insufficient involvement of patients and healthcare professionals. Furthermore, innovation is expected to occur linearly as a result of research. Restrictive rules for collaboration with industry, reimbursement, and procurement mechanisms limit entrepreneurial experimentation, commercialization, and spread of innovations. Research limitations/implications In this study, the authors analyzed how certain functions of the functional dynamics approach to ISs related to each other. The authors grouped knowledge creation, resource mobilization, and legitimacy as they jointly constitute conditions for needs articulation and entrepreneurial experimentation. The economic effects of entrepreneurial experimentation and needs articulation are mainly determined by the stage of market formation and existence of positive externalities. Social implications Stronger user involvement; a joint innovation strategy for healthcare, academia, and industry; and institutional reform are necessary to remove blocking mechanisms that today prevent innovation from occurring. Originality/value This study is the first to provide an analysis of the system of innovation in healthcare using a functional dynamics approach, which has evolved as a tool for public policy making. A better understanding of ISs in general, and in healthcare in particular, may provide the basis for designing and evaluating innovation policy.
Purpose – The British Columbia Ministry of Health’s Clinical Care Management initiative was used as a case study to better understand large-scale change (LSC) within BC’s health system. Using a complex system framework, the purpose of this paper is to examine mechanisms that enable and constrain the implementation of clinical guidelines across various clinical settings. Design/methodology/approach – Researchers applied a general model of complex adaptive systems plus two specific conceptual frameworks (realist evaluation and system dynamics mapping) to define and study enablers and constraints. Focus group sessions and interviews with clinicians, executives, managers and board members were validated through an online survey. Findings – The functional themes for managing large-scale clinical change included: creating a context to prepare clinicians for health system transformation initiatives; promoting shared clinical leadership; strengthening knowledge management, strategic communications and opportunities for networking; and clearing pathways through the complexity of a multilevel, dynamic system. Research limitations/implications – The action research methodology was designed to guide continuing improvement of implementation. A sample of initiatives was selected; it was not intended to compare and contrast facilitators and barriers across all initiatives and regions. Similarly, evaluating the results or process of guideline implementation was outside the scope; the methods were designed to enable conversations at multiple levels – policy, management and practice – about how to improve implementation. The study is best seen as a case study of LSC, offering a possible model for replication by others and a tool to shape further dialogue. Practical implications – Recommended action-oriented strategies included engaging local champions; supporting local adaptation for implementation of clinical guidelines; strengthening local teams to guide implementation; reducing change fatigue; ensuring adequate resources; providing consistent communication especially for front-line care providers; and supporting local teams to demonstrate the clinical value of the guidelines to their colleagues. Originality/value – Bringing a complex systems perspective to clinical guideline implementation resulted in a clear understanding of the challenges involved in LSC.
No abstract available
Background: In 2014, nursing home administration and government officials were facing increasing public and media scrutiny around the variation of antipsychotic medication (APM) prescribing across Ontario nursing homes. In response, policy makers partnered to test an academic detailing (AD) intervention to address appropriate prescribing of APM in nursing homes in a cluster-randomized trial. This mixed-methods study aimed to explore how and why the AD intervention may have resulted in changes in the nursing home context. The objectives were to understand how the intervention was implemented, explore contextual factors associated with implementation, and examine impact of the intervention on prescribing.
BACKGROUND AND OBJECTIVES: The purpose of this study was to use qualitative methods to explore nursing home staff perceptions of antipsychotic medication use and identify both benefits and barriers to reducing inappropriate use from their perspective.
Abstract: With an aging population and a healthcare system that is overly reliant on providing expensive and sometimes problematic hospital-based care for older Canadians, driving improvements that promote elder-friendly care has never been more critical. The Acute Care for Elders (ACE) Strategy at Toronto’s Mount Sinai Hospital is the focus of a pan-Canadian collaborative delivered by the Canadian Foundation for Healthcare Improvement in partnership with the Canadian Frailty Network. The intent is to spread the ACE Strategy’s elder-friendly models of care and practices to 18 participating healthcare delivery organizations. A key element of the ACE Collaborative is the inclusion of patient advisors as members of the 18 teams. This article considers the development of elder-friendly care models and practices, with lessons for patient advisors and organizations on the necessary skill-mix, as well as lessons for providers and managers on ways to more effectively engage patient advisors in health system improvement to better serve an aging population.
Examining practical nursing experiences to discover ways in which to retain and invigorate the remaining functions of the elderly with a demented and complex disability in nursing homes
Non UofA Access
AIM: The bedridden elderly with moderate-to-severe dementia account for a large proportion of the residents in nursing homes and form a specialized group requiring customized care in order to encourage their remaining functions, which determine the quality of their residual life. The purpose of this study was to search for ways to invigorate and foster the remaining functions of this complex-disability group, based on practical nursing strategies in nursing homes.
