August 27, 2018

With provincial policy changing institutional care provision for older adults who are unable to safely remain at home, supportive living represents a new middle-ground to provide care for older adults. We compared characteristics of supportive living staff and residents to those in long-term care (LTC), using facility and staff surveys, as well as administrative Resident Assessment Instrument (RAI) data, to describe differences and similarities between facility types. Data analysis included t-tests, chi-square tests, ridit analyses and odds ratios. Participants from 15 supportive living facilities were compared to participants from eight LTC homes. Supportive living healthcare aides were younger, worked fewer years and were more likely to work full time than LTC healthcare aides. LTC residents were more likely than supportive living residents to have: cognitive impairment, medical instability, and activities of daily living dependence. This knowledge, which situates supportive living in the new care continuum, is useful for policy makers and administrators deciding on interventions and clinical guidelines for care groups.

Stemming from the growing global interest on the importance of effective evidence implementation, Canadian implementation experts are exploring the value of establishing a network and what purpose it may serve here in Canada.

Seniors hospitalized for non-life-threatening conditions are at higher risk of confusion, complications and death compared to elders treated at home. Potentially avoidable hospitalizations (PAH) may occur if long-term care homes (LTCHs) staff do not identify early warning signs of illness, missing opportunities to modify care plans before residents are in crisis.
This project aimed to adapt and test the E-INTERACT tools for use in Canadian LTCHs to proactively identify residents at risk of transfer to emergency departments (ED) and/or death in the Greater Toronto Area and Calgary, with potential for spread across Canada.
This webinar will describe lessons learned throughout the research study, including challenges with implementation and barriers encountered for the use of the tools in the Canadian context.

Pediatric acute gastroenteritis (AGE) is a common childhood illness with substantial health, family, and system impacts. Connecting parents to evidence-based patient education is key to effective decision-making and therapeutic management of AGE. Digital knowledge translation (KT) tools offer a promising approach to communicate complex health information to parents; therefore, we developed a whiteboard animation video for parents about AGE. To optimize future effectiveness evaluation of this video, the purpose of this pilot study is to assess feasibility of effectiveness outcomes and specific trial methods in four key trial domains. Methods: A single-site, parallel-arm, pilot randomized trial will be conducted. The trial will employ quantitative and qualitative methods to evaluate feasibility objectives in key scientific, process, management, and resource domains. Parents seeking care for a child with AGE in the emergency department (ED) over a 6-month period will be randomized to receive the whiteboard animation video or a sham control video. Quantitative data will be collected electronically in the ED and at home (4-10 days post-ED visit). Qualitative data will be collected via semi-structured interviews with experimental condition participants after quantitative data collection. Data will be collected to perform a sample size calculation for a full-scale trial. Scientific outcomes will include parental knowledge, decision regret, and health utilization, and estimation for these outcomes will use confidence intervals (CI) of different widths to illustrate strength of preliminary evidence. CIs will be presented alongside minimum clinically important differences (MCIDs) calculated using two methods: (1) data driven and (2) patient perspective. Descriptive statistics will be calculated to describe process, management, and resource domain outcomes. Qualitative thematic analysis will be conducted to describe additional process, management, and resource outcomes in the experimental group. Analyses will be performed using intention-to-treat. Discussion: This pilot randomized trial will inform the design and conduct of a full-scale, effectiveness trial by gathering key data in four domains: scientific, process, management, and resource. These results will impact the emerging field of KT efforts targeting health consumers and advance the science on the best mode of patient education for acute childhood illnesses. Trial registration: clinicaltrails.gov registration number NCT03234777. Registered 31 July 2017.

To identify the outcome priorities of parents of children who had experienced an acute respiratory infection (ARI). DESIGN: This was a two-phase, mixed methods study with a sequential exploratory design. We used a cross-sectional quantitative web-based survey to elicit parents’ priorities for paediatric ARI. We then used a discussion moderated via Facebook to elucidate richer descriptions of parents’ priorities. SETTING: Survey and discussion data were collected via the internet. PARTICIPANTS: 110 parents (90% women, median age 35 years, 92.7% urban dwelling, 94.5% with a postsecondary education) with a child who had experienced an ARI responded to the survey. Four parents participated in the Facebook discussion. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was parents’ rankings of outcomes related to paediatric ARI. The secondary outcomes were the alignment of parent-reported important outcomes with those commonly reported in Cochrane systematic reviews (SRs). RESULTS: Commonly reported ARIs included croup (44.5%), wheezing (43.6%) and influenza (38.2%). Parents ranked major complications, illness symptoms and length of stay as the most important outcome categories. With respect to specific outcomes, severe complications, major side effects, doctor’s assessment, relapse, oxygen supplementation and results from laboratory measures were reported as most important (75th-99th percentile). Taking time off work, mild complications, interference with daily activities, treatment costs, absenteeism, follow-up visits and other costs were deemed minimally important (<25th percentile). In 35 Cochrane SRs, 29 unique outcomes were reported. Although participants’ priorities sometimes aligned with outcomes frequently reported in the literature, this was not always true. Additional priorities from the survey (n=50) and Facebook discussions (n=4) included healthcare access, interacting with healthcare providers, education, impact on daily activities and child well-being. CONCLUSIONS: In the context of paediatric ARI, parents’ priorities did not always align with commonly researched outcomes. Appealing and efficient strategies to engage patients and parents in research should be developed.

One of the mechanisms for the CIHR Institutes/Initiatives to achieve their mandates is by offering Planning and/or Dissemination grants within the Institute Community Support (ICS) Program. The Planning and Dissemination Grants are intended to provide support for planning and/or dissemination activities consistent with the mandate of CIHR and relevant to CIHR Institutes, or Initiatives.

This funding opportunity is one of several planned as part of the Transition in Care (TiC) Initiative. The focus of the Best and Wise Practices Grants is to support groups of researchers and knowledge users to identify best and wise practices in the areas of transitions in care. The grants will provide development funds to groups that require additional evidence gathering and/or the building of relevant relationships and partnerships to address challenges, gaps and/or barriers related to improving care transitions and mitigating negative outcomes resulting from poor transitions. This competition will support planning and information-sharing activities, partnership development as well as evidence gathering to facilitate the collection of data and building of relevant research capacity in preparation for the launch of future TiC funding opportunities.

