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New TREC article
Aging Together: Caring Relations in Families of Adults With Intellectual Disabilities
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PURPOSE OF THE STUDY :To examine the dynamics of caring relations in older families that include an adult with Intellectual Disabilities (ID). To date, there has been very little research exploring the experiences of aging families of community-dwelling adults with ID.
Articles by TREC researchers
Reaching consensus on reporting patient and public involvement (PPI) in research: methods and lessons learned from the development of reporting guidelines
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INTRODUCTION: Patient and public involvement (PPI) is inconsistently reported in health and social care research. Improving the quality of how PPI is reported is critical in developing a higher quality evidence base to gain a better insight into the methods and impact of PPI. This paper describes the methods used to develop and gain consensus on guidelines for reporting PPI in research studies (updated version of the Guidance for Reporting Patient and Public Involvement (GRIPP2)).
Development of an evidence-based complex intervention for community rehabilitation of patients with hip fracture using realist review, survey and focus groups
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OBJECTIVES: To develop an evidence and theory-based complex intervention for improving outcomes in elderly patients following hip fracture.
Survey – Call for Participants
Medical Assistance in Dying – MAID Education Study
Each province has a unique set of procedures to follow before MAID can be done. It is important to have an understanding of these procedures. Two professors at the University of Alberta are asking Alberta physicians and others to complete a brief anonymous online survey to identify educational needs about MAID in Alberta https://www.surveymonkey.com/r/MAIDinAlberta
Thank you. Drs. Donna Wilson and Jean Triscott
Publications
KT
Health Care Administration and Organization
Health Care Innovation and Quality Assurance
Organizational Change
Research Practice and Methodology
Aging
KT
Implementation of evidence into practice for cancer-related fatigue management of hospitalized adult patients using the PARIHS framework
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Abstract: This study aimed to explore an evidence-based nursing practice model of CRF management in hospitalized adult patients using the PARIHS evidence-implementation framework as the theoretical structure to provide guidance for similar nursing practices. The implementation of guideline evidence into clinical practice was conducted on the oncology and radiotherapy wards of a university-affiliated hospital. The process of integrating the guideline into the symptom management system of cancer patients was described. The impact of the evidence implementation was evaluated from three aspects: organizational innovations and outcome measures associated with nurses and with patients pre- and post-evidence implementation. During the implementation of evidence into practice on the wards, a nursing process, health education, a quality control sheet and CRF training courses were established. Through this implementation, compliance with evidence related to CRF increased significantly on the two wards, with that of ward B being higher than that of ward A. Regarding nursing outcomes, nursing knowledge, attitude and behavior scores with respect to CRF nursing care increased substantially after its application on the two wards, and the ward B nurses’ scoring was higher than that of the ward A nurses. Qualitative analysis concerning the nurses suggested that leadership, patient concern about CRF management, and the need for professional development were the main motivators of the application, whereas the shortage and mobility of nursing human resources and insufficient communication between doctors and nurses were the main barriers. Additionally, most nurses felt more professional and confident about their work. Regarding patient outcomes, patient knowledge, attitude and behavior scores regarding CRF self-management increased significantly. Patients’ post-implementation CRF was alleviated compared with the pre-implementation treatment cycle. The PARIHS framework may provide instructive guidance for the incorporation of evidence into practice, and the process-oriented framework might provide greater operational utility of the application.
Putting research in place: an innovative approach to providing contextualized evidence synthesis for decision makers 
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BACKGROUND: The Contextualized Health Research Synthesis Program (CHRSP), developed in 2007 by the Newfoundland and Labrador Centre for Applied Health Research, produces contextualized knowledge syntheses for health-system decision makers. The program provides timely, relevant, and easy-to-understand scientific evidence; optimizes evidence uptake; and, most importantly, attunes research questions and evidence to the specific context in which knowledge users must apply the findings.
Beyond “implementation strategies”: classifying the full range of strategies used in implementation science and practice
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BACKGROUND: Strategies are central to the National Institutes of Health’s definition of implementation research as “the study of strategies to integrate evidence-based interventions into specific settings.” Multiple scholars have proposed lists of the strategies used in implementation research and practice, which they increasingly are classifying under the single term “implementation strategies.” We contend that classifying all strategies under a single term leads to confusion, impedes synthesis across studies, and limits advancement of the full range of strategies of importance to implementation. To address this concern, we offer a system for classifying implementation strategies that builds on Proctor and colleagues’ (2013) reporting guidelines, which recommend that authors not only name and define their implementation strategies but also specify who enacted the strategy (i.e., the actor) and the level and determinants that were targeted (i.e., the action targets).
Criteria for selecting implementation science theories and frameworks: results from an international survey
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BACKGROUND: Theories provide a synthesizing architecture for implementation science. The underuse, superficial use, and misuse of theories pose a substantial scientific challenge for implementation science and may relate to challenges in selecting from the many theories in the field. Implementation scientists may benefit from guidance for selecting a theory for a specific study or project. Understanding how implementation scientists select theories will help inform efforts to develop such guidance. Our objective was to identify which theories implementation scientists use, how they use theories, and the criteria used to select theories.
