New TREC articles
PURPOSE OF THE STUDY: To (a) describe A Scheduled Shifts Staffing measure (ASSiST) to derive care aide worked hours per resident day (HCA WHRD) at facility and unit levels in nursing homes, (b) report reliability through comparisons to administrative staffing data; (c) report validity by examining associations between HCA WHRD, staff outcomes (job satisfaction, emotional exhaustion), and resident quality indicators (QIs) (e.g. falls, delirium, stage 2+ pressure ulcers), and (d) explore intrafacility variation in staffing intensity levels related to unit-level variation in resident and staff outcomes.
BACKGROUND: Implementing research findings into practice is a complex process that is not well understood. Facilitation has been described as a key component of getting research findings into practice. The literature on facilitation as a practice innovation is growing. This review aimed to identify facilitator roles and to describe characteristics of facilitation that may be associated with successful research use by healthcare professionals.
Calls for Abstracts
Please see the Call for Sessions document for details.
This competition will fund innovative research proposals that address the ongoing concern of polypharmacy and related medication issues in older Canadians living with frailty. The projects funded are intended to be the first step in improving medication prescribing/deprescribing and overall medication management in older Canadians living with frailty.
The International Program and Advisory Committee (IPAC) is pleased to invite authors to submit abstracts for oral, symposium, workshop, and poster presentations, to be delivered at the International Federation on Ageing 14th Global Conference: Towards a Decade of Healthy Ageing.
The IFA 14th Global Conference on Ageing will be held in Toronto from August 8-10, 2018. The Global Conference will revolve around four categories of themes related to the field of ageing, and will feature prominent experts presenting upon critical issues.
Abstract: Knowledge mobilisers (people who move knowledge into action) face a number of challenges. These include making sense of diverse definitions, navigating through fragmented literature and identifying helpful models and tools. This paper presents a framework designed to help. Based on a review of 47 knowledge mobilisation models, it consists of four questions: Why is knowledge being mobilised? Whose knowledge is being mobilised? What type of knowledge is being mobilised? How is knowledge being mobilised? These questions and accompanying categories can help knowledge mobilisers reflect on, communicate and evaluate their aims and objectives, increasing clarity and understanding across the field.
Abstract: Worldwide, policymakers, health system managers, practitioners and researchers struggle to use evidence to improve policy and practice. There is growing recognition that this challenge relates to the complex systems in which we work. The corresponding increase in complexity-related discourse remains primarily at a theoretical level. This paper moves the discussion to a practical level, proposing actions that can be taken to implement evidence successfully in complex systems. Key to success is working with, rather than trying to simplify or control, complexity. The integrated actions relate to co-producing knowledge, establishing shared goals and measures, enabling leadership, ensuring adequate resourcing, contributing to the science of knowledge-to-action, and communicating strategically.
OBJECTIVES: Limited research exists on nursing home information technologies, such as health information exchange (HIE) systems. Capturing the experiences of early HIE adopters provides vital information about how these systems are used. In this study, we conduct a secondary analysis of qualitative data captured during interviews with 15 nursing home leaders representing 14 nursing homes in the midwestern United States that are part of the Missouri Quality Improvement Initiative (MOQI) national demonstration project.
Commentary: As we approach the 10th Annual Conference on the Science of Dissemination and Implementation in Health, it seems appropriate to reflect upon the growth and development of the field. Wynne Norton and colleagues 1 attempted to characterize the field of dissemination and implementation (D&I) by surveying subscribers to the Dissemination and Implementation in Health e-Newsletter (Implementation Science News’ predecessor). Thus, their findings not only have relevance to the broader field of D&I, but to the Implementation Science News community in particular.
BACKGROUND: Efficient information systems support the provision of multi-disciplinary aged care and a variety of organisational purposes, including quality, funding, communication and continuity of care. Agreed minimum data sets enable accurate communication across multiple care settings. However, in aged care multiple and poorly integrated data collection frameworks are commonly used for client assessment, government reporting and funding purposes.
Abstract: Scientists are required to communicate science and research not only to other experts in the field, but also to scientists and experts from other fields, as well as to the public and policymakers. One fundamental suggestion when communicating with non-experts is to avoid professional jargon. However, because they are trained to speak with highly specialized language, avoiding jargon is difficult for scientists, and there is no standard to guide scientists in adjusting their messages. In this research project, we present the development and validation of the data produced by an up-to-date, scientist-friendly program for identifying jargon in popular written texts, based on a corpus of over 90 million words published in the BBC site during the years 2012-2015. The validation of results by the jargon identifier, the De-jargonizer, involved three mini studies: (1) comparison and correlation with existing frequency word lists in the literature; (2) a comparison with previous research on spoken language jargon use in TED transcripts of non-science lectures, TED transcripts of science lectures and transcripts of academic science lectures; and (3) a test of 5,000 pairs of published research abstracts and lay reader summaries describing the same article from the journals PLOS Computational Biology and PLOS Genetics. Validation procedures showed that the data classification of the De-jargonizer significantly correlates with existing frequency word lists, replicates similar jargon differences in previous studies on scientific versus general lectures, and identifies significant differences in jargon use between abstracts and lay summaries. As expected, more jargon was found in the academic abstracts than lay summaries; however, the percentage of jargon in the lay summaries exceeded the amount recommended for the public to understand the text. Thus, the De-jargonizer can help scientists identify problematic jargon when communicating science to non-experts, and be implemented by science communication instructors when evaluating the effectiveness and jargon use of participants in science communication workshops and programs.
