September 10, 2017



New TREC Article
Implementing Frontline Worker-Led Quality Improvement in Nursing Homes: Getting to “How”
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L. Ginsburg, A. Easterbrook, W. Berta, et al.
Jt Comm J Qual Patient Saf 2018 Sep;44(9):526-535


Despite emerging frameworks for quality improvement (QI) implementation, little is known about how the implementation process works, particularly in nursing home settings. A study was conducted to describe “how”‘ a complex frontline worker-led QI program was implemented in nursing homes. METHODS: Six focus groups were conducted in February 2017 with participants of a year-long, multicomponent, unit-level QI intervention in seven nursing homes in the Canadian province of Manitoba. Constant comparative analysis was used to examine perspectives of different groups of QI program participants-35 health care aides, health professionals, and managers. RESULTS: Five themes important to the implementation process were identified: (1) “supportive elements of the QI program structure,” (2) “navigating the workplace,” (3) “negotiating relationships,” (4) “developing individual skills,” and (5) “observable program impact.” Data on theme integration suggest that “supportive elements of the QI program structure” (Theme 1), “developing individual skills” (Theme 4), and “observable program impact” (on residents, health care aides, and leaders; Theme 5) operated as part of a reinforcing feedback loop that boosted team members’ ability to navigate the workplace, negotiate relationships, and implement the QI program. CONCLUSION: Health care aide-led QI teams are feasible. However, a leadership paradox exists whereby worker-led QI programs also must incorporate concrete mechanisms to promote strong leadership and sponsor support to teams. The findings also point to the underexplored impact of interpersonal relationships between health care aides and professional staff on QI implementation.

Upcoming TREC Webinar
The extent and impact of wounds in nursing homes

Tuesday 18 September 10:00-11:00 MT
Presenter: Dr. Simon Palfreyman


The webinar will explore how common wounds are in nursing homes, describe the impact of wounds and review prevention and treatment strategies for different wound types.

New Article by Dr. Jennifer Baumbusch
A Seat at the Table: The Positioning of Families During Care Conferences in Nursing Homes
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G. Puurveen, H. Cooke, R. Gill and J. Baumbusch.
Gerontologist 2018 Aug 29


Current nursing home policy emphasizes the need for collaborative, team-based care planning in which families and/or residents are actively involved. Resident care conferences are common where care providers, families, and/or residents discuss and coordinate resident care needs and evaluate care goals. This study critically examines the process, structure, and content of care conferences to expand our understanding of how resident care is negotiated among care providers and families in this context. Research Design and Methods: This study was part of a larger critical ethnography examining the negotiation of care work among care providers, families, and residents in three purposively selected nursing homes in British Columbia, Canada. Thirty-seven care conferences were observed. Field notes and interview data were thematically analyzed with a focus on what was said, who said what and to whom, whose voice was privileged, and how power manifested between care providers, families, and/or residents. Results: As illustrated by three key themes, Exclusion by Process-Following Script, Exclusion by Content-Scripted Reports, and Exclusion through Devalued Knowledge, families were overtly and covertly excluded from contributing to the care conferences. As such, families’ presence did not guarantee open communication or active solicitation of their perspectives. Discussion and Implications: The use of predetermined agendas and processes, clinically generic reporting, and technical jargon reproduced the structural inequality between care providers and families making collaboration difficult to effectively negotiate. For care conferences to meaningfully contribute to person-centered care, it is imperative that mutual exchange be promoted and families empowered to participate as equals

New Article by Dr. Gillian Harvey
The Influence of Context and Practitioner Attitudes on Implementation of Person‐Centered Assessment and Support for Family Carers Within Palliative Care
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J. Diffin, G. Ewing, G. Harvey and G. Grande.
Worldviews Evid Based Nurs 2018 Aug 27


The Carer Support Needs Assessment Tool (CSNAT) intervention is an evidence-based, person-centered approach to carer assessment and support within palliative care. As such, it requires a change in practice from a practitioner- to a carer-led assessment and support process. A paucity of research has investigated factors affecting implementation of evidence-based interventions within palliative care. OBJECTIVE: To examine differences between high and low adopters of the CSNAT intervention in terms of practitioner attitudes to the intervention and organizational context. METHODS: Phase IV study of the implementation of the CSNAT intervention at scale in 36 UK palliative care services over 6 months. Survey at baseline and 6 months of practitioners at implementation sites, informed by the Promoting Action on Research Implementation in Health Services (PARIHS) Framework. Survey tools: (a) questionnaire to assess attitudes to the CSNAT intervention; (b) Alberta Context Tool (ACT) to assess organizational context. Monthly data on intervention use enabled service classification as “high” or “low” adopters. RESULTS: Surveys returned at baseline were 157/462 and at 6 months were 69/462. Compared with low adoption services, high adopters were more likely to be hospice, at home, and day services; have a higher ratio of internal facilitators to total staff numbers; and higher scores for ACT “informal interactions” denoting more discussions about care between colleagues. Both had similarly positive attitudes to the CSNAT intervention pre-implementation, but by 6 months low adoption services developed significantly more negative attitudes, while high adoption services attitudes mostly remained the same or improved. LINKING EVIDENCE TO ACTION: Implementation may be more successful for services that offer regular opportunities to use the intervention in practice, have sufficient levels of facilitators, stimulate more staff discussion, and encourage maintenance of positive motivation. Implementation of person-centered interventions needs to plan for such factors. This has informed an implementation toolkit for the CSNAT intervention.