Abstract: Quality of care in nursing homes has begun to address the importance of resident choice in daily life, yet there are no published tools to teach nursing home staff how to offer such choice. In the current study, a formative assessment tool was developed that can provide staff with detailed and concrete feedback on how to realize resident choice. The tool was created and refined through 22 hours of ethnographic observation in two Veterans Health Administration Community Living Centers (CLCs), 22 hours of developmental testing in two CLCs, review by a modified Delphi panel, and use of an algorithm to assess its logical structure. The resulting Supporting Choice Observational Tool (SCOT) documents how choice is or is not offered and is or is not enabled within a singular staff-resident interaction. SCOT findings could be used in clinical teaching, quality improvement, or research efforts intent on enhancing nursing home resident quality of life.
Abstract: Thermal comfort (TC) parameters were measured in 130 rooms from nursing homes (NH), following ISO 7730:2005 in order to evaluate the influence of winter season TC indices on quality of life (QoL) in older individuals. Mean radiant temperature (mrT), predicted mean vote (PMV) and predicted percent of dissatisfied people (PPD) indices, and the respective measurement uncertainties were calculated using Monte Carlo Method. The WHOQOL-BREF questionnaire was conducted from September 2012 to April 2013, during the winter season TC sampling campaign. Winter PMV and PPD indices showed significant differences between seasons in median values for comfort. There were also significant differences between seasons for air temperature, air velocity, mrT, and relative humidity. The winter PMV index displayed a “slightly cool” [≤-1] to “cool” [≤-2] in thermal sensation scale [-3 to 3]. PPD index reflected this discomfort as evidenced by a high rate of predicted dissatisfied occupants (64%). The influence of winter season TC on older individual QoL results demonstrated that values of PMV above -0.7 had higher mean score of QoL (coefficient estimate: 11.13 units) compared with values of PMV below -0.7. These ﬁndings are of relevance to public health and may be useful for understanding NH indoor environment variables thus implementing preventive policies in terms of standards and guidelines for these susceptible populations.
No abstract available
No abstract available
Abstract: Nursing assistants provide the majority of direct resident care in nursing homes and are centrally involved in implementing quality improvement (QI), yet little is known about their experiences in QI. Interviews with nursing assistants found that respondents perceive themselves as having a unique and important role in QI. They described key outcomes of QI as positive gains in the daily lives of residents, improved work processes, and increased time between staff and residents.
Abstract: We conducted a systematic review of the literature on telemedicine use in long-term care facilities (LTCFs) and assessed the quality of the published evidence. A database search identified 22 papers which met the inclusion criteria. The quality of the studies was assessed and if they contained economic data, they were rated according to standard criteria. The clinical services provided by telemedicine included allied health (n = 5), dermatology (3), general practice (4), neurology (2), geriatrics (1), psychiatry (4) and multiple specialities (3). Most studies (17) employed real-time telemedicine using videoconferencing. The remaining five used store and forward telemedicine. The papers focused on economics (3), feasibility (9), stakeholder satisfaction (12), reliability (5) and service implementation (2). Overall, the quality of evidence for telemedicine in LTCFs was low. There was only one small randomised controlled trial (RCT). Most studies were observational and qualitative, and focused on utilisation. They were mainly based on surveys and interviews of stakeholders. A few studies evaluated the cost associated with implementing telemedicine services in LTCFs. The present review shows that there is evidence for feasibility and stakeholder satisfaction in using telemedicine in LTCFs in a number of clinical specialities.
PURPOSE: Comfort is central to patient experience but the concept of comfort is poorly defined. This review aims to develop a framework representing patients’ complex perspective of comfort to inform practice and guide initiatives to improve the quality of healthcare.
AIMS: To investigate the associations between the quality of the physical environment and the psychological and social well-being of older people living in residential care facilities.
Abstract: This qualitative study explored the vital role of line managers, namely the managerial level directly above employees, in effectively implementing evidence-based practice (EBP) from their own perspectives. Interviews were carried out with twenty-eight line managers within social services and older people care in seven Swedish municipalities. Thematic analysis was performed. Findings revealed that managers in social care perceived their role as important in implementing EBP. However, notable differences were observed between the two settings, where social services managers had more knowledge and held more positive attitudes towards working according to EBP, and described a more active role in the implementation process than managers in older people care. Overall, the implementation of EBP was performed ad hoc rather than systematically, and with little consideration to analysis of needs according to the local context and limited focus on follow-up and sustainability. This study highlighted that line managers in social services and older people care have different prerequisites for implementing EBP, and are greatly dependent on organisational strategies and context. Gaining knowledge of line managers’ perceptions is essential for making informed decisions regarding the support required to achieve EBP in social care, and thus for providing the best possible care for clients.
