November 6, 2018



New TREC Article
Knowledge translation interventions to sustain direct care provider behaviour change in long-term care: A process evaluation.
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S. E. Slaughter, E. Bampton, D. F. Erin, et al.
J Eval Clin Pract 2018 Feb;24(1):159-165
Process evaluation can be used to understand the factors influencing the impact of knowledge translation (KT) interventions. The aim of this mixed methods process evaluation was to evaluate the processes and perceived outcomes of eight KT interventions that were used with healthcare aides (HCAs) to introduce a mobility innovation into their daily care practices. The study examined the perceived effectiveness of various KT interventions in sustaining daily performance of the sit-to-stand mobility innovation by HCAs with residents in long-term care. METHOD: In-person interviews were conducted with four leaders across three long-term care facilities. Seven focus groups with 27 HCAs were conducted across the three facilities. All participants were asked to rank the eight interventions involved in the trial according to their perceived effectiveness and, for the leaders, their perceived ease of implementation. Focus group and interview questions asked participants to discuss the relative merits of each KT intervention. Two research assistants coded all of the transcripts independently using content analysis. RESULTS: Both HCAs and their leaders perceived reminders, followed by discussion groups, to be the most effective KT interventions to sustain practice change. Healthcare aide champions were deemed least effective by both leaders and HCAs. Leaders identified both the focus group discussion and audit and feedback posters in the study as the most difficult to implement. Participants valued interventions that were strategically visible, helped to clarify misconceptions about the new care innovation, supported teamwork, and made visible the resident benefits of the care innovation. Logistical issues, such as staff scheduling and workload, influenced the perceived feasibility of the various KT interventions. CONCLUSIONS: Understanding how care staff in long-term care settings perceive KT interventions can inform the choice of future use of these interventions to move research evidence into practice.

New article by Dr. Janet Squires
Job satisfaction among critical care nurses: A systematic review.
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A. Dilig-Ruiz, I. MacDonald, M. Demery Varin, A. Vandyk, I. D. Graham and J. E. Squires.
Int J Nurs Stud 2018 Sep 1;88:123-134
Nursing shortages, particularly in critical care units, are a major concern worldwide. Job satisfaction is a key factor associated with the high turnover of critical care nurses. OBJECTIVES: The purpose of this systematic review was to synthesize the evidence on critical care nurses’ job satisfaction. Specific research questions were: 1. How is job satisfaction defined and measured in studies of critical care nurses? 2a. What is the level of job satisfaction among critical care nurses? 2b. How has it changed over time? 2c. Do nurses’ levels of job satisfaction differ by type of critical care unit? 3. What factors are associated with critical care nurses’ job satisfaction? DESIGN: Systematic review. DATA SOURCES: We searched five electronic databases from January 1980 to May 2015: MEDLINE, CINAHL, PsychINFO, EMBASE, and Proquest Nursing & Allied Health Source. REVIEW METHODS: Two team members independently screened all titles and abstracts and extracted data and assessed methodological quality on all included papers. A narrative synthesis with vote counting was undertaken. RESULTS: A total of 1995 titles were identified, of which 61 satisfied our inclusion criteria. Only 24 (39%) of the included studies reported a conceptual definition of job satisfaction. Forty-two different quantitative measures of job satisfaction were identified, of which only 10 (24%) were used in multiple studies. The weighted mean job satisfaction score for critical care nurses across all studies was 56% satisfied and demonstrated fluctuations over time. Four factors showed significant positive relationships to job satisfaction: 1. shift worked – rotating 8- to 12-h and rotating days, evenings or nights; 2. Autonomy; 3. personnel resources and staffing; and 4. teamwork and cohesion; while two factors showed significant negative relationships to job satisfaction: 1. job stress; and 2. burnout-emotional exhaustion. CONCLUSION: From this review, we did not find any evidence to support relationships between individual (socio-demographic) factors and critical care nurses’ job satisfaction. We did however find evidence to support relationships between several employment and organizational factors and job satisfaction. Several of these factors are different from those reported among general hospital nurses and long-term care nursing staff, supporting the need for differential strategies to improve critical care nurses’ job satisfaction. While the findings from this review hold promise as potential targets of future job satisfaction interventions, there were several methodological problems inherent in many of the studies.

New article by Dr. Anne-Marie Boström
Perpetuating harms from isolation among older adults with cognitive impairment: observed discrepancies in homecare service documentation, assessment and approval practices
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I. Nilsson, M. Luborsky, L. Rosenberg, L. Sandberg, A. M. Bostrom and L. Borell.
BMC Health Serv Res 2018 Oct 20;18(1):800-018-3616-6
Older persons with cognitive impairment (CI) risk social isolation. Strong evidence shows that perceived loneliness, or inadequate social networks, triggers and increases health problems. How homecare systems address social participation remains unknown; anecdotal data suggests there are significant gaps. This study’s objective was to identify and describe how the assessors of homecare needs document social participation among persons with CI and how their documentation corresponds with the services actually provided to meet social needs. The research questions were: How and what kinds of social participation needs are documented on need assessment forms? What types of homecare services (with a social focus) are documented and approved? How are specified needs in social participation profiles addressed by a homecare service? METHODS: Descriptive data from need assessment forms and their attached care plans for all applicants aged 65+ were collected during a 2 month period from a large homecare agency serving a municipality in Sweden. Persons with documented CI (n = 43) in the group were identified. Qualitative data analysis was conducted to examine the research questions. RESULTS: Social participation factors were not documented consistently. The relationship between recognition of limitations to social participation and approval of service eligibility was not consistent. Social participation was designated by references to social status, sometimes by social network size, and occasionally by limitations to social participation. The range of approved homecare services (with social focus) covered services such as day care center visits or companionship. Three profiles of social participation were identified: clients with, (a) no participation limitations; (b) potential limitations; and (c) marked limitations. CONCLUSION: Given the known health harms from social isolation and the high risk of isolation among older persons with CI, this novel study’s documentation of inadequate and inconsistent information in homecare social need assessments and services is sobering. The findings suggest a pressing need for initiatives to formulate best practices and standards to ensure alignment of care service systems to the health needs of the growing group of aging individuals with CI.