New article by Dr. Greta Cummings
Organisational antecedents, policy and horizontal violence among nurses: An integrative review
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S. Blackstock, B. Salami and G. G. Cummings.
J Nurs Manag 2018 Aug 31
To explore the organisational antecedents related to horizontal violence among nurses and the extent to which policy initiatives reduce its incidence. BACKGROUND: Organisational re-engineering initiatives affect registered nurse roles, adding complexity to organisational antecedents related to horizontal violence and policy. No previous systematic review has examined the role of organisational policies in reducing horizontal violence among nurses. METHODS: An integrative review was undertaken, beginning with a search through 18 electronic databases and reference lists of key articles. The studies included were quality appraised. RESULTS: 1,423 abstracts were screened, resulting in 22 studies being included. Emergent themes were the influence of working conditions, relational aspects of teams and leadership, organisational culture, climate and role of structural processes, leadership role and decision-making authority, and the relationship of organisational structures to anti-horizontal violence policy. CONCLUSION: Further research exploring historical health care organisational hierarchies that inadvertently propagate oppressive nursing work conditions is needed. IMPLICATIONS FOR NURSING MANAGEMENT: If nurse managers understand the impacts of organisational antecedents and climate on registered nurse roles, they can advocate for the breakdown of hierarchies and power inequalities that keep registered nurses in oppressed positions. This awareness and advocacy could facilitate a new understanding of horizontal violence inclusive of organisational roles and the creation of effective anti-horizontal violence policies.

New Charter from Alzheimer Society Canada
The Canadian Charter of Rights for People with Dementia

The Alzheimer Society of Canada is pleased to officially launch the first-ever Canadian Charter of Rights for People with Dementia. The landmark Charter is the culmination of over a year’s work by the Society’s Advisory Group of people with dementia, whose members represent different walks of life from across the country. The Charter defines seven explicit rights to empower Canadians living with dementia to self-advocate, while also ensuring that the people and organizations that support them know and protect their rights.


Health Care Administration and Organization
Health Care Innovation and Quality Assurance
Research Practice and Methodology


Learning from the emergence of NIHR Collaborations for Leadership in Applied Health Research and Care (CLAHRCs): A systematic review of evaluations
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R. Kislov, P. M. Wilson, S. Knowles and R. Boaden.
Implement Sci 2018 Aug 15;13(1):111-018-0805-y
Collaborations for Leadership in Applied Health Research and Care (CLAHRCs) were funded by NIHR in England in 2008 and 2014 as partnerships between universities and surrounding health service organisations, focused on improving the quality of healthcare through the conduct and application of applied health research. The aim of this review is to synthesise learning from evaluations of the CLAHRCs. METHODS: Fifteen databases including CINAHL, MEDLINE, EMBASE and PsycINFO were searched to identify any evaluations of CLAHRCs. Current and archived CLAHRC websites and the reference lists of retrieved articles were scanned to identify any additional evaluations. Searches were restricted to English language only. Any publications from evaluations of the CLAHRCs were eligible for inclusion if they fulfilled at least one of three pre-specified inclusion criteria. A narrative synthesis was undertaken. RESULTS: Twenty-six evaluations (reported in 37 papers) were deemed eligible for inclusion. Evaluations focused on describing and exploring the formative partnerships, vision, values, structures and processes of CLAHRCs; the nature and role of boundaries; the deployment of knowledge brokers and hybrid roles to support knowledge mobilisation; patient and public involvement; and capacity building. The relative lack of data about the early impact of CLAHRCs on health care provision or outcomes is notable. CONCLUSIONS: Much of the evaluative focus on CLAHRCs has been on how they have been organised and on the development of theory around their emergent properties. Evidence is lacking on the impact of CLAHRCs particularly in relation to the knowledge mobilisation processes and practices adopted. Further evaluation of CLAHRCs and other similar research and practice partnerships is warranted and should focus on which knowledge mobilisation approaches work where, how and why. TRIAL REGISTRATION: PROSPERO (Registration number: CRD42016042945 ).