An empirical research on relationships between subjective judgement, technology acceptance tendency and knowledge transfer
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Abstract: The purpose of this study was to explore the relationships among employees’ usage intention pertaining to mobile information devices, focusing on subjective judgement, technology acceptance tendency, information sharing behavior and information transfer. A research model was established to verify several hypotheses. The research model based on integrated concepts of knowledge management and technology acceptance modeling. Participants were employees of enterprises in Taiwan, selected by combining snowball and convenience sampling. Data obtained from 779 e-surveys. Multiple-regression analysis was employed for hypothesis verification. The results indicate that perceived ease-of-use of mobile devices was affected by computer self-efficacy and computer playfulness directly; meanwhile, perceived ease-of-use directly affects perceived usefulness. In addition, perceived ease-of-use and perceived usefulness can predict information-sharing behavior in a positive manner, and impact knowledge transfer as well. Based on the research findings, it suggested that enterprises should utilize mobile information devices to create more contact with customers and enrich their service network. In addition, it is recommended that managers use mobile devices to transmit key information to their staff and that they use these devices for problem-solving and decision-making. Further, the staff’s skills pertaining to the operation of mobile information devices and to fully implement their features are reinforced in order to inspire the users’ knowledge transfer. Enhancing the playfulness of the interface is also important. In general, it is useful to promote knowledge transfer behavior within an organization by motivating members to share information and ideas via mobile information devices. In addition, a well-designed interface can facilitate employees’ use of these devices.
Enabling Continuous Quality Improvement in Practice: The Role and Contribution of Facilitation
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Abstract: Facilitating the implementation of continuous quality improvement (CQI) is a complex undertaking. Numerous contextual factors at a local, organizational, and health system level can influence the trajectory and ultimate success of an improvement program. Some of these contextual factors are amenable to modification, others less so. As part of planning and implementing healthcare improvement, it is important to assess and build an understanding of contextual factors that might present barriers to or enablers of implementation. On the basis of this initial diagnosis, it should then be possible to design and implement the improvement intervention in a way that is responsive to contextual barriers and enablers, often described as “tailoring” the implementation approach. Having individuals in the active role of facilitators is proposed as an effective way of delivering a context-sensitive, tailored approach to implementing CQI. This paper presents an overview of the facilitator role in implementing CQI. Drawing on empirical evidence from the use of facilitator roles in healthcare, the type of skills and knowledge required will be considered, along with the type of facilitation strategies that can be employed in the implementation process. Evidence from both case studies and systematic reviews of facilitation will be reviewed and key lessons for developing and studying the role in the future identified.
Unpacking Action Research and Implementation Science: Implications for Nursing
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THE AIM: is to unpack the key concepts of action research and implementation science thereby enabling appropriate use of these methods in nursing.
BACKGROUND: A key issue in action research is not so much the methodology employed to gather data/evidence but who decides the research agenda and who benefits from it. Implementation science is a way to ensure that evidence is translated into practice. The question arises as to how action research and implementation may be understood in relation to one another in nursing.
Integrated Knowledge Transfer and Exchange: An Organizational Approach for Stakeholder Engagement and Communications
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Background Knowledge transfer and exchange (KTE) is a process of making relevant research information available and accessible for use in practice or policy. Integrated KTE, where knowledge users are engaged in the research process, is considered to better facilitate uptake and use. The objective of this article is to describe a fully integrated KTE approach developed over the past 20 years.
Are quality improvement collaboratives effective? A systematic review
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BACKGROUND: Quality improvement collaboratives (QIC) have proliferated internationally, but there is little empirical evidence for their effectiveness.
Validity and reliability of the Spanish version of the Organizational Readiness for Knowledge Translation (OR4KT) questionnaire
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BACKGROUND: Organizational readiness to change healthcare practice is a major determinant of successful implementation of evidence-based interventions. However, we lack of comprehensive, valid, and reliable instruments to measure it. We assessed the validity and reliability of the Spanish version of the Organizational Readiness for Knowledge Translation (OR4KT) questionnaire in the context of the implementation of the Prescribe Vida Saludable III project, which seeks to strengthen health promotion and chronic disease prevention in primary healthcare organizations of the Osakidetza (Basque Health Service, Spain).
Knowledge translation to advance evidence-based health policy in Thailand
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Abstract: Significant gaps between scientific evidence and policy have resulted in growing interest in the role that knowledge translation (KT) can play in informing evidence-based policy. The Mitsampan Community Research Project, in consultation with the local community of people who inject drugs, developed a comprehensive KT strategy that aimed to translate research into policy related to HIV and illicit drug use in Bangkok, Thailand. Though barriers to KT activities were experienced, findings suggest that KT has the potential to facilitate dialogue and policy change. Further development and evaluation are needed to refine KT approaches and thereby bridge evidence and policy.
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Health Care Administration and Organization
Determining the Optimum Physician-to-Resident Ratio in the Nursing Home
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Nursing home (NH) practice has changed dramatically over the past decade. Shorter lengths of stay, higher patient acuity, pay for performance, and bundled payment are but a few of the trends impacting the delivery of medical care in the NH. Recognizing these changes, as well as the unique skill set necessary for optimal practice in the NH, AMDA has defined 26 core competencies for NH attending physicians. An accompanying online curriculum sets forth expectations for NH medical providers as it relates to the provision of high-quality, evidence-based NH care.