Instrumental knowledge utilization is the process whereby knowledge influences political decision making. Such processes are complex and, consequently, hard to measure. Nevertheless, knowing what determines degrees of knowledge utilization is a prerequisite for fostering more evidence-based policy making. Numerous factors that contribute to, and co-determine, knowledge utilization are beyond the reach of researchers, but among the factors that researchers can influence, one variable has been presented as being crucial: the degree to which researchers adapt their research to meet the demands of intended knowledge users. In other words, making their research comprehensible, operational, realistic in terms of interventions and implications, and appealing to users. Drawing on the conceptual work of Landry, Amara, and Lamari, this paper develops a new, and more direct, measurement of adaptation. This measurement is subsequently applied in an analysis employing the Degrees of Knowledge Utilization (DoKU) scale and, thus, extending Knudsen?s five-year meta-evaluation related to the Danish pesticide area. Surprisingly, the statistical tests show that degrees of adaptation have no significant influence on degrees of knowledge utilization.

Emergency medicine and paediatric hospital medicine physicians each provide a portion of the initial clinical care for the majority of hospitalised children in the USA. While these disciplines share goals to increase quality of care, there are scant data describing their collaboration. Our national, multihospital learning collaborative, which aimed to increase narrow-spectrum antibiotic prescribing for paediatric community-acquired pneumonia, provided an opportunity to examine factors influencing the success of quality improvement efforts across these two clinical departments. OBJECTIVE: To identify barriers to and facilitators of interdepartmental quality improvement implementation, with a particular focus on increasing narrow-spectrum antibiotic use in the emergency department and inpatient settings for children hospitalised with pneumonia. METHODS: We used a mixed-methods design, analysing interviews, written reports and quality measures. To describe hospital characteristics and quality measures, we calculated medians/IQRs for continuous variables, frequencies for categorical variables and Pearson correlation coefficients. We conducted in-depth, semistructured interviews by phone with collaborative site leaders; interviews were transcribed verbatim and, with progress reports, analysed using a general inductive approach. RESULTS: 47 US-based hospitals were included in this analysis. Qualitative analysis of 35 interview transcripts and 142 written reports yielded eight inter-related domains that facilitated successful interdepartmental quality improvement: (1) hospital leadership and support, (2) quality improvement champions, (3) evidence supporting the intervention, (4) national health system influences, (5) collaborative culture, (6) departments’ structure and resources, (7) quality improvement implementation strategies and (8) interdepartmental relationships. CONCLUSIONS: The conceptual framework presented here may be used to identify hospitals’ strengths and potential barriers to successful implementation of quality improvement efforts across clinical departments.

Pragmatic dissemination and implementation (D&I) research approaches can benefit patient care because they emphasize real-world settings and populations. Nurse scientists have an opportunity to reduce the gap between science and practice by using pragmatic D&I research and sustainability strategies. PURPOSE: This article discusses pragmatic models, methods, and measures used in D&I research and their relevance for nursing research and enhancing population health. METHODS: Summary of pragmatic D&I models and related methods for designing a pragmatic studies. We discuss the RE-AIM framework and the PRECIS-2 planning aid and figure in detail. A case study is provided and application to nursing research is discussed. DISCUSSION: Successful translation of pragmatic D&I research demands an approach that addresses external validity, and customization at multiple levels including the patient, clinician, and setting. Context is critically important, and it is never too early to design for dissemination. CONCLUSIONS: Pragmatic D&I approaches are needed to speed research translation, reduce avoidable waste of funding, improve clinical care, and enhance population health. Pragmatic D&I research is an area of tremendous opportunity for the nursing science community.

This paper draws on Stokes’ (1997) framework to position the disconnection between theory and practice as a knowledge production problem. In this sense, we argue that a better understanding of different academic profiles is extremely important to focus efforts on those academics that may overcome the “lost before translation” problem. Our data, that come from a survey of researchers affiliated to the Spanish National Research Council (CSIC), provide a good opportunity to explore the factors that might increase or impede the likelihood that researchers engage in research that reconciles the quest for fundamental understanding with the consideration of use (Pasteur’s profile), rather than in research complying with fundamental understanding, but not with the consideration of use (Bohr’s profile). The descriptive and bivariate analyses reveal that the largest proportion of the researchers belongs to Bohr’s profile. The econometric exercise enables to identify several motives that might increase or decrease the likelihood that researchers belong to Pasteur’s profile instead of Bohr’s profile, notably the lack of fit between researchers and non-academic agents, their motivation for learning in the context of application, having access to in-kind resources, and to a lesser extent, motives linked to career promotion imperatives and personal income. The results of the paper are also discussed to derive policy and managerial implications for research institutions.

Few training opportunities are available for implementation practitioners; we designed the Practicing Knowledge Translation (PKT) to address this gap. The goal of PKT is to train practitioners to use evidence and apply implementation science in healthcare settings. The aim of this study was to describe PKT and evaluate participant use of implementation science theories, models, and frameworks (TMFs), knowledge, self-efficacy, and satisfaction and feedback on the course. METHODS: PKT was delivered to implementation practitioners between September 2015 and February 2016 through a 3-day workshop, 11 webinars. We assessed PKT using an uncontrolled before and after study design, using convergent parallel mixed methods. The primary outcome was use of TMFs in implementation projects. Secondary outcomes were knowledge and self-efficacy across six core competencies, factors related to each of the outcomes, and satisfaction with the course. Participants completed online surveys and semi-structured interviews at baseline, 3, 6, and 12 months. RESULTS: Participants (n = 15) reported an increase in their use of implementation TMFs (mean = 2.11; estimate = 2.11; standard error (SE) = 0.4; p = 0.03). There was a significant increase in participants’ knowledge of developing an evidence-informed, theory-driven program (ETP) (estimate = 4.10; SE = 0.37; p = 0.002); evidence implementation (estimate = 2.68; SE = 0.42; p < 0.001); evaluation (estimate = 4.43; SE = 0.36; p < 0.001); sustainability, scale, and spread (estimate = 2.55; SE = 0.34; p < 0.001); and context assessment (estimate = 3.86; SE = 0.32; p < 0.001). There was a significant increase in participants’ self-efficacy in developing an ETP (estimate = 3.81; SE = 0.34; p < 0.001); implementation (estimate = 3.01; SE = 0.36; p < 0.001); evaluation (estimate = 3.83; SE = 0.39; p = 0.002); sustainability, scale, and spread (estimate = 3.06; SE = 0.46; p = 0.003); and context assessment (estimate = 4.05; SE = 0.38; p = 0.016). CONCLUSION: Process and outcome measures collected indicated that PKT participants increased use of, knowledge of, self-efficacy in KT. Our findings highlight the importance of longitudinal evaluations of training initiatives to inform how to build capacity for implementers.