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Health Care Administration and Organization
Organizational Culture and Change
Research Practice and Methodology


Knowledge translation for realist reviews: a participatory approach for a review on scaling up complex interventions
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J. A. Boyko, B. L. Riley, C. D. Willis, et al.
Health Res Policy Syst 2018 Oct 22;16(1):101-018-0374-1
Knowledge syntheses that use a realist methodology are gaining popularity. Yet, there are few reports in the literature that describe how results are summarised, shared and used. This paper aims to inform knowledge translation (KT) for realist reviews by describing the process of developing a KT strategy for a review on pathways for scaling up complex public health interventions. METHODS: The participatory approach used for the realist review was also used to develop the KT strategy. The approach included three main steps, namely (1) an international meeting focused on interpreting preliminary findings from the realist review and seeking input on KT activities; (2) a targeted literature review on KT for realist reviews; and (3) consultations with primary knowledge users of the review. RESULTS: The international meeting identified a general preference among knowledge users for findings from the review that are action oriented. A need was also identified for understanding how to tailor findings for specific knowledge user groups in relation to their needs. The literature review identified four papers that included brief descriptions of planned or actual KT activities for specific research studies; however, information was minimal on what KT activities or products work for whom, under what conditions and why. The consultations revealed that KT for realist reviews should consider the following: (1) activities closely aligned with the preferences of specific knowledge user groups; (2) key findings that are sensitive to factors within the knowledge user’s context; and (3) actionable statements that can advance KT goals, activities or products. The KT strategy derived from the three activities includes a planning framework and tailored KT activities that address preferences of knowledge users for findings that are action oriented and context relevant. CONCLUSIONS: This paper provides an example of a KT strategy for realist reviews that blends theoretical and practical insights. Evaluation of the strategy’s implementation will provide useful insights on its effectiveness and potential for broader application.

An Integrative Review of Interventions for Enhancing Leadership in the Implementation of Evidence-Based Nursing
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T. Valimaki, P. Partanen and A. Haggman-Laitila.
Worldviews Evid Based Nurs 2018 Oct 15
The most common barriers to evidence-based nursing (EBN) are related to nurse leadership and to organizational characteristics. Scientific evidence is needed regarding interventions that support nurse leadership. AIMS: The aim was to gather, assess, and synthesize the current empirical evidence regarding interventions for enhancing nursing leadership in EBN implementation. METHODS: We conducted an integrative review of interventions that enhance the roles of nurse leaders in EBN implementation using reporting guidance according to the PRISMA statement. RESULTS: The search identified five studies, which described two intervention types: interventions improving nurse leaders’ capabilities for EBN implementation and supporting the activities for EBN implementing. The interventions focused on strategic, teamwork, and individual levels. All interventions produced positive outcomes on primary outcomes, however all not statistically significant. LINKING EVIDENCE TO ACTION: The studies mainly had descriptive designs and short follow-up times, so it was not possible to propose evidence-based recommendations for effective interventions. The certainty of evidence was very low due to the study designs and the risk of bias. Structured clinical education might promote new innovations in evidence-based leadership in nursing. Conclusions about the impact of the interventions must be drawn with caution. They might be useful for promoting the abilities of nurse leaders to implement EBN, but further studies are needed to provide more reliable recommendations.


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Health Care Administration and Organization

Rationing of Nursing Care: Exploring the Views of Care Workers and Residents in a Swiss Nursing Home.
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D. Braun, O. Mauthner and F. Zuniga.
J Am Med Dir Assoc 2018 Oct 15.
The aim of this study was to explore implicit rationing of nursing care in a Swiss 100-bed nursing home. We chose a qualitative approach to explore the perceptions and perspectives of both care workers and residents. Nine care workers, spanning all educational levels, participated in 2 focus group interviews, which were analyzed using a knowledge mapping approach. Eleven semistructured individual interviews were conducted with residents, then analyzed according to Braun and Clarke’s thematic analysis methodology. This led to 2 main sets of observations.

Comparison Between Quality of Care Provided by Trained Feeding Assistants and Certified Nursing Assistants During Between-Meal Supplementation in Long-Term Care Settings
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E. K. Hollingsworth, E. A. Long and S. F. Simmons.
J Appl Gerontol 2018 Nov;37(11):1391-1410
The purpose of this study was to compare the quality of feeding assistance provided by trained non-nursing staff with care provided by certified nursing assistants (CNAs). Research staff provided an 8-hr training course that met federal and state requirements to non-nursing staff in five community long-term care facilities. Trained staff were assigned to between-meal supplement and/or snack delivery for 24 weeks. Using standardized observations, research staff measured feeding assistance care processes between meals across all study weeks. Trained staff, nurse aides, and upper level staff were interviewed at 24 weeks to assess staff perceptions of program impact. Trained staff performed significantly better than CNAs for 12 of 13 care process measures. Residents also consumed significantly more calories per snack offer from trained staff ( M = 130 +/- 126 [ SD] kcal) compared with CNAs ( M = 77 +/- 94 [ SD] kcal). The majority of staff reported a positive impact of the training program.