Knowledge translation and health technology reassessment: identifying synergy.
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R. Esmail, H. Hanson, J. Holroyd-Leduc, D. J. Niven and F. Clement.
BMC Health Serv Res 2018 Aug 30;18(1):674-018-3494-y
Health Technology Reassessment (HTR) is an emerging field that shifts the focus from traditional methods of technology adoption to managing technology throughout its lifecycle. HTR is a mechanism to improve patient care and system efficiency through a reallocation of resources away from low-value care towards interventions and technologies that are high value. To achieve this, the outputs of HTR and its recommendations must be translated into practice. The evolving field of knowledge translation (KT) can provide guidance to improve the uptake of evidence-informed policies and recommendations resulting from the process of HTR. This paper argues how the theories, models and frameworks from KT could advance the HTR process. DISCUSSION: First, common KT theories, models and frameworks are presented. Second, facilitators and barriers to KT within the context of HTR are summarized from the literature. Facilitators and barriers to KT include ensuring a solid research evidence-base for the technology under reassessment, assessing the climate and context, understanding the social an political context, initiating linkage and exchange, having a structured HTR Process, adequate resources, and understanding the roles of researchers, knowledge users, and stakeholders can enhance knowledge translation of HTR outputs. Third, three case examples at the individual (micro), organizational (meso), and policy (macro) levels are used to illustrate to describe how a KT theory, model or framework could be applied to a HTR project. These case studies show how selecting and applying KT theories, models and frameworks can facilitate the implementation of HTR recommendations. CONCLUSION: HTR and KT are synergistic processes that can be used to optimize technology use throughout its lifecycle. We argue that the application of KT theories, models and frameworks, and the assessment of barriers and facilitators to KT can facilitate translation of HTR recommendations into practice.

Key Components of Knowledge Transfer & Exchange in Health Services Research: Findings from a Systematic Scoping Review
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L. Prihodova, S. Guerin, C. Tunney and W. G. Kernohan.
J Adv Nurs 2018 Aug 30
To identify the key common components of knowledge transfer and exchange in existing models to facilitate practice developments in health services research. BACKGROUND: There are over 60 models of knowledge transfer and exchange designed for various areas of health care. Many of them remain untested and lack guidelines for scaling-up of successful implementation of research findings and of proven models ensuring that patients have access to optimal health care, guided by current research. DESIGN: A scoping review was conducted in line with PRISMA guidelines. Key components of knowledge transfer and exchange were identified using thematic analysis and frequency counts. DATA SOURCES: Six electronic databases were searched for papers published before January 2015 containing four key terms/variants: knowledge, transfer, framework, healthcare. REVIEW METHODS: Double screening, extraction and coding of the data using thematic analysis were employed to ensure rigour. As further validation stakeholders’ consultation of the findings was performed to ensure accessibility. RESULTS: Of 4,288 abstracts, 294 full-text articles were screened, with 79 articles analysed. Six key components emerged: knowledge transfer and exchange message, Stakeholders and Process components often appeared together, while from two contextual components Inner Context and the wider Social, Cultural and Economic Context, with the wider context less frequently considered. Finally, there was little consideration of the Evaluation of knowledge transfer and exchange activities. Additionally, specific operational elements of each component were identified. CONCLUSIONS: The six components offer the basis for knowledge transfer and exchange activities, enabling researchers to more effectively share their work. Further research exploring the potential contribution of the interactions of the components is recommended.


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Health Care Administration and Organization

Health Workers’ Knowledge and Perceptions on Dementia in Skilled Nursing Homes: A Pilot Implementation of Teepa Snow’s Positive Approach to Care Certification Course.
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M. C. Ehlman, S. Nimkar, B. A. D. Nolan, P. Thomas, C. E. Caballero and T. Snow.
J Contin Educ Health Prof 2018 Summer;38(3):190-197
A knowledge gap on caring for people with dementia exists among health workers employed in skilled nursing facilities. This article reports on knowledge gained and perceptions changed among 24 skilled nursing facility health workers who completed Teepa Snow’s innovative Positive Approach to Care Certification course as a regional initiative. METHODS: This pilot study used a quasi-experiment with a one-group pretest-posttest design to assess the dementia knowledge and perceptions of health workers who participated in the course. Paired responses (n = 22) for the 54-item dementia knowledge and training/coaching perceptions survey were compared using the McNemar test, Paired t test, and Wilcoxon signed-rank test to analyze the improvement in knowledge and perceptions of dementia. RESULTS: Significant knowledge gain was found among health workers after completing the program (t(21) = -7.46, P < .001). Statistical differences (P < .05) were present in eight knowledge items (ie, working memory, mental health, temporal lobe, “sapphire”, “space and awareness”, personal space, binocular vision, and hippocampus) and four perception areas (ie, approaching, understanding, calming, and instructing) about dementia. Significant changes were also found in four areas of health workers’ perceptions about dementia (P < .05). DISCUSSION: The certification course can improve knowledge and facilitate perceptual change on dementia. Implementing this program as a novel regional initiative has robust potential in ensuring continuing workforce development in health care settings challenged with ever-changing people living with dementia needs and high staff turnover.