Good knowledge translation efforts can lead to significant changes in health status and service delivery. Although there is growing literature around ways to conduct knowledge translation within policy and health service delivery sectors, literature around how to conduct dissemination within indigenous community-based contexts remains scant. STUDY DESIGN: Using creative, strengths-based approaches to not only return results but also to function as tools to address gaps in health knowledge as identified by participants and community members within intergenerational contexts was a central component applied to dissemination and knowledge translation. METHODS: We developed a series of seven key considerations that we applied to the creation of dissemination products from qualitative interviews and focus group discussions from two Manitoba, Canada-specific public health research projects with indigenous communities. RESULTS: Products created (activity sheets, board game, and non-fiction storybooks) considered principles of timeliness, literacy level, feasibility of reproduction, and meeting the stated needs of study participants. CONCLUSIONS: By creating products that seek not only to return study information but also to answer questions and address specific challenges identified by participants, it is possible to continue to engage in research that is meaningful and ethical and strengthens relationships with all stakeholders.

Due to inadequate pain assessment documentation in our paediatric post-anaesthetic care unit (PACU), we were unable to monitor pain intensity, and target factors contributing to moderate and severe postoperative pain in children. The purpose of this study was to improve pain assessment documentation in PACU through a process improvement intervention and knowledge translation (KT) strategy. The study was set in a PACU within a large university affiliated paediatric hospital. Participants included PACU and Acute Pain Service nursing staff, administrative staff and anaesthesiologists.Methods The Plan–Do–Study-Act method of quality improvement was used. Benchmark data were obtained by chart review of 99 patient medical records prior to interventions. Data included pain assessment documentation (pain intensity score, use of validated pain intensity measure) during PACU stay. Repeat chart audit took place at 4, 5 and 6 months after the intervention.Intervention Key informant interviews were conducted to identify barriers to pain assessment documentation. A process improvement was implemented whereby the PACU flowsheets were modified to facilitate pain assessment documentation. KT strategy was implemented to increase awareness of pain assessment documentation and to provide the knowledge, skill and judgement to support this practice. The KT strategy was directed at PACU nursing staff and comprised education outreach (educational meetings for PACU nurses, discussions at daily huddles), reminders (screensavers, bedside posters, email reminders) and feedback of audit results.Results The proportion of charts that included at least one documented pain assessment was 69%. After intervention, pain assessment documentation increased to >90% at 4 and 5 months, respectively, and to 100% after 6 months.Conclusion After implementing process improvement and KT interventions, pain assessment documentation improved. Additional work is needed in several key areas, specifically monitoring moderate to severe pain, in order to target factors contributing to significant postoperative pain in children.

The many negative effects of burnout have prompted researchers to better understand the factors contributing to it. The purpose of this paper is to add to this body of knowledge through the study of burnout among direct-care workers in nursing homes. BACKGROUND: Perhaps the factor most often associated with employee burnout is the level of staffing-insufficient staffing results in work overload and eventually employee burnout. A closer look at research findings suggests that there are many other factors also contributing to burnout. These range from those at the organisational level, such as availability of training and resources to individual characteristics such as self-esteem and length of employment. METHODS: A self-administered survey instrument was completed by 410 direct-care workers working within 11 nursing homes in the north Texas region. Regression analyses were performed, adjusting for clustering by nursing home. Beta coefficients and structure coefficients are reported. Burnout was measured through three dimensions: emotional exhaustion, depersonalisation and personal accomplishment. RESULTS: Organisational, work design, interpersonal and individual characteristics were found to be associated with one or more dimensions of burnout. CONCLUSIONS: The analyses largely support previous research. Organisational variables of significance included the availability of resources to do the work, available training and fair pay. Work design variables of significance included adequate staffing. The individual characteristic, self-esteem, appeared to have the strongest impact on burnout. Commitment to the organisation also had a large impact. RELEVANCE TO CLINICAL PRACTICE: While the data do not allow for the testing of causal relationships, the data do suggest that providing adequate staffing, perceived fair pay, sufficient work resources (e.g., towels, gowns), management support and adequate training may result in less direct-care worker burnout on the job.

To implement an educational program for nursing staff on recognising, reporting and managing resident to resident elder mistreatment in aged care facilities. BACKGROUND: The phenomenon of a growing ageing population increases the demand of optimum care for older people living in aged care facilities. Caring for older people is complex, but should include the management of aggressive interaction between them. Nursing staff play a vital role in identifying and managing those behaviours. However, many nurses may not recognise these aggressive interactions as abuse. Therefore, this study aims to manage and reduce this abuse through an educational program. DESIGN: Cluster randomised trial registered on the Australia New Zealand Clinical Trial Registry (ACTRN 12617001618347). METHODS: This trial was undertaken in an aged care facility located in Melbourne-Australia and was funded in January 2017. Wards were randomly allocated (as the intervention and control group) by using sealed opaque envelopes. Nursing staff, who met eligibility, were consecutively recruited and supplied their informed consent. Nurses from the intervention group received an educational program, while nurses from the control group continued with the usual standard care. Main outcomes included recognising, managing and reporting the abuse before and after the intervention and will be evaluated on an intention-to-treat analysis. DISCUSSION: It is vital to manage and reduce resident to resident elder mistreatment. This educational program may assist nursing staff to protect vulnerable older people experiencing this abuse and may improve comprehensive evidence-based care for older people residing in aged care facilities. This article is protected by copyright. All rights reserved.