Is the burnout syndrome associated with elder mistreatment in nursing homes: results of a cross-sectional study among nurses
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Abstract: As this issue has not yet been addressed in Croatia, our aim was to explore the presence of the burnout syndrome in nurses and see how it is related to their perception of elder mistreatment in nursing homes and extended care units. The burnout syndrome was assessed in 171 nursing professionals with a standardised Maslach Burnout Inventory for Human Services Survey (MBI-HSS) for three dimensions: emotional exhaustion (EE), depersonalisation (DP), and personal accomplishment (PA). High EE was reported by 43.9 %, high DP by 22.2 %, and low PA by 39.8 % of the respondents. Their perception of elder abuse and neglect was investigated with two self-completion questionnaires. The answers suggest that elder mistreatment in Croatian nursing homes and extended care units is more common than expected: 55 % witnessed shouting at a resident in anger, 43 % insulting and swearing at a resident, 42 % force-feeding the resident, 39 % ignoring a resident when they called, and 38 % neglecting to turn or move a resident to prevent pressure sores. We also established associations between a number of questionnaire items on perceived abuse and neglect and the burnout syndrome dimensions and determined the items that predicted the type and level of burnout in our respondents. One way to avoid the pitfalls that lead to abuse and neglect is education in schools and at work. We believe our research could contribute to this end.
The Relationship Between Reported Staffing and Expenditures in Nursing Homes
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Abstract: Dramatic improvements in reported nursing home quality, including staffing ratios, have come under increased scrutiny in recent years because they are based on data self-reported by nursing homes. In contrast to other domains, the key mechanism for real improvement in the staffing ratios domain is clearer: to improve scores, nursing homes should increase staffing expenditures. We analyze the relationship between changes in expenditures and reported staffing quality pre- versus post the 5-star rating system. Our results show that the relationship between expenditures and licensed practical nurse staffing is weaker in the post-5-star period, overall, and across subgroups; furthermore, there is a weaker relationship between expenditures and registered nurse staffing among for-profit facilities with a high share of Medicaid residents in the post-5-star period. The weaker relationship between staffing expenditures and staffing scores in the post-5-star era underscores the potential for gaming of the self-reported staffing scores and the need for more reliable sources.
Preventing physical abuse of nursing home residents- as seen from the nursing staff’s perspective
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AIM: This study aims to capture first-hand information from nursing home staff’s own understanding regarding what they think and have experienced about prevention of physical abuse of nursing home residents and what measures they consider useful to implement in their daily work.
Palliative care for advanced dementia: knowledge and attitudes of long-term care staff
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AIM AND OBJECTIVES: To investigate the knowledge of and attitudes toward palliative care for advanced dementia and their associations with demographics among nursing staff, including nurses and nursing assistants, in long-term care settings.
The evolving role of the personal support worker in home care in Ontario, Canada
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Abstract: To meet increasing demand for home care, the role of personal support workers (PSWs) is shifting from providing primarily personal and supportive care to include care activities previously provided by regulated health professionals (RHPs). Much of the research examining this shift focuses on specialty programmes, with few studies investigating the daily care being provided by PSWs, frequency of care activities being provided by PSWs, and characteristics of the population receiving more complex tasks. Between January and April 2015, a review of 517 home-care service user charts was undertaken in Ontario, Canada, to: (1) describe the range of tasks being performed by PSWs in home care, (2) identify tasks transferred by RHPs to PSWs, and (3) examine characteristics of service users receiving transferred care. Findings indicate that normally, PSWs provide personal and supportive care commensurate with their training. However, in approximately one quarter of care plans reviewed, PSWs also completed more complex care activities transferred to them by RHPs. Service users receiving transferred care were older and had higher levels of cognitive and functional impairment. Although there is potential for the expansion of home-care services through increased utilisation of PSWs, healthcare leadership must ensure that the right provider is being utilised at the right time and in the right place to ensure safe and effective quality care. Thus, several actions are recommended: PSW core competencies be clearly articulated, processes used to transfer care activities from RHPs to PSWs be standardised and a team-based approach to the delivery of home-care services be considered. Utilisation of a team-based model can help establish positive relationships among home-care providers, provide increased support for PSWs, allow for easier scheduling of initial training and ensure regular reassessments of PSW competence among PSWs providing added skills.
Nurses’ Knowledge, Perception, and Self-Confidence Regarding Evidence-Based Antibiotic Use in the Long-Term Care Setting
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OBJECTIVE: Describe knowledge, perceptions, and self-confidence of nurses in the long-term care setting before and after online antibiotic stewardship education, and assess effectiveness and satisfaction with the education.
Nursing Home Patient Safety Culture Perceptions Among US and Immigrant Nurses
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Abstract: Patient safety is a global concern, yet little is known about how and whether perceptions of patient safety culture (PSC) vary by nurses’ countries of origin and preparation. This is particularly important in American nursing homes (NHs), which are increasingly hiring non-US born and prepared nurses to fill staffing needs.
OBJECTIVES: This study compared the PSC perceptions of foreign and domestic born and trained nurses working in urban NHs in 5 states to analyze how nurses’ PSC perceptions corresponded to their personal and professional characteristics.
Development of a clinical pharmacy model within an Australian home nursing service using co-creation and participatory action research: the Visiting Pharmacist (ViP) study
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OBJECTIVE: To develop a collaborative, person-centred model of clinical pharmacy support for community nurses and their medication management clients.
Preparedness for Death: How Caregivers of Elders With Dementia Define and Perceive its Value
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PURPOSE: The purpose of this study is to ascertain how bereaved caregivers of a family member who died from a dementia-related diagnosis (a) define preparedness and (b) perceive its value.