Moral distress in healthcare assistants: a discussion with recommendations
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D. Rodger, B. Blackshaw and A. Young.
Nurs Ethics 2018 Aug 22:969733018791339
Moral distress can be broadly described as the psychological distress that can develop in response to a morally challenging event. In the context of healthcare, its effects are well documented in the nursing profession, but there is a paucity of research exploring its relevance to healthcare assistants. OBJECTIVE: This article aims to examine the existing research on moral distress in healthcare assistants, identity the important factors that are likely to contribute to moral distress, and propose preventative measures. RESEARCH DESIGN: This is a survey of the existing literature on moral distress in healthcare assistants. It uses insights from moral distress in nursing to argue that healthcare assistants are also likely to experience moral distress in certain contexts. Participants and Research Context: No research participants were part of this analysis. Ethical Considerations: This article offers a conceptual analysis and recommendations only. FINDINGS: The analysis identifies certain factors that may be particularly applicable to healthcare assistants such as powerlessness and a lack of ethical knowledge. We demonstrate that these factors contribute to moral distress. DISCUSSION: Recommendations include various preventative measures such as regular reflective debriefing sessions involving healthcare assistants, nurses and other clinicians, joint workplace ethical training, and modifications to the Care Certificate. Implementation of these measures should be monitored carefully and the results published to augment our existing knowledge of moral distress in healthcare assistants. CONCLUSION: This analysis establishes the need for more research and discussion on this topic. Future research should focus on evaluating the effectiveness of the proposed recommendations.

The impact of facility ownership on nurses’ and care workers’ perceptions of missed care in Australian residential aged care
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Julie Henderson, Ian Blackman, Eileen Willis, et al.
Aust J Soc Issues 2018 08/19; 2018/09;0(0)
The Australian government has reduced restrictions on ownership of residential aged care facilities (RACF) as part of aged care reform enabling the growth of private-for-profit ownership. This study explores the impact of private-for-profit ownership through comparison of perceptions of the volume of missed care in government, private-not-profit and for-profit RACF in Australia. Data were collected through development and administration of a MISSCARE survey to 3,206 nurses and personal care workers (PCW) working in RACF and hospitals providing aged care services. Employees working within government owned facilities reported levels of missed care that are significantly lower than privately owned facilities on six activities: moving patients who cannot walk; assisting residents? toileting within 5Â min of request; assisting resident mouth care; assessing skin integrity; answering call bells within 5Â min and wound care. Staffing levels were identified as the most common reason for missed care across all settings. Of the 27 factors identified as causing missed care, government employees reported significantly lower scores for 16 items. Further research is needed on the impact of facility ownership upon capacity of nurses and personal care workers to deliver care.

Supporting autonomy in long-term care: Lessons from nursing assistants
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M. Lindsey Jacobs, A. Lynn Snow, R. S. Allen, C. W. Hartmann, N. Dautovich and P. A. Parmelee.
Geriatr Nurs 2018 Aug 16
Maximizing nursing home (NH) resident autonomy is a person-centered care (PCC) best practice. The purpose of this study was to identify and describe specific autonomy-supportive techniques used by nursing assistants (NAs) in three NH neighborhoods at one Veterans Affairs medical center. Thirteen interviews and approximately 80 h of behavioral observation of NAs were conducted across the three NH neighborhoods. Data were analyzed using thematic analysis. Ten autonomy-supportive tactics were identified: assisting, monitoring, encouraging, bargaining, informing, providing instructions, persuading, asking, providing options, and redirecting. Although all tactics honored some degree of resident autonomy, some were more restrictive than others. Results from the study elucidate specific actions NAs can take to promote resident autonomy, even when cognitive or physical limitations are present or there is potential concern for safety, and thereby support PCC best practice.

