K. Seers, J. Rycroft-Malone, K. Cox, N. Crichton, R.T. Edwards, A.C. Eldh, C.A. Estabrooks, G. Harvey, C. Hawkes, C. Jones, A. Kitson, B. McCormack, C. McMullan, C. Mockford, T. Niessen, P. Slater, A. Titchen, T. van der Zijpp, L. Wallin
Implement Sci 2018 Nov 16;13(1):137-018-0831-9
Health care practice needs to be underpinned by high quality research evidence, so that the best possible care can be delivered. However, evidence from research is not always utilised in practice. This study used the Promoting Action on Research Implementation in Health Services (PARIHS) framework as its theoretical underpinning to test whether two different approaches to facilitating implementation could affect the use of research evidence in practice. METHODS: A pragmatic clustered randomised controlled trial with embedded process and economic evaluation was used. The study took place in four European countries across 24 long-term nursing care sites, for people aged 60 years or more with documented urinary incontinence. In each country, sites were randomly allocated to standard dissemination, or one of two different types of facilitation. The primary outcome was the documented percentage compliance with the continence recommendations, assessed at baseline, then at 6, 12, 18, and 24 months after the intervention. Data were analysed using STATA15, multi-level mixed-effects linear regression models were fitted to scores for compliance with the continence recommendations, adjusting for clustering. RESULTS: Quantitative data were obtained from reviews of 2313 records. There were no significant differences in the primary outcome (documented compliance with continence recommendations) between study arms and all study arms improved over time. CONCLUSIONS: This was the first cross European randomised controlled trial with embedded process evaluation that sought to test different methods of facilitation. There were no statistically significant differences in compliance with continence recommendations between the groups. It was not possible to identify whether different types and “doses” of facilitation were influential within very diverse contextual conditions. The process evaluation (Rycroft-Malone et al., Implementation Science. doi: 10.1186/s13012-018-0811-0) revealed the models of facilitation used were limited in their ability to overcome the influence of contextual factors.
E. Belita, J. Yost, J. E. Squires, R. Ganann, T. Burnett and M. Dobbins.
Syst Rev 2018 Nov 3;7(1):181-018-0849-8
There are growing professional expectations for nurses to engage in and develop competence in evidence-informed decision-making (EIDM) due to opportunities for improved client and community outcomes and provision of the highest quality of care. However, EIDM is underdeveloped, with low implementation rates among nurses. The use of indicators to assess EIDM performance has potential to encourage nurses’ engagement in EIDM through competence recognition and support assessment of strengths and competency gaps for individual nurses and organizations. Currently, the state of evidence regarding measures that assess EIDM competence attributes (i.e., knowledge, skills, beliefs/values, behaviors) among nurses is unknown. This systematic review aims to address this gap through a narrative synthesis of the characteristics and psychometric properties of EIDM competence measures. METHODS: The search strategy, developed in consultation with a Health Sciences Librarian, consists of online databases, contacting experts, hand searching reference lists, key journals, websites, conference proceedings, and grey literature. Studies will be included if the following criteria are met: (1) sample includes practicing nurses and data for nurses are reported separately; (2) conducted in any healthcare setting; (3) quantitative or mixed-methods design; (4) reports use or testing of a measure assessing EIDM competence attributes (i.e., knowledge, skills, attitudes/values, and/or behaviors); and (5) published in English. Screening will be conducted independently by two reviewers using a two-stage process: (1) title and abstract level; and (2) full-text level. Data extraction of study characteristics (e.g., sample, setting) will be conducted by a single reviewer and checked for accuracy by a second reviewer. Psychometric properties of acceptability, reliability, and validity evidence for each measure will be independently extracted by two reviewers. Data on measures will be synthesized narratively according to acceptability, number of validity evidence sources established, and reliability of scores. Data pertaining to population and healthcare setting will also be reported for each measure. DISCUSSION: This systematic review will provide a current understanding about the state of evidence with respect to EIDM competence measures in nursing to assist in determining potentially relevant and robust measures for use in different nursing practice settings. SYSTEMATIC REVIEW REGISTRATION: Protocol registered in PROSPERO Registration #: CRD42018088754.
G. G. Cummings, P. McLane, R. C. Reid, et al.
J Aging Health 2018 Nov 15:898264318808908
For long-term care (LTC) residents, transfers to emergency departments (EDs) can be associated with poor health outcomes. We aimed to describe characteristics of residents transferred, factors related to decisions during transfer, care received in emergency medical services (EMS), ED settings, outcomes on return to LTC, and times of transfer segments along the transition. METHOD: We prospectively followed 637 transitions to an ED in British Columbia and Alberta, Canada, over a 12-month period. Data were captured through an electronic Transition Tracking Tool and interviews with health care professionals. RESULTS: Common events triggering transfer were falls (26.8%), sudden change in condition (23.5%), and shortness of breath (19.8%). Discrepancies existed between reason for transfer, EMS reported chief complaint, and ED diagnosis. Many transfers resulted in resident return directly to LTC (42.7%). DISCUSSION: Avoidable transfers may put residents at risk of receiving inappropriate care. Standardized communication strategies to highlight changes in resident condition are warranted.
Cummings GG, Reid RC, Cummings GE, Cooper SL, Abel S, Bissell LJ, Estabrooks CA, Rowe BH, Wagg A, Norton PG, Ertel M.
The T3 is a pilot-tested electronic data collection tool used to obtain case-related data about long-term care (LTC) residents during the emergency transition process. It is comprised of data elements from LTC, emergency transport and emergency department settings.
Gill Harvey, Wendy Gifford, Greta Cummings, et al.
