New TREC article by Dr. Cummings and Dr. Estabrooks
BACKGROUND: Extended lifespans and complex resident care needs have amplified resource demands on nursing homes. Nurse managers play an important role in staff job satisfaction, research use, and resident outcomes. Coaching skills, developed through leadership skill-building, have been shown to be of value in nursing.
New TREC articles
Background: A number of long-term care homes in Nova Scotia, Canada, have been built or redesigned with new models of care with expanded care aide scope of practice and neighborhood-style layouts. Our objective was to examine what physical characteristics (bed size, owner-operator), model of care, and relational (family–staff relationship, perceived staff–resident relationship) factors were associated with increased family-member perception of homelikeness in long-term care homes. Methods: We analyzed surveys collected from 273 family members from 23 long-term care homes in Nova Scotia, Canada. We conducted a multivariate linear regression to assess variables associated with increased family-member perception of homelikeness. Results: We found that relationships between family and staff, perceived resident-to-resident relationships, and family involvement in decision making were positively associated with increased family perception of homelikeness. We found no significant associations between model of care or physical characteristics and increased family perception of homelikeness. Conclusion: Relationships among family members, residents, and staff are integral to family members feeling at home in their loved one’s long-term care home. Feeling at home in long-term care is largely related to family-member perception of meaningful social interactions between family and staff, and between residents.
Abstract: This study aimed to (1) explore how palliative care in long-term care (LTC) addresses the tensions associated with caring for the living and dying within one care community, and (2) to inform how palliative care practices may be improved to better address the needs of all residents living and dying in LTC as well as those of the families and support staff. This article reports findings from 19 focus groups and 117 participants. Study findings reveal that LTC home staff, resident, and family perspectives of end-of-life comfort applied to those who were actively dying and to their families. Our findings further suggest that eliciting residents’ perceptions of end-of-life comfort, sharing information about a fellow resident’s death more personally, and ensuring that residents, families, and staff can constructively participate in providing comfort care to dying residents could extend the purview of end-of-life comfort and support expanded integration of palliative principles within LTC.
Calls for Abstracts
The Margaret Scott Wright Research Day is a day when Faculty, Alumni, Clinicians, Graduate and Undergraduate Students have an opportunity to share current research with others.
Conference Theme: “Inspiration and Research”
“Inspiration” is the process of being mentally stimulated to do or feel something creative. Who or what inspires your research? Why is your research question and topic important to you and others?
Grants & Awards
The objective of this funding opportunity is to support cross-jurisdictional programs of research that respond to the priorities of the Primary and Integrated Health Care Innovations (PIHCI) Network in order to generate findings that will guide evidence-informed policy decision-making, with the intent of having an impact on the health system for all Canadians within four years.
Abstract: This study addresses the problem of knowledge dissemination in science–society relation, its connection with the specialization of scientific research fields and the proliferation of academic and practitioner-oriented journals. Specifically, we elaborate on the scientists’ failure to communicate successfully with practitioners and the need for establishing alternative mechanisms that help boost the flow of knowledge between academics and industry. To do so, a thorough literature review is conducted and the author guidelines of the most prominent journals that appeal to both academics and practitioners are reviewed. Based on the analysis, the article offers suggestions on how to narrow the science–industry knowledge gap and how to find a way of not only delivering science to practitioners, but also making science benefit society. Progress is necessary to move towards a better academic–practitioner dialogue and thereby advance both science and practice.
Health Care Administration and Organization
Abstract: Integrating theorizing on emotional labor performed by human service workers with assumptions of self-determination theory, this study tests a model of stressful patient interactions, psychological regulation of negative emotions, and symptoms of job burnout in healthcare professionals. Survey data of N = 1848 geriatric nurses in 111 nursing homes for the elderly in Germany were analyzed using latent-variable structural equation modeling. The specified phase model of interaction work and emotional regulation was well supported by the data. Emotion regulation mediated between stressful patient interactions and three dimensions of job burnout, namely emotional exhaustion, depersonalization, and reduced accomplishment. Differential correlational patterns confirmed faking in bad faith and deviant display as psychologically maladaptive, whereas faking in good faith and deep acting were found to be more functional. As hypothesized, factors connected to psychological need fulfillment according to self-determination theory positively influenced interactions, emotion regulation, and coping processes.