Health Care Administration and Organization
OBJECTIVES: This 10 weeks feasibility study investigated whether residential care nurses with 12 hours advanced oral health training in assessments and saliva testing could formulate, implement and monitor individualised oral care plans of early dementia residents.
Abstract: Objective To develop, deliver, and evaluate dementia-specific training designed to inform service delivery by enhancing the knowledge of community-based service providers. Methods This exploratory qualitative study used an interdisciplinary, interuniversity team approach to develop and deliver dementia-specific training. Participants included management, care staff, and clients from three organizations funded to provide services in the community. Data on the acceptability, applicability, and perceived outcomes of the training were gathered through focus group discussions and individual interviews. Transcripts were analyzed to generate open codes which were clustered into themes and sub-themes addressing the content, delivery, and value of the training. Findings Staff valued up-to-date knowledge and “real stories” grounded in practice. Clients welcomed the strengths-based approach. Contractual obligations impact on the application of knowledge in practice. Implications The capacity to implement new knowledge may be limited by the legislative policies which frame service provision, to the detriment of service users.
Background: Few studies have empirically investigated factors that define residential aged care units that are perceived as being highly person-centred. The purpose of this study was to explore factors characterising residential aged care units perceived as being highly person-centred, with a focus on organisational and environmental variables, as well as residents’ and staff’ characteristics.
Abstract: Research indicates that staff in aged residential care may be unprepared for their role in palliative care provision. In collaboration with a local hospice, the project piloted an innovative problem-based experiential learning intervention Supportive Hospice and Aged Residential Exchange (SHARE) to enhance aged residential care staff palliative care skills. The aim was to explore the impact of SHARE for staff. SHARE was implemented in two aged residential care facilities in one urban centre for six months. Measurement of the impact of the intervention consisted of 1) pre-test-post-test questionnaires (n = 27) to assess changes in staff confidence in palliative care delivery 2) Eleven post-intervention interviews to describe staff perceptions of SHARE. Results from the SHARE pilot indicate that the intervention overall is seen as a success, especially in relation to advanced care planning documentation. Relationships between hospice and facility staff, and consequently facility staff and residents are seen as the key to the success of the project. Staff survey results indicated increased confidence in palliative care delivery and decreased depression. Key lessons learnt from for the development of any palliative care intervention within aged residential care include the importance of reciprocal learning, as well as the necessity of a strong partnership with key stakeholders.
Exploring the enablers and barriers to implementing the Medication Appropriateness Tool for Comorbid Health conditions during Dementia (MATCH-D) criteria in Australia: a qualitative study
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OBJECTIVES: The Medication Appropriateness Tool for Comorbid Health conditions in Dementia (MATCH-D) criteria provide expert consensus guidance about medication use for people with dementia. This study aimed to identify enablers and barriers to implementing the criteria in practice.
IMPORTANCE: Off-label antipsychotic prescribing in nursing homes (NHs) is common and is associated with increased risk of mortality in older adults. Prior large-scale, controlled trials in the NH setting failed to show meaningful reductions in antipsychotic use.
OBJECTIVE: To quantify the influence of a large-scale communication training program on NH antipsychotic use called OASIS.
Background: Variation in post-operative mortality rates has been associated with differences in registered nurse staffing levels. When nurse staffing levels are lower there is also a higher incidence of necessary but missed nursing care. Missed nursing care may be a significant predictor of patient mortality following surgery.
Aim: Examine if missed nursing care mediates the observed association between nurse staffing levels and mortality.
Purpose: The ability to predict mortality and admission to acute care hospitals, skilled nursing facilities (SNFs), and long-term care (LTC) facilities in the elderly and how it varies by activity of daily living (ADL) and instrumental ADL (IADL) status could be useful in measuring the success or failure of economic, social, or health policies aimed at disability prevention and management. We sought to derive and assess the predictive performance of rules to predict 3-year mortality and admission to acute care hospitals, SNFs, and LTC facilities among Medicare beneficiaries with differing ADL and IADL functioning levels.
Abstract: This grounded theory study examined how the certified nursing assistant (CNA) understands and responds to bullying in the workplace. Constant comparative analysis was used to analyze data from in-depth telephone interviews with CNAs ( N = 22) who experienced bullying while employed in a nursing home. The result of the analysis is a multistep model describing CNA perceptions of how, over time, they recognized and responded to the “toxic” work environment. The strategies used in responding to the “toxic” environment affected their care provision and were attributed to the development of several resident and worker safety outcomes. The data suggest that the etiology of abuse and neglect in nursing homes may be better explained by institutional cultures rather than individual traits of CNAs. Findings highlight the relationship between worker and patient safety, and suggest worker safety outcomes may be an indicator of quality in nursing homes.