Assessing nursing assistants’ competency in palliative care: An evaluation tool
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S. Karacsony, E. Chang, A. Johnson, A. Good and M. Edenborough.
Nurse Educ Pract 2018 Sep 17;33:70-76
Nursing assistants are the largest aged care workforce providing direct care to older people in residential aged care facilities (RACF) in Australia and internationally. A palliative approach is a large component of this direct care that necessitates nursing assistants possess requisite knowledge, skills and attitudes. While training needs have been identified to enhance their practices, preservice education is variable, educational interventions have been adhoc and professional development found to be inadequate to the demands of the workplace. In addition, evaluation of nursing assistants’ knowledge, skills and attitudes has lacked an instrument specifically tailored to nursing assistants’ level of education and role responsibilities when providing a palliative approach. This paper reports on Phase 3 of a research study to develop such an instrument capable of assessing nursing assistants’ knowledge of, skills in, and attitudes within a palliative approach. This phase assesses the usability and performance capabilities of the new instrument on a purposive sample of nursing assistants in two RACFs using the survey method. Results showed that the instrument was able to discriminate between groups of nursing assistants based on experience in role. Usability results indicated that the instrument is user friendly and time efficient.

Work Environment and Elderly Abuse in Nursing Homes: The Mediating Role of Burnout.
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M. Andela, D. Truchot and V. Huguenotte.
J Interpers Violence 2018 Oct 19:886260518803606
The present study focuses on elderly abuse committed by nurses and nurses’ aides in nursing homes. Elderly abuse includes neglect and abusive behaviors deleterious to the health and welfare of the elderly. The study aimed at a better understanding of neglect and abusive behaviors by considering caregiver burnout and the work context of these professionals. To achieve this goal, direct effects of job demands (workload and emotional demands) and organizational resources (quality of relationships with colleagues and with the supervisor) on elderly abuse were analyzed. Moreover, the mediating role of caregiver burnout was explored by suggesting that job demands and lack of organizational resources were related to neglect and abusive behaviors through burnout. The study was conducted among 481 nurses and health care assistants from different French nursing homes. Correlations, multiple regressions, and mediation analyses were performed. Results globally confirmed our hypotheses. Emotional demands and poor quality relationships with colleagues and the team supervisor were the most predictive variables for caregiver burnout, neglect, and abusive behaviors toward the elderly. Moreover, the results contributed to the literature by highlighting the mediating effect of burnout and give rise to potential implications in preventing elderly abuse in nursing homes.

End-of-Life Education and Discussions With Assisted Living Certified Nursing Assistants.
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W. L. Mohlman, K. Dassel, K. P. Supiano and M. Caserta.
J Gerontol Nurs 2018 Jun 1;44(6):41-48
In previous work, the current researchers examined attitudes and experiences of certified nursing assistants (CNAs) providing end-of-life (EOL) care in an assisted living facility (ALF). Results showed that 70% of participating CNAs felt unprepared to provide EOL care, largely due to not having received prior EOL care education within their schools or workplaces. Therefore, the goal of the current study was to implement and evaluate EOL and postmortem education to ALF CNAs. A focus group of 14 CNAs within an ALF was provided EOL education pertaining to the physiological and psychological changes observed in patients nearing EOL and postmortem care. Immediately following training, CNAs participated in a 30-minute focus group in which they discussed their experiences and educational needs regarding EOL care. Responses were recorded, transcribed, and analyzed for common themes using descriptive qualitative inquiry. All participants reported that CNA programs need to place greater emphasis on teaching EOL care, and 80% desired continuing education on EOL care through their employers. There is a need for CNAs to receive EOL care education to understand the psychological and physical signs and symptoms associated with the dying process to provide best practices in postmortem care.

Resident Choice: A Nursing Home Staff Perspective on Tensions and Resolutions.
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J. A. Palmer, V. A. Parker, D. Berlowitz, A. L. Snow and C. W. Hartmann.
Geriatr Nurs 2018 May – Jun;39(3):271-278
A central component of person-centered care, resident choice in daily life, has received little research attention in the U.S. CONTEXT: This study investigated nursing home staff experiences in realizing resident choice. Twenty-six qualitative staff interviews were conducted in an opportunistic sample from two Veterans Health Administration (VHA) Community Living Centers (CLCs, i.e., nursing homes) implementing the Green House Model. Thematic content analysis surfaced several key tensions at the intra-personal, inter-personal, and organizational levels. Most salient were staff mental models within the intra-personal level. Staff conveyed a lack of clarity on how to realize resident choice when faced with varying tensions, especially the competing goal of resident medical and safety needs. Staff-employed resolutions to resident choice-related tensions also emerged (e.g., preventive practices, staff reinforcement, and staff deliberation). This study offers specific and concrete insights on how resident choice in daily life, and thus resident quality of life, can be advanced.

Person-directed care planning in nursing homes: A scoping review.
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M. Lepore, K. Scales, R. A. Anderson, et al.
Int J Older People Nurs 2018 Oct 25:e12212
Federal regulations require nursing homes in the United States to support residents in directing their own care rather than having their care plans developed for them without their engagement, but knowledge of person-directed approaches to care planning in nursing homes is limited. The purpose of this study was to advance understanding of person-directed care planning (PDCP). METHODS: A multidisciplinary research team conducted a scoping review on individual and family involvement in care planning, including literature from a variety of care contexts. Search results were systematically screened to identify literature that addressed individual or family involvement in care planning as a primary concern, and then analysed using thematic content analysis. RESULTS: Several themes were identified, including definitions of the concept of PDCP, essential elements of PDCP, barriers, facilitators and outcomes. The concept of PDCP is informed by multiple disciplines, including humanist philosophy, disability rights and end-of-life care. Essential elements of PDCP include knowing the person, integrating the person’s goals in care planning and updating care plans as individuals’ needs or preferences change. Limited time for care planning in nursing homes hinders PDCP. Facilitators include regulatory mandates and humanist social trends. Outcomes of PDCP were found to be positive (e.g., increased independence), but were inconsistently assessed across studies. CONCLUSION: This study offers pragmatic information that can support PDCP within nursing homes and insights for policy reform that may more effectively support PDCP. IMPLICATIONS FOR PRACTICE: These findings can be used to guide implementation of PDCP.