Who Should Deliver Primary Care in Long-term Care Facilities to Optimize Resident Outcomes? A Systematic Review.
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R. O. Barker, D. Craig, G. Spiers, P. Kunonga and B. Hanratty.
J Am Med Dir Assoc 2018 Aug 31
Across the world, health care for residents in long-term care facilities (LTCFs) is provided by a range of different professionals, and there is no consensus on which professional group(s) deliver the best outcomes for residents. The objective of this review is to investigate how the health outcomes of older adults in LTCFs vary according to which professional group(s) provides first-line medical care. DESIGN: A systematic review and narrative synthesis were performed. Medline, Embase, the Cochrane Central Register of Controlled Trials, and Scopus were searched for studies from high-income countries, of any design, published after 2000. Quality was assessed using the Cochrane Risk of Bias and ROBINS-I tools. The exposure of interest was the professional group(s) involved in the delivery of first-line primary care. SETTING AND PARTICIPANTS: Older adults living in LTCFs. MEASURES: The principal outcomes were unplanned transfer to hospital, prescribing quality, and mortality. RESULTS: Searches identified 10,532 citations after removing duplicates. Twenty-six publications (across 24 studies) met the inclusion criteria. A narrative synthesis was conducted of the 20 experimental and 4 observational studies, involving approximately 98,000 residents. Seven studies were set in the USA, 6 in Australia, 3 in Canada, 2 in New Zealand, and 6 in European countries. Interventions were varied, complex and multi-faceted. Nineteen interventional studies, including 4 randomized trials, involved the addition of a specialist practitioner, either a doctor or nurse, to supplement usual primary care. The most commonly reported outcomes were unplanned hospital transfer and prescribing quality. Interventions based on specialist nurses were associated with reductions in unplanned hospital transfers in 10 out of 12 publications. There was no consistent evidence of a positive impact of specialist doctor interventions on unplanned hospital transfers. However, specialist doctors were associated with improvements in prescribing quality in all 7 relevant studies. There was a paucity of evidence on the impact of specialist nurse interventions on prescribing, and of specialist practitioners on mortality, and no improvements were reported. CONCLUSIONS: Addition of specialist doctors or nurses to the first-line medical team has the potential to improve key health outcomes for residents in LTCFs.

Workforce Retention and Wages in Nursing Homes: An Analysis of Managerial Ownership.
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S. S. Huang and J. R. Bowblis.
J Appl Gerontol 2018 Aug 31:733464818795433
Owner-managers are administrators that hold significant equity interests in the facility they operate. We examine how the presence of owner-managers is related to the workforce outcomes of retention and wages in nursing homes (NHs). Using a sample of for-profit NHs in Ohio from 2005 to 2015, multivariate regression analysis compares workforce outcomes in facilities operated by owner-managers to salaried managers. On average, owner-managed NHs have higher workforce retention rates, with larger effects among chain-affiliated NHs. Better retention is not achieved through higher wages, as we do not find higher wages at owner-managed NHs. Further qualitative studies are warranted to identify the exact mechanisms which lead to owner-managers having better staff retention rates. Plausible mechanisms include greater autonomy to allocate resources and create policies that foster a work environment that achieves better retention while maintaining financial sustainability.

I-Hydrate training intervention for staff working in a care home setting: An observational study.
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C. Greene, D. Canning, J. Wilson, et al.
Nurse Educ Today 2018 Sep;68:61-65
Dehydration is a complex and well-recognised problem for older people residing in care homes. Within the social care sector support staff provide the majority of direct care for residents, and yet receive minimal training. OBJECTIVES: To design, deliver and evaluate a hydration specific training session for care home staff to develop their knowledge and skills in supporting the hydration of care home residents. DESIGN: An observational study comprising a pre-test post-test survey of staff knowledge following a training intervention. PARTICIPANTS AND SETTINGS: Training of care home staff took place in two care homes in North West London. METHODS: An interactive training session was developed and delivered, with content informed by observations of hydration care within the two homes and evaluated using CIRO model. Participant self-evaluation forms were used to collect data after the session regarding satisfaction and usefulness of the session, and pre and post levels of self-reported knowledge across six facets of hydration care. Training facilitators captured qualitative data in the form of field notes. Observations of hydration care explored the impact of training on practice. RESULTS: Eighteen training sessions were delivered. A total of 161 participant evaluation forms were returned. There was a significant increase in self-reported knowledge across all six facets of hydration care (p=0.000). The majority of participants found the training enjoyable and useful, and expressed an expected change in their practice. Participants enjoyed the interactive components of the training. A lack of reflective practice skills meant participants were unable to reflect realistically about the hydration care provided in the home. CONCLUSION: Focused training on hydration in the care home environment benefits from being interactive and experiential. Although such training can be effective in increasing staff knowledge, inclusion of skills in reflective practice is required if this knowledge is to be translated into practice.

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Health Care Innovation and Quality Assurance

Improving hydration of care home residents by increasing choice and opportunity to drink: A quality improvement study.
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J. Wilson, A. Bak, A. Tingle, et al.
Clin Nutr 2018 Aug 4
Dehydration is recognised as an important problem among care home residents and can be associated with severe consequences. Insufficient provision of fluids to meet resident preferences and lack of assistance to drink have been identified as key factors driving under-hydration of care home residents. Using targeted interventions, this study aimed to optimise hydration care for frail older people in a care home setting. METHODS: The study used quality improvement methods to develop and test interventions to extend drinking opportunities and choice in two care homes. Changes were made and evaluated using Plan-Do-Study-Act (PDSA) cycles. Data were captured on the amount of fluids served and consumed, and staff and resident feedback. The long-term impact of the interventions was assessed by measuring daily laxative and antibiotic consumption, weekly incidence of adverse health events, and average fluid intake of a random sample of six residents captured monthly. RESULTS: The interventions were associated with an increase in the amount and range of fluids consumed, in one home mean fluid intakes exceeded 1500 ml for three consecutive months. Laxative use decreased significantly in both homes. A number of practical and organisational barriers affected the sustainability of interventions. CONCLUSIONS: Interventions to optimise the hydration of care home residents can be effective. Plan-Do-Study-Act cycles provide an effective methodology to implement new interventions into existing practice in care homes. Sustainable change requires strong leadership, organisational support and teamwork.