Int J Nurs Stud 2018 11/27
The approach and style of leaders is known to be an important factor influencing the translation of research evidence into nursing practice. However, questions remain as to what types of roles are most effective and the specific mechanisms through which influence is achieved. Objectives The aim of the study was to enhance understanding of the mechanisms by which key nursing roles lead the implementation of evidence-based practice across different care settings and countries and the contextual factors that influence them. Design The study employed a qualitative descriptive approach. Settings Data collection was undertaken in acute care and primary/community health care settings in Australia, Canada, England and Sweden. Participants 55 individuals representing different levels of the nursing leadership structure (executive to frontline), roles (managers and facilitators), sectors (acute and primary/community) and countries. Methods Individual semi-structured interviews were conducted with all participants exploring their roles and experiences of leading evidence-based practice. Data were analysed through a process of qualitative content analysis. Results Different countries had varying structural arrangements and roles to support evidence-based nursing practice. At a cross-country level, three main themes were identified relating to different mechanisms for enacting evidence-based practice, contextual influences at a policy, organisational and service delivery level and challenges of leading evidence-based practice. Conclusions National policies around quality and performance shape priorities for evidence-based practice, which in turn influences the roles and mechanisms for implementation that are given prominence. There is a need to maintain a balance between the mechanisms of managing and monitoring performance and facilitating critical questioning and reflection in and on practice. This requires a careful blending of managerial and facilitative leadership. The findings have implications for theory, practice, education and research relating to implementation and evidence-based practice.
E. A. Lynch, A. Mudge, S. Knowles, A. L. Kitson, S. C. Hunter and G. Harvey.
BMC Health Serv Res 2018 Nov 14;18(1):857-018-3671-z
A multitude of theories, models and frameworks relating to implementing evidence-based practice in health care exist, which can be overwhelming for clinicians and clinical researchers new to the field of implementation science. Clinicians often bear responsibility for implementation, but may be unfamiliar with theoretical approaches designed to inform or understand implementation. MAIN TEXT: In this article, a multidisciplinary group of clinicians and health service researchers present a pragmatic guide to help clinicians and clinical researchers understand what implementation theories, models and frameworks are; how a theoretical approach to implementation might be used; and some prompts to consider when selecting a theoretical approach for an implementation project. Ten commonly used and highly cited theoretical approaches are presented, none of which have been utilised to their full potential in the literature to date. Specifically, theoretical approaches tend to be applied retrospectively to evaluate or interpret findings from a completed implementation project, rather than being used to plan and design theory-informed implementation strategies which would intuitively have a greater likelihood of success. We emphasise that there is no right or wrong way of selecting a theoretical approach, but encourage clinicians to carefully consider the project’s purpose, scope and available data and resources to allow them to select an approach that is most likely to “value-add” to the implementation project. CONCLUSION: By assisting clinicians and clinical researchers to become confident in selecting and applying theoretical approaches to implementation, we anticipate an increase in theory-informed implementation projects. This then will contribute to more nuanced advice on how to address evidence-practice gaps and ultimately to contribute to better health outcomes.
R. Mannion and H. Davies.
BMJ 2018 Nov 28;363:k4907.
Ideas of culture are also central to quality improvement methods. From basic clinical audit to sustained improvement “collaboratives,” business process re-engineering, Lean Six Sigma, the need for cultural reorientation is part of the challenge. Yet although the language of organisational culture—sometimes culprit, sometimes remedy, and always part of the underlying substrate at which change is directed—has some immediate appeal, we should ask deeper questions. What actually is culture in health services? How does culture relate to healthcare quality, safety, and performance? And can changing culture lead to improvements in care and organisational performance?
The Public Health Agency of Canada (PHAC) is pleased to invite organizations to submit applications for programs and initiatives that address the objectives and priorities of the Dementia Community Investment. This solicitation is a two-step process. The first step is the submission of a Letter of Intent (LOI). Applicants with LOIs best aligned with the overall requirements of the funding program will move onto the second stage of the application process under which they will receive an Invitation to Submit a Funding Request (ISFR). The ISFR will ask for more detailed information on the applicability of the proposed project as well as the applicant’s capacity to successfully conduct the proposed work. Applicants with late, ineligible, incomplete or unsuccessful LOIs will not receive an ISFR.
Open to current CFN trainees (HQP) and alumni
DEADLINE 10:00 MT Monday 14 January
Take a moment to think about your experiences with someone who is an older adult living with frailty, or their family/friend caregiver. This could be a mentor, colleague, neighbour, friend or family member. Think about what they struggle with every day, what is important to them, and what/how changes could improve their quality of life.
Create a video of one to three minutes in length sharing this experience, and you could win! FRAILTY MATTERS!
The Transitions in Care (TiC) Initiative is co-led by the Institute of Circulatory and Respiratory Health (ICRH), Institute of Health Services and Policy Research (IHSPR), Institute of Human Development, Child and Youth Health (IHDCYH), and the Institute of Indigenous Peoples’ Health (IIPH) in collaboration with the Institute of Aging (IA), Institute of Cancer Research (ICR), Institute of Gender and Health (IGH) and Institute of Musculoskeletal Health and Arthritis (IMHA)
This award is intended to recognize published research in a peer-reviewed journal that has significantly contributed to the advancement of the field of health services and policy research in Canada. IHSPR will consider articles related to:
-Research that demonstrates a clear impact or potential impact on policy, practice, or health outcomes (e.g., decision maker uptake, change management for improved practice);
-Research that breaks ground in the way health services or policy research is conducted (e.g., innovations in methodology, novel theory or application of theory, new approaches to existing problems).
Lisa M. Puchalski Ritchie and Sharon Straus.
International Journal of Health Policy and Management 2018
This commentary provides an overview of the organizational readiness for change (ORC) literature over the last decade, with respect to prevailing definitions, theories, and tools to guide assessment of ORC in preparation for implementation. The development of the OR4KT by Gagnon et al is an important contribution to this body of work. This commentary highlights the strengths of the OR4KT including development based on two systematic reviews conducted by the authors to synthesize OR theory and measurement tools, and applicability to a wider range of high-income country healthcare settings through inclusion of input from a diverse group of international experts and transcultural adaptation of the tool, in the context of the literature to date. Limitations and future directions for further development of the tool are also discussed and include application of quantitative psychometric approaches and evaluation of the tool in a broader range of healthcare settings.
Shawn Zheng Kai Tan and Jose Angelo Udal Perucho.
Science Communication 2018 12/01; 2018/11;40(6):819-826
It is well accepted that it is part of a scientist?s duty to communicate science, yet most practicing scientists lack the training and opportunity to do so. In this article, we use the framework of science talks in bars to highlight the importance of locality and environment. We propose that science communication programs should be developed around the locales of the target community as an effective strategy to counter the rising mistrust in science and scientists.