Factors Influencing New RNs’ Supervisory Performance in Long-Term Care Facilities
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Abstract: In long-term care facilities (LTCF), registered nurses (RNs) perform both clinical and supervisory roles as part of a team aiming to provide high-quality care to residents. The residents have several co-morbidities and complex care needs. Unfortunately, new RNs receive minimal preparation in gerontology and supervisory experience during their program, leading to low retention rates and affecting resident outcomes. This qualitative study explored factors that influence supervisory performance of new RNs in LTCF from the perspective of 24 participants from Ontario, Canada. Data were collected through individual interviews, followed by a directed content analysis. Three levels of influences were identified: personal influences, organizational influences, and external influences. Each level presented with sub-elements, further describing the factors that impact the supervisory performance of the new RN. To retain new RNs in LTC, organizations must provide additional gerontological education and mentoring for new RNs to flourish in their supervisory roles.
Factors Influencing Job Satisfaction Among Long-Term Care Staff
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OBJECTIVE: We assessed the intrapersonal, interpersonal, and organizational factors that predicted job satisfaction among long-term care employees.
Understanding implementation of comprehensive geriatric care programs: a multiple perspective approach is preferred
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BACKGROUND: The Prevention and Reactivation Care Program (PReCaP) provides a novel approach targeting hospital-related functional decline among elderly patients. Despite the high expectations, the PReCaP was not effective in preventing functional decline (ADL and iADL) among older patients. Although elderly PReCaP patients demonstrated slightly better cognitive functioning (Mini Mental State Examination; 0.4 [95% confidence interval (CI) 0.2-0.6]), lower depression (Geriatric Depression Scale 15; -0.9 [95% -1.1 to -0.6]), and higher perceived health (Short-form 20; 5.6 [95% CI 2.8-8.4]) 1 year after admission than control patients, the clinical relevance was limited. Therefore, this study aims to identify factors impacting on the effectiveness of the implementation of the PReCaPand geriatric care ‘as usual’.
Cognitive interventions in nursing homes : Systematic review of the preventive effectiveness on cognitive performance in persons in need of care
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BACKGROUND: The strengthening of cognitive resources is considered to be a preventive field of action within inpatient care. The aim is to evaluate the effectiveness of such interventions on cognitive performance in nursing home residents. Article published in German.
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Health Care Innovation and Quality Assurance
Memory Keeper: A prototype digital application to improve engagement with people with dementia in long-term care (innovative practice)
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Abstract: People with dementia living in long-term care commonly experience loneliness and lack of meaningful activity. Memory Keeper is a prototype digital application that presents personalised prompts to stimulate reminiscences and meaningful engagement with formal and informal carers. A trial involving three persons with dementia in long-term care and seven family and staff members revealed no negative responses to the device or application. Family members said it was valuable in improving the quality of engagement and made visits more enjoyable. If practical and technical barriers can be overcome, Memory Keeper could become an innovative family engagement tool for dementia management.
Crucial aspects promoting meaning and purpose in life: perceptions of nursing home residents
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BACKGROUND: Meaning and purpose in life are fundamental to human beings. In changing times, with an aging population and increased life expectancy, the need for health care services and long-term care is likely to grow. More deeply understanding how older long-term care residents perceive meaning and purpose in life is critical for improving the quality of care and the residents’ quality of life. The purpose of this study was to explore crucial aspects promoting nursing home residents’ experience of meaning and purpose in everyday life.
The impact of long-term care on quality of life
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Abstract: Long-term care services are provided to help people manage the consequences of impairment, but their impact goes beyond the meeting of basic needs. Accordingly, the main aim was to explore the marginal effectiveness of care when measured in terms of people’s overall care-related quality of life (CRQoL) and assess changes in marginal effect for increasing intensity. The associated aim was to refine and apply an observational method to estimate marginal effectiveness. A “production function” approach was used with survey data, including Adult Social Care Outcomes Toolkit-measured CRQoL, whereby we statistically modelled the expected relationship between service utilisation rates and CRQoL. This method seeks to limit endogeneity issues by controlling on observables and using instrumental variable. Using a survey of publicly funded long-term care service users in England, we found that community-based long-term care significantly improved people’s CRQoL but with diminishing marginal effects and effects differentiated by baseline impairment levels. There are implications for how the care system should respond to changes in global public budgets. For example, where there is unmet need, a system aimed to maximise (unadjusted) CRQoL would put more emphasis on access (more recipients) than intensity of support compared to a system operating on a needs basis.
A Scoping Review of Physical Rehabilitation in Long-Term Care: Interventions, Outcomes, Tools
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Abstract: Residents in long-term care (LTC) often require physical rehabilitation (PR) to maintain/improve physical function. This scoping review described the breadth of literature regarding PR in LTC to date, synthesizing PR interventions that have been evaluated, outcomes used, and tools for determining service eligibility. A structured search, conducted in six licensed databases and grey literature, identified 381 articles for inclusion. Most interventions were delivered and evaluated at the resident level and typically were multicomponent exercise programs. Performance-based measures, activities of daily living, and mood were the most frequently reported outcomes. A key knowledge gap was PR in relation to goals, such as quality of life. Future studies should reflect medically complex residents who live in LTC, and length of residents’ stay should be differentiated. Intervention studies should also explore realistic delivery methods; moreover, tool development for determining service eligibility is necessary to ensure equality in rehabilitative care across the LTC sector.