Aims and objectives: (i) To assess the level of burnout in nursing home caregivers within a unique healthcare network in France and (ii) to evaluate potential risk factors in this population. Background: Burnout syndrome occurs frequently among nursing home caregivers and has strong detrimental effects on the quality of health care for residents. Design: We used an observational survey to study burnout in nursing home caregivers. The survey was used to quantify burnout level (Maslach Burnout Inventory) and potential risk factors and was implemented from October 2013-April 2014. Methods: A logistic regression was used to explore the association between burnout and its risk factors. Results: Three hundred and sixty questionnaires were delivered to caregivers in 14 nursing homes within a unique healthcare network. The response rate was 37% (132/360), and 124/132 (94%) surveys were analysed. Caregiver burnout rate was 40% (49/124). Median age was 41 years (range, 20-70) and most caregivers were female. The most common profession (n = 54; 44%) was nurse caregiver and 90% (n = 112) had an antecedent of bullying by a resident. Risk factors identified were as follows: the presence of institutional protocols (death announcement [OR: 3.7] and pain assessment [OR: 2.8]), working in a profit-making establishment (OR: 2.6) and the antecedent of bullying by a resident (OR: 6.2). Factors most negatively associated with burnout included: practising pastimes (OR: 0.4) and working as a nurse (OR: 0.3). The only significant risk factor in the multivariate analysis was the antecedent of bullying by a resident (OR: 5.3). Conclusion: Several specific risk factors for burnout in nursing home caregivers were identified. Relevance to clinical practice: In high-risk populations of healthcare professionals, screening and management of risk factors is crucial for preventing burnout.
Aims and objectives: To develop, implement and evaluate a workplace continuing education programme about nursing care of hospitalised older people. Background: The healthcare system cannot rely solely upon nurses’ prelicensure education to prepare them to meet the evolving needs of hospitalised older patients. Over the past decade, there has been a dramatic rise in the proportion of older people in hospitals, yet many nurses do not have specialised knowledge about the unique care needs of this population. Design: A multimethod pre-to post-design was employed. Methods: Between September 2013 and April 2014, data were collected via surveys, focus groups and interviews. Thirty-two Registered Nurses initially enrolled in the programme of which 22 completed all data points. Three managers also participated in interviews. One-way repeated-measures ANOVAs were conducted to evaluate the effect of the programme and change over time. Qualitative data were analysed using thematic analysis. Results: Survey results indicated improvements in perceptions about nursing care of older people but no changes in knowledge. Themes generated from the qualitative data focused on participants’ experiences of taking part in the programme and included: (i) relevance of content and delivery mode, (ii) value of participating in the programme and (iii) continuing education in the context of acute care. Conclusions: This study illustrated the potential role of workplace continuing education in improving care for hospitalised older people, particularly the potential to change nurses’ perceptions about this population. Nurses prefer learning opportunities that are varied in delivery of educational elder-focused content and accessible at work. Organisational leaders need to consider strategies that minimise potential barriers to workplace continuing education. Implications for practice: Workplace continuing education can play a key role in improving quality of care for hospitalized older adults and ought to be a priority for employers planning education for nurses.
BACKGROUND: Medication reconciliation is a safety practice to identify medication order discrepancies when patients’ transitions between settings. In nursing homes, registered nurses (RNs) and licensed practical nurses (LPNs), each group with different education preparation and scope of practice responsibilities, perform medication reconciliation. However, little is known about how they differ in practice when making sense of medication orders to detect discrepancies. Therefore, the purpose of this study was to describe differences in RN and LPN sensemaking when detecting discrepancies.
Health Care Innovation and Quality Assurance
Background: Previous reviews and meta-analyses demonstrated effects of cognitive interventions in dementia, but none specifically considered residents with dementia in long-term care (LTC) facilities.
Objective: To analyse the efficacy of cognitive interventions in institutionalised individuals with dementia.