S. A. Birken, C. L. Rohweder, B. J. Powell, et al.
Implement Sci 2018 Nov 22;13(1):143-018-0836-4
Theories, models, and frameworks (TMF) are foundational for generalizing implementation efforts and research findings. However, TMF and the criteria used to select them are not often described in published articles, perhaps due in part to the challenge of selecting from among the many TMF that exist in the field. The objective of this international study was to develop a user-friendly tool to help scientists and practitioners select appropriate TMF to guide their implementation projects. METHODS: Implementation scientists across the USA, the UK, and Canada identified and rated conceptually distinct categories of criteria in a concept mapping exercise. We then used the concept mapping results to develop a tool to help users select appropriate TMF for their projects. We assessed the tool’s usefulness through expert consensus and cognitive and semi-structured interviews with implementation scientists. RESULTS: Thirty-seven implementation scientists (19 researchers and 18 practitioners) identified four criteria domains: usability, testability, applicability, and familiarity. We then developed a prototype of the tool that included a list of 25 criteria organized by domain, definitions of the criteria, and a case example illustrating an application of the tool. Results of cognitive and semi-structured interviews highlighted the need for the tool to (1) be as succinct as possible; (2) have separate versions to meet the unique needs of researchers versus practitioners; (3) include easily understood terms; (4) include an introduction that clearly describes the tool’s purpose and benefits; (5) provide space for noting project information, comparing and scoring TMF, and accommodating contributions from multiple team members; and (6) include more case examples illustrating its application. Interview participants agreed that the tool (1) offered them a way to select from among candidate TMF, (2) helped them be explicit about the criteria that they used to select a TMF, and (3) enabled them to compare, select from among, and/or consider the usefulness of combining multiple TMF. These revisions resulted in the Theory Comparison and Selection Tool (T-CaST), a paper and web-enabled tool that includes 16 specific criteria that can be used to consider and justify the selection of TMF for a given project. Criteria are organized within four categories: applicability, usability, testability, and acceptability. CONCLUSIONS: T-CaST is a user-friendly tool to help scientists and practitioners select appropriate TMF to guide implementation projects. Additionally, T-CaST has the potential to promote transparent reporting of criteria used to select TMF within and beyond the field of implementation science.
C. B. Pimentel, W. L. Mills, J. A. Palmer, et al.
J Nurs Care Qual 2018 Nov 21
Blended facilitation, which leverages the complementary skills and expertise of external and internal facilitators, is a powerful strategy that nursing stakeholders and researchers may use to improve implementation of quality improvement (QI) innovations and research performed in nursing homes. PROBLEM: Nursing homes present myriad challenges (eg, time constraints, top-down flow of communication, high staff turnover) to QI implementation and research. APPROACH: This methods article describes the theory and practical application of blended facilitation and its components (external facilitation, internal facilitation, relationship building, and skill building), using examples from a mixed QI and research intervention in Veterans Health Administration nursing homes. CONCLUSIONS: Blended facilitation invites nursing home stakeholders to be equal partners in QI and research processes. Its intentional use may overcome many existing barriers to QI and research performed in nursing homes and, by strengthening relationships between researchers and stakeholders, may accelerate implementation of innovative care practices.
M. Jabbour, A. S. Newton, D. Johnson and J. A. Curran.
Implement Sci 2018 Nov 12;13(1):139-018-0832-8
While clinical pathways have the potential to improve patient outcomes and reduce healthcare costs, their true impact has been limited by variable implementation strategies and suboptimal research designs. This paper explores a comprehensive set of factors perceived by emergency department staff and administrative leads to influence clinical pathway implementation within the complex and dynamic environments of community emergency department settings. METHODS: This descriptive, qualitative study involved emergency health professionals and administrators of 15 community hospitals across Ontario, Canada. As part of our larger cluster randomized controlled trial, each site was in the preparation phase to implement one of two clinical pathways: pediatric asthma or pediatric vomiting and diarrhea. Data were collected from three sources: (i) a mediated group discussion with site champions during the project launch meeting; (ii) a semi-structured site visit of each emergency department; and (iii) key informant interviews with an administrative lead from each hospital. The Theoretical Domains Framework (TDF) was used to guide the interviews and thematically analyze the data. Domains within each major theme were then mapped onto the COM-B model-capability, opportunity, and motivation-of the Behaviour Change Wheel. RESULTS: Seven discrete themes and 58 subthemes were identified that comprised a set of barriers and enablers relevant to the planned clinical pathway implementation. Within two themes, three distinct levels of impact emerged, namely (i) the individual health professional, (ii) the emergency department team, and (iii) the broader hospital context. The TDF domains occurring most frequently were Memory, Attention and Decision Processes, Environmental Context and Resources, Behavioural Regulation, and Reinforcement. Mapping these barriers and enablers onto the COM-B model provided an organized perspective on how these issues may be interacting. Several factors were viewed as both negative and positive across different perspectives. Two of the seven themes were limited to one component, while four involved all three components of the COM-B model. CONCLUSIONS: Using a theory-based approach ensured systematic and comprehensive identification of relevant barriers and enablers to clinical pathway implementation in ED settings. The COM-B system of the Behaviour Change Wheel provided a useful perspective on how these factors might interact to effect change. TRIAL REGISTRATION: ClinicalTrials.gov, NCT01815710 .
C. F. Stanick, H. M. Halko, C. N. Dorsey, et al.
BMC Health Serv Res 2018 Nov 22;18(1):882-018-3709-2
Implementation science measures are rarely used by stakeholders to inform and enhance clinical program change. Little is known about what makes implementation measures pragmatic (i.e., practical) for use in community settings; thus, the present study’s objective was to generate a clinical stakeholder-driven operationalization of a pragmatic measures construct. EVIDENCE ACQUISITION: The pragmatic measures construct was defined using: 1) a systematic literature review to identify dimensions of the construct using PsycINFO and PubMed databases, and 2) interviews with an international stakeholder panel (N = 7) who were asked about their perspectives of pragmatic measures. EVIDENCE SYNTHESIS: Combined results from the systematic literature review and stakeholder interviews revealed a final list of 47 short statements (e.g., feasible, low cost, brief) describing pragmatic measures, which will allow for the development of a rigorous, stakeholder-driven conceptualization of the pragmatic measures construct. CONCLUSIONS: Results revealed significant overlap between terms related to the pragmatic construct in the existing literature and stakeholder interviews. However, a number of terms were unique to each methodology. This underscores the importance of understanding stakeholder perspectives of criteria measuring the pragmatic construct. These results will be used to inform future phases of the project where stakeholders will determine the relative importance and clarity of each dimension of the pragmatic construct, as well as their priorities for the pragmatic dimensions. Taken together, these results will be incorporated into a pragmatic rating system for existing implementation science measures to support implementation science and practice.