Involvement of people with dementia in making decisions about their lives: a qualitative study that appraises shared decision-making concerning daycare
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OBJECTIVE: To explore how people with dementia, their informal caregivers and their professionals participate in decision making about daycare and to develop a typology of participation trajectories.
Resident Choice: A Nursing Home Staff Perspective on Tensions and Resolutions
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CONTEXT: This study investigated nursing home staff experiences in realizing resident choice. Twenty-six qualitative staff interviews were conducted in an opportunistic sample from two Veterans Health Administration (VHA) Community Living Centers (CLCs, i.e., nursing homes) implementing the Green House Model. Thematic content analysis surfaced several key tensions at the intra-personal, inter-personal, and organizational levels. Most salient were staff mental models within the intra-personal level. Staff conveyed a lack of clarity on how to realize resident choice when faced with varying tensions, especially the competing goal of resident medical and safety needs. Staff-employed resolutions to resident choice-related tensions also emerged (e.g., preventive practices, staff reinforcement, and staff deliberation). This study offers specific and concrete insights on how resident choice in daily life, and thus resident quality of life, can be advanced.
Nursing Staff Distress Associated With Neuropsychiatric Symptoms in Young-Onset Dementia and Late-Onset Dementia
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OBJECTIVE: The aims of this study were (1) to investigate the relationship between different neuropsychiatric symptoms (NPS) and the level of distress experienced by nurses caring for residents with young-onset dementia (YOD) and (2) to compare these findings with those for nurses caring for residents with late-onset dementia (LOD).
Delivering Person-Centered Care: Important Preferences for Recipients of Long-term Services and Supports
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OBJECTIVES: Although assessing individual consumer preferences are an important first step in providing person-centered care, the purpose of this study was to identify the top 10 shared preferences that are important to a majority of consumers receiving long-term services and supports.
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Organizational Change
Optimal NHS service delivery to care homes: a realist evaluation of the features and mechanisms that support effective working for the continuing care of older people in residential settings
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BACKGROUND: Care homes are the institutional providers of long-term care for older people. The OPTIMAL study argued that it is probable that there are key activities within different models of health-care provision that are important for residents’ health care.
OBJECTIVES: To understand ‘what works, for whom, why and in what circumstances?’. Study questions focused on how different mechanisms within the various models of service delivery act as the ‘active ingredients’ associated with positive health-related outcomes for care home residents.
Association between organisational and workplace cultures, and patient outcomes: systematic review
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INTRODUCTION: Despite widespread interest in the topic, no current synthesis of research is available analysing the linkages between organisational or workplace cultures on the one hand, and patient outcomes on the other. This protocol proposes a systematic review to analyse and synthesise the literature to date on this topic. The resulting review will discuss characteristics of included studies in terms of the type of healthcare settings researched, the measurements of organisational and workplace culture, patient outcomes measured and the influence of these cultures on patient outcomes.
Nurses’ professional competency and organizational commitment: Is it important for human resource management?
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BACKGROUND: Professional competency is a fundamental concept in nursing, which has a direct relationship with quality improvement of patient care and public health. Organizational commitment as a kind of affective attachment or sense of loyalty to the organization is an effective factor for professional competency.
Do Safety Culture Scores in Nursing Homes Depend on Job Role and Ownership? Results from a National Survey
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OBJECTIVES: To identify facility- and individual-level predictors of nursing home safety culture.
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Research Practice and Methodology
Aide-memoire diaries in longitudinal research
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BACKGROUND:Diaries can be used as contemporaneous tools for gathering data, frequently in combination with interviews. However, diaries can also be used by study participants as personal records to improve their recall during interviews, without having to be collected for analysis.
Development of a discussion tool to enable well-being by providing choices for people with dementia: a qualitative study incorporating codesign and participatory action research
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OBJECTIVE: To codesign a discussion tool to facilitate negotiation of risk between health professionals, people with dementia and carers.
QualiBuddy: an online tool to improve research skills in qualitative data analysis
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Purpose: Novice researchers experience difficulties in analysing qualitative data. To develop the skills necessary for qualitative data analysis, theoretical manuals are often insufficient. Supervisors supporting students in analysing qualitative data stress the need for practical guidance, including exercises and feedback. The purpose of this paper is to present and discuss QualiBuddy, an interactive online support tool in answer to this need. Design/methodology/approach: An online support tool was developed in answer to existing problems regarding analysing qualitative data. The tool provides a learning trajectory of 11 stages of analysis, which all contain examples, exercises, feedback, verification questions and questions for reflection. This tool is developed from a multidisciplinary perspective and is constructed around various steps. During the development process, internal feedback from the members of the project team, as well as external feedback from an international steering group with experts in qualitative research were taken into account. Findings: The tool QualiBuddy is based on an empirically and theoretically grounded approach to qualitative data analyses. Pilot tests with experienced qualitative researchers suggest that the tool potentially allows novice researchers from various domains to develop and improve their skills in conceptualising interview data, specifically within a grounded theory approach. Originality/value: QualiBuddy is a newly developed interactive online education tool based on and complementary to existing guides for qualitative data analysis.