Research Practice and Methodology
Context: Lack of engagement with healthcare stakeholders results in missed opportunities to understand translation of evidence into practice.
Case: Stakeholder engagement is a key component of the Comparing Outcomes of Drugs and Appendectomy (CODA) Study, a pragmatic clinical trial funded by PCORI to evaluate the effectiveness of antibiotics versus urgent appendectomy for acute uncomplicated appendicitis. We provide a framework for developing a stakeholder coordinating center (SCC) and describe two examples of how stakeholder engagement can inform study development.
In several ways, randomized controlled trials represent a high standard of rigor in clinical biomedical research. Randomized controlled trials fail, however, to yield knowledge applicable to specific individuals. This article presents a methodological rationale for a mixed methods approach to n-of-1 clinical studies that attends to the preferences and concerns of individuals while attaining high standards of qualitative and quantitative rigor. An illustrative research design involving a hypothetical music therapy intervention for a quality of life outcome is examined in some detail and a concluding argument is made that the proposed mixed methods approach is especially appropriate for early-stage research interventions intended to generate explanatory hypotheses.; In several ways, randomized controlled trials represent a high standard of rigor in clinical biomedical research. Randomized controlled trials fail, however, to yield knowledge applicable to specific individuals. This article presents a methodological rationale for a mixed methods approach to n-of-1 clinical studies that attends to the preferences and concerns of individuals while attaining high standards of qualitative and quantitative rigor. An illustrative research design involving a hypothetical music therapy intervention for a quality of life outcome is examined in some detail and a concluding argument is made that the proposed mixed methods approach is especially appropriate for early-stage research interventions intended to generate explanatory hypotheses.
Health and social service practitioners have not readily incorporated research-based behavioral interventions in HIV prevention practice due to lack of awareness, lack of training, and challenges translating research findings into practice. Practitioners? involvement in research is associated with their willingness to use research to guide practice. Likewise practitioners? personal and organizational characteristics have been shown to be associated with use of research findings in practice. Factors associated with practitioners? use of evidence-based interventions (EBIs) in HIV prevention, however are not well understood. While research involvement has been recommended to help practitioners overcome barriers to the use of EBIs, the types of research involvement that result in practitioners? actual use of EBIs is not known. This is partly because most studies are either qualitative or quantitative and ignore the voices of practitioners, which can be best unearthed with qualitative research followed by survey research including larger numbers of participants. By using a mixed methods approach, this study fills this gap by showing associations between practitioners? and organizational characteristics, specific areas of research involvement, and practitioners? use of EBIs. The use of mixed methods was extremely helpful to integrate in-depth qualitative interview data from practitioners across 10 community-based agencies providing social and health services, with cross-sectional survey data from practitioners across 24 agencies in New York City. We used a sequential approach for data collection and a concurrent approach for data analysis, content analysis of in-depth interviews, and multivariate linear regression analysis. Practitioners who performed research tasks/procedures similar to their professional duties as well as their level of education, knowledge about EBIs, and their agency capacity were all positively associated with HIV evidence?based interventions. Training practitioners in research, engaging practitioners in research tasks that resemble their professional practices, and capacity building within organizations to foster academic-research partnerships could optimize practitioners? use of EBIs.; Health and social service practitioners have not readily incorporated research-based behavioral interventions in HIV prevention practice due to lack of awareness, lack of training, and challenges translating research findings into practice. Practitioners? involvement in research is associated with their willingness to use research to guide practice. Likewise practitioners? personal and organizational characteristics have been shown to be associated with use of research findings in practice. Factors associated with practitioners? use of evidence-based interventions (EBIs) in HIV prevention, however are not well understood. While research involvement has been recommended to help practitioners overcome barriers to the use of EBIs, the types of research involvement that result in practitioners? actual use of EBIs is not known. This is partly because most studies are either qualitative or quantitative and ignore the voices of practitioners, which can be best unearthed with qualitative research followed by survey research including larger numbers of participants. By using a mixed methods approach, this study fills this gap by showing associations between practitioners? and organizational characteristics, specific areas of research involvement, and practitioners? use of EBIs. The use of mixed methods was extremely helpful to integrate in-depth qualitative interview data from practitioners across 10 community-based agencies providing social and health services, with cross-sectional survey data from practitioners across 24 agencies in New York City. We used a sequential approach for data collection and a concurrent approach for data analysis, content analysis of in-depth interviews, and multivariate linear regression analysis. Practitioners who performed research tasks/procedures similar to their professional duties as well as their level of education, knowledge about EBIs, and their agency capacity were all positively associated with HIV evidence?based interventions. Training practitioners in research, engaging practitioners in research tasks that resemble their professional practices, and capacity building within organizations to foster academic-research partnerships could optimize practitioners? use of EBIs.