C. Vossius, G. Selbaek, J. Saltyte Benth, A. Wimo and S. Bergh.
Int J Geriatr Psychiatry 2018 Nov 14
To evaluate the trend in the use of direct care in a cohort of Nursing home (NH) residents and explore its association with resident characteristics and organizational factors. METHODS/DESIGN: A total of 696 NH residents from 47 Norwegian NHs were included at admissions at NH. In 537 residents the use of direct care was assessed every 6 months over a course of three years. A multiple model was estimated to identify demographic, clinical and organizational characteristics associated with the use of direct care time. RESULTS: Six months after admission, on average, 76.2 hours of direct care were rendered to each resident per month, while this number was reduced to 50.3 hours per month at the end of the study period. Most residents (92%) showed a stable use of direct care time, while a small group of residents displayed a much higher and varying use of direct care time. Increasing dementia, neuropsychiatric symptoms and decreasing function in activities of daily living were associated with higher use of direct care time. Direct care time constituted about 50% of the staff’s working time. CONCLUSION: In Norwegian NHs, high use of direct care time was associated with younger age, more severe dementia and severe neuropsychiatric symptoms. By identifying factors that impact on direct care time, preventive measures might be put in place to the benefit of the residents and possibly to improve resource use. Further research should explore the association between direct care time, quality of care and the residents’ quality of life.
M. S. Cole.
Nurs Leadersh (Tor Ont) 2017;30(4):39-44
Presently only about 9% of seniors over the age of 75 live in residential care facilities but the anticipated exponential growth of the senior population will put increasing pressure on the need for supportive, continuing care services in the years ahead (CIHI 2017a). They are on average 86 years of age with a diagnosis of dementia (67%) and some cognitive and/or functional impairment (98%) (CIHI 2017b). These compromised seniors are also more likely to use hospital services than others, and in many jurisdictions occupy acute care beds for extended periods because ongoing management of their complex conditions is often not possible within long-term care (LTC) homes. In addition, unnecessary and futile care at the end of life often leads to suffering for individuals and their families (Dobbins 2016), which might otherwise be avoided with the presence of institutionally based providers such as nurse practitioners (NPs). Christian and Barker (2009) identified NPs as a valuable resource to prevent unnecessary hospitalizations which often lead to complications and devastating results for seniors. Although evidence of the positive impact of NPs working in LTC facilities dates back to the 1970s, very few organizations have created and obtained funding support for these positions in LTC settings. This case study illustrates the impact of the NP role in a New Brunswick LTC facility; demonstrating the value of a model that includes an NP collaborating with physicians, nurses and allied health professionals. As shown in this case, the presence of an NP clearly impacted a reduction in emergency room visits and hospitalizations, events that more often than not accelerate further physical, mental and functional decline particularly among the frail elderly. Christian and Barker (2009) described the significant consequences of hospitalization for the elderly patient including irreversible decline in function, delirium and exposure to iatrogenic disease. Having an NP available within LTC affords the residents ongoing monitoring that allows for preemptive and proactive care. NPs providing oversight to the collaborative management of the care of LTC residents has the potential to not only realize cost-avoidance for the healthcare system but also enhance the quality of care for residents and their families.
To examine the relationship between nurse staffing and quality of care of nursing home residents, longitudinally. BACKGROUND: Mixed results abound on the relationship between nurse staffing and quality of care of residents in nursing homes. Cross-sectional designs may underpin bias because the relationship between staffing and quality emerges over time, with latent unobserved variables. To offset this limitation, I used a longitudinal design in this study. DESIGN: I used repeated quarterly survey methods. METHODS: I measured staffing information with a formula developed by the Centers for Medicare & Medicaid Services. Outcome variables were 15 quality indicators and the Korean National Health Insurance Service 2015 nursing home evaluation manual. RESULTS AND FINDINGS: As registered nurse hours per resident day increased by 1, the percentage of residents with depression decreased by 3.88%, and the prevalence of residents with nasogastric tubes increased by 1.17% in 3 months. Prevalence of residents with bed rest decreased by 5.72%, and residents with restraints decreased by 1.092%. More registered nurses and fewer certified nursing assistants or qualified care workers yielded a statistically significant negative influence on aggressive behavior, depression, weight loss, and bed rest. The higher turnover of total nursing staff related to more use of antidepressants. CONCLUSIONS: Results supported registered nurses’ exclusive impact on resident outcomes. More longitudinal research is required to confirm the influence of nurses on nursing home residents’ outcomes. CLINICAL RELEVANCE: This study supported about the contributions of increased input of Registered Nurses, additional to previous longitudinal studies. The nursing homes in Korea should have mandatory Registered Nurse placement for optimal quality of care. CLINICAL RELEVANCE: This study supported about the contributions of increased input of Registered Nurses, additional to previous longitudinal studies. The nursing homes in Korea should have mandatory Registered Nurse placement for optimal quality of care.
R. Blumberg, C. Feldman, D. Murray, N. Burnes and D. Murawski.
J Nutr Gerontol Geriatr 2018 Oct 30:1-13
Malnutrition in older adults residing in long-term care facilities continues to be a problem in the United States. Existing research has identified a list of possible contributing factors, including staffing problems. Few studies on food and nutrition care have attempted to gain the perspectives of nursing or dietary aides (henceforth, aides), the frontline staff who work most closely with the residents of long-term care facilities. The current study takes a qualitative approach grounded in a theoretical perspective based on Total Quality Management (TQM) to increase understanding of the interpersonal and management practices that affect resident wellbeing, health, and nutrition. Four focus groups (n = 24) were conducted with aides working in long-term care facilities. Aides expressed emotional closeness with residents and provided detailed knowledge about food and nutrition care. They reported both compassion fatigue and satisfaction. An element of dissatisfaction related to aide relationships with management and other employees who did not actively solicit their perspectives and knowledge on resident feeding. The knowledge and experience of aides could be better utilized by shifting management strategies to focus on employee empowerment and training. Principles of TQM could be applied to improve food and nutrition care in long-term care facilities.