OBJECTIVES: An Asia-Pacific regional collaboration group conducted its first multi-country research project to determine whether or not European quality indicators (QIs) for psychosocial care in dementia could be implemented as a valid tool in residential aged care across seven Asia-Pacific sites (Australia, Hong Kong Special Administrative Region, Mainland China, Malaysia, Singapore, South Korea, and Thailand).
BACKGROUND AND AIMS: Little is known about whether a self-management program for nursing-home residents (NHR) with cognitive impairment is likely to have an impact on the care of this growing population. This study aimed to evaluate the effects of the health-coaching self-management program for NHR (HCSMP-NHR) on 1) self-efficacy and goal attainment scaling (GAS), 2) health status and quality of life (QoL) among older people, including those with cognitive impairment, in Korean nursing homes.
Abstract: Nursing homes are the major provider of intermediate and long-term care outside of the hospital setting to individuals whose capacity for self-care is limited due to physical or cognitive impairments. Yet, despite their need for assistance, residents of nursing homes want to control their lives, set their routines, and do enjoyable things. The extent to which residents can maintain autonomy and dignity is important. The current study suggests an environmental gerontological framework, rooted in a capabilities approach, that can be used to consider environmental impact on quality of life in nursing homes. Using a cross-sectional survey of nursing home residents in Texas, environmental factors that might predict residents’ quality of life as well as possible interactions of environmental factors and residents’ characteristics that might predict well-being were examined. Environmental orientation and perception of social activities were important predictors of residents’ quality of life, but geographic location and facility size were not important predictors.
PURPOSE: The goals of the Missouri Quality Initiative (MOQI) for long-stay nursing home residents were to reduce the frequency of avoidable hospital admissions and readmissions, improve resident health outcomes, improve the process of transitioning between inpatient hospitals and nursing facilities, and reduce overall healthcare spending without restricting access to care or choice of providers. The MOQI was one of 7 program sites in the United States, with specific interventions unique to each site tested for the Centers for Medicaid and Medicare Services (CMS) Innovations Center.
OBJECTIVE: Person-centered care (PCC) is meant to enhance nursing home residents’ quality of life (QOL). Including residents’ perspectives is critical to determining whether PCC is meeting residents’ needs and desires. This study examines whether PCC practices promote satisfaction with QOL and quality of care and services (QOC and QOS) among nursing home residents.
BACKGROUND: Autonomy has become a key organizing principle in the official and expert discourses of the social services focused on strengthening of clients’ independence and self-sufficiency. While “caring” has been seen as a threat to the autonomy of an individual, the care dependency and need for palliative care for people with dementia living in residential institutions are growing.
BACKGROUND: Dementia is a common and serious neuropsychiatric syndrome, characterised by progressive cognitive and functional decline. The majority of people with dementia develop behavioural disturbances, also known as behavioural and psychological symptoms of dementia (BPSD). Several non-pharmacological interventions have been evaluated to treat BPSD in people with dementia. Simulated presence therapy (SPT), an intervention that uses video or audiotape recordings of family members played to the person with dementia, is a possible approach to treat BPSD.
OBJECTIVES: Nursing home (NH) residents suffer from sleep disturbances which are associated with a low quality of life (QoL). The purpose of this study was to explore the effectiveness of comparing acupressure on specific acupoints with acupressure on non-specific acupoints in older NH residents with sleep disturbances.
BACKGROUND: Despite the finding that involvement in activities is one of the most important needs of residents with dementia living in care homes, care facilities struggle to fulfill this need. Over the years, various factors are suggested which may contribute to or disable activity provision in dementia care homes. These include limited financial resources, task oriented staff and disease-related characteristics of residents. This study aims to further clarify which of these factors predict higher activity involvement.
BACKGROUND: The growing use of social media creates opportunities for patients and families to provide feedback and rate individual healthcare providers. Whereas previous studies have examined this emerging trend in hospital and physician settings, little is known about user ratings of nursing homes (NHs) and how these ratings relate to other measures of quality.