Clustered domestic model of residential care is associated with better consumer rated quality of care.
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E. S Gnanamanickam, S. M Dyer, R. Milte, E. Liu, J. Ratcliffe and M. Crotty.
Int J Qual Health Care 2018 Aug 28
To compare consumer rated quality of care among individuals living long-term in homelike clustered domestic and standard models of residential care in Australia. Design: Cross-sectional study. Setting: Seventeen residential aged care facilities in four Australian states providing alternative models of care. Study participants: A sample of individuals with high prevalence of cognitive impairment living in residential care for 12 months or longer, not immediately in palliative care and having a proxy available to provide consent and assist with data collection. Of 901 eligible participants, 541 consented and participated in the study. Main outcome measure: Consumer rated quality of care was measured using the Consumer Choice Index-6 Dimension instrument (CCI-6D) providing a preference weighted summary score ranging from 0 to 1. The six dimensions of care time, shared-spaces, own-room, outside and gardens, meaningful activities and care flexibility were individually evaluated. Results: Overall consumer rated quality of care (Mean : 0.138, 95% CI 0.073-0.203 P < 0.001) was higher in clustered domestic models after adjusting for potential confounders. Individually, the dimensions of access to outside and gardens (P < 0.001) and flexibility of care (P < 0.001) were rated significantly better compared to those living in standard model of care. Conclusions: Homelike, clustered domestic models of care are associated with better consumer rated quality of care, specifically the domains of access to outdoors and care flexibility, in a sample of individuals with cognitive impairment. Including consumer views on quality of care is feasible and should be standard in future evaluations of residential care.

Designing Large-Scale Improvement: Using an Academic-Practice Partnership to Enhance Care Transitions.

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S. Polancich, C. S. Selleck, T. Poe, R. Miltner and M. R. Shirey.
J Healthc Qual 2018 Sep/Oct;40(5):318-325
This department column highlights translation of research into healthcare quality practice. Achieving the highest quality in healthcare requires organizations to understand care delivery and to develop and design process efficiencies. The improvement process may be enhanced through a partnership between the healthcare facility and an affiliated school of nursing. The purpose of this article was to describe the process for developing a large-scale improvement project focused on enhancing care transitions within an academic medical center using an academic-practice partnership model.


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Research Practice and Methodology

Advancing Research on Care Needs and Supportive Approaches for Persons With Dementia: Recommendations and Rationale
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A. Kolanowski, R. H. Fortinsky, M. Calkins, et al.
J Am Med Dir Assoc 2018 Aug 22
The first National Research Summit on Care, Services, and Supports for Persons with Dementia and Their Caregivers was held on October 16-17, 2017, at the National Institutes of Health. In this paper, participants from the Summit Session on Research on Care Needs and Supportive Approaches for Persons with Dementia summarize the state of the science, identify gaps in knowledge, and offer recommendations to improve science and practice in long-term care. Recommendations cover 4 areas focused on persons living with dementia: (1) symptoms (behavioral and psychological symptoms of dementia, function, cognition, and sleep); (2) dementia care settings (physical and social environments, home, and residential care); (3) living with dementia (living well with dementia, living alone with dementia, and living with dementia and intellectual and developmental disabilities); and (4) technology as a cross-cutting theme. The participants identify 10 of the most pressing research issues based on the findings from their collective papers. Final Summit recommendations included those presented by session participants and will be used to advise federal agencies and other organizations that fund research.

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The Adult Sensory Profile™ in Care Homes Targeting People Diagnosed with Dementia: A Qualitative Study from the Care Provider Perspective.
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M. B. Ravn, T. Klingberg and K. S. Petersen.
Rehabil Res Pract 2018 Aug 5;2018:5091643
The background of this study is the pilot testing of the Adolescent /Adult Sensory Profile (A/ASP) in dementia units at municipal nursing homes. Based on the results from therapists’ A/ASP assessment, recommendations are made according to individual needs and forwarded to the health care providers. This study looks into the health care providers’ perspective on the usability of these recommendations. Aim: The aim of this qualitative study is to explore the health care providers’ perspective on the usability of recommendations derived from the A/ASP during a pilot testing of the profile in dementia units for people living with severe dementia. Methods: Participant observations and informal and formal interviews with health care providers at five municipal dementia units during the pilot testing of the A/ASP. Results: In the health care provider perspective, the A/ASP is a relevant and useful tool to use when behavioural challenges among residents living with dementia occur. However, in their opinion, it requires time, adjustment, and further education if recommendations are to be fully implemented in everyday practice at the dementia units.