Edited by Sally Chivers and Ulla Kriebernegg
Transcript-Verlag May 2018 ISBN: 9783837638059
Institutional care for seniors offers a cultural repository for fears and hopes about an aging population. Although enormous changes have occurred in how institutional care is structured, the legacies of the poor house still persist, creating panicked views of the nursing home as a dreaded fate. The paradoxical nature of a space meant to be both hospital and home offers up critical tensions for examination by age studies scholars. The essays in this book challenge stereotypes of institutional care for older adults, illustrate the changes that have occurred over time, and illuminate the continuities in the stories we tell about nursing homes.
M. Matthews, M. K. Carsten, D. J. Ayers and N. Menachemi.
Geriatr Nurs 2018 Jul – Aug;39(4):407-413
The demand for Long-Term Care (LTC) is steadily increasing as Baby Boomers age and enter retirement. High turnover rates among employees in LTC creates challenges for supervisors and administrators, and can negatively impact quality of care. This study examines manager-subordinate relationship quality using Leader-Member Exchange Theory (LMX) as an antecedent to turnover among low-wage earners in the LTC environment. Survey data measuring LMX, job satisfaction, and demographic information was collected at time 1, and turnover data was collected 18 months later at time 2. The results reveal that all four LMX dimensions were rated significantly different among subordinates who left versus those who stayed, however, only the LMX dimension of supervisor loyalty was a significant predictor of turnover among low wage earners. Our study adds a more nuanced view of the reasons low-wage employees turnover, and presents implications for clinical managers and LTC organizations more broadly.
A. L. Snow, M. L. Jacobs, J. A. Palmer, et al.
Gerontologist 2018 Mar 19;58(2):e15-e24
To develop a structured observational tool, the Resident-centered Assessment of Interactions with Staff and Engagement tool (RAISE), to measure 2 critical, multi-faceted, organizational-level aspects of person-centered care (PCC) in nursing homes: (a) resident engagement and (b) the quality and frequency of staff-resident interactions. Design and Methods: In this multi-method psychometric development study, we conducted (a) 120 hr of ethnographic observations in one nursing home and (b) a targeted literature review to enable construct development. Two constructs for which no current structured observation measures existed emerged from this phase: nursing home resident-staff engagement and interaction. We developed the preliminary RAISE to measure these constructs and used the tool in 8 nursing homes at an average of 16 times. We conducted 8 iterative psychometric testing and refinement cycles with multi-disciplinary research team members. Each cycle consisted of observations using the draft tool, results review, and tool modification. Results: The final RAISE included a set of coding rules and procedures enabling simultaneously efficient, non-reactive, and representative quantitative measurement of the interaction and engagement components of nursing home life for staff and residents. It comprised 8 observational variables, each represented by extensive numeric codes. Raters achieved adequate to high reliability with all variables. There is preliminary evidence of face and construct validity via expert panel review. Implications: The RAISE represents a valuable step forward in the measurement of PCC, providing objective, reliable data based on systematic observation.
A. E. Kris, L. A. Henkel, K. M. Krauss and S. C. Birney.
J Gerontol Nurs 2017 Jun 1;43(6):35-43
The purpose of the current study was to understand (a) the extent to which reminiscence is used among nursing home staff (RNs, licensed practical nurses, and certified nursing assistants), (b) the reasons nursing home staff engage in reminiscence activities with nursing home residents, and (c) the value they attribute to these activities. The degree to which engagement in reminiscence activities by nursing staff contributed to knowledge about residents was also explored. The most frequently used functions of reminiscence, as reported by nursing staff, were to calm anxiety, help residents see meaning in life, and reorient confused residents. Although nursing caregivers (N = 43) found reminiscence activities moderately to very enjoyable (76.5%), less than one half (46.5%) reported engaging in reminiscence activities with residents frequently or very frequently. Nurses who engaged in reminiscence activities more often also reported knowing residents better-a hallmark of high-quality care for residents with dementia.
C. A. McAiney, J. Ploeg, A. Wickson-Griffiths, et al.
Nurs Leadersh (Tor Ont) 2017;30(4):10-25
Nurse practitioners (NPs) can play an important role in providing primary care to residents in long-term care (LTC) homes. However, relatively little is known about the day-to-day collaboration between NPs and physicians (MDs) in LTC, or factors that may influence this collaboration. Survey data from NPs in Canadian LTC homes were used to explore these issues. Thirty-seven of the 45 (82%) identified LTC NPs across Canada completed the survey. NPs worked with an average of 3.4 MDs, ranging from 1-26 MDs. The most common reasons for collaborating included managing acute and chronic conditions, and updating MDs on resident status changes. Satisfaction with NP-MD collaboration was high, and did not significantly differ among NPs working full versus part time, NPs working in a single versus multiple homes, or NPs with more versus less experience. By understanding the nature of NP-MD collaboration, we can identify ways of supporting and enhancing collaboration between these professionals.
V. P. Weale, Y. Wells and J. Oakman.
J Adv Nurs 2018 Nov 20
To examine whether the work-life interface (through work-family conflict and overall work-life balance) moderates the relationship between work ability and workplace demands and resources. DESIGN: This study used a cross-sectional survey design to collect data from 426 employees working in residential aged care. METHODS: A paper-based questionnaire was distributed to all permanent and casual employers at eight aged care facilities in Melbourne, Australia, between June – September 2013. Moderation analyses were conducted using PROCESS v. 2.13 in SPSS v. 22. RESULTS/FINDINGS: As expected, workplace demands and resources directly influenced workers’ work ability. In addition, moderate-to-high levels of work-family conflict and low-to-moderate levels of satisfaction with work-life balanced combined interactively with particular workplace demands and resources (relationships with management, physical demands and safety climate) to reduce work ability. CONCLUSIONS: This study advances understanding of how work-life balance and work-life conflict can influence work ability levels and shows that addressing the work-life interface may be a legitimate means to improve work ability, potentially leading to continued workforce participation. IMPACT: Staff retention in the residential aged care sector needs to be addressed. One possible means of achieving this is through improving work ability. The present study expanded knowledge of how the work-life interface may influence work ability. The research demonstrated that releationships between work ability and particular workplace demands and resources were moderated by the work-life interface. This finding has implications for how human resources managers of residential aged care facilities may improve workforce retention-through facilitating employees to manage the work-life interface better.