Dentistry and nursing working together to improve oral health care in a long-term care facility
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Mark Keboa, Anne Beaudin, Julie Cyr, et al.
Geriatr Nurs 2018/11
Inadequate oral care in long-term care (LTC) facilities compromises the quality of life of residents. This study assessed oral care knowledge of, and challenges experienced by, nurses and allied nursing staff (ANS) in a LTC facility in Canada. Dentists and nursing staff used the findings to implement strategies for improved care. Using a sequential mixed method design, data on oral care knowledge and practices were collected using self-administered questionnaires (n?=?114) and focused groups (n?=?39). Data were analyzed using descriptive statistics and thematic analysis. While participants (>80%) felt knowledgeable and confident in providing oral care, they desired improved skills to overcome resistive behavior, communication, and wanted adapted oral care materials. Implemented strategies included skills-acquisition workshop, oral care posters, and oral health champion. Overall, our interprofessional collaboration increased awareness of the need for oral care training, and implemented strategies to help nursing staff overcome barriers in providing care.; Inadequate oral care in long-term care (LTC) facilities compromises the quality of life of residents. This study assessed oral care knowledge of, and challenges experienced by, nurses and allied nursing staff (ANS) in a LTC facility in Canada. Dentists and nursing staff used the findings to implement strategies for improved care. Using a sequential mixed method design, data on oral care knowledge and practices were collected using self-administered questionnaires (n?=?114) and focused groups (n?=?39). Data were analyzed using descriptive statistics and thematic analysis. While participants (>80%) felt knowledgeable and confident in providing oral care, they desired improved skills to overcome resistive behavior, communication, and wanted adapted oral care materials. Implemented strategies included skills-acquisition workshop, oral care posters, and oral health champion. Overall, our interprofessional collaboration increased awareness of the need for oral care training, and implemented strategies to help nursing staff overcome barriers in providing care.


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Organizational Culture and Change

Organisational citizenship behaviour: Sensitization to an organisational phenomenon.
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S. O’Grady.
J Nurs Manag 2018 Oct;26(7):795-801
The purpose of this article is to sensitize managers to the phenomenon of organisational citizenship behaviours-extra-role behaviours in which employees participate without expecting rewards and that bring forth positive impacts for the organisation. BACKGROUND: In a context of recurring budget cuts, health care organisations are expected to provide quality and safe care. Organisational citizenship behaviour is one of the measures that organisations can use to meet this mandate. LITERATURE REVIEW: A literature review of English scholarly articles available on the ABI Inform platform, and PubMed was undertaken. KEY ISSUES: Individual and organisational factors influence the presence of organisational citizenship behaviour. Such behaviour can have positive and negative impacts. CONCLUSIONS: Managers can influence the presence of organisational citizenship behaviour in their organisation through their leadership style and the organisational culture. IMPLICATIONS FOR NURSING MANAGEMENT: A better knowledge of organisational citizenship behaviour, and its antecedents allows managers to identify organisational citizenship behaviour and implement measures to facilitate and encourage it in their organisation.

An integrative review of nurses’ prosocial behaviours contributing to work environment optimization, organizational performance and quality of care
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J. Feather, L. McGillis Hall, P. Trbovich and G. R. Baker.
J Nurs Manag 2018 Oct;26(7):769-781
To rigorously review the literature on the prosocial workplace behaviours of nurses. BACKGROUND: Prosocial workplace behaviours, predominantly organisational citizenship behaviours have been theoretically and empirically found to promote individual and group level performance in various industries. However, little consensus exists in the literature regarding the impact of nurses’ workplace behaviours on the work environment and organisational performance. EVALUATION: An integrative literature review was conducted on studies between 1980 and 2016. Nineteen articles were included related to nurses’ prosocial behaviours and performance. RESULTS: A positive relationship was noted between workplace behaviours and individual level performance and unit level performance. Albeit multifactorial, leadership and the social structure of the work environment are important factors contributing to the workplace behaviour-performance relationship. CONCLUSIONS: Prosocial behaviours influence the social functioning of the work environment and offer insights into the delivery of quality care. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers should recognize the influence of leadership style and characteristics in the work environment that encourage employee participation in prosocial behaviours. These additional voluntary efforts by nursing staff may improve organisational effectiveness and quality of care. Inclusion of these behaviours in performance reviews and as cultural norms may help to foster a more collaborative work environment.

Explaining organisational responses to a board-level quality improvement intervention: findings from an evaluation in six providers in the English National Health Service
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L. Jones, L. Pomeroy, G. Robert, et al.
BMJ Qual Saf 2018 Oct 31
Healthcare systems worldwide are concerned with strengthening board-level governance of quality. We applied Lozeau, Langley and Denis’ typology (transformation, customisation, loose coupling and corruption) to describe and explain the organisational response to an improvement intervention in six hospital boards in England. METHODS: We conducted fieldwork over a 30-month period as part of an evaluation in six healthcare provider organisations in England. Our data comprised board member interviews (n=54), board meeting observations (24 hours) and relevant documents. RESULTS: Two organisations transformed their processes in a way that was consistent with the objectives of the intervention, and one customised the intervention with positive effects. In two further organisations, the intervention was only loosely coupled with organisational processes, and participation in the intervention stopped when it competed with other initiatives. In the final case, the intervention was corrupted to reinforce existing organisational processes (a focus on external regulatory requirements). The organisational response was contingent on the availability of ‘slack’-expressed by participants as the ‘space to think’ and ‘someone to do the doing’-and the presence of a functioning board. CONCLUSIONS: Underperforming organisations, under pressure to improve, have little time or resources to devote to organisation-wide quality improvement initiatives. Our research highlights the need for policy-makers and regulators to extend their focus beyond the choice of intervention, to consider how the chosen intervention will be implemented in public sector hospitals, how this will vary between contexts and with what effects. We provide useful information on the necessary conditions for a board-level quality improvement intervention to have positive effects.