Due to the high morbidity and disability level among diabetes patients in nursing homes, the conditions for caregivers are exceedingly complex and challenging. The patient safety culture in nursing homes should be evaluated in order to improve patient safety and the quality of care. Thus, the aim of this study was to examine the perceptions of patient safety culture of nursing personnel in nursing homes, and its associations with the participants’ (i) profession, (ii) education, (iii) specific knowledge related to their own residents with diabetes, and (iv) familiarity with clinical diabetes guidelines for older people. Methods: Cross-sectional survey design. The study included 89 nursing home personnel (38 registered nurses and 51 nurse aides), 25 (28%) with advanced education, at two nursing homes. We collected self-reported questionnaire data on age, profession, education and work experience, diabetes knowledge and familiarity with diabetes guidelines. In addition, we applied the Nursing Home Survey on Patient Safety Culture instrument, with 42 items and 12 dimensions. Results: In general, those with advanced education scored higher in all patient safety culture dimensions than those without, however statistically significant only for the dimensions “teamwork” (mean score 81.7 and 67.7, p = 0.042) and “overall perceptions of resident safety” (mean score 90.0 and 74.3, p = 0.016). Nursing personnel who were familiar with diabetes guidelines for older people had more positive perceptions in key areas of patient safety culture, than those without familiarity with the guidelines. Conclusions: The findings from this study show that advanced education and familiarity with current diabetes guidelines was related to adequate evaluations on essential areas of patient safety culture in nursing homes.

To evaluate the effects of the implementation of a methodological framework for a narrative-based approach to practice development and person-centred care in residential aged care settings. BACKGROUND: Care in long-term residential settings for older people is moving away from the biomedical approach and adopting a more person-centred one. Narrative can help shape the way care is planned and organised. The provision of person-centred care that is holistic and that takes account of resident’s beliefs and values can be enhanced by incorporating narrative approaches to care within a practice development framework. DESIGN: The chosen methodology was participatory action research. METHODS: Between 2010-2014, a methodological framework of narrative practice was implemented in two residential care settings, comprising 37 residents and 38 staff, using an action research approach. Three action cycles: (i) narrative practice and culture identification, (ii) developing narrative practice and (iii) working in a storied way emerged during the implementation. RESULTS: Key outcomes emerged in relation to the findings. These were based on narrative being, knowing and doing and centred around the key outcomes of (i) how people responded to change (narrative being), (ii) the development of shared understandings (narrative knowing) and (iii) intentional action (narrative doing). CONCLUSION: The implementation of a framework of narrative practice demonstrated that how people respond to change, the development of shared understandings and intentional action were interrelated and interlinked. It illustrated the importance of ensuring that practice context is taken account of in the implementation of action research and the importance of ensuring that narrative being, knowing and doing are clear and understandable for change to occur. RELEVANCE TO CLINICAL PRACTICE: Implementation of a narrative approach to care can develop new ways of working that value biography and promote the development of a co-constructed plan of care.

Clinical decision support systems (CDSS) hold promise to influence clinician behavior at the point of care in nursing homes (NHs) and improving care delivery. However, the success of these interventions depends on their fit with workflow. The purpose of this study was to characterize workflow in NHs and identify implications of workflow for the design and implementation of CDSS in NHs. Research Design and Methods: We conducted a descriptive study at 2 NHs in a metropolitan area of the Mountain West Region of the United States. We characterized clinical workflow in NHs, conducting 18 observation sessions and interviewing 15 staff members. A multilevel work model guided our data collection and framework method guided data analysis. Results: The qualitative analysis revealed specific aspects of multilevel workflow in NHs: (a) individual, (b) work group/unit, (c) organization, and (d) industry levels. Data analysis also revealed several additional themes regarding workflow in NHs: centrality of ongoing relationships of staff members with the residents to care delivery in NHs, resident-centeredness of care, absence of memory aids, and impact of staff members’ preferences on work activities. We also identified workflow-related differences between the two settings. Discussion and Implications: Results of this study provide a rich understanding of the characteristics of workflow in NHs at multiple levels. The design of CDSS in NHs should be informed by factors at multiple levels as well as the emergent processes and contextual factors. This understanding can allow for incorporating workflow considerations into CDSS design and implementation.

Existential questions concerning life and death or meaning in life are very salient for many older people receiving long-term care. However, little is known about how long-term care organizations deal with existential issues. This study describes the practice in two long-term care organizations that took part in a Dutch pilot programme on existential questions and formulates recommendations for building a professional quality framework. METHOD: Starting from theoretical notions on ultimate concerns, life events and meaning in life, organization policy and care practices were explored. Existing documents, in-depth interviews and participatory observations were used as data sources. RESULTS: The outcomes indicate that the long-term care organizations had little active policy on dealing with existential questions; also, personnel had few specific tools except listening closely. Central requirements for dealing with existential questions appeared to involve organizational framework conditions like the availability of spiritual counsellors, having facilities in the building, and clear roles for various actors. Moreover, social-communicative competence building for care personnel was found to be an important demand as well as an organization-wide attitude that puts residents at centre stage. CONCLUSIONS: A professional quality framework requires a “tiered system” that differentiates organizational roles in dealing with existential questions.

Healthcare workers regularly face the risk of violent physical, sexual, and verbal assault from their patients. To explore this phenomenon, a collaborative descriptive qualitative study was undertaken by university-affiliated researchers and a union council representing registered practical nurses, personal support workers, and other healthcare staff in Ontario, Canada. A total of fifty-four healthcare workers from diverse communities were consulted about their experiences and ideas. They described violence-related physical, psychological, interpersonal, and financial effects. They put forward such ideas for prevention strategies as increased staffing, enhanced security, personal alarms, building design changes, “zero tolerance” policies, simplified reporting, using the criminal justice system, better training, and flagging. They reported such barriers to eliminating risks as the normalization of violence; underreporting; lack of respect from patients, visitors, higher status professionals, and supervisors; poor communication; and the threat of reprisal for speaking publicly. Inadequate postincident psychological and financial support compounded their distress.