T. K. Vassbo, M. Kirkevold, D. Edvardsson, et al.
J Adv Nurs 2018 Oct 29
To explore the associations between job satisfaction and perceived person-centredness and ethically difficult situations among staff in nursing homes (NHs). BACKGROUND: Previous studies have indicated that person-centredness and few ethically difficult situations can contribute positively to NH staff’s job satisfaction. However, empirical evidence of these associations is lacking. DESIGN: Cross-sectional survey design. METHOD: Nursing home staff (N = 341) in six NHs in Australia, Norway, and Sweden completed the questionnaire measuring job satisfaction, person-centredness, and ethically difficult situations. Data were collected between April – June 2016. Univariate analysis was used to describe the sample, one-way analysis of variance examined differences between variables. Bivariate correlation tested the relationships between variables and hierarchical multiple regression explored the extent to which person-centredness and ethically difficult situations could explain job satisfaction among staff. RESULTS: After controlling for socio-demographic variables in a regression model, three variables of person-centredness and “ethically difficult situations” were significantly associated with job satisfaction. A “climate of community” contributed the most, followed by the “amount of organizational and environmental support,” “a climate of everydayness,” and few “ethically difficult situations.” CONCLUSION: The results support the theoretical foundation and previous findings suggesting that establishing NHs organizations based on person-centredness will increase staff job satisfaction. However, this is a cross-sectional study and the causality may go in both directions and should be further explored.
N. Pandhi, S. Kraft, S. Berkson, et al.
BMC Health Serv Res 2018 Nov 9;18(1):847-018-3650-4
Health systems in the United States are increasingly required to become leaders in quality to compete successfully in a value-conscious purchasing market. Doing so involves developing effective clinical teams using approaches like the clinical microsystems framework. However, there has been limited assessment of this approach within United States primary care settings. METHODS: This paper describes the implementation, mixed-methods evaluation results, and lessons learned from instituting a Microsystems approach across 6 years with 58 primary care teams at a large Midwestern academic health care system. The evaluation consisted of a longitudinal survey augmented by interviews and focus groups. Structured facilitated longitudinal discussions with leadership captured ongoing lessons learned. Quantitative analysis employed ordinal logistic regression and compared aggregate responses at 6-months and 12-months to those at the baseline period. Qualitative analysis used an immersion/crystallization approach. RESULTS: Survey results (N = 204) indicated improved perceptions of: organizational support, team effectiveness and cohesion, meeting and quality improvement skills, and team communication. Thematic challenges from the qualitative data included: lack of time and coverage for participation, need for technical/technology support, perceived devaluation of improvement work, difficulty aggregating or spreading learnings, tensions between team and clinic level change, a part-time workforce, team instability and difficulties incorporating a data driven improvement approach. CONCLUSIONS: These findings suggest that a microsystems approach is valuable for building team relationships and quality improvement skills but is challenged in a large, diverse academic primary care context. They additionally suggest that primary care transformation will require purposeful changes implemented across the micro to macro-level including but not only focused on quality improvement training for microsystem teams.
Kate Bak, Lesley Moody, Sarah M Wheeler and,Julie Gilbert.
Healthcare Quarterly 2018 07/31;21(2):24-29
Surveys and interviews were undertaken in Ontario, Canada, with healthcare staff, patients, caregivers and family members to evaluate the adoption and effectiveness of the experience-based co-design (EBCD) approach. EBCD combines patient and staff experiences to identify opportunities for healthcare improvement. Participants reported that EBCD was an effective form of improving experience. Implementation barriers included time, human resources and funding. Suggestions for increased EBCD utilization included funding, training, promotion of success stories, leadership and greater participant involvement. EBCD can be an effective method of identifying and transforming how healthcare services are delivered to improve the patient, caregiver and family experience.
V. M. Montori, I. Hargraves, R. J. McNellis, et al.
J Gen Intern Med 2018 Nov 14
The Agency for Healthcare Research and Quality conducted internal work to formulate a model that could be used to analyze the Agency’s research portfolio, identify gaps, develop and prioritize its research agenda, and evaluate its performance. Existing models described the structure and components of the healthcare system. Instead, we produced a model of two functions: caring and learning. Central to this model is the commitment to and participation of people-patients, communities, and health professionals-and the organization of systems to respond to people’s problems using evidence. As a product of caring, the system produces evidence that is then used to adapt and continuously improve this response, closely integrating caring and learning. The Agency and the health services research and improvement communities can use this Care and Learn Model to frame an evidence-based understanding of vexing clinical, healthcare delivery, and population health problems and to identify targets for investment, innovation, and investigation.
K. T. Unroe, S. E. Hickman, J. L. Carnahan, Z. Hass, G. Sachs and G. Arling.
Innov Aging 2018 Jul 5;2(2):igy017
To examine the relationship between hospital diagnoses associated with hospital transfers of long stay nursing home residents, ratings of avoidability of transfer, and RN-identified quality improvement opportunities. Research Design and Methods: Prospective clinical demonstration project, named OPTIMISTIC, with trained RNs embedded in nursing homes that performed root cause analyses for 1,931 transfers to the hospital between November 2014 and July 2016. OPTIMISTIC RNs also rated whether transfers were avoidable, identified quality improvement opportunities, and recorded hospital diagnoses. Resident characteristics were obtained from Minimum Data Set assessments. Relationships between six hospital diagnoses commonly considered “potentially avoidable” and OPTIMISTIC RN root cause analysis findings were examined. Facilities were participating in the OPTIMISTIC demonstration project designed to reduce hospital transfers during the study period. Results: Twenty-five percent of acute transfers associated with six common diagnoses were considered definitely or probably avoidable by project RNs versus 22% of transfers associated with other diagnoses. The most common quality improvement opportunity identified for transfers rated as avoidable was that the condition could have been managed safely if appropriate resources were available, a factor cited in 45% of transfers associated with any of the six diagnoses. Problems with communication among stakeholders were the most commonly noted area for improvement (48%) for transfers associated with other diagnoses. Many other areas for quality improvement were noted, including earlier detection of change in status and the need for understanding patient preferences or a palliative care plan. Discussion and Implications: Although some nursing home transfers may later be deemed potentially avoidable based on post-transfer hospital diagnosis from Medicare claims data, OPTIMISTIC nurses caring for these residents at time of transfer categorized the majority of these transfers as unavoidable irrespective of the hospital diagnosis. Multiple quality improvement opportunities were identified associated with these hospital transfers, whether the transfer was considered potentially avoidable or unavoidable.