OBJECTIVE: The aim of the study was to develop and test an instrument, underpinned by a recognized theoretical framework, that examines how staff perceive person-centred practice, using proven methods of instrument design and psychometric analysis.
OBJECTIVE: The objective of this descriptive qualitative study was to identify best practices of nursing research councils (NRCs) at Magnet®-designated hospitals.
Abstract: Despite the growing recognition of the value of stakeholder engagement in research, there is limited guidance on effectively eliciting stakeholder views during the comparative effectiveness research (CER) process. This article outlines the potential role of each stakeholder (patient, provider, policymaker and payer) throughout the CER process and provides examples of practical questions that researchers can ask the four primary stakeholder groups at each step of the CER process. This guide aims to assist in the development of meaningful stakeholder-researcher shared decision-making to incorporate stakeholder views in the design, conduct and dissemination of patient-centered CER.
Objectives: To conceptualise and discuss dissemination bias in qualitative research. Results: It is likely that the mechanisms leading to dissemination bias in quantitative research, including time lag, language, gray literature, and truncation bias also contribute to dissemination bias in qualitative research. These conceptual considerations have informed the development of a research agenda. Conclusion: Further exploration of dissemination bias in qualitative research is needed, including the extent of non-dissemination and related dissemination bias, and how to assess dissemination bias within qualitative evidence syntheses. We also need to consider the mechanisms through which dissemination bias in qualitative research could occur to explore approaches for reducing it.
ObjectiveTo assess whether type of long-term care service is a risk factor of the incidence of pressure ulcers among older adults with dementia who are receiving long-term care insurance (LTCI).
Objectives To identify factors associated with admission to residential aged care (RAC), respite RAC and transitional care (TC) for older individuals following an injury hospitalisation. Method A retrospective analysis was conducted of individuals aged ≥65 years who had an injury hospitalisation and who were admitted to RAC during 1 July 2008 and 30 June 2013 in New South Wales, Australia. Multinominal logistic regression was used to examine the factors associated with admissions to aged care services compared to returning to the community. Results Of 191,301 injury hospitalisations, 41,085 (21.5%) individuals either returned or were new admissions to long-term or respite RAC and 3,218 individuals were admitted to TC. Older individuals newly admitted to long-term RAC were four times more likely (OR: 4.36; 95%CI 4.15–4.57), those admitted to respite RAC were twice as likely (OR: 2.37; 95%CI 2.21–2.54) and people admitted to TC were less likely (OR: 0.60; 95%CI 0.53–0.68) to have dementia compared to individuals who returned to the community. Overall, individuals who were admitted to long-term or respite RAC had a higher likelihood of experiencing limitations associated with their physical, cognitive or social abilities, with individuals admitted to TC having a higher likelihood of issues with hygiene and mobility, compared to individuals returning to the community. Conclusion Understanding the profile and predictive risk factors for injured older individuals using RAC (long-term, respite or TC services) can inform current and future aged care service resource use needs and can be used to understand factors associated with service use.
Dementia is an important predictor of nursing home admissions. Due to progressive dementia symptoms, over time it becomes difficult for persons with dementia to communicate their wishes and participate in decisions concerning their everyday lives. Their well-being, sense of dignity, integrity and personhood are at risk. The persons’ life stories have been highlighted as particularly important in dementia care and are referred to as seeing the person beyond the dementia. The aim of this study was to explore and describe the use of life stories and its influence on persons with dementia living in nursing homes, their relatives and staff.
Healthcare organisations are facing large demands in recruiting employees with adequate competency to care for the increasing numbers of elderly. High degrees of turnover and dissatisfaction with working conditions are common. The gendered notion of care work as ‘women’s work’, in combination with low salaries and status, may contribute to negative work experiences. There is abundant information about the negative aspects of elderly care health services, but little is known about positive aspects of this work. The study aim was to investigate work satisfaction from a gender perspective among Swedish registered nurses, physiotherapists, and occupational therapists, focusing specifically on healthcare services for the elderly.