BACKGROUND: As part of the ActifCare (ACcess to Timely Formal Care) project, we conducted expert interviews in eight European countries with policy and political decision makers, or representatives of relevant institutions, to determine their perspectives on access to formal care for people with dementia and their carers.
Research Practice and Methodology
BACKGROUND: Mild cognitive impairment (MCI) is a prevalent symptom associated with the increased risk of dementia. There are many cognitive tests available for detection of MCI, and investigation of the diagnostic performance of the tests is deemed necessary.
BACKGROUND AND OBJECTIVE: The identification of frail individuals has been recognized as a priority for the effective implementation of healthy aging strategies. Only a limited number of studies have examined frailty in nursing homes, and there is a big heterogeneity in the methods used. The primary objective of this study was to determine the prevalence and feasibility of different frailty screening tools in nursing homes as well as its relationship with multimorbidity and disability.
Purpose: The literature is reviewed to examine how ‘improvement capability’ is conceptualized and assessed and to identify future areas for research.
Abstract: Evidence-based practice and research utilisation has become a commonly used concept in health care. The Research Utilization Questionnaire (RUQ) has been recognised to be a widely used instrument measuring the perception of research utilisation among nursing staff in clinical practice. Few studies have however analysed the psychometric properties of the RUQ. The aim of this study was to examine the psychometric properties of the Swedish version of the three subscales in RUQ using a Rasch measurement model. This study has a cross-sectional design using a sample of 163 staff (response rate 81%) working in one nursing home in Sweden. Data were collected using the Swedish version of RUQ in 2012. The three subscales Attitudes towards research, Availability of and support for research use and Use of research findings in clinical practice were investigated. Data were analysed using a Rasch measurement model. The results indicate presence of multidimensionality in all subscales. Moreover, internal scale validity and person response validity also provide some less satisfactory results, especially for the subscale Use of research findings. Overall, there seems to be a problem with the negatively worded statements. The findings suggest that clarification and refining of items, including additional psychometric evaluation of the RUQ, are needed before using the instrument in clinical practice and research studies among staff in nursing homes.
BACKGROUND: Dementia is a life-limiting condition that is increasing in global prevalence in line with population ageing. In this context, it is necessary to accurately measure dementia knowledge across a spectrum of health professional and lay populations with the aim of informing targeted educational interventions and improving literacy, care, and support. Building on prior exploratory analysis, which informed the development of the preliminarily valid and reliable version of the Dementia Knowledge Assessment Scale (DKAS), a Confirmatory Factor Analysis (CFA) was performed to affirm construct validity and proposed subscales to further increase the measure’s utility for academics and educators.
BACKGROUND: Unpaid, informal carers or caregivers play an important role in supporting people living with dementia but the role can be challenging and carers themselves may benefit from support. Alzheimer’s, dementia or memory cafés are one such form of support . These cafés are usually provided in the voluntary sector and are a place where people with dementia and those supporting them, usually family carers, can meet with others in similar situations.
Quasi-experimental evaluation of a multifaceted intervention to improve quality of end-of-life care and quality of dying for patients with advanced dementia in long-term care institutions
Non UofA Access
BACKGROUND: Improvement in the quality of end-of-life care for advanced dementia is increasingly recognized as a priority in palliative care.
AIM: To evaluate the impact of a multidimensional intervention to improve quality of care and quality of dying in advanced dementia in long-term care facilities.
OBJECTIVE: The objective of this study was to evaluate, among nursing home residents, the extent to which the various operational definitions of frailty predict mortality and falls at 1 year.
Objectives: This study aimed to document change in neuropsychological, physical and functional performance over one year and to investigate the relationship between baseline gait speed and cognitive decline in this period in older people with dementia.
Purpose of the study: (1) to identify the main predictors of the emotional state of the frail elderly at the end-of-life and that of their primary family caregivers, taking into consideration the presence/absence of significant cognitive impairment in the patient and (2) to analyse the relationship between the emotional state of the patient and that of their primary family caregiver.
BACKGROUND/OBJECTIVES: To estimate the prevalence of potentially inappropriate medication (PIM) use among older adults with cognitive impairment or dementia prior to and following admission to nursing homes and in relation to frailty.