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Research Practice and Methodology

Patient engagement in research related to dementia: A scoping review.
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J. Bethell, E. Commisso, H. M. Rostad, et al.
Dementia (London) 2018 Nov;17(8):944-975
Patient ‘engagement’ or ‘involvement’ in health research broadly refers to including people with lived experience (i.e. individuals with personal experience of a health issue and their friends, family and caregivers or carers) in the research process. Although previous reviews have systematically summarized approaches to patient engagement in research, it is unclear whether and how engagement activities have been implemented or adapted for research related to dementia. We conducted a scoping review to describe the extent and nature of patient engagement approaches that have been used to involve persons with dementia and their care partners in research. We then summarized the reported barriers, enablers, and impacts of this engagement. Fifty-four research articles were included in the review and almost all were published after 2010. Persons with dementia and their care partners have been engaged in diverse phases of the research process. The majority of engagement involved both persons with dementia and care partners. Barriers and enablers to engagement included those identified for general patient engagement in research, but some more specific to engaging persons with dementia and their care partners were also reported. Very few studies assessed the impact of patient engagement. While the arguments for patient engagement in research are compelling, research to demonstrate the impact – on the research process and outcomes as well as on persons with dementia, care partners, researchers, research institutions and society – is still needed.

Qualitative Methods In Implementation Science (US)

Qualitative methods generally emerged from the social sciences, specifically anthropology and sociology, and tend to focus on approaches for studying human behavior and experience. These attributes are particularly salient for implementation science because of its focus on understanding how implementation processes influence and are influenced by dynamic contextual factors, which requires study of human behaviors and experiences, individually and within collectives (e.g., a healthcare organization or setting). Qualitative methods do not depend upon numerical manipulation of data, although basic frequencies and summations may be used to present data, provide contextual information, and transpose data for use in mixed methods analysis.

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Prevalence and Risk Factors Associated With Low Fluid Intake in Institutionalized Older Residents
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T. Botigue, O. Masot, J. Miranda, et al.
J Am Med Dir Assoc 2018 Oct 15
The aim of this study was to determine the prevalence of low fluid intake in institutionalized older residents and the associated factors. DESIGN: This was a cross-sectional study. SETTING AND PARTICIPANTS: The study was carried out at a nursing home with a capacity for 156 residents, all of whom were older than 65 years. MEASURES: Data were collected on the fluids consumed by each resident over a period of 1 week. Information relating to sociodemographic variables and to residents’ health, nutrition, and hydration status was also collected. RESULTS: Of 53 residents, 34% ingested less than 1500 mL/d. The factors with the greatest correlation associated with low fluid intake were cognitive and functional impairment, the risk of suffering pressure ulcers, being undernourished, a texture-modified diet, dysphagia, impaired swallowing safety, and BUN:creatinine ratio. CONCLUSIONS/IMPLICATIONS: The results obtained highlight the scale of low fluid intake in nursing homes and also aid to identify and understand the factors associated with this problem. The findings could help us to develop specific strategies to promote the intake of liquids and thereby reduce the incidence of dehydration in nursing homes.

Social and Societal Implications of Frailty, Including Impact on Canadian Healthcare Systems
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M. K. Andrew, S. Dupuis-Blanchard, C. Maxwell, et al.
J Frailty Aging 2018;7(4):217-223
Frailty has many social and societal implications. Social circumstances are key both as contributors to frail older adults’ health outcomes and as practical facilitators or barriers to intervention and supports. Frailty also has important societal implications for health systems and social care policy. In this discussion paper, we use a social ecology framework to consider the social and societal implications and impact of frailty at each level, from the individual, through relationships with family and friend caregivers, institutions, health systems, neighborhoods and communities, to society at large. We conclude by arguing that attention to these issues at a policy level is critical. We identify three target actions: 1) Social dimensions of frailty should be systematically considered when frailty is assessed. 2) Action is needed at the level of policies and programs to improve support for caregivers. 3) Policy review across all portfolios will benefit from a social frailty lens.

Healthy adjustment for new residents with dementia using SettleIN: A feasibility study in UK care homes
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J. K. Hayward, K. M. Nunez, C. Ballard and A. Spector.
Dementia (London) 2018 Oct 24:1471301218806082
This study aimed to develop and explore feasibility of SettleIN, a staff-led programme about healthy adjustment for people with dementia following care home placement. The main foci were intervention feasibility and the impact of the programme on resident quality of life and mood. METHOD: A manualised intervention developed through consultation with 47 experts was trialled using a mixed-method design. Thirteen new residents with dementia and 24 staff were recruited from six UK care homes. Outcomes were measured at baseline, intervention completion and four-week follow-up. Analysis of staff interviews and field notes is reported. RESULTS: Most experts deemed SettleIN to be well structured, comprehensive and appropriate. However, uptake of SettleIN was low. When implemented, staff emphasised integration ease and staff benefits, but that SettleIN may not be universally suitable. High attrition, most commonly due to death and hospitalisation, and partial results from only four participants meant that there was a lack of support for the positive outcomes. Feasibility problems included a lack of staff time and dependency on families for some components. CONCLUSION: SettleIN is acceptable to a wide range of stakeholders though does not appear to be feasible in its current form and improvements are recommended. A second pilot phase is required, which will address the reasons for the high attrition rate in this study and amend the methodology accordingly. This is an important work, as a manualised and standardised approach to healthy adjustment in care is unique and could have huge clinical significance if effective.