Coping with predeath grief (PDG) is an unmet need in caregivers of persons with dementia (PWD). The Marwit-Meuser Caregiver Grief Inventory (MM-CGI) and its abbreviated MM-CGI-Short-Form (MM-CGI-SF) are among the few empirically developed scales that detect PDG, yet they have not been substantially validated outside United States. We evaluated the reliability and validity of the PDG scales in a multiethnic Asian population distinct from that of United States.
Historically, research, practice, and policy on Alzheimer’s family care has been largely focused on dyadic relationships and the experience of burden and stress, often failing to capture the complex caring dynamics as they unfold over time. This study sought to develop a more nuanced understanding of how people with Alzheimer’s disease (AD) and their families are affected by the disease and how they respond to the challenges AD poses.
Quality of life (QoL) in the face of declining health, mobility, and social losses is a central issue for older adults. Our study examined changes in QoL over time for older adults residing in independent senior housing within continuing care retirement communities (CCRCs) and estimated how residents’ social engagement during their first year influenced QoL over the next 4 years. Data were drawn from a 5-year panel study of 267 older adults who moved into senior housing within four CCRCs. Although initial QoL varied between individuals, QoL declined for the group over time. One component of early social engagement-participating in a greater number of formal social activities organized by the CCRC-significantly slowed the rate of decline in QoL. Findings suggest that senior housing residents may benefit from early participation in organized social and leisure activities soon after move-in to forestall declines in QoL over the long term.
OBJECTIVES: To evaluate the effectiveness of strategies that nursing home care providers can apply to either prevent/overcome residents’ responsive behaviors to oral care, or enable/motivate residents to perform their own oral care.
PURPOSE: This study aimed to explore older adults’ perceptions of their daily lives in South Korean nursing homes.
BACKGROUND: The sustained interest in electronic assistive technology in dementia care has been fuelled by the urgent need to develop useful approaches to help support people with dementia at home. Also the low costs and wide availability of electronic devices make it more feasible to use electronic devices for the benefit of disabled persons. Information Communication Technology (ICT) devices designed to support people with dementia are usually referred to as Assistive Technology (AT) or Electronic Assistive Technology (EAT). By using AT in this review we refer to electronic assistive devices. A range of AT devices has been developed to support people with dementia and their carers to manage their daily activities and to enhance safety, for example electronic pill boxes, picture phones, or mobile tracking devices. Many are commercially available. However, the usefulness and user-friendliness of these devices are often poorly evaluated. Although reviews of (electronic) memory aids do exist, a systematic review of studies focusing on the efficacy of AT for memory support in people with dementia is lacking. Such a review would guide people with dementia and their informal and professional carers in selecting appropriate AT devices.
OBJECTIVES: Primary objective – To assess the efficacy of AT for memory support in people with dementia in terms of daily performance of personal and instrumental activities of daily living (ADL), level of dependency, and admission to long-term care. Secondary objective – To assess the impact of AT on: users (autonomy, usefulness and user-friendliness, adoption of AT); cognitive function and neuropsychiatric symptoms; need for informal and formal care; perceived quality of life; informal carer burden, self-esteem and feelings of competence; formal carer work satisfaction, workload and feelings of competence; and adverse events.
BACKGROUND: Alongside changes in society and the economy, the family’s function of taking care of older people is weakening and the formal care mode is becoming more accepted. Older Chinese people are facing diverse choices of long-term care (LTC) modes. Acknowledging this situation, to optimize older people’s arrangements for LTC services and improve quality of later life, this study sets out to explore and make theoretical sense of older people’s LTC needs and to identify the factors influencing their LTC needs.
BACKGROUND: Older adults living in long term care (LTC) homes are nutritionally vulnerable, often consuming insufficient energy, macro- and micronutrients to sustain their health and function. Multiple factors are proposed to influence food intake, yet our understanding of these diverse factors and their interactions are limited. The purpose of this paper is to fully describe the protocol used to examine determinants of food and fluid intake among older adults participating in the Making the Most of Mealtimes (M3) study.
Abstract: Background/Study Context: Depression is a common psychiatric disorder in the elderly that leads to a decrease in quality of life and functional impairment, among other health problems. The study of depressive symptoms in institutionalized elderly is scarce in Latin America and can contribute to plan prevention and treatment actions in order to improve health conditions for the residents as well as quality of life. Therefore, the aim of this study is to determine the prevalence of depressive symptoms and identify its associated factors in institutionalized elderly.
To synthesise evidence to identify the components of effective psychosocial interventions in dementia care to inform clinical practice, policy and research.