V. Guion, P. De Souto Barreto, S. Sourdet and Y. Rolland.
J Am Med Dir Assoc 2018 Dec;19(12):1118-1123.e2
To determine whether an intervention based on education and professional support to nursing home (NH) staff would decrease the number of residents with a pain complaint, and to determine whether the intervention would improve pain management. DESIGN: Nonrandomized controlled trial. NHs were nonrandomly allocated either to a strong intervention group consisting in audit, feedback, and collaborative work on quality indicators with a hospital geriatrician, or to a light intervention group (LIG) consisting in audit and feedback only. SETTING: One hundred fifty-nine NHs located in France. PARTICIPANTS: A subgroup of 3722 residents. MEASURES: Information on pain complaint and pain-related covariates at the resident-related and at the NH level were recorded by NH staff at baseline and 18 months later. These covariates were included in a mixed-effects logistic regression on resident’s pain complaint. Pain management was compared between intervention groups by chi-square tests. RESULTS: A greater reduction of residents with a pain complaint after the strong intervention (odds ratio 0.69, 95% confidence interval 0.53, 0.90) and a better pain management (47.6% gold standard, vs 30.6% in the LIG, P < .001) than controls. CONCLUSION/IMPLICATIONS: Combining educational and organizational measures, evaluating pain as a patient-reported outcome and as a process endpoint, and implementing a broad-spectrum intervention were original approaches to improve quality of care in NHs. Our results support nonspecific, collaborative, educational, and organizational interventions in NHs to decrease residents’ pain complaint and improve pain management.
R. Romeo, D. Zala, M. Knapp, M. Orrell, J. Fossey and C. Ballard.
Alzheimers Dement 2018 Nov 1
To examine whether an optimized intervention is a more cost-effective option than treatment as usual (TAU) for improving agitation and quality of life in nursing home residents with clinically significant agitation and dementia. METHODS: A cost-effectiveness analysis within a cluster-randomized factorial study in 69 care homes with 549 residents was conducted. Each cluster was randomized to receive either the Well-being and Health for people with Dementia (WHELD) intervention or TAU for nine months. Health and social care costs, agitation, and quality of life outcomes were evaluated. RESULTS: Improvements in agitation and quality of life were evident in residents allocated to the WHELD intervention group. The additional cost of the WHELD intervention was offset by the higher health and social care costs incurred by TAU group residents (mean difference, pound2103; 95% confidence interval, -13 to 4219). DISCUSSION: The WHELD intervention has clinical and economic benefits when used in residents with clinically significant agitation.
A. M. C. Giguere, E. Farmanova, J. M. Holroyd-Leduc, et al.
BMC Geriatr 2018 Nov 26;18(1):290-018-0969-y
Frail seniors often receive ineffective care, which does not meet their needs. It is still unclear how healthcare systems should be redesigned to be more sensitive to the needs and values of frail seniors and their caregivers. We thus aimed to describe key stakeholders’ perspectives on the current healthcare and services available to frail seniors. METHODS: In this qualitative descriptive study, we conducted semi-structured interviews with a convenience sample of 42 frail seniors, caregivers, clinicians, or healthcare administrators/decision makers involved in frail senior care from five Canadian provinces. We explored participants’ perspectives on the quality of care and services for frail seniors. We used an inductive/deductive thematic data analysis approach based on the Square-of-Care model, including emerging themes using the constant comparison method. RESULTS: We grouped participants’ perspectives into strengths, weaknesses and opportunities for improvement, and then into nine themes: care processes, continuity of care, social frailty, access to healthcare and services, models of healthcare delivery, cost of care, healthcare staff management and professional development of healthcare providers, material resources and environmental design of healthcare facilities, and coordination of care. Our findings suggest redesigning assessment, communication with frail seniors and their caregivers, targeting care and services to the needs, and integrating care better across settings and in time. CONCLUSIONS: A systematic identification of frail older people is the first step to adapt healthcare systems to this population’s needs. Participation of frail older people and their caregivers to decision making would also allow choosing care plans meeting their care goals. The integration of care and services across settings, over time, and with various providers, is also needed to meet frail senior needs.
J. L. Sullivan, R. L. Engle, D. Tyler, et al.
Inquiry 2018 Jan-Dec;55:46958018787031
The purpose of this research was to explore and compare common health system factors for 5 Community Living Centers (ie Veterans Health Administration nursing homes) with high performance on both resident-centered care and clinical quality and for 5 Community Living Centers (CLC) with low performance on both resident-centered care and quality. In particular, we were interested in “how” and “why” some Community Living Centers were able to deliver high levels of resident-centered care and high quality of care, whereas others did not demonstrate this ability. Sites were identified based on their rankings on a composite quality measure calculated from 28 Minimum Data Set version 2.0 quality indicators and a resident-centered care summary score calculated from 6 domains of the Artifacts of Culture Change Tool. Data were from fiscal years 2009-2012. We selected high- and low-performing sites on quality and resident-centered care and conducted 12 in-person site visits in 2014-2015. We used systematic content analysis to code interview transcripts for a priori and emergent health system factor domains. We then assessed variations in these domains across high and low performers using cross-site summaries and matrixes. Our final sample included 108 staff members at 10 Veterans Health Administration CLCs. Staff members included senior leaders, middle managers, and frontline employees. Of the health system factors identified, high and low performers varied in 5 domains, including leadership support, organizational culture, teamwork and communication, resident-centered care recognition and awards, and resident-centered care training. Organizations must recognize that making improvements in the factors identified in this article will require dedicated resources from leaders and support from staff throughout the organization.