OBJECTIVE: We used latent transition analysis to explore common long-term care (LTC) service trajectories and their predictors for older adults with dementia.
OBJECTIVES: To put into practice and to evaluate an initial dissemination programme for the Strategies for Relatives (START), a clinically and cost-effective manualised intervention for family carers of people with dementia.
PURPOSE: We report the findings of a knowledge synthesis research project on the topic of dementia-friendly acute care (D-FAC) design. This exploratory project systematically mapped what is known about D-FAC physical design in hospitals. We discuss our challenges in locating reportable evidence and the implications of such design for maximizing independent function while ensuring safety and harm reduction in older people living with dementia.
Health Care Innovation and Quality Assurance
Development and evaluation of the content validity, practicability and feasibility of the Innovative dementia-oriented Assessment system for challenging behaviour in residents with dementia
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BACKGROUND: One of the most difficult issues for care staff is the manifestation of challenging behaviour among residents with dementia. The first step in managing this type of behaviour is analysing its triggers. A structured assessment instrument can facilitate this process and may improve carers’ management of the situation. This paper describes the development of an instrument designed for this purpose and an evaluation of its content validity and its feasibility and practicability in nursing homes.
INTRODUCTION:: Antibiotic stewardship programs (ASPs) are coordinated interventions promoting the appropriate use of antibiotics to improve patient outcomes and reduce microbial resistance. These programs are now mandated in nursing homes (NHs) but it is unclear if these programs improve resident outcomes. This systematic review evaluated the current evidence regarding outcomes of ASPs in the NH.
Background: Antipsychotic prescribing is prevalent in nursing homes for the management of behavioral and psychological symptoms of dementia (BPSD), despite the known risks and limited effectiveness. Many studies have attempted to understand this continuing phenomenon, using qualitative research methods, and have generated varied and sometimes conflicting findings. To date, the totality of this qualitative evidence has not been systematically collated and synthesized.
Aims: To synthesize the findings from individual qualitative studies on decision-making and prescribing behaviors for antipsychotics in nursing home residents with dementia, with a view to informing intervention development and quality improvement in this field.
Abstract: A new and innovative pedagogical approach that administers hands-on visual arts activities to persons with dementia based on the field of Visual Arts Education is reported in this paper. The aims of this approach are to enhance cognition and improve quality of life. These aims were explored in a small qualitative study with eight individuals with moderate dementia, and the results are published as a thesis. In this paper, we summarize and report the results of this small qualitative study and expand upon the rationale for the Visual Arts Education pedagogical approach that has shown promise for enhancing cognitive processes and improving quality of life for persons with dementia.
BACKGROUND: Health and care technologies often succeed on a small scale but fail to achieve widespread use (scale-up) or become routine practice in other settings (spread). One reason for this is under-theorization of the process of scale-up and spread, for which a potentially fruitful theoretical approach is to consider the adoption and use of technologies as social practices.
Abstract: Communication is one of the areas where people with dementia and their caregivers experience most challenges. The purpose of this study is to contribute to the understanding of possibilities and pitfalls of using personalized communication applications installed on tablet computers to support communication for people with dementia and their conversational partners. The study is based on video recordings of a woman, 52 years old, with Alzheimer’s disease interacting with her husband in their home. The couple was recorded interacting with and without a tablet computer including a personalized communication application. The results from the present study reveal both significant possibilities and potential difficulties in introducing a digital communication device to people with dementia and their conversational partners. For the woman in the present study, the amount of interactive actions and the number of communicative actions seem to increase with the use of the communication application. The results also indicate that problems associated with dementia are foregrounded in interaction where the tablet computer is used.
Abstract: We used a web-based mixed methods survey (HowsYourHealth – Frail) to explore the health of frail older (78% age 80 or older) adults enrolled in a home-based primary care program in Vancouver, Canada. Sixty per cent of eligible respondents participated, representing over one quarter (92/350, 26.2%) of all individuals receiving the service. Despite high levels of co-morbidity and functional dependence, 50 per cent rated their health as good, very good, or excellent. Adjusted odds ratios for positive self-rated health were 7.50, 95 per cent CI [1.09, 51.81] and 4.85, 95 per cent CI [1.02, 22.95] for absence of bothersome symptoms and being able to talk to family or friends respectively. Narrative responses to questions about end of life and living with illness are also described. Results suggest that greater focus on symptom management, and supporting social contact, may improve frail seniors’ health.
BACKGROUND: Palliative care planning for nursing home residents with advanced dementia is often suboptimal. This study compared effects of facilitated case conferencing (FCC) with usual care (UC) on end-of-life care.
PURPOSE: Unpaid care is an important source of support of people with long-term conditions. Interdependence of carers’ and care recipients’ quality of life would be expected due to the relational nature of caregiving. This study aims to explore interdependence of quality of life in carer/care-recipient dyads, especially in relation to mutual interdependence due to social feedback in the caregiving relationship and also the partner effects of one partner’s experience of long-term care support on the other’s outcomes.