The course of neuropsychiatric symptoms in nursing home residents from admission to 30-month follow-up.
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A. S. Helvik, G. Selbaek, J. Saltyte Benth, I. Roen and S. Bergh.
PLoS One 2018 Oct 18;13(10):e0206147
The aim of this study was to describe the prevalence and persistence of clinically significant neuropsychiatric symptoms (NPS) in nursing home residents with dementia, and to study the association between severity of dementia and specific neuropsychiatric sub-syndromes over time. METHODS: In total, 583 residents with dementia were included at admission to a nursing home and followed with biannual assessments until death, or to 30-month follow-up. At the end of the 30-month follow-up, 305 participants had died and 57 had left the study for other reasons, leaving 221 residents in the study. We collected data on demographics, cognition, severity of dementia, NPS, personal activities of daily living (P-ADL), physical health, medication and type of nursing home unit. NPS was assessed using the Neuropsychiatric Inventory (NPI), the Nursing Home version. RESULTS: The prevalence and persistence at two consecutive time-points of clinically significant NPS was high during the study period. The mean NPI agitation sub-syndrome score increased during the study period, while the NPI affective and psychosis sub-syndrome scores remained unchanged. More severe dementia was associated with higher NPI agitation, psychosis and affective sub-syndrome scores. The association remained unchanged over time for agitation and psychosis. For the NPI affective sub-syndrome, the association was stronger at the beginning, and declined towards the end of the study period. CONCLUSION: The findings of high prevalence and persistence at two consecutive time points of clinically significant NPS over time, and the associations between severity of dementia and NPI sub-syndromes shed light on the burden and care needs of nursing home residents with dementia after admission to nursing home care. This information is of interest to health care planners and providers to enable them to increase the quality of care for nursing home residents.

A systematic review of non-pharmacological interventions for BPSD in nursing home residents with dementia: from a perspective of ergonomics.
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G. Wang, A. Albayrak and T. J. M. van der Cammen.
Int Psychogeriatr 2018 Oct 18:1-13
Non-pharmacological interventions for Behavioral and Psychological Symptoms of Dementia (BPSD) have been developed; however, a systematic review on the effectiveness of this type of intervention from a perspective of ergonomics is lacking. According to ergonomics, the capabilities of Persons with Dementia (PwD) should be considered in the interventions for the outcomes to be reliable. We aimed to systematically review the non-pharmacological interventions for BPSD in nursing home residents with an additional assessment criterion based on ergonomics, specifically, capability consideration. METHODS: The electronic databases MEDLINE, EMBASE, and PsycINFO were searched for non-pharmacological interventions treating BPSD in nursing homes. The interventions were categorized according to the capabilities of PwD required to participate. Study quality was assessed by National Health and Medical Research Council (NHMRC) evidence hierarchy and the capability consideration. RESULTS: Sixty-four clinical trials met the inclusion criteria; 41 trials reported a significant reduction in at least one BPSD symptom; 20 trials reported no significant reduction in BPSD symptoms; three trials reported adverse effects after the intervention. Interventions were categorized into sensory-, cognition-, and movement-oriented. Capabilities of PwD were not considered in 28 trials, especially for sensory capabilities. CONCLUSIONS: The majority of the clinical trials reported a significant reduction in BPSD. The quality of evidence for nonpharmacological interventions in these trials is low due to the lack of capability consideration, data inhomogeneity, and inadequate study design and reporting. Future studies should focus on improving the quality of evidence by including capability consideration and examining if a relationship between capability consideration and effectiveness of non-pharmacological interventions exists.

Resident-centred care and architecture of two different types of caring residences: a comparative study.
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C. Nord.
Int J Qual Stud Health Well-being 2018 Dec;13(1):1472499
The relationship between architectural space and resident-centred care is poorly understood, even though architectural space is indicated as an important factor in the quality of care. This paper aims to address this gap in existing research by putting resident-centred care in the theoretical context of relationality and emergence in which space is a co-producing component. This qualitative case study includes two housing alternatives, which are compared: one assisted living and one extra-care housing residence, which differ in their legal status and architecturally. Similar fieldwork was carried out in the two residences. Individual interviews with staff and residents, as well as observations-direct and shadowing-were the main data collection methods. The concept of assemblage was used for the analysis of how resident-centred care and architectural space co-evolved. The findings show that resident-centred care appears in similar but also diverse and sometimes contradictory ways in different spaces in the two housing alternatives, suggesting that resident-centred care is situated, volatile and emergent. Although architecture has strong agency, space and care need to be considered together-a caring architecture-in order to understand the nuances and rich conceptual palette of resident-centred care.

Using Multi-Layer Foam Dressing to Prevent Pressure Injury in a Long-Term Care Setting.
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K. Woo.
Surg Technol Int 2018 Jun 1;32:75-79
Maintaining skin integrity is espoused by several international authorities as a benchmark for patient safety and quality of care. National guidelines advocate the use of prophylactic multi-layer foam dressings over bony prominences for the prevention of pressure ulcers or injuries. The purpose of this study was to evaluate the implementation of best practice guidelines including the use of multi-layer foam dressings for the prevention of pressure injuries. The analysis involved data from a total number of 62 unique patients. The incidence rate prior to the implementation of best practices was 5.2%. The incidence after the implementation was 0%.