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Aging
Post-fall assessment reporting methods in Canadian long-term care facilities
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Abstract: Falls are a significant problem among residents of long-term care facilities (LTCFs). Post-fall assessment (PFA) has an important role to play in recording potential risk factors so as to prevent future falls.The objective of the current study was to examine how fall incidents are recorded, the type of information gathered in the reporting forms, and how the information is used. To investigate various PFA tools and procedures for their use, telephone interviews were conducted with a staff member from 52 LTCFs in Nova Scotia, Canada. Interviewee information, facility information, fall reporting methods, and report template data were collected and analyzed. Findings showed that reporting forms mostly required information that was administrative in nature and failed to gather information on the risk factors surrounding the fall incident. Current reporting systems seem to be inadequate for identifying or addressing future fall risk. A more systematic and evidence-based approach is needed to address the issue of falls in LTCFs.
Moving from place to place in the last year of life: A qualitative study identifying care setting transition issues and solutions in Ontario
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Abstract: Moving from one care setting to another is common as death nears. Many concerns exist over these end-of-life (EOL) care setting transitions, including low-quality moves as mistakes and other mishaps can occur. Delayed or denied moves are also problematic, such as a move out of hospital for dying inpatients who want to spend their last hours or days at home. The aim of the study was to identify current issues or problems with care setting transitions during the last year of life as well as potential or actual solutions for these problems. A grounded theory analysis approach was used based on interviews with 38 key informants who represent a wide range of healthcare providers, healthcare managers, government representatives, lawyers, healthcare recipients and their family/friends across Ontario in 2016. Three interrelated themes were revealed: (a) communication complexities, (b) care planning and coordination gaps and (c) health system reform needs. Six solutions were highlighted, with these designed to prevent care setting transition issues and monitor care setting transitions for continued improvements.
London Transfer Project: improving handover documentation from long-term care homes to hospital emergency departments
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Abstract: About one-quarter of all long-term care (LTC) residents are transferred to an emergency department (ED) every 6 months in Ontario, Canada. When residents are unable to describe their health issues, ED staff rely on LTC transfer reports to make informed decisions. However, transfer information gaps are common, and may contribute to unnecessary tests, unwanted treatments and longer ED length of stay. London Health Sciences Centre, an academic hospital system in London, Ontario, partnered with 10 LTC homes to improve emergency reporting of their residents’ reason for transfer and baseline cognition. After conducting a root cause analysis, 7 of 10 homes implemented a standard minimum set of currently available transfer forms, including a computer-generated summary of resident’s most recent interRAI functional assessment. Results were analysed using statistical process control charts and data were posted on a public website (LondonTransferProject.com). The documentation rate of ‘reason for transfer’ improved from 61% to 84%, and ‘baseline cognitive status’ improved from 4% to 56% across all 10 homes. These results suggest that transfer communication can be improved by codesigning and implementing solutions with ED and LTC staff, which build upon current reporting practices shared across multiple LTC organisations.
Optimizing medication use in elderly people in primary care: Impact of STOPP criteria on inappropriate prescriptions
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Background: STOPP (Screening Tool of Older Person’s Prescriptions) criteria have been used in acute care and nursing home settings as a screening tool to assess Potentially Inappropriate Medication (PIM) for elderly people. Furthermore, this tool could help General Practitioners (GPs) to lower PIM frequency in primary care.
Objective: The aim of the study was to measure the impact of STOPP criteria applied by the GP on prescriptions during a primary care consultation.
“Leisurely Dining”: Exploring How Work Organization, Informal Care, and Dining Spaces Shape Residents’ Experiences of Eating in Long-Term Residential Care
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Abstract: Mealtimes are among the busiest times in nursing homes. Austerity measures resulting in insufficient staff with heavy workloads limit the amount of time available to assist residents with eating. Within a feminist political economy framework, rapid team-based ethnography was used for an international study involving six countries exploring promising practices and also for a study conducted in one Canadian province in which interrelationships between formal and informal care were investigated. Data collection methods included interviews and observations. In addition, dining maps were completed providing a cross-jurisdictional comparison of mealtime work organization, and illustrating the time spent assisting residents with meals. Dining maps highlight the reliance on unpaid care as well as how low staffing levels leave care providers rushing around, preventing a pleasurable resident dining experience, which is central to overall health and well-being.
Meaningful Deprescribing in the Nursing Home
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Editorial – no abstract available.
Trajectories Over the First Year of Long-Term Care Nursing Home Residence
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Objectives: To describe the trajectories in the first year after individuals are admitted to long-term care nursing homes.
Clinical Complexity and Use of Antipsychotics and Restraints in Long-Term Care Residents with Parkinson’s Disease
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BACKGROUND: Patients with Parkinson’s disease (PD) and/or Parkinsonism are affected by a complex burden of comorbidity. Many ultimately require institutional care, where they may be subject to the application of physical restraints or the prescription of antipsychotic medications, making them more vulnerable to adverse outcomes.
OBJECTIVES: The objectives of this paper are to: 1) describe the clinical complexity of older institutionalized persons with PD; and 2) examine patterns and predictors of restraint use and prescription of antipsychotics in this population.
Neuropsychiatric Symptoms in People With Korsakoff Syndrome and Other Alcohol-Related Cognitive Disorders Living in Specialized Long-Term Care Facilities: Prevalence, Severity, and Associated Caregiver Distress
Non UofA Access
OBJECTIVES: Caring for people with Korsakoff syndrome (KS) residing in specialized long-term care facilities (LTCFs) can be distressing because of challenging neuropsychiatric symptoms (NPS). However, good-quality studies on NPS in this under-researched population are lacking. This study examined the prevalence and severity of NPS in people with KS living in specialized LTCFs and the associated caregiver distress.