Abstract: Touchscreen technology (TT) is a resource that can improve the quality of life of residents with dementia, and care staff, in residential aged care facilities (RACF) through a person-centered care approach. To enable the use of TTs to engage and benefit people with dementia in RACFs, education is needed to explore how these devices may be used, what facilitates use, and how to address barriers. We sought to provide education and explore RACF staff views and barriers on using TT to engage their residents with dementia. An educational session on using TT with residents with dementia was given to staff from three long-term RACFs in Melbourne, Australia. A cross-sectional convenience sample of 17 staff members (personal care attendants, registered nurses, enrolled nurses, allied health clinicians, and domestic staff) who attended were administered questionnaires pre- and post-sessions. As a result of the education seminar, they were significantly more confident in their ability to use TT devices with residents. TT, and education to staff about its use with residents with dementia, is a useful strategy to enhance RACF staff knowledge and confidence, thereby enhancing the use of technology in RACFs in order to improve care standards in people with dementia.
OBJECTIVES: Palliative care needs rounds are triage meetings that have been introduced in residential care for older adults to help identify and prioritise care for people most at risk for unplanned dying with inadequately controlled symptoms. This study sought to generate an evidence-based checklist in order to support specialist palliative care clinicians integrate care in residential nursing homes for older people.
AIMS AND OBJECTIVES: To examine agreement between Minimum Data Set clinician ratings and researcher assessments of depression among ethnically diverse nursing home residents using the 9-item Patient Health Questionnaire.
OBJECTIVES: To quantify prescription analgesic use of elderly nursing home (NH) residents with persistent noncancer pain and to identify individual and facility traits associated with no treatment.
BACKGROUND: There is a general belief that the markers of nursing home quality do not aggregate easily. Identifying consistent and coherent dimensions of quality that usefully summarize the multiplicity of nursing home quality measures is an important goal. It would simplify interpretation and help consumers, their families and advocates to choose nursing facilities.
BACKGROUND: Higher acuity of care at the time of admission to long-term care (LTC) is resulting in a shorter period to time of death, yet most LTC homes in Canada do not have formalized approaches to palliative care. Namaste Care is a palliative care approach specifically tailored to persons with advanced cognitive impairment who are living in LTC. The purpose of this study was to employ the ecological framework to identify barriers and enablers to an implementation of Namaste Care.
BACKGROUND: Majority of the progress and development in palliative care in the last decade has been improvements in physical aspects of treatment, namely pain and symptom management. Psychosocial aspects of care have improved, although not enough to meet the needs of many patients and family members. This is evident in many parts of the world and notably in Singapore, where palliative care is seen as an emerging medical and nursing specialty.
Abstract: Patients at the center of care is often the stated focus of clinicians and healthcare services. The quality and safety movement has shown that effective organization of care is needed, in addition to professional skills. This movement has provided professionals and others with methods to improve both organization and practice for patients. These methods include measurement to give those carrying out improvement feedback about the effects of their changes. New types of measures that enable patients to report treatment outcomes can now be use in quality improvement and quality reporting to bring a renewed focus on making care more patient-centered. Although used for some time in research, these measures are relatively new tools for quality improvement and not all research measures are suitable for everyday feedback or improvement projects. The purpose of the paper is to provide an introduction to the use and value of patient-reported outcome measures in quality improvement and to give practical guidance and resources for using PROMs for quality improvement. It draws on the authors’ experiences using patient reported outcomes measures for quality research and improvement and their workshop at the 2016 Tokyo ISQUA conference, as well as on reviews and guidance documents about the use of PROMs. It does not provide a comprehensive and systematic review of research, but an overview and introduction to PROMs for quality improvement.
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.
Abstract: A significant issue affecting the healthcare system across Ontario is the number of patients admitted to hospitals that are then subsequently being designated alternate level of care (ALC). In 2016, 14.5% of Ontario in-patient beds were occupied by ALC-designated patients. Contributing to this phenomenon are ethical errors that can affect decision-making around discharge. Since 2012, William Osler Health System has redesigned their discharge process to eliminate ethical errors and align more fully with the Health Care Consent Act (HCCA) and the Public Hospitals Act (PHA). Through quality improvement processes including the use of scripting, education, checklists, mentoring and role clarity, Osler’s ALC days are currently the lowest in the province of Ontario. The elimination of such errors also decreased patient confusion and improved the discharge experience.
Abstract: Providers across the healthcare system want to provide the right care, in the right place, in a timely manner. Patients listed as alternate level of care (ALC) are often not in the right place to receive the necessary care. In 2014, using a standardized approach, the Toronto Central Community Care Access Centre (CCAC), now Toronto Central Local Health Integration Network (LHIN), set out to reduce the number of ALC beds in hospitals to ensure that more people received the most appropriate level and type of care. Case studies cited in this article will highlight the successes that CCAC and its various partners have realized in developing and implementing strategies.