Evidence translation and improvement research indicate that healthcare contexts are complex systems, characterized by uncertainty and surprise, which often defy orchestrated intervention attempts. This article reflects on the implications of complexity on attempts to translate evidence, and on a newly published framework for Successful Healthcare Improvements From Translating Evidence in complex systems (SHIFT-Evidence). Discussion: SHIFT-Evidence positions the challenge of evidence translation within the complex and evolving context of healthcare, and recognizes the wider issues practitioners routinely face. It is empirically grounded, and designed to be comprehensive, practically relevant and actionable. SHIFT-evidence is summarized by three principles designed to be intuitive and memorable: ‘act scientifically and pragmatically’; ’embrace complexity’; and ‘engage and empower’. Common challenges and strategies to overcome them are summarized in 12 ‘simple rules’ that provide actionable guidance. Conclusion: SHIFT-Evidence provides a practical tool to guide practice and research of evidence translation and improvement within complex dynamic healthcare settings. Implications are that improvement initiatives and research study designs need to take into account the unique initial conditions in each local setting; conduct needs to respond to unpredictable effects and address dependent problems; and evaluation needs to be sensitive to evolving priorities and the emergent range of activities required to achieve improvement.

Medicare incentivizes the reduction of hospitalizations of nursing facility (NF) residents. The effects of these incentives on resident safety have not been examined. OBJECTIVE: Examine safety indicators in NFs participating in a randomized, controlled trial of the INTERACT Quality Improvement Program. DESIGN: Secondary analysis of a randomized trial in which intervention NFs exhibited a statistically nonsignificant reduction in hospitalizations. SETTING: NFs with adequate on-site medical, radiography, laboratory, and pharmacy services, and capability for online training and data input were eligible. PARTICIPANTS: 264 NFs randomized into intervention and comparison groups stratified by previous INTERACT use and self-reported hospital readmission rates. INTERVENTION: NFs randomized to the intervention group received INTERACT materials, access to online training and a series of training webinars, feedback on hospitalization rates and root-cause analysis data, and monthly telephonic support. MEASURES: Minimum data set (MDS) data for unintentional weight loss, malnutrition, hip fracture, pneumonia, wound infection, septicemia, urinary tract infection, and falls with injury for the intervention year and the year prior; unintentional weight loss, dehydration, changes in rates of falls, pressure ulcers, severe pain, and unexpected deaths obtained from the NFs participating in the intervention through monthly telephone calls. RESULTS: No adverse effects on resident safety, and no significant differences in safety indicators between intervention and comparison group NFs were identified, with 1 exception. Intervention NFs with high levels of INTERACT tool use reported significantly lower rates of severe pain. CONCLUSIONS/IMPLICATIONS: Resident safety was not compromised during implementation of a quality improvement program designed to reduce unnecessary hospitalization of NF residents.

To describe the proportion of residents receiving rehabilitation in long-term care (LTC) homes, and scores on activities of daily living (ADL) and falls quality indicators (QIs) before and after change from fee-for-service to an episode of care model; and to evaluate the effect of the change on the QIs. DATA SOURCES: Secondary data were collected from all LTC homes in Ontario, Canada, between January 1, 2011 and March 31, 2015. Variables of interest were the proportion of residents per home receiving physical therapy (PT), and the scores on seven ADL and one falls QI. STUDY DESIGN: Retrospective, longitudinal study. DATA EXTRACTION: All data were extracted from the Resident Assessment Instrument Minimum Data Set. PRINCIPAL FINDINGS: Fewer residents received PT after the policy change (84.6 percent, 2011; 56.6 percent, 2015). The policy change was associated with improved performance on several ADL QIs. However, having a large proportion of residents receive no PT or little PT was associated with poorer performance on two of the QIs measuring improvement in ADLs [No PT: -0.029 (-0.043 to -0.014); -0.048 (-0.068 to -0.027). PT <45 minutes per week: -0.012 (-0.026 to -0.002); -0.026 (-0.045 to -0.007); p < .01]. CONCLUSIONS: While controversial, the policy and subsequent PT service delivery change appears to be associated with improved performance on several ADL QIs, except in homes where a large proportion of residents receive no PT and low time-intensive PT.

The objective of this paper is to demonstrate the utility of the CFIR framework for evaluating broad-scale change by discussing the challenges to be addressed when planning the assessment of broad-scale change and the solutions developed by the evaluation team to address those challenges. The evaluation of implementation of Patient-centered Care and Cultural Transformation (PCC&CT) within the Department of Veterans Affairs (VA) will be used as a demonstrative example. Patient-Centered Care (PCC) is personalized health care that considers a patient’s circumstances and goals. The Department of Veterans Affairs (VA) is working towards implementing PCC throughout its healthcare system, comprised of multiple interventions with a singular long-term goal of cultural transformation, however little is known about the factors influencing its implementation. This paper discusses the issues that arose using CFIR to qualitatively assess the factors influencing implementation of cultural transformation. RESULTS: Application of CFIR to this broad-scale evaluation revealed three strategies recommended for use in evaluating implementation of broad-scale change: (1) the need for adapted definitions for CFIR constructs (especially due to new application to broad-scale change), (2) the use of a mixed deductive-inductive approach with thematic coding to capture emergent themes not encompassed by CFIR, and (3) its use for expedited analysis and synthesis for rapid delivery of findings to operational partners. This paper is among the first to describe use of CFIR to guide the evaluation of a broad-scale transformation, as opposed to discrete interventions. The processes and strategies described in this paper provide a detailed example and structured approach that can be utilized and expanded upon by others evaluating implementation of broad-scale evaluations. Although CFIR was the framework selected for this evaluation, the strategies described in this paper including: use of adapted definitions, use of mixed deductive-inductive approach, and the approach for expedited analysis and synthesis can be transferred and tested with other frameworks.

Family satisfaction, while recognized as important, is frequently missing from validated measures of long-term care quality. This is the first study to compare family satisfaction across two states using validated measures and to compare the organizational and structural factors associated with higher family satisfaction with nursing home care. Data sources are family satisfaction surveys from Minnesota (MN) and Ohio (OH), linked to facility characteristics from Certification and Survey Provider Enhanced Reports (CASPER) for both states ( N = 378 facilities for MN; N = 926 facilities for OH). Activities and food were among lowest rated items in both states. Relationships with staff were the highest rated domain. Higher occupancy rates, smaller facility size, and non-profit ownership consistently predicted better satisfaction in both states. Our findings show consistent organizational factors associated with family satisfaction and provide further evidence to the validity of family satisfaction as a person-centered measure of quality. This lays the foundation for tool development on the national level.