Abstract: Dementia is a common neurodegenerative process that can significantly impair decision-making capacity as the disease progresses. When a person is found to lack capacity to make a decision, a surrogate decision-maker is generally sought to aid in decision-making. Typical bases for surrogate decision-making include the substituted judgment standard and the best interest standard. Given the heterogeneous and progressive course of dementia, however, these standards for surrogate decision-making are often insufficient in providing guidance for the decision-making for a person with dementia, escalating the likelihood of conflict in these decisions. In this article, the narrative interest standard is presented as a novel and more appropriate approach to surrogate decision-making for people with dementia. Through case presentation and ethical analysis, the standard mechanisms for surrogate decision-making for people with dementia are reviewed and critiqued. The narrative interest standard is then introduced and discussed as a dementia-specific model for surrogate decision-making. Through incorporation of elements of a best interest standard in focusing on the current benefit–burden ratio and elements of narrative to provide context, history, and flexibility for values and preferences that may change over time, the narrative interest standard allows for elaboration of an enriched context for surrogate decision-making for people with dementia. More importantly, however, a narrative approach encourages the direct contribution from people with dementia in authoring the story of what matters to them in their lives.
Background: Dementia is an important predictor of nursing home admissions. Due to progressive dementia symptoms, over time it becomes difficult for persons with dementia to communicate their wishes and participate in decisions concerning their everyday lives. Their well-being, sense of dignity, integrity and personhood are at risk. The persons’ life stories have been highlighted as particularly important in dementia care and are referred to as seeing the person beyond the dementia. The aim of this study was to explore and describe the use of life stories and its influence on persons with dementia living in nursing homes, their relatives and staff. Methods: A systematic mixed studies review was conducted. The literature searches were performed in the following databases: CINAHL, PubMed and PsycINFO and the Cochrane library, as well as by hand searching references in the studies included. An updated search was performed eight months after the first search. Data was synthesised inspired by integrative analysis. Results: Three studies using quantitative design and two studies (presented in three papers) using qualitative design representing research from 2006 to 2015 were included in the review. Life stories generally had a positive influence on the persons with dementia, their relatives, and staff. The use of life stories might contribute to ‘Maintenance of the person with dementia as a whole person rather than a demented patient’. On the other hand, enabling persons with dementia to tell their own story could be a challenge. For the staff it could be challenging when sensitive information emerged uninvited. Involving relatives could also be difficult as to whose story were uncovered. Conclusions: The use of person’s life story might be of significance, but there is not enough evidence to make any statement about its importance as the research is scarce. Studies, including randomised controlled trials, are needed to measure the impact of life story work on the physiological and psychological aspects of persons with dementia, and also how it influences their relatives and staff.
Background: To compare different methods for identifying a long term care (LTC) nursing home stay, distinct from stays in skilled nursing facilities (SNFs), to the method currently used by the Center for Medicare and Medicaid Services (CMS). We used national and Texas Medicare claims, Minimum Data Set (MDS), and Texas Medicaid data from 2011-2013. Methods: We used Medicare Part A and B and MDS data either alone or in combination to identify LTC nursing home stays by three methods. One method used Medicare Part A and B data; one method used Medicare Part A and MDS data; and the current CMS method used MDS data alone. We validated each method against Texas 2011 Medicare-Medicaid linked data for those with dual eligibility. Results: Using Medicaid data as a gold standard, all three methods had sensitivities > 92% to identify LTC nursing home stays of more than 100 days in duration. The positive predictive value (PPV) of the method that used both MDS and Medicare Part A data was 84.65% compared to 78.71% for the CMS method and 66.45% for the method using Part A and B Medicare. When the patient population was limited to those who also had a SNF stay, the PPV for identifying LTC nursing home was highest for the method using Medicare plus MDS data (88.1%). Conclusions: Using both Medicare and MDS data to identify LTC stays will lead to more accurate attribution of CMS nursing home quality indicators.
Background: The purpose of the study was to establish the test–retest reliability of the Norwegian version of the Short Physical Performance Battery (SPPB).
Background: Caring and supporting older people with dementia have become a major public health priority. Recent reports have also revealed a diminishing number of family carers to provide dementia care in the future. Carers who are engaged in the caring role are known to bear significant psychological, practical and economic challenges as the disease advances over time. Seemingly, evidence indicates that the burden of care can be relieved by formal services. This study aims to explore decision-making experiences of family members of older adults with moderate dementia towards the use of community support (CS) and residential care home (RCH) services.
Objectives: Over the last 10 years, appropriate workforce utilisation has been an important discussion among healthcare practitioners and policy-makers. The role of healthcare aides (HCAs) has also expanded to improve their utilisation. This evolving role of HCAs in Canada has prompted calls for standardised training, education and scope of practice for HCAs. The purpose of this research was to examine the differences in HCAs training and utilisation in continuing care facilities.