Abstract: A case is presented in which the staff of a long-term care facility discovers that the husband of a resident with dementia is engaged in sexual activity with her. The case illustrates a dilemma for long-term care facilities that create a home-like environment with a goal of maximizing residents’ autonomy while ensuring their safety. An approach to assessing capacity to consent to intimate sexual activity is described, followed by guidelines that nursing homes can implement to support residents who wish to engage in sexual activity. Recommendations are also offered for supporting long-term care staff and family members of residents who are interested in intimate sexual activity.
BACKGROUND: Reducing health care-associated infections (HAIs), such as catheter-associated urinary tract infection (CAUTI), is a critical performance improvement target in nursing homes. The Agency for Healthcare Research and Quality Safety Program for Long-term Care: Health Care-Associated Infections/Catheter-Associated Urinary Tract Infection, a national performance improvement program, was designed to promote implementation of a CAUTI prevention program through state-based or regional collaboratives in more than 500 nursing homes across the United States.
Abstract: This study was designed as an intervention study to determine the effect of light therapy on sleep problems and sleep quality of elderly people. The study sample was composed of a total of 61 elderly persons from Social Security Institution Narlıdere Municipal Nursing Home, 30 in the test group and 31 in the control group. Those 65 years and older, not diagnosed with major depression, not exercising regularly, not having sun allergy, not using sleeping pills, independent in activities of daily living, and having bad sleep quality were included in the study. The Pittsburgh Sleep Quality Index, the Demographic Data Form, and the Follow-up Form for Elderly were used for data collection, whereas the Pittsburgh Sleep Quality Index was used for sample selection. It was found that exposure to direct sunlight between 8 AM and 10 AM for 5 days seems to be effective in increasing the global sleep quality score (P < .001). In light of the findings in this study, it is suggested that allocating living places in the institution's architectural setting and providing social opportunities for elderly persons to get direct sunlight exposure can help increase the sleep quality of older adults.
Abstract: A growing number of healthcare organizations have moved from traditional, institutional nursing home models to ones that emphasize culture change, or resident-centered care (RCC). In 2006, the Department of Veterans Affairs (VA) began implementing a number of changes to VA nursing homes, now called Community Living Centers (CLCs), to provide veterans with a more resident-centered and homelike environment. This study aimed to understand the barriers CLC staff face when delivering RCC. Ten CLCs were included on the basis of their performance levels on RCC and quality of care. Semistructured interviews that focused on facility efforts in RCC and quality were conducted with all levels of staff. Interviews were systematically content coded. We found similarities and differences in barriers reported at high- and low-performing sites. Staff across all performance levels cited 5 main categories of barriers to delivering RCC: staffing, resources, acuity of residents, RCC and quality of care conflicts, and regulations. Staff in high-performing sites reported fewer barriers to RCC, although 1 barrier cited was difficulty coordinating RCC across departments. Staff in low-performing sites reported additional categories of barriers related to administrator turnover/lack of guidance, CLC culture/staff morale, and difficulty working with residents and families. As RCC continues to spread, it is important to anticipate the barriers to implementing these practices. Particular focus on regulatory, leadership, organizational, workforce, and process factors may help organizations avoid or reduce barriers to RCC. Given their training and skill set, mental health providers may be uniquely situated to assist staff in overcoming these barriers.
CONTEXT: Delivering goal-directed care is a hallmark of high quality palliative care, but requires an understanding of preferences.
OBJECTIVES: To describe and identify factors associated with level of care preferences among proxies of nursing home residents with advanced dementia.
BACKGROUND: For people with dementia high-quality care is vital, since at present dementia cannot be cured. In nursing homes this care is provided by the staff, who therefore require dementia-specific training enabling them to improve the quality of life for people with dementia.
BACKGROUND: Person-centered care interventions can improve the quality of life and decrease behavioral problems of people with dementia. Although not convincingly proven, person-centered care interventions may benefit the caregivers as well. This study aims to gain insight into how working with the Veder Contact Method (VCM) – a new person-centered care method – influences the job satisfaction of caregivers.
OBJECTIVES: To test the effects of individual, nonfacilitated sessions with PARO (version 9), when compared against a look-alike plush toy and usual care, on the emotional and behavioral symptoms of dementia for people living in long-term care facilities.
Abstract: We examine recipients of publicly funded ongoing care in a single Ontario jurisdiction who reside in three different settings: long-stay home care patients in private homes and apartments, other patients in retirement homes and residents of long-term care homes, using interRAI assessment instruments. Among home care patients, those in retirement homes have higher proportions of dementia and moderate cognitive impairment, less supportive informal care systems as well as more personal care and nursing services above those provided by the public home care system, more frequent but shorter home support visits and lower than expected public home care expenditures. These lower expenditures may be because of efficiency of care delivery or by retirement homes providing some services otherwise provided by the public home care system. Although persons in each setting are mostly older adults with high degrees of frailty and medical complexity, long-term care home residents show distinctly higher needs. We estimate that 40% of retirement home residents are long-stay home care patients, and they comprise about one in six of this Community Care Access Centre’s long-stay patients.
BACKGROUND: Understanding the cultural characteristics of healthcare organisations is widely recognised to be an important component of patient safety. A growing number of vulnerable older people are living in care homes but little attention has been paid to safety culture in this sector. In this study, we aimed to adapt the Manchester Patient Safety Framework (MaPSaF), a commonly used tool in the health sector, for use in care homes and then to test its face validity and preliminary feasibility as a tool for developing a better understanding of safety culture in the sector.