BACKGROUND: Dementia and diabetes mellitus are common long-term conditions and co-exist in a large number of older people. People living with dementia (PLWD) may be less able to manage their diabetes, putting them at increased risk of complications such as hypoglycaemia. The aim of this review was to identify key mechanisms within different interventions that are likely to improve diabetes outcomes in PLWD.
Background: Physical activity is recommended for people living with dementia, but evidence for the positive effects of physical activity is limited by the use of heterogeneous outcomes and measurement tools. This systematic literature review aimed to summarise previously reported outcomes and identify the measurement tools used most frequently in physical activity interventions for people with dementia.
Abstract: Alzheimer’s disease (AD) affects more than 5 million Americans, with substantial consequences for individuals with AD, families, and society in terms of morbidity, mortality, and healthcare costs. With disease-modifying treatment trials unsuccessful at the present time and only medications to treat symptoms available, an emerging approach is prevention. Advances in diagnostic criteria, biomarker development, and greater understanding of the biophysiological basis of AD make these initiatives feasible. Ongoing pharmacological trials using anti-amyloid therapies are underway in sporadic and genetic forms of AD, although a large number of modifiable risk factors for AD have been identified in observational studies, many of which do not appear to exert effects through amyloid or tau. This suggests that prevention studies focusing on risk reduction and lifestyle modification may offer additional benefits. Rather than relying solely on large-sample, long-duration, randomized clinical trial designs, a precision medicine approach using N-of-1 trials may provide more-rapid information on whether personalized prevention plans can improve person-centered outcomes. Because there appear to be multiple pathways to developing AD, there may also be multiple ways to prevent or delay the onset of AD. Even if these precision approaches alone are not successful in preventing AD, they may greatly improve the likelihood of amyloid- or tau-specific therapies to reach their endpoints by reducing comorbidities. Keeping this in mind, dementia may be a disorder that develops over a lifetime, with individualized ways to build a better brain as we age.
Audit and feedback national meeting
The Audit & Feedback National Meeting will be comprised of two full-day events: the Audit & Feedback Scientific Update and the Implementing Audit & Feedback Workshop. This event will bring together audit and feedback experts from across Canada, and internationally, to share their strategies and experiences with you. Registration will open soon.
Celebrating our 25th anniversary, the Institute for Clinical Evaluative Sciences (ICES) will welcome external partners and stakeholders in addition to our ICES scientists and staff at this very special day of learning and networking.
We’re excited to announce that the Institute for Healthcare Improvement’s 2017 National Forum’s full agenda is now available — complete with 158 unique sessions and 390 presenters! From December 10–13, 2017, in Orlando, FL, USA, you’ll enjoy countless networking opportunities with nearly 5,000 expected attendees at this year’s conference. And be sure to take advantage of the Early Bird savings of $100 when you register by September 29 (use code EARLY at checkout).
This conference will explore emerging trends and best practices that include relationship-centred care and highlight innovative ways to build capacity through community engagement, education, research and technology; cultivating compassion and dignity in an aging society.
CAG2017 is the 46th Annual Scientific and Educational Meeting of the Canadian Association on Gerontology, Canada’s premier association of those who work, research or have an interest in the field of aging.
The Canadian Conference on Dementia is a biennial national conference dedicated to advance knowledge on dementia in scientific research and clinical care. Over 2 and half days you will engage with eminent researchers and renowned scholars on cutting edge topics in dementia. The 9th CCD is thrilled to offer a new and exciting program involving interactive discussions, workshops, plenary sessions and a lively debate.
11th International French Congress of Gerontology and Geriatrics (CIFGG): Aging well in the 21st Century (French only)
This virtual online conference is designed to address major strategies in the planning and implementation of effective and efficient KT measurement approaches. Participants will be able to register, view, and ask questions through the event’s virtual conference platform, Adobe Connect. Participants will listen using their computer speakers and will interact by way of a chat box (CART and accessible options will be available). Each day will include live polls as well as interactive discussions.