Aim: To identify characteristics of highly-rated leadership in nursing homes. Background: An ageing population entails fundamental social, economic and organizational challenges for future aged care. Knowledge is limited of both specific leadership behaviors and organizational and managerial characteristics which have an impact on the leadership of contemporary nursing home care.
Abstract: In the U.K. context where the emphasis is (quite rightly) on living well with dementia, on positivity and enabling approaches, it can be difficult for researchers to investigate and report negative experiences. Failing to re-present perceptions and experiences as they are lived, however, does a serious disservice to the research endeavor and can prevent policy and service development and positive change. In this article, we present some stories told by participants in an Alzheimer’s Society (United Kingdom) Funded project uniquely investigating the perceptions and experiences of children and young people who have a parent with dementia. Sometimes the stories were not easy to hear, especially when they challenged dominant master narratives around dementia. We discuss our view that when the young people we spoke with told us how things were for them, we were ethically bound to respect and disseminate their accounts.
OBJECTIVE: The objective of this study is to describe the prevalence of depression and cognitive impairment among newly admitted nursing home residents in the USA and to describe the treatment of depression by level of cognitive impairment.
BACKGROUND: Older patients with dementia are often unable to take their medications as prescribed due to cognitive and physical impairment.
OBJECTIVES: To review the evidence on medication adherence in older patients with dementia in terms of the level of adherence, outcomes, contributing factors, and available interventions.
BACKGROUND: Earlier studies of nursing home patients show a high prevalence of dementia, neuropsychiatric symptoms (NPS), pain, and dependency in activities of daily living. The REDIC-NH cohort was set up to study the disease course and the resources used in patients with dementia in Norway. The aim of this paper was to describe the methods and the data collection, and to present selected data about patients at admission to a nursing home.
OBJECTIVES: This study aimed to examine the effects of introducing participatory action research (PAR) within the nursing home (NH) on residents’ quality of life (QoL) and NH experience and participation, and to explore their experiences with PAR.
OBJECTIVES: To study pain prevalence, pain type, and its pharmacological treatment in Dutch nursing home residents in relation to dementia subtype and dementia severity.
BACKGROUND: Oral health of nursing home residents is generally poor, with severe consequences for residents’ general health and quality of life and for the health care system. Care aides in nursing homes provide up to 80% of direct care (including oral care) to residents, but providing oral care is often challenging. Interventions to improve oral care must tailor to identified barriers and facilitators to be effective. This review identifies and synthesizes the evidence on barriers and facilitators care aides perceive in providing oral care to nursing home residents.
Abstract: This paper reports on part of a doctoral study which explored stakeholder perceptions of the importance of a homelike environment in a care home and which factors contributed to this. The changes in institutional care for older people have evolved from being a ‘warehouse’ type of environment for those too poor, too mad, too sick and too unloved, to a place where older people in need of care can spend their days in safety, in a ‘homely’ environment. Such an environment is one of the quality indicators of care home provision. Yet defining what ‘homeliness’ means is fraught with difficulties. This article presents a narrative literature review on the concept of ‘home’ and the common measures taken to address homeliness in a care home setting. The results show that although the word ‘homely’ is used with the presumption of a shared understanding, the concept is elusive and highly subjective. Given that long-term care now provides homes for an increasingly wide range of age groups and individuals with increasingly diverse backgrounds and personal histories, is a shared viewpoint on homeliness possible? Indeed, is it ever possible to make an institution homely?
No abstract available
Save the Dates in 2018! Our 2018 Symposium will be held in Halifax, Nova Scotia, from April 15 to 17, 2018. We are also pleased to be co-hosting the HTAi 2018 Annual Meeting in Vancouver, British Columbia, June 1 to 5, 2018. 2018 is going to be a big year for HTA in Canada! We hope you can join us!
8-10 August, Toronto, ON
Understanding Dementia is a Massive Open Online Course (MOOC), offering university-quality education about the latest in dementia research and care. This free 9-week course provides an opportunity to engage with the perspectives of an international community, without requiring exams or assignments.
In this webinar, participants will be introduced to the range of literary, performative and visual methods used in arts-based approaches to KT. Specific challenges and opportunities related to using these innovative KT approaches in the field of health policy development will be considered through closer examination of a series of examples drawn from my own as well as colleagues’ work. The webinar will conclude with reflections on ethical and methodological issues arising and tips on where to turn for resources and support.
Join us as we:
– introduce and explain the CARES approach
– examine key results for the interprovincial CARES initiative
– explore the potential and current plans for sustainability and spread
Lessons learned from developing and implementing novel approaches to support evidence-informed health systems: The Caribbean Public Health Agency. This webinar featured a discussion with Andrea Yearwood (Senior Health Policy Analyst, Caribbean Public Health Agency) and Kaelan Moat (Scientific Lead, Health Systems Evidence and Learning, McMaster Health Forum).