Exposure to nature gardens has time-dependent associations with mood improvements for people with mid- and late-stage dementia: Innovative practice.
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P. C. White, J. Wyatt, G. Chalfont, et al.
Dementia (London) 2018 Jul;17(5):627-634
Exposure to green space and nature has a potential role to play in the care of people with dementia, with possible benefits including improved mood and slower disease progression. In this observational study at a dementia care facility in the UK, we used carer-assessed measures to evaluate change in mood of residents with mid- to late-stage dementia following exposure to a nature garden. We found that exposure to nature was associated with a beneficial change in patient mood. There was a non-linear relationship between time spent outdoors and mood outcome. Improvements in patient mood were associated with relatively short duration exposures to nature, and no additional measureable increases in mood were found with exposures beyond 80-90 minutes duration. Whilst further investigation is required before causality can be determined, these results raise important questions for policy about the integration of outdoor space into the design of dementia care facilities and programmes.

Quality of Life, Care Resource Use, and Costs of Dementia in 8 European Countries in a Cross-Sectional Cohort of the Actifcare Study.
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R. L. H. Handels, A. Skoldunger, A. Bieber, et al.
J Alzheimers Dis 2018 Oct 25
With 10.5 million people with dementia in Europe and $301 billion associated costs, governments face challenges organizing access to care. OBJECTIVE: To examine the costs related to formal and informal care use and quality of life for people with dementia in eight European countries, and explore the association with unmet needs. METHODS: Cross-sectional data from 451 persons with dementia and their informal caregivers of the Actifcare cohort study were obtained. Formal and informal care use was multiplied by country specific unit prices of services. Needs were measured using the CANE and health-related quality of life (HRQOL) of the person with dementia (both self- and proxy-rated) and informal caregiver’s quality of life using EQ-5D-5L, ICECAP-O, DEMQOL-U, and CarerQol utility scores. The association between costs and country, European region, and unmet needs was assessed using multi-level linear regression. RESULTS: Self-rated EQ-5D-5L utility score was higher than proxy-rated (0.84 and 0.71, respectively). Informal caregivers’ utility score was 0.84. Across eight countries annual mean costs of formal and informal care were approximately euro 17,000. Unmet needs were not associated with annual costs of care, nor with proxy-rated HRQOL, but were associated with self-rated HRQOL. CONCLUSION: We found varying relationships between unmet needs and quality of life, and no association between unmet needs and care costs, although the results were sensitive to various factors. Future research should further investigate the relation between unmet needs, quality of life and costs to generate a better understanding of the effects of (un)timely access to care.

What do nursing home residents with mental-physical multimorbidity need and who actually knows this? A cross-sectional cohort study.
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A. M. A. van den Brink, D. L. Gerritsen, M. M. H. de Valk, A. T. Mulder, R. C. Oude Voshaar and R. T. C. M. Koopmans.
Int J Nurs Stud 2018 May;81:89-97
Aging societies will bring an increase in the number of long-term care residents with mental-physical multimorbidity. To optimize care for these residents, it is important to study their care needs, since unmet needs lower quality of life. To date, knowledge about care needs of residents with mental-physical multimorbidity is limited. The aim of this study was to explore (un)met care needs of residents with mental-physical multimorbidity and determinants of unmet needs. METHODS: Cross-sectional cohort study among 141 residents with mental-physical multimorbidity without dementia living in 17 geronto-psychiatric nursing home units across the Netherlands. Data collection consisted of chart review, semi-structured interviews, (brief) neuropsychological testing, and self-report questionnaires. The Camberwell Assessment of Need for the Elderly (CANE) was used to rate (un)met care needs from residents’ and nursing staff’s perceptions. Descriptive and multivariate regression analyses were conducted. RESULTS: Residents reported a mean number of 11.89 needs (SD 2.88) of which 24.2% (n=2.88, SD 2.48) were unmet. Nursing staff indicated a mean number of 14.73 needs (SD 2.32) of which 10.8% (n=1.59, SD 1.61) were unmet. According to the residents, most unmet needs were found in the social domain as opposed to the psychological domain as reported by the nursing staff. Different opinions between resident and nursing staff about unmet needs was most common in the areas accommodation, company, and daytime activities. Further, nearly half of the residents indicated ‘no need’ regarding behavior while the nursing staff supposed that the resident did require some kind of support. Depression, anxiety and less care dependency were the most important determinants of unmet needs. CONCLUSIONS: Systematic assessment of care needs showed differences between the perspectives of resident and nursing staff. These should be the starting point of a dialogue between them about needs, wishes and expectations regarding care. This dialogue can subsequently lead to the most optimal individually tailored care plan. To achieve this, nurses with effective communication and negotiation skills, are indispensable.

Physical diagnoses in nursing home residents – is dementia or severity of dementia of importance?
Non UofA Access

L. B. Jorgensen, B. M. Thorleifsson, G. Selbaek, J. Saltyte Benth and A. S. Helvik.
BMC Geriatr 2018 Oct 22;18(1):254-018-0943-8
Dementia and physical morbidity are primary reasons for nursing home admission globally. However, data on physical morbidity in nursing home residents with and without dementia are scarce. The first aim of the present study was to explore whether presence and severity of dementia were related to the number of physical diagnoses in nursing home residents. The second aim was to explore if the severity of dementia was associated with having registered the most frequent complexes of physical diagnoses when controlling for physical health and demographic factors. METHODS: A total of 2983 Norwegian nursing home residents from two cross-sectional samples from 2004/2005 and 2010/2011 were included in the analysis. By the use of assessment scales, the severity of dementia (Clinical Dementia Rating), physical health (General Medical Health Rating), activities of daily living (Physical Self-Maintenance Scale) and neuropsychiatric symptoms (Neuropsychiatric Inventory Nursing Home) were determined. Physical diagnoses and medications were assembled from the medical records. The physical diagnoses were categorized into complexes, using the ICD-10 chapters. Linear mixed models and generalized linear mixed models were estimated. RESULTS: Residents with dementia were registered with fewer physical diagnoses than residents without dementia. The frequency of physical diagnoses decreased with increasing severity of dementia. Cardiovascular, musculoskeletal and endocrine, nutritional and metabolic diagnoses were the most common complexes of physical diagnoses in individuals with and without dementia. The odds of having cardiovascular and musculoskeletal diagnoses increased for males and decreased for females with increasing severity of dementia, in contrast to endocrine diagnoses where the odds increased for both genders. CONCLUSION: Increasing severity of dementia in nursing home residents may complicate the diagnostics of physical disease. This might reflect a need for more attention to the registration of physical diagnoses in nursing home residents with dementia.