BACKGROUND: The sustainability of long-term care (LTC) is a prominent policy priority in many Western countries. LTC is one of the most pressing fiscal issues for the growing population of elderly people in the European Union (EU) Member States. Country recommendations regarding LTC are prominent under the EU’s European Semester.
METHODS: This paper examines challenges related to the financial- and organizational sustainability of LTC systems in the EU. We combined a targeted literature review and a descriptive selected country analysis of: (1) public- and private funding; (2) informal care and externalities; and (3) the possible role of technology in increasing productivity. Countries were selected via purposive sampling to establish a cohort of country cases covering the spectrum of differences in LTC systems: public spending, private funding, informal care use, informal care support, and cash benefits.
Abstract: Nursing homes have been challenged in their attempts to achieve deep, organizational change (i.e., culture change) aimed at providing quality of care and quality of life for nursing home residents through person-centered care. To attain deep change, 2 well-defined components must be in place: a shared understanding of (a) the what, or content goals, and (b) the how, or process of change. However, there are few examples of this at a macro or micro level in long-term care. In an effort to enact true culture change in nursing homes statewide, the Kansas Department for Aging and Disability Services implemented the Promoting Excellent Alternatives in Kansas Nursing Homes program. This program is a Medicaid, pay-for-performance program that formalizes the content and process of achieving culture change through person-centered care principles. This article aims to detail the content (what) and process (how) of a model macro-level program of culture change throughout the State of Kansas. Applications to the micro level (individual homes) are presented, and implications for psychologists’ roles in facilitating culture change are discussed.
Research Practice and Methodology
Is it acceptable to video-record palliative care consultations for research and training purposes? A qualitative interview study exploring the views of hospice patients, carers and clinical staff
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BACKGROUND: Research using video recordings can advance understanding of healthcare communication and improve care, but making and using video recordings carries risks.
AIM: To explore views of hospice patients, carers and clinical staff about whether videoing patient-doctor consultations is acceptable for research and training purposes.
BACKGROUND: In the UK, routinely recorded data may benefit prospective studies including randomised controlled trials (RCTs). In an on-going study, we aim to assess the feasibility of access and agreement of routinely recorded clinical and non-clinical data compared to data collected during a RCT using standard prospective methods. This paper will summarise available UK routinely recorded data sources and discuss our experience with the feasibility of accessing routinely recorded data for participants of a RCT before finally proposing recommendations for improving the access and implementation of routinely recorded data in RCTs.
Abstract: Enhanced interpersonal relationships and meaningful resident engagement in daily life are central to nursing home cultural transformation, yet these critical components of person-centered care may be difficult for frontline staff to measure using traditional research instruments. To address the need for easy-to-use instruments to help nursing home staff members evaluate and improve person-centered care, the psychometric method of cognitive-based interviewing was used to adapt a structured observation instrument originally developed for researchers and nursing home surveyors. Twenty-eight staff members from 2 Veterans Health Administration (VHA) nursing homes participated in 1 of 3 rounds of cognitive-based interviews, using the instrument in real-life situations. Modifications to the original instrument were guided by a cognitive processing model of instrument refinement. Following 2 rounds of cognitive interviews, pretesting of the revised instrument, and another round of cognitive interviews, the resulting set of 3 short instruments mirrored the concepts of the original longer instrument but were significantly easier for frontline staff to understand and use. Final results indicated frontline staff found the revised instruments feasible to use and clinically relevant in measuring and improving the lived experience of a changing culture. This article provides a framework for developing or adapting other measurement tools for frontline culture change efforts in nursing homes, in addition to reporting on a practical set of instruments to measure aspects of person-centered care.
OBJECTIVES: Describe nursing home polypharmacy prevalence in the context of prescribing for diabetes and hypertension and determine possible associations between lower surrogate markers for treated hypertension and diabetes (overtreatment) and polypharmacy.
Abstract: Existing cognitive health literature focuses on the perspectives of older adults with dementia. However, little is known about the ways in which healthy older adults without dementia understand their cognitive health. In rural communities, early dementia diagnosis may be impeded by numerous factors including transportation challenges, cultural obstacles, and inadequate access to health and support services. Based on participant observation and two waves of 42 semi-structured interviews, this study examined healthy, rural older adults’ perceptions of cognitive health. By providing an innovative theoretical foundation informed by local perspectives and culture, findings reveal a complex and multidimensional view of cognitive health. Rural older adults described four key areas of cognitive health ranging from independence to social interaction. As policy makers, community leaders, and researchers work to address the cognitive health needs of the rural aging demographic, it is essential that they listen to the perspectives of rural older adults.
OBJECTIVE: The aim of this study is to conduct a systematic review of the published research to examine the extent, nature, and risk factors of mortality due to physical restraint use.