Antipsychotic and other tranquilising medicines are prescribed to help care staff manages behaviour in one-quarter of older people living in Australian long-term care homes. While these medicines pose significant health risks, particularly for people with dementia, reliance on their use occurs when staff are not educated to respond to resident behaviour using nonpharmacological approaches. The Halting Antipsychotic use in Long-Term care (HALT) single-arm study was undertaken to address this issue with 139 people 60 years and over with behaviours of concern for staff living in 24 care homes. A train-the-trainer approach delivered person-centred care education and support for 22 HALT (nurse) champions and 135 direct care staff, dementia management education for visiting general practitioners (GP) and pharmacists, use of an individualised deprescribing protocol for residents, and awareness-raising for the resident’s family. The HALT champions completed open-ended questionnaires and semistructured interviews to identify the contextual elements they considered most critical to facilitating, educating care staff, and achieving success with the study intervention. They reported that person-centred approaches helped care staff to respond proactively to resident behaviours in the absence of antipsychotic medicines; the champions considered that this required strong managerial support, champion empowerment to lead change, reeducation of care staff, and the cooperation of families and GPs.

Altered behaviour associated with dementia can present a number of challenges in the provision of care within both community and residential aged care settings. This paper presents a qualitative case study investigation of the implementation of the Positive Interactive Engagement programme within a residential aged care setting. The Positive Interactive Engagement programme incorporates non-pharmacological sensory techniques that have been informed by a person-centred, Montessori approach. Face-to-face semi-structured interviews with workers at a residential aged care facility in South Australia yielded seven case studies. Data were thematically analysed both within and between cases. Our data indicate the programme demonstrates underlying Montessori principles and supports participant behaviour change, with a noted reduction in ‘disruptive’ behaviours and increased social connection amongst participants. Programme staff report increased job satisfaction. The Positive Interactive Engagement programme offers a model that demonstrates encouraging outcomes, and further research would be useful in ascertaining whether these outcomes translate to quantifiable improvements in the quality of life for people with dementia in a residential aged care setting.

To engage persons with dementia, friends, family, caregivers, and health and social care providers to identify and prioritize their questions for research related to living with dementia and prevention, diagnosis, and treatment of dementia. DESIGN: The Canadian Dementia Priority Setting Partnership (PSP) followed James Lind Alliance PSP methods. Results were compared with the World Health Organization research prioritization exercise and the United Kingdom Dementia PSP. SETTING: Canada. PARTICIPANTS: In the first survey, 1,217 individuals and groups from across Canada submitted their questions about dementia. 249 participated in the interim prioritization. For the final prioritization workshop, the 28 participants included persons with dementia, friends, family, caregivers, health and social care providers, Alzheimer Society representatives, and members of an organization representing long-term care home residents. MEASUREMENTS: *** RESULTS: The Canadian Dementia PSP top 10 priorities relate to health, quality of life, societal issues, and dementia care. Five priorities overlap with one or both of the other two prioritization initiatives. CONCLUSION: These results provide researchers and research funding agencies with topics that individuals with personal or professional experience of dementia prioritize, but they are not intended to preclude research into other aspects of dementia.

As knowledge translation trainee participants, we report on the discussions that took place during the 2017 Knowledge Translation Canada Summer Institute. The theme of the institute was patient-oriented research and patient engagement in research. Trying to move knowledge into health care practice can be difficult. Including patients and families as members of the research team can help to overcome some of these challenges by producing more relevant research designs and results. However, in the absence of guidelines and best practices, it can be difficult for trainees and researchers to effectively engage patients and families in designing and conducting research. We detail how trainees and early career researchers are currently engaging patients in their research, the strengths and challenges of engaging patients in research, and lessons learned. These discussions have helped us to identify important areas where future training and guidance is needed to support trainees as patient-oriented researchers. Abstract: Background Moving knowledge into health care practice can present a number of challenges for researchers. Including patients and families as members of the research team can help to overcome some of these challenges by producing more relevant research designs and results. However, many trainees and researchers experience difficulty in engaging patients and families in research effectively. Main body We report on the discussions that took place at the 2017 Knowledge Translation (KT) Canada Summer Institute (KTCSI). The theme of the KTCSI was patient-oriented research and patient engagement in research. We provide an important viewpoint on how trainees and early career researchers are currently engaging patients in their research, the strengths and challenges of engaging patients in research, and lessons learned. As the target audience of the KTCSI, we provide our thoughts on what is needed to support trainees and researchers to more effectively engage patients and families in research. Conclusion While many of the participants at the KTCSI are conducting patient-oriented research, practical guidance, resources and tools are needed to ensure the effective engagement of patients in research. These discussions have helped us to identify how to move forward as patient-oriented researchers and where future work and support is needed to achieve effective engagement.

Veterans Affairs nursing homes (Community Living Centers; CLCs) have largely shifted focus to providing short-term rehabilitative care, preferring longer-term care to be provided in contract nursing homes or at home. The goal of this retrospective cohort study is to identify resident characteristics associated with longer length of stay using the CLC Minimum Data Set (n = 35,114). Length of stay was defined as three groups: short (<90 days), moderate (91-365 days), and long (beyond 365 days). Residents who remained beyond 90 days were more likely to be black and to have a diagnosis of Alzheimer’s disease, dementia, or schizophrenia, lived in another facility prior to admission, had a financial power of attorney, and had greater dependence in activities of daily living. Unique predictors of those who remained beyond 365 days were older age, cancer diagnosis, cognitive impairment, and admission from assisted living. Our findings can help CLC staff with admission decisions.