Effects of garden visits on people with dementia: A pilot study.
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M. L. Liao, S. J. Ou, C. Heng Hsieh, Z. Li and C. C. Ko.
Dementia (London) 2018 Aug 28:1471301218793319
The number of people with dementia is increasing rapidly worldwide. Developing strategies to improve quality of life for those with dementia is crucial and is receiving more attention. Natural environments are known for their healing effects on most people. This pilot study aimed to understand the benefits that natural environments, such as gardens, can provide for people with dementia. In total, 42 staff members in nine dementia care facilities were recruited as participants in this study and answered a semistructured questionnaire. One-way analysis of variance with repeated measures and the Mann-Whitney U test were used to compare the effects of garden visits on evaluated characteristics and the differences in evaluated characteristics between free garden use and unfree garden use groups. Data from open-ended questions underwent text analysis to obtain the principal beliefs of the participants. The staff members reported that garden visits had positive effects on mood, social interaction, depression, and agitation in people with dementia because of the multisensory, gentle stimuli of the natural environment. Of the evaluated cognitive characteristics, attention and orientation to time were improved the most after residents with dementia had spent time in a garden. Additionally, staff members in the free garden use group scored the effects of garden visits on the mood, long-term memory, language abilities, spatial ability, aggression, and agitation of patients with dementia as significantly higher than staff members in the unfree garden use group. Recommendations for future studies are discussed.

Potentially avoidable hospitalizations, non-potentially avoidable hospitalizations and in-hospital deaths among residents of long-term care facilities.
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B. Jeon, N. Tamiya, S. Yoshie, K. Iijima and T. Ishizaki.
Geriatr Gerontol Int 2018 Aug;18(8):1272-1279
The present study aimed to examine the percentage of and risk factors for potentially avoidable hospitalizations (PAH), non-PAH and in-hospital deaths among residents of special nursing homes for the elderly (SNH) and geriatric health service facilities (GHSF). METHODS: Long-term care and national health insurance claims data (April 2012 to September 2013) were obtained from a suburban city in Chiba prefecture, Japan. Study participants were aged >/=75 years and resided in either SNH (n = 1138) or GHSF (n = 885). The PAH were defined using 17 medical condition groups, and the percentage of PAH, non-PAH and in-hospital deaths was identified, and associated factors were compared using multilevel logistic regression models for SNH and GHSF, respectively. RESULTS: A total of 34.5% SNH residents experienced any hospitalization, and this was composed of PAH (16.3%), non-PAH (12.2%) or in-hospital deaths (6.1%). Of the GHSF residents, 23.8% experienced any hospitalization, and this was comprised of PAH (9.5%), non-PAH (10.6%) and in-hospital death (3.7%). More than 70% of the PAH were related to respiratory infections, urinary tract infections or congestive heart failure. In both SNH and GHSF, artificial nutrition was positively associated with PAH and non-PAHs, and male sex was positively associated with non-PAHs and in-hospital deaths. However, there were also discrepancies between SNH and GHSF in terms of risk factors for PAH. CONCLUSIONS: The percentage of PAH was higher in SNH than in GHSF, which might be related to their different personnel and managerial regulations. The linkage of health and long-term care claims data might facilitate data-based evidence on policy-making

The impact of care practices and health demographics on the prevalence of skin tears and pressure injuries in aged care.
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R. E. Brimelow and J. A. Wollin.
J Clin Nurs 2018 Apr;27(7-8):1519-1528
To determine whether differences in care practices and demographics between two long-term aged care facilities affected the incidence of residents’ skin wounds. METHODS: A retrospective analysis of care plans and clinical outcomes was conducted for a 6-month period in 2016 at two aged care facilities, N = 39 Home 1 and N = 45 Home 2. Skin tears, pressure injuries and usual care practices and associated health demographics were recorded. RESULTS: Over the 6-month period, 84 residents were found to have a total of 206 aged care acquired skin wounds (skin tears, pressure injuries, haematomas, rashes, infections). The frequency of skin tears or total wounds did not differ between the homes. Several factors were identified that influenced the skin wounds. A reduction in skin tears was associated with the use of heel protectors and antiembolic stockings, whilst a diagnosis of vascular dementia was associated with increased prevalence of skin wounds. Pressure injuries were significantly higher at Home 2. Increased use of strategies to moderate-risk activities, such as tray tables and bed rails, and impaired cognitive function were associated with higher pressure injury prevalence. CONCLUSION: A number of care factors and health demographics influenced the rate of skin wounds. A holistic approach to skin management is needed. RELEVANCE TO CLINICAL PRACTICE: Practices, such as repositioning and skin hygiene, are well known to reduce the incidence of pressure injuries and skin tears; however, there are other care practices that take place in homes as part of usual care that also impact skin wounds that have been largely ignored. This study highlights those care practices, as well as resident characteristics and comorbidities that may increase the risk of skin wounds, requiring further monitoring/mitigating strategies.