Communication Empowerment Framework: An integrative framework to support effective communication and interaction between carers and people living with dementia
Non UofA Access

L. Morris, W. Mansell, T. Williamson, A. Wray and P. McEvoy.
Dementia (London) 2018 Oct 28:1471301218805329
To demonstrate the power of integrating three theoretical perspectives (Mentalization Theory, Perceptual Control Theory and the Communicative Impact model), which jointly illuminate the communication challenges and opportunities faced by family carers of people with dementia. To point the way to how this framework informs the design and delivery of carer communication and interaction training. METHOD: Conceptual synthesis based on a narrative review of relevant literature, supported by examples of family carers. RESULTS: We use the conceptual models to show how the capacity to mentalize (“holding mind in mind”) offers a greater sense of control over internal and external conflicts, with the result that they can be deescalated in pursuit of mutual goals. CONCLUSIONS: The integrative conceptual framework presented here highlights specific psychological and relational mechanisms that can be targeted through carer training to enhance communication with a person living with dementia.


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Rehabilitation as the future of dementia care

brainXchange Tuesday 20 November 12:30-1:30 MT
Presenters: Kate Swaffer, Monica Cations
Session 1: Dementia as a Cognitive Disability (featuring Kate Swaffer)
There are currently an estimated 50 million people living with dementia and 10 million new diagnosis each year. The WHO state dementia is the leading cause of disability and dependence in older persons, however health systems and service providers do not yet support this in their approach to post diagnostic support for dementia. In this presentation, I will briefly outline my personal experience and global advocacy for human rights and access to the CRPD, an approach supported at the Rehabilitation 2030 WHO Forum in 2017. Finally, I will outline a pathway of support which includes rehabilitation and disability support for all people with dementia.
Session 2: A Health professional perspectives on the delivery of multidisciplinary rehabilitation to people with dementia (featuring Monica Cations)
Multidisciplinary rehabilitation is not incorporated into the usual care pathway for dementia despite increasing demand from advocates. We explored the perspectives of health professionals to understand key barriers to delivery of rehabilitation to this group and identify strategies for change. In this presentation, I will discuss how we as health professionals can change our understanding of dementia care to embrace rehabilitation as a means to deliver a more proactive and continuous care pathway.

FRAMING-LTC: Frailty and Recognizing Appropriate Medications IN Geriatrics and Long-Term Care

Wednesday 7 November 10:00-11:00 MT
Presenters: Dr. Andrew Morris, Dr. Susan Bronskill, Dr. Lianne Jeffs, Dr. Colleen Maxwell
Older adults in long-term care (LTC) often have multiple chronic conditions that increase their exposure to multiple medications. This places them at risk for potentially inappropriate medication (PIM) use, adverse events and high health care utilization. Optimal prescribing for vulnerable older populations, particularly those in LTC, may be influenced by various system, provider, individual and caregiver factors, and represents a key quality-of-care concern. There is a lack of empirical data in this area, and thus our understanding of the relative benefits, harms and economic implications posed by select medications commonly prescribed in LTC remains inadequate and underdeveloped.

Embedding KT research within a provincial quality improvement program for chronic diseases in primary care

Thursday 8 November 10:00-11:00
Presenter: Dr. Matthew Menear
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. To register as an individual or a site, please contact us:

NCCMT Success Stories in Evidence-Informed Decision Making

Wednesday 28 November 11:00-12:30 MT
Sharing health information with community organizations to promote healthy living for all
Dr. M. Mustafa Hirji and Cassandra Ogunniyi, Niagara Region Public Health & Emergency Services
Putting research in place: An innovative approach to decision support in Newfoundland and Labrador
Dr. Stephen Bornstein and Rochelle Baker, Newfoundland and Labrador Centre for Applied Health Research


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Learning the Ropes for Living with MCI®

16 November $180 Early Bird Offer 5% off before November 2nd – Discount Code: earlyMCI Student Offer $60.00 off – Discount Code: studentMCI
Learning the Ropes for Living with MCI® is aimed at community dwelling older adults experiencing Mild Cognitive Impairment (MCI) and their close relative. The focus is on optimizing cognitive health through lifestyle choices, memory training, and psychosocial support. The immediate goals of the program are to improve healthy lifestyle behaviours in all participants, memory strategy knowledge and use in participants with MCI, and adaptive coping skills in close relatives (family/friend). The overarching long term goals are to prevent or delay the onset of clinical dementia in persons with MCI and to prevent or minimize physical and mental health declines in their close relative. The content of this evidence-based program is crafted to meet the specific needs of people living with MCI based on the most current research. This workshop provides healthcare professionals with an in-depth understanding of MCI and the necessary background and training to deliver an effective group intervention targeted to the specialized needs of those affected by MCI.

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A Safe Alternative to Nursing Homes

Seniors care is “honourable” and rewarding career path, say survey respondents

Understanding the spread challenge

Five questions to consider before conducting a stepped wedge trial

Nursing home chain starts big shift toward new care model

Do authors comply when funders enforce open access to research?
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CIHR Scientific Director, Institute of Aging

DEADLINE: 3 December 2018
CIHR is looking to hire a renowned and visionary Scientific Director for the Institute of Aging (IA). This is a 4-year mandate, with the possibility of an additional 4-year extension

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