More patients also dying at home, with the caregiving burden falling on loved ones.
The $100 million IDEAS (Imaging Dementia — Evidence for Amyloid Scanning) Study is working closely with researchers and government officials to add three additional studies to the main project, where more than 18,000 people with cognitive deterioration but whose diagnosis is unclear are receiving a brain amyloid PET scan.
The nation’s health leaders will again be asked next week to step up to the plate and identify the Canadian health care system’s most pressing current need.
A new report commissioned by the province calls the current seniors’ healthcare system fragmented, complex and confusing.
In the latest Stanford Social Innovation Review, Mary Ann Bates and Rachel Glennerster from J-PAL propose a four-step strategy to help policy makers through that process of appropriate adaptation of results from one context to another.
Emergency departments are the usual destination for older patients in need of treatment. For the sick and injured, the ER is supposed to be a beacon of hope. For seniors, it’s becoming a place of futility.
Pain that continues, day in and day out, may trigger an unexpected and unwanted side effect — a bigger risk of mental decline and dementia, a new study suggests.
Half of adults in this age group visit the ER in their last month of life, according to a study in the journal Health Affairs. Of those, half die in the hospital, the study found, even though most people say they’d prefer to die at home.
The allegations of neglect and substandard care are contained in letters the families of five patients at a nursing home in Sault Ste. Marie, Ont., sent to Health Minister Eric Hoskins earlier this month.
An Alzheimer’s Society investigation has laid bare the unachievable cost of dementia care, calculating that the typical person’s bill for dementia social care would take 125 years to save for.
The number of people who die from dementia is set to almost quadruple in coming years, a new study has found. Increasing deaths from the condition will contribute to a rocketing number of people who will need end-of-life care, researchers added.
The World Health Organization (WHO) has unanimously adopted a global plan on dementia at the 70th session of the World Health Assembly in Geneva. The plan follows ten years of advocacy by ADI for a global response to the growing impact of dementia worldwide.
Alberta health officials are hashing out the details of a provincial dementia strategy, to be unveiled in the coming weeks.
The federal government’s failure to address a slew of issues relating to seniors means Canada is “woefully unprepared” to deal with its aging society.
More infection-prevention education and policies are needed, study findings suggest.
The development of this framework was supported by a diverse means of data collection including a literature review, a disseminated online survey, expert consultation and stakeholder interviews with a broad range of individuals including patients, families and health care providers. This framework outlines current gaps in palliative care research and provides a road map for the direction for future research efforts in the area of palliative care.
In May 2017, the Health Affairs blog launched a new blog series on “Diffusion of Innovation.” Health Affairs uses the term “diffusion” to describe implementation and dissemination science, translational science, scale, spread, adoption, and other related fields and labels. The new blog series—which will continue through February 2018 and will culminate in a theme issue of the Health Affairs journal—will encompass all aspects of the journey between development of a health care innovation and widespread adoption of change in the health care delivery system.
KT Alberta will be Alberta’s community of practice for researchers, practitioners, administrators, and policy-makers working in the area of health-related knowledge translation. The community of practice will be supported by the Alberta SPOR KT Platform as part of the platform’s commitment to building the capacity of, and connections between, the talented KT people working in our province.
Offers an analysis of the root causes behind the lack of progress toward effective integration of healthcare in Alberta. It identifies opportunities based on models from other jurisdictions to take Alberta’s health system to a higher level in a quantum leap rather than through incremental change and reorganization.
This report highlights current trends in nursing practice in Canada across a variety of demographic, education, mobility and employment characteristics for the 3 groups of regulated nursing professionals: registered nurses (including nurse practitioners), licensed practical nurses, and registered psychiatric nurses.
The NHS Five-Year Forward view recognises that the NHS needs to do more to support older people living with frailty in care homes. This paper presents the findings from a rapid review and consensus events that explored how organisational context affects uptake of healthcare innovation in long term care settings. Care home managers and front line staff, care home researchers, NHS commissioners and NHS practitioners participated in the workshops.
Life Story work is an activity in which the person with dementia is supported by staff and family members to gather and review their past life events and build a personal biography. It is used to help the person understand their past experiences and how they have coped with events in their life.
The Institute for Work & Health is an acknowledged innovator in knowledge transfer methods. As a member of the Institute’s executive team, you will be responsible for our continued global leadership in this field, ensuring that our research evidence is available, understandable and usable for decision-makers.