Nursing Homes Without Walls for Aging in Place
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S. Dupuis-Blanchard and O. N. Gould.
Can J Aging 2018 Aug 30:1-8
Given the urgency of finding cost-effective and innovative solutions to providing community services for aging in place, novel solutions that take advantage of existing infrastructure are clearly needed. In this sequential mixed-method study, we chose to explore the role that nursing homes could play in offering services to a non-traditional target population, namely seniors with loss of independence living in the community. Forty-two (n = 42) nursing homes in the province of New Brunswick completed an online survey, and 10 agreed to participate in face-to-face interviews. Results show that 100 per cent of participants agreed that nursing homes could offer services to seniors in their communities for aging in place. Results suggest that nursing homes are cost-effective, innovative solutions for aging in place.

Professional and family caregivers’ attitudes towards involuntary treatment in community-dwelling people with dementia
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A. M. H. J. Mengelers, M. H. C. Bleijlevens, H. Verbeek, E. Capezuti, F. E. S. Tan and J. P. H. Hamers.
J Adv Nurs 2018 Aug 30
To gain insight into professional and family caregivers’ attitudes towards involuntary treatment in community-dwelling people with dementia (PwD). BACKGROUND: The number of PwD with complex care needs living at home is increasing rapidly. In some situations, caregivers provide care against the will of PwD, referred to as involuntary treatment, which includes non-consensual care, psychotropic medication and physical restraints. DESIGN: A cross-sectional study. METHODS: A total of 228 professional (nursing staff, general practitioners (GPs) and other health care professionals such as physical therapists and psychologists) and 77 family caregivers of PwD completed the Maastricht Attitude Questionnaire – Home Care. This questionnaire measures attitudes towards involuntary treatment and perceived restrictiveness of and experienced discomfort in using involuntary treatment. Data were collected in the Netherlands between June – November 2016. RESULTS: Family caregivers and GPs had more positive attitudes towards involuntary treatment than nursing staff and other health care professionals, indicating that they are more accepting of involuntary treatment. A more positive attitude was associated with higher perceived caregiver burden and being a family caregiver. Family caregivers and GPs found the use of involuntary treatment less restrictive and indicated feeling more comfortable when using these measures. CONCLUSION: It is important to account for the differences in attitudes and foster dialogue among professional and family caregivers to find common ground regarding alternatives to involuntary treatment. These results will inform the development of an intervention that aims to prevent involuntary treatment in home care.


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Top Ten lessons learned from the Forum’s efforts to support evidence-informed policymaking

Wednesday 19 September 09:00-10:00

There is a growing international focus on evidence-informed policymaking, and a corresponding demand from policymakers, stakeholders and researchers who want to find and use the best available research evidence covering a wide range of health- and social-system program and services areas. Join our webinar as John Lavis, Director of the McMaster Health Forum, shares his insights into strengthening health- and social-systems and key lessons learned from the Forum’s efforts to support evidence-informed policymaking.


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Cochrane: A research program on rapid reviews: where should we venture next?

In these videos, originally part of the Cochrane Learning Live webinar series, Dr Andrea Tricco highlights the differences between rapid reviews and systematic reviews. Dr Tricco describes a research program on rapid reviews and outlines practical recommendations on doing rapid reviews, focusing on the Guide to Rapid Reviews, which was published by the Alliance, World Health Organization. The webinar was organized by the Cochrane Statistical Methods Group, with support from Cochrane’s Membership, Learning and Support Services.

WHO: Ageing and health fact sheet

People worldwide are living longer. Today, for the first time in history, most people can expect to live into their sixties and beyond. By 2050, the world’s population aged 60 years and older is expected to total 2 billion, up from 900 million in 2015. Today, 125 million people are aged 80 years or older. By 2050, there will be almost this many (120 million) living in China alone, and 434 million people in this age group worldwide. By 2050, 80% of all older people will live in low- and middle-income countries.

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Workplace routines are stifling innovation

The town that’s found a potent cure for illness – community

Can You Spot Your Influencers?

Older LGBTQI People Call to Action – Sign the Pledge

Earwax, Of All Things, Poses Unrecognized Risk In Long-Term Care

Why did they put her on a geriatric ward?

We need more carrots: give academic researchers the support and incentives to share data

‘It’s like magic’: Ottawa’s youngest volunteers bring smile, laughter to long-term care residents

Minister of Seniors Mandate Letter

India targets universities in predatory-journal crackdown. But academics say government incentives to publish are part of the problem.

Numbers of elderly in 24-hour care set to double by 2035 (UK)

The New Old Age Longevity is now our reality. Are we ready for it?

Preventing Muscle Loss as We Age: Sarcopenia, a decline in skeletal muscle in older people, contributes to loss of independence.
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