The transition to a care home can involve multiple changes and losses that can affect an older person’s well-being and identity. It is not clear how older people perceive and manage their identity within a care home over time. This study explores how living in a care home affects the identities of residents and how they address this in their daily lives. Research Design and Methods: A multiple qualitative case study approach incorporated interview and observational data. Eighteen semistructured interviews and 260 hr of observations were conducted over 1 year with care home residents, relatives, and staff across three care homes within Greater Manchester, UK. Data were analyzed using framework analysis, drawing on the social identity perspective as an interpretive lens. Results: Four themes were identified: (a) changing with age, (b) independence and autonomy, (c) bounded identity, and (d) social comparison. The impact of aging that initially altered residents’ identities was exacerbated by the care home environment. Institutional restrictions jeopardized independence and autonomy, provoking residents to redefine this within the allowances of the care home. Strict routines and resource constraints of well-meaning staff resulted in the bounded expression of personalities. Consequently, to forge a positive identity, residents without dementia engaged in social comparison with residents with dementia, emphasizing their superior cognitive and physical abilities. Discussion and Implications: Social comparison as an adaptive strategy has previously been unidentified in care home literature. Residents need more support to express their identities, which may reduce the necessity of social comparison, and improve interrelationships and well-being.

Residents in nursing homes are old and frail and are dependent on constant care, medical, or otherwise, by trained professionals. But they are also social beings, secluded in an institutional setting which is both total and foreign. In this setting, most of the residents most of the time must relate to other residents: other residents are the nursing home residents’ peers, companions, and perhaps even significant others. In this article, we will discuss how resident communities in nursing homes are influenced by the approaches of nursing home staff. Two nursing homes have been included in this article-one from Canada and one from Norway. Participant observation was conducted at these two nursing homes, predominantly focusing on everyday-life activities. The cases from Norway and Canada are illustrative of two very different general approaches to residents: one collectivistic and one individualistic. These general approaches produce different contexts for the formation and content of resident communities, greatly affecting nursing home residents. The significance of these approaches to resident community is profound and also somewhat unanticipated; the approaches of staff provide residents with different opportunities and limitations and also yield unintended consequences for the social life of residents. The two different general approaches are, we suggest, “cultural expressions,” conditioned by more than official preferences and recommendations. The difference between the institutions is, in other words, anchored in ideas and ideologies that are not explicitly addressed.

Older lesbian, gay, bisexual, and transgender (LGBT) adults are a vulnerable yet resilient population who face unique stressors as they foresee health decline. This paper presents the results of a study about community-dwelling LGBT older adults’ anticipated needs and fears related to nursing homes and assisted living. METHODS: This qualitative study collected data through seven focus groups. The sample (N = 50) consisted of LGBT-identified adults age 55 and over. We used an inductive, thematic analysis approach to data analysis. RESULTS: Participants seek an inclusive environment where they will be safe and feel connected to a community. They fear dependence on healthcare providers, dementia, mistreatment, and isolation. Importantly, these fears can lead to identity concealment and psychological distress, including suicide ideation. DISCUSSION: This study adds to the existing literature about the worries of older LGBT adults as they anticipate long-term care. The results suggest that older LGBT adults seek LGBT-inclusive residential care settings that encompass two distinct yet related aspects of LGBT-affirmative care: the procedural (e.g. culturally competent skills and knowledge of practitioners) and the implicit (e.g. the values and mission of the organization). This paper identifies implications for practice, policy, and training.

To evaluate the nutritional status and needs of a person with dementia living in an aged care home, including identification of barriers to, and effective strategies for, the provision of person-centred care. BACKGROUND: Nutrition and hydration care are integral to quality of life for adults with dementia, but there is little research on whether staff knowledge around effective care strategies for residents is translated into optimal care. DESIGN: Focused ethnographic single-case design. METHODS: The perspectives of the resident, her prime family member, and six care staff were triangulated through interviews, observation, document audit, and medical file review to investigate the resident’s nutrition and hydration status and needs (October 2014-April 2015). RESULTS: During 3 years in care, this resident had lost weight steadily. Staff appeared attentive but did not maintain a systematic record of body mass index. At meals, staff encouraged eating but used ineffective strategies. Food was not served in ways that facilitated active participation. Eating and drinking were structured as tasks to be completed rather than activities to be enjoyed. CONCLUSION: This instrumental case study identified a task-oriented, rather than person-centred, approach to nutrition and hydration care, adversely affecting the resident’s nutritional health and capability to participate actively.

Loneliness is suggested to be one of the most prominent feelings nursing home residents are struggling with, and is related to various negative health outcomes and impaired quality of life. While there has been some research on social predictors and the impact of depression and loneliness on social relationships in nursing home residents, there has been very little qualitative research in investigating their own perception of such feelings. OBJECTIVE: To explore general feelings among nursing home residents, with a specific interest in loneliness in order to develop strategies for support and relief. METHOD: This phenomenological study used an interview guide with open-ended questions to ensure focused in-depth data collection. Data were obtained through face-to-face interviews (n = 11). Interpretative phenomenological analysis was used for data analyses. RESULTS: Loneliness is more than being alone among others. The residents’ unfulfilled need for meaningful relationships plays a crucial role in feelings of loneliness. Losing their self-determination due to institutionalisation was strongly related to loneliness and caused strong emotions, such as grief. CONCLUSION: It is vital that healthcare professionals are aware of these feelings and pay much attention to resident preferences while developing (individualised) interventions to prevent loneliness.

Finding new approaches to increase positive health and well-being of elderly individuals living in nursing homes (NH) is highly warranted. Several Norwegian municipalities have implemented the certification scheme framed ‘Joy of Life Nursing Home’ (JOLNH). JOLNH is based on a health-promoting perspective directing elderly individuals’ resources. Through health promotion, preventive and social activities across generations, NH care promotes respect, well-being, health and cultural experiences among elderly individuals. AIMS: The aims of this study were to explore the phenomenon of Joy of life (JOL) among elderly individuals living in NHs and to provide a deeper understanding of which dimensions constitute JOL in this population. METHODS: The present study explored the JOL phenomenon using qualitative methodology. Data were collected between December 2015 and May 2016 by individual qualitative research interviews of 29 elderly individuals who met the inclusion criteria. The informants were living in ten different NHs in two large municipalities in Norway. Prior approval was obtained from all regulatory institutions dealing with research issues and the management in both municipalities. RESULTS: The results showed that (i) positive relations, (ii) a sense of belonging, (iii) sources of meaning, (iv) moments of feeling well, and (v) acceptance constituted the conceptualisation of the JOL phenomenon. CONCLUSION: The dimensions constituting the JOL concept correspond to the concepts of well-being and flourishing. Knowledge of the JOL phenomenon may help professionals to target elderly individuals’ health and well-being more precisely and thereby increase flourishing, JOL and well-being among them.