Development and pilot testing of a decision aid for the initiation of antipsychotic medications in persons with dementia in long-term care using a systematic approach: a study protocol
Non UofA Access
INTRODUCTION: Antipsychotic medications are commonly used in long-term care to treat neuropsychiatric symptoms of dementia despite concerns that their risks (eg, infection, falls, death) may outweigh their benefits. This study protocol outlines the development and pilot testing of a decision aid for antipsychotic medications that is tailored to the information needs of residents with dementia in long-term care and family caregivers (or decision makers). The goals of the decision aid are to help residents and caregivers (1) better understand the risks and benefits of antipsychotic medications in long-term care, and (2) make informed decisions about their use (or non-use).
Improving Oral Hygiene for Veterans With Dementia in Residential Long-term Care
Non UofA Access
Abstract: Oral hygiene care is neglected in long-term care (LTC) due to patient-, staff-, and systems-level barriers. A dementia-specific oral hygiene program, implemented and evaluated in a Department of Veterans Affairs LTC unit, addressed barriers to oral care at multiple levels. Improved staff competency, access to oral care supplies, and standardized documentation systems were accompanied by reduced oral plaque and gingivitis, demonstrating the feasibility and benefits of direct care staff providing improved oral hygiene in LTC.
Physical activity and physical fitness of nursing home residents with cognitive impairment: A pilot study
Non UofA Access
Abstract; Physical activity and physical fitness are important for health, functional mobility and performance of everyday activities. To date, little attention has been given to physical activity and physical fitness among nursing home residents with cognitive impairment. Therefore, the main aim of this study was to examine physical activity behavior and physical fitness of institutionalized older adults with cognitive impairment and to investigate their interrelations. Forty-eight older adults with cognitive impairment (83.9±7.7years; 72.9% women) and 22 without cognitive impairment (82.2±8.8years; 54.5% women) participated. Physical activity was objectively assessed with accelerometers and physical fitness components (muscular strength, flexibility, balance, body composition and reaction time) were evaluated with physical fitness field tests. Nursing home residents with cognitive impairment spent only ~1min per day in moderate physical activity and ~89min in light physical activity. In average they accumulated 863 (±599) steps per day and spent 87.2% of the accelerometer wear time in sedentary behavior. Participants’ physical fitness components were markedly low and according to the cut-offs used for interpreting the results a great number of nursing home residents had an increased risk of associated health problems, functional impairment and of falling. The performance in some physical fitness tests was positively associated with physical activity. Participants without cognitive impairment had higher levels of physical activity and physical fitness than their counterparts with cognitive impairment. These results indicate that nursing home residents, especially those with cognitive impairment, have low levels of physical activity, spent a high proportion of daytime in sedentary behavior and have low physical fitness. Nursing homes should implement health promotion strategies targeting physical activity and physical fitness of their residents.
A longitudinal study looking at and beyond care recipient health as a predictor of long term care home admission
Non UofA Access
BACKGROUND: The unpaid care provided by informal caregivers allows care recipients to live longer in their homes, which often results in fewer unnecessary long term care home (LTCH) admissions. Although the relationship between care recipient’s health characteristics and institutionalization is well known, the influence of caregiver distress and caregiving coresidence and relationship on this outcome is less clear. This study examines the association of care recipient care needs, caregiver distress and caregiving coresidence and relationship with care recipient long term care home admission.
Supported Discharge Teams for older people in hospital acute care hospital: a randomised controlled trial
Non UofA Access
BACKGROUND: Supported Discharge Teams aim to help with the transition from hospital to home, whilst reducing hospital length-of-stay. Despite their obvious attraction, the evidence remains mixed, ranging from strong support for disease-specific interventions to less favourable results for generic services.
New Institutionalization in Long-Term Care After Hospital Discharge to Skilled Nursing Facility
Non UofA Access
BACKGROUND/OBJECTIVES: Approximately half of individuals newly admitted to long-term care (LTC) nursing homes (NHs) experienced a prior hospitalization followed by discharge to a skilled nursing facility (SNF). The objective was to examine characteristics associated with new institutionalizations of older adults on this care trajectory.
Survival prediction among nursing home residents: A longitudinal study
Non UofA Access
AIM:To determine the survival time and predictors of survival of residents in a nursing home.
A qualitative study exploring issues related to medication management in residential aged care facilities
Non UofA Access
BACKGROUND: Globally, the population of older people is on the rise. As families are burdened with the high cost of care for aging members, demand is increasing for medical care and nursing homes. Thus, medication management is crucial to ensure that residents in a care center benefit and assist the management of the care center in reducing the burden of health care. This study is aimed to qualitatively explore issues related to medication management in residential aged care facilities (RACFs).
Prevalence, incidence and associated factors of pressure ulcers in home palliative care patients: A retrospective chart review
Non UofA Access
BACKGROUND: Terminally ill patients are at high risk of pressure ulcers, which have a negative impact on quality of life. Data about pressure ulcers’ prevalence, incidence and associated factors are largely insufficient.