Abstract: The movement of people with dementia in long-term care continues to be an issue of concern among clinicians, caregivers and families. This article will examine the social construction “wandering” and its association with pathology, risk discourse and surveillance technologies. Further, the article will explore the recent shift from the term “wanderer” to the phrase “people who like to walk” in person-centred dementia care. Engaging with Ingold’s concept of movement as wayfaring, an alternative becoming-centred understanding of movement and its significance for people with dementia will be presented and illustrated through a case study. The paper concludes that depathologizing movement opens the possibility to see movement in people with dementia as an intention to be alive and to grow, rather than as a product of disease and deterioration. Suggestions for future research and implications for care interventions are discussed.
Background/Question: Volunteers are important in the support of frail older adults requiring palliative care, especially in rural areas. However, there are challenges associated with volunteer supports related to training, management and capacity to work in partnership with healthcare providers (HCP). This review addresses the question: What is the feasibility of a volunteer-HCP partnership to support frail older adults residing in rural areas, as they require palliative care?
BACKGROUND: The Delphi technique is widely used for the development of guidance in palliative care, having impact on decisions with relevance for patient care.
AIM: To systematically examine the application of the Delphi technique for the development of best practice guidelines in palliative care.
BACKGROUND: In dementia care, a large number of treatment decisions are made by family carers on behalf of their family member who lacks decisional capacity; advance care planning can support such carers in the decision-making of care goals. However, given the relative importance of advance care planning in dementia care, the prevalence of advance care planning in dementia care is poor
Abstract: Improving communication during transitions from acute care hospitals into long-term post-acute care (LTPAC) settings is imperative for clinical staff to have the information they need to admit and care for the patient with accurate medical information provided in an efficient way. The research goals of this study are to examine the user experience of a new data sharing method, “Continued Access,” a supplement to the standard summary of care, and to evaluate staff attitudes of the model on LTPAC residents’ care. Clinical staff ( n = 20) from a U.S. Midwestern LTPAC setting were interviewed to give their evaluation of the new model of data access, their concerns, and ways to improve the effectiveness of the model. Respondents reported better opportunities for quality care based on improved insight and clarity around patients’ medical history, medications, and tests. Strategies for integrating Continued Access into the workflow and improving quality outcomes are discussed.
BACKGROUND: Pressure ulcers increase the risk of costly hospitalization and mortality of nursing home residents, so timely healing is important. Disparities in healthcare have been identified in the nursing home population but little is known about disparities in the healing of pressure ulcers.
Abstract: The official vision of the U.S. Alzheimer’s Association is “A world without Alzheimer’s disease.” The “dual mission” of the organization is “to eliminate Alzheimer’s disease through the advancement of research and to enhance care and support for individuals, their families and caregivers.” Using numerous reports from leading researchers and practitioners, a case is made by which the “dual mission” is grossly unbalanced with predominant focus on biomedical research aimed at curing the disease compared to research and practices focused on the psycho-social impacts of and adaptations to living with it. These experts discuss the likelihood of curing the disease, the complexity of realizing this goal, and the urgent need to “bring back the social and psychological aspects” of living with dementia to center stage. The moral responsibility to balancing the “dual mission” in accordance with the original motivation of the grassroots organizations who formed the association in 1980 is discussed.
BACKGROUND: Medication management is a complex, error-prone process. The aim of this study was to explore what constitutes the complexity of the medication management process (MMP) in specialized home healthcare and how healthcare professionals handle this complexity. The study is theoretically based in resilience engineering.
OBJECTIVE: To describe prevalence and content of AD documentation among NH residents by dementia stage.
BACKGROUND: The prevalence of advance directives (ADs) among nursing home (NH) residents with mild, moderate, and advanced dementia remains unclear.
Abstract: Healthcare use in the year prior to death represents a large portion of healthcare spending by older adults. While Canada is considered to have advanced integration of palliative care services within our healthcare system, much of this care is still delivered in hospitals and with varying levels of access according to cause of death trajectory and geography. Results presented in a series of studies from the Institute for Clinical Evaluative Sciences (ICES) unveil gaps in current palliative care delivery and offer directions for future research and policy development.
BACKGROUND: Japan is known for its long life expectancy and rapidly aging society that there are various demands of older adults need to be fulfilled with, and one of them is long-term care needs. Therefore, Japan implemented the Long-Term Care Insurance in year 2000 for citizens who are above 65-year old and citizens who are above 40-year old in needs of long-term care services. This study was undertaken to longitudinally examine the influence of dementia and living alone on care needs increases among older long-term care insurance service users in Japan.
BACKGROUND: Eighty per cent of care home residents in the UK are living with dementia. The prevalence of faecal incontinence (FI) in care homes is estimated to range from 30% to 50%. There is limited evidence of what is effective in the reduction and management of FI in care homes.
OBJECTIVE: To provide a theory-driven explanation of the effectiveness of programmes that aim to improve FI in people with advanced dementia in care homes.
Abstract: “Physical restraint” formerly used as a measure of protection for psychiatric patients is now widely used. However, existing studies showed that physical restraint not only has inadequate effect of protection but also has negative effects on residents. To analyzes the impact of educational program on the physical restraint use in long-term care facilities.