This is a prospective cohort study using population-level administrative data to describe the scope of pressure ulcers in terms of its prevalence, incidence risk, associating factors and the extent to which best practices were applied across a spectrum of health care settings. The data for this study includes the information of Ontario residents who were admitted to acute care, home care, long term care or continuing care and whose health care data is contained in the resident assessment instrument-minimum data set (RAI-MDS) and the health outcomes for better information and care (HOBIC) database from 2010 to 2013. The analysis included 203 035 unique patients. The overall prevalence of pressure ulcers was approximately 13% and highest in the complex continuing care setting. Over 25% of pressure ulcers in long-term care developed one week after discharge from acute care hospitalisation. Individuals with cardiovascular disease, dementia, bed mobility problems, bowel incontinence, end-stage diseases, daily pain, weight loss and shortness of breath were more likely to develop pressure ulcers. While there were a number of evidence-based interventions implemented to treat pressure ulcers, only half of the patients received nutritional interventions.

Although films and television are frequently used in nursing homes, there is limited knowledge of how they affect people with dementia. Life in the Memories is a collection of 50 short films targeted at people with dementia. The overall objective of the study was to assess the usability of these films in nursing homes and whether they can be used for reminiscence purposes. Workshops were carried out in seven nursing homes, followed by four weeks of practice testing. Data were obtained from 63 professional caregivers working with residents with dementia through a cross-sectional survey and focus group interviews. The results consistently indicated that the films can maintain the attention of people with dementia, evoke memories, and create conversation. Compared to classic reminiscence activities, caregivers rate the use of the films as easier and less time consuming. The study supported that the films can be utilized for recreational and reminiscence purposes.

Interested in utilizing social media outreach and engagement more effectively as part of your knowledge translation (KT) activities? Don’t miss the opportunity to hear from social media expert Madalyn Sklar and learn 11 effective ways to elevate your presence on social media using a variety of tactics, tips, and tools. The webinar will cover topics such as branding, content curation, engagement, analytics, and live video.

Systematic review and meta-analysis are techniques used to synthesize and summarize large bodies of research literature. Compared to results from a single primary study, meta-analysis provide greater generalizability, increased precision, and the ability to explore heterogeneity across studies (Borenstein, Hedges, Higgins, & Rothstein, 2010; Pigott, 2012). In this Webcast, we will provide participants with an overview of the foundation of meta-analysis, an effect size, which is a quantitative indicator of a treatment effect or relation between two variables. We will also explicate the basic processes of a meta-analysis and how the technique can be used to answer complex questions asked by policymakers and practitioners.

Are you interested in learning strategies for engaging in systematic outreach to stakeholders as part of your KT research and development activities? Register today for the 2018 Online KT Conference: Engaging Ways to Engage Stakeholders. This conference is designed for grantees and other stakeholders of the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR). The free, virtual conference takes place across three afternoons during one work week in November.

This webinar will discuss and review the following objectives:
Criteria for diagnosis
Basics on the pathology/cause
Genetics of Behavioral variant frontotemporal dementia
Symptomatic treatment options

To register as an individual or a site, please contact us: StoreyM@smh.ca KT Canada has developed and hosted the first, expert-led seminar series dedicated to current and emerging topics in KT. Each session includes a question and answer period (15 minutes per 1 hour session). Sessions are held via WEBEX.

This event is part of a series which will engage knowledge brokers, researchers and support staff within the Research Impact Canada network. Brokers from University of Brighton in the UK will present on their work in sustaining their Community Campus Partnership Programme (CUPP). A brief presentation will be followed by ample time for questions.

This webinar will outline the process for submitting abstracts and offer tips and ideas to increase the chances for success. We will explain the process for selection of presentations, posters, and panel sessions and describe a volunteer opportunity to be part of the abstract review committee. Panelists Peter Chinneck, Maureen Smith, and Linda Wilhelm will answer your questions about the CADTH Symposium including topics such as submitting an abstract, presenting at the symposium, or volunteering for the abstract selection committee.

Knowledge translation (KT) is the process for using evidence in practice and decision making thereby strengthening health systems and improving health outcomes. But how do you gain a working knowledge of what KT is when so much confusion and complexity surrounds it? Our approach to KT is rooted in theory and science, but our application of KT is uniquely pragmatic and focused on real-world impact. Our approach to training involves presenting KT in a relevant and practical way so that individuals and organizations become empowered to support KT initiatives within their own network.

The National Collaborating Centre for Mental Health’s Dementia Care Pathway contains an under-stated appendix entitled “Other helpful web-based resources”. This undiscovered gem is worthy of mention by itself alone.

Health Education England, Skills for Health and Skills for Care have produced an update to the “Dementia Core Skills Education and Training Framework” regarding personalised care and support for people living with dementia. The re-titled version includes sections covering food, drink and oral health.

A guide to evaluation resources has been created by the King’s College London centre for King’s Improvement Science (KIS), which covers resources for the evaluation of health and social care interventions, including quality improvement programmes. This is just one section of a broader collection of resources:

This role will oversee and develop programs and projects that develop capacity for community-based research (CBR) across McMaster University. The RC IV will proactively navigate CBR requests to a suite of campus-based opportunities that may include (but are not limited to): Research Shop, undergraduate CBR courses or programs, graduate CBR courses or programs, and faculty. The RC IV will contribute to the development and management of the day-to day operations for the McMaster Research Shop. This role will develop and oversee a CBR working group, with the goal to build internal capacity for CBR while also supporting new CBR partnerships within the greater Hamilton community in a collaborative, coordinated, and principled way. This role will also liaise with regional and national CBR networks on behalf of McMaster. Responsible for managing the daily operations of multiple research projects ensuring that all aspects of project protocol are adhered to. Applies specialized knowledge to initiate, design, develop, coordinate, and manage major research projects across multiple sites. Develops collaborations and partnerships with research user groups