Prevalence of key care indicators of pressure injuries, incontinence, malnutrition, and falls among older adults living in nursing homes in New Zealand
Non UofA Access
Abstract: Pressure injuries, incontinence, malnutrition, and falls are important indicators of the quality of care in healthcare settings, particularly among older people, but there is limited information on their prevalence in New Zealand (NZ). The aim of this study was to establish the prevalence of these four problems among older people in nursing home facilities. The cross-sectional study was an analysis of data collected on a single day for the 2016 National Care Indicators Programme-New Zealand (NCIP-NZ). The sample included 276 people ages 65 and older who were residents in 13 nursing home facilities in a geographically diverse area of central NZ. Data were analyzed with descriptive statistics. Prevalence rates in these nursing home settings was pressure injuries 8%; urinary incontinence 57%; fecal incontinence 26%; malnutrition 20%, and falls 13%, of which half resulted in injuries. As people age, complex health issues can lead to increasing care dependency and more debilitating and costly health problems. Measuring the prevalence of basic care problems in NZ healthcare organizations and contributing to a NZ database can enable monitoring of the effectiveness of national and international guidelines.
Malnutrition, Dysphagia, and Tongue Strength in Long Term Care
AM Namasivayam, PhD. diss., University of Toronto, 2017
Could delirium and anti-dementia drugs effect on the treatment of agitated nursing home residents with Alzheimer dementia?
Non UofA Access
No abstract available
Hospice Care for Patients With Dementia in the United States: A Longitudinal Cohort Study
Non UofA Access
OBJECTIVES: To characterize the hospices that serve patients with dementia, to compare patterns of hospice disenrollment for patients with dementia and without dementia, and to evaluate patient-level and hospice-level characteristics associated with hospice disenrollment.
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Events
Online
Traditional research dissemination methods, such as the publication of journal articles and conference presentations, often do not engage the public. For this reason, researchers are seeking to widen their KT approaches to more effectively include potential knowledge users. In this webinar, participants will be introduced to an innovative research and KT method involving visual imagery and narrative, which has been used to spark community dialogues on suicide prevention. Drawing on an example from Dr. Ferlatte’s own research on suicide among LGBTQ2S people, this webinar highlights key considerations for researchers who want to effectively incorporate novel KT approaches into their work.
Learning objectives:
– Identify opportunities for knowledge translation afforded by photovoice
– Illustrate the potential of photovoice to destigmatize mental illness and generate discussion on suicide
Courses
Knowledge Translation Professional Certificate
KTPC is a five-day professional development initiative for knowledge translation (KT) professionals (ie. knowledge brokers, KT specialists, KT managers, and the like). Participation in this week-long intensive requires some background in KT. The curriculum focuses on the core competencies of KT work in Canada, as identified by a survey of KT practitioners. These competencies include KT Planning, KT Theories and Frameworks, Implementation and Evaluation, among others. The course includes a balance of theory and practical application and we invite active participation by employers/mentors to help build organizational culture for KT.
News
For Canadians in queue for long-term care spots, waiting costs ‘astronomical’
Nova Scotia woman staying in a downtown Halifax hotel until the money runs out or she gets a placement.
New plan will see Ontario government employees deliver home care
The Wynne government is getting into the business of providing home care directly, quietly creating a new provincial agency that could eventually serve hundreds of thousands of patients in Ontario, CBC News has learned.
America’s Dementia Caregivers Cite Stresses, Rewards
It’s tough, often thankless work done by millions of Americans every day. And people who tend to a loved one with dementia say they’re often overburdened, but the task has its rewards, too. Those are just some of the findings from a new University of Michigan survey, the National Poll on Healthy Aging, which tallied the experiences of dementia caregivers.
Should Patients With Dementia Be Able To Decline Spoon-Feeding?
Nora Harris, who died in October after a battle with Alzheimer’s disease, signed an advance directive stipulating no care to prolong her life. Her husband took the state of Oregon to court because she was spoon-fed against her wishes.
The NDP government introduced a new bill in the Alberta legislature on Tuesday that would enshrine the rights of residents of long-term care facilities, and their families, to create “self-governing councils.”
Resources
The WHO Global strategy and action plan on ageing and health calls for action on aligning health systems to the needs of older populations. The Programme on Integrated Care for Older People (ICOPE) provides direction on how to initiate such system changes. The Global Consultation meeting provided an opportunity for discussion and debate among global experts and WHO Member States about how health and social care systems can implement integrated care for older people.
The Research Data Centres (RDC) Program
The Research Data Centres RDCs are part of an initiative by Statistics Canada, the Social Sciences and Humanities Research Council (SSHRC) and university consortia to help strengthen Canada’s social research capacity and to support the policy research community. The program would like to acknowledge the generous support of the Canada Foundation for Innovation (CFI) and the Canadian Institutes of Health Research (CIHR).
RDCs provide researchers with access, in a secure university setting, to microdata from population and household surveys, administrative data holdings and linked data. The centres are staffed by Statistics Canada employees. They are operated under the provisions of the Statistics Act in accordance with all the confidentiality rules and are accessible only to researchers with approved projects who have been sworn in under the Statistics Act as ‘deemed employees.’
RDCs are located throughout the country, so researchers do not need to travel to Ottawa to access Statistics Canada microdata.
For researchers at U of A, there is a Research Data Center at Rutherford Library.
Newsletters
CIHR Institute of Aging Newsletter
16 November 2017
15 November 2017
8 November 2017