The event will occur over 3 days on Oct. 30, Nov. 1, and Nov. 3, 2017, between 1 and 5 PM (Eastern) each day.
Oct. 30: Overcoming Barriers to Outreach
Nov. 1: Tools for Tracking Implementation
Nov. 3: Strategies for Measuring Impact
Registration will be limited to 250 participants. There is no fee to participate but all must register by close of business Friday, October 26, 2017.
The ROBINS-I tool can be used to appraise non-randomized studies comparing the health effects of two or more interventions. This includes a number of observational study designs such as cohort studies, quasi-randomized trials, and case-control and cross-sectional studies. Join us for a webinar to learn about the ROBINS-I!
• Participants will be able to describe Audit and Feedback in their own words.
• Participants will be able to summarize the effect of Audit and Feedback on
improving quality of care.
• Participants will be able to identify strategies to optimize Audit and Feedback.
This session is offered by Webex from St. Michael’s Hospital in Toronto. All registration requests should be sent to Meghan Storey: email@example.com by Wednesday, Sept. 13th at 12:00pm EST.
To register a site: please identify one person who will be in attendance and provide their email address to Meghan Storey. To register as an individual: please email Meghan Storey.
Please note that everyone must register to attend, as you need to be invited into the Webex session.
“Overworked and underpaid”: PSWs say burnout leads to problems
A delegation of nursing instructors from China are in Calgary to see how Canadian nurses are trained and how the rest of the world is dealing with its aging populations.
The public inquiry into the Elizabeth Wettlaufer case will look at the procedures and oversight mechanisms that allowed the former Ontario nurse to murder eight patients without anyone noticing until she confessed, the province announced Tuesday.
The theme of this year’s Peer Review Week is transparency in peer review. Many peer review experts will be gathering in Chicago in September for the Peer Review Congress (PRC), an international event that is held every four years. So we will be kicking off this year’s Peer Review Week celebrations with a panel session. We invited the four speakers to share their initial thoughts on what transparent peer review means to them and why it’s important.
Older adults in the US deserve safe, effective, and patient-centered care in the settings in which they receive their care. Recognizing the challenge of meeting this increasingly urgent need, The John A. Hartford Foundation has adopted the aim of producing meaningful improvements in the outcomes that matter to older adults and their families.
To achieve this aim, The John A. Hartford Foundation and the Institute for Healthcare Improvement (IHI) are partnering on the Creating Age-Friendly Health Systems initiative. The goal of the initiative is to develop an Age-Friendly Health Systems model and rapidly spread the model to 20 percent of US hospitals and health systems by 2020.
Journal of the American Geriatrics Society Research Summary
Medical experts know that older adults who have dementia or other mental health concerns that impact thinking or decision making should avoid certain “potentially inappropriate medications” (PIMs). PIMs can worsen confusion and raise the risks for falls, fractures, and even death, particularly for people with complex health needs. See article Frailty and Potentially Inappropriate Medication Use at Nursing Home Transition above.
In a new study, published in the Journal of the American Geriatrics Society, James E. Galvin, MD, MPH, Professor of Integrated Medical Science and Associate Dean for Clinical Research, Charles E. Schmidt College of Medicine, Florida Atlantic University, examined potential AD prevention strategies. See article The Prevention of Alzheimer’s Disease: Lessons Learned and Applied above.
8 August 2017
This survey of organisations providing specialist palliative care services to care homes highlights the good work they do and identifies the key challenges they face. The report, commissioned by Public Health England, undertaken by the Marie Curie Research Centre at Cardiff University, with input from the National Council for Palliative Care and Hospice UK, examines the role of specialist palliative care in providing support to care homes in England.
Reporting to the Manager, Knowledge Translation Strategy, the purpose of this role is to support CIHR in achieving its mandate by providing relevant strategic advice, developing, implementing and managing projects, reviewing and/or developing policies and practices related to knowledge translation and the stewardship of health research and related data. This includes responsibility for ensuring consistency across the organization and alignment with the other granting councils, where appropriate.
Additionally, Senior Advisors act as consultants on issues related to knowledge translation and health research data to the Institutes, Initiatives and branches within CIHR.