BACKGROUND: Polypharmacy is considered the most important etiologic factor of hyposalivation, which in turn can initiate oral health problems.
OBJECTIVES: To describe the medication use of nursing home residents, to identify the medications related to hyposalivation and to find possible associations between the different classes of medication, the number of medications, and the oral health status of the residents.
As part of the Advanced Topics in Implementation Science webinar series hosted by the National Cancer Institute Division of Cancer Control & Population Sciences Implementation Science Team, Dr. David Chambers hosted a discussion with Drs. Shannon Wiltsey Stirman and James W. Dearing to reflect on sustainability in implementation science: progress made and challenges ahead. The session included approximately 35 minutes of discussion from the speakers and 25 minutes for Q&A with the audience. Please click here to see the full archive of previous IS webinars.
• 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.
Advancing the methods of patient-oriented knowledge translation research
This interactive Educators Forum fosters friendly discussions and sharing between you and other professionals across Canada concerning best practices, approaches and tools regarding the assessment of pain using the RAI MDS 2.0 standards. To register, log in to CIHI Client Services and select the Learning Centre.
Researchers have created the De-Jargonizer, a free tool for scientists hoping to make their work more accessible to the general public. This kind of tool is important now, as better science communication is critical to regaining public trust.
Thirty years from now, China’s elderly population will vastly outnumber its younger citizens. In a country where assisted-living homes are scarce, and dementia is not widely understood, asks Nathan VanderKlippe, will people pay the price before the government does?
At IHI, we teach that successful measurement is a cornerstone of successful improvement. That’s clear and relatively straightforward when we’re focused on infection rates, wait times, or patient falls. But how can you measure something like joy in work?
As we explain in the new IHI White Paper,IHI Framework for Improving Joy in Work, right now, there is no single validated measure of joy in work. Until there is, leaders need to draw on other indicators known to contribute to, or signal trouble for, joy in work.
The City of Ottawa has been slapped with an “unheard of” blanket order from the province to improve safety and care at three of its four long-term care homes following a string of incidents, including the repeated punching of one resident by a caregiver and head injuries suffered by another resident that were later covered up.
In 2011, one in four nursing home residents on Medicare was hospitalized. It’s an issue that impacts many facets of health care, from quality of life for nursing home residents to spending of taxpayer dollars, and on Tuesday’s St. Louis on the Air, host Don Marsh spoke with a University of Missouri Nursing School professor about ways to reduce avoidable hospital admissions.
The province’s Adult Day Program helped Sandra MacFadyen care for her father at home longer, and now she says she’s encouraged that more hours are being added to the program so other families can benefit from the support.
Older adults with confusion are more likely to remain in the hospital longer once they are admitted, and are more likely to die, a new study finds.
The mistreatment of older adults is called elder abuse. It is more widespread than many of us realize. Although statistics suggest that one in 10 older people is abused every year, the actual number is likely to be much higher because so many cases of elder abuse go unreported.
Accident and emergency attendance among patients with dementia in the last year of life is both “common” and has increased over time, warn UK researchers. They found more than three quarters of dementia patients had at least one A&E attendance in their last year of life.
Christine Sincennes (adviser for CIHR’s awards program) gave a presentation at the 2017 Congress of the Humanities and Social Sciences, provided a list of 10 best practices to improve your chances of a successful application.
Women with a genetic predisposition for Alzheimer’s disease face a 10-year window when they have far greater chances of developing the disease than men with similar genetic risks, a new analysis suggests.
Scientists have developed a virtual reality computer game as part of the world’s biggest dementia research experiment.
Are patients active participants in your organization’s quality improvement (QI) efforts? Does your housekeeping staff know how to run PDSA cycles to test changes for improvement? The answer to both these questions is “yes” at the East London NHS Foundation Trust (ELFT) because — like most health care organizations — we are trying to improve the quality of our care while reducing costs. The key way we do this is by developing the QI skills of staff throughout our organization and engaging our service users to help us rethink and redesign care.
The RE-AIM framework is an evaluation framework designed to enhance the quality, speed, and public health impact of efforts to translate research into practice. The planning tool is designed to help interested individuals across various sectors think through the dimensions of the RE-AIM framework in an iterative way and includes important questions to ask while planning or evaluating an initiative. The brief questions are designed to determine your confidence in achieving each element of the 5 dimensions of the RE-AIM framework.
17 August 2017
This toolkit is for researchers to help increase influence and impact in health and health care
After years of team based rapid improvement events, Cleveland Clinic realized that they needed a different approach to process improvement. This white paper tells the story of how Cleveland Clinic engaged 52,000 caregivers in a culture of continuous improvement on a quest to deliver safer, more efficient, and more compassionate care.
23 August 2017
JAN is an international, peer-reviewed scientific journal which contributes to the advancement of evidence-based nursing, midwifery and healthcare by disseminating high quality research and scholarship of contemporary relevance and with potential to advance knowledge for practice, education, management or policy. The main functions within this role are: manuscript handling and quality control, strategic development, and journal promotion. The post involves working closely with the Publisher, the other Editors, and the Editor-in-Chief.