This report shines a light on the challenges facing the NHS in improving the uptake of new ideas and practices, and the need for new approaches when developing national and local programmes to support the spread of innovation.
M. Sklar, M. R. Hatch and G. A. Aarons.
J Eval Clin Pract 2018 Oct 23
The patient-centred medical home (PCMH) is an important part of health care reform. While there is hope, the PCMH model can facilitate the provision of higher quality care, the extent to which organizational climate within the PCMH supports the implementation of evidence-based practices (EBPs) is unknown. Identifying and addressing factors that facilitate implementation and use of EBPs within the PCMH are crucial for improving the health and health care of the United States. METHODS: This study used mixed methods to assess EBP implementation climate (ie, the extent to which organizational members perceive that the adoption and use of EBPs is expected, supported, and rewarded) and attitudes about EBPs in two PCMH clinics. RESULTS: Staff and physicians from two Rhode Island PCMHs, the Family Care Centre (FCC; n = 39) and Internal Medicine Clinic (IMC; n = 21), participated in this study. Results identified differences between FCC and IMC with regard to attitudes toward EBPs and implementation climate. Compared with the IMC, FCC staff and physicians reported significantly more positive attitudes toward EBPs and greater willingness to adopt EBPs. FCC staff and physicians reported significantly greater educational support for EBPs than IMC staff and physicians. Analysis of in-depth interviews revealed themes regarding attitudes toward EBPs. Most physicians reported valuing EBPs, although a number of barriers to EBP use were identified including time pressure, disjointed coordination of services, complexity of patients’ presenting health concerns, and patient choice. CONCLUSIONS: Understanding factors that facilitate EBP implementation in the PCMH is important given widespread adoption of the PCMH model. Barriers to EBP implementation in the PCMH must be addressed for the sustainable implementation of EBP in the PCMH. Improving implementation climate may be an effective strategy to aid in creating an organizational context conducive to consideration and use of EBPs.
Alex Pollock, Pauline Campbell, Caroline Struthers, et al.
Systematic Reviews 2018 11/24;7(1):208
There is increasing recognition that it is good practice to involve stakeholders (meaning patients, the public, health professionals and others) in systematic reviews, but limited evidence about how best to do this. We aimed to document the evidence-base relating to stakeholder involvement in systematic reviews and to use this evidence to describe how stakeholders have been involved in systematic reviews.
J. C. Crocker, I. Ricci-Cabello, A. Parker, et al.
BMJ 2018 Nov 28;363:k4738
To investigate the impact of patient and public involvement (PPI) on rates of enrolment and retention in clinical trials and explore how this varies with the context and nature of PPI. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Ten electronic databases, including Medline, INVOLVE Evidence Library, and clinical trial registries. ELIGIBILITY CRITERIA: Experimental and observational studies quantitatively evaluating the impact of a PPI intervention, compared with no intervention or non-PPI intervention(s), on participant enrolment and/or retention rates in a clinical trial or trials. PPI interventions could include additional non-PPI components inseparable from the PPI (for example, other stakeholder involvement). DATA EXTRACTION AND ANALYSIS: Two independent reviewers extracted data on enrolment and retention rates, as well as on the context and characteristics of PPI intervention, and assessed risk of bias. Random effects meta-analyses were used to determine the average effect of PPI interventions on enrolment and retention in clinical trials: main analysis including randomised studies only, secondary analysis adding non-randomised studies, and several exploratory subgroup and sensitivity analyses. RESULTS: 26 studies were included in the review; 19 were eligible for enrolment meta-analysis and five for retention meta-analysis. Various PPI interventions were identified with different degrees of involvement, different numbers and types of people involved, and input at different stages of the trial process. On average, PPI interventions modestly but significantly increased the odds of participant enrolment in the main analysis (odds ratio 1.16, 95% confidence interval and prediction interval 1.01 to 1.34). Non-PPI components of interventions may have contributed to this effect. In exploratory subgroup analyses, the involvement of people with lived experience of the condition under study was significantly associated with improved enrolment (odds ratio 3.14 v 1.07; P=0.02). The findings for retention were inconclusive owing to the paucity of eligible studies (odds ratio 1.16, 95% confidence interval 0.33 to 4.14), for main analysis). CONCLUSIONS: These findings add weight to the case for PPI in clinical trials by indicating that it is likely to improve enrolment of participants, especially if it includes people with lived experience of the health condition under study. Further research is needed to assess which types of PPI work best in particular contexts, the cost effectiveness of PPI, the impact of PPI at earlier stages of trial design, and the impact of PPI interventions specifically targeting retention. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42016043808.
Health research is a crucial investment. The valuable knowledge it produces leads to healthier individuals, families, and communities. Read this report to learn more about how CIHR is creating a brighter future for all Canadians, by supporting research that improves our health and strengthens our health care system.
C. Doran, M. Noonan and O. Doody.
J Clin Nurs 2018 Nov 15
To systematically review the literature regarding the experience of older people, families and staff using life-story work in residential care facilities for older people. BACKGROUND: Life-story work has been promoted as an approach to enhance care provided and involves collecting memories and moments that are important to the person assisting them to regain their sense of self. DESIGN: An integrative review utilising the PRISMA reporting guidelines where seven databases; Scopus, Embase, CINAHL, MEDLINE, PsychInfo, Psych Articles, Cochrane were searched within the timeframe; 1(st) January 2006 to 14(th) March 2016. Data was reviewed using Whittemore & Knalf’s (2005) methodological approach for integrative reviews. Analysis was conducted utilising Braun & Clarke’s (2006) six phases to identify, analyse and record themes within the data. RESULTS: Thirteen articles were reviewed and the review found that life-story work has been introduced using a range of different approaches, with no common approach. Thematic analysis identified two; maintaining identity and building and maintaining relationships. CONCLUSION: The review extends the current evidence on the experience of using life-story work in long-term aged care facilities for older people. Life-story work has the potential to enhance person centred care in long-term care. However, improving the process of implementation of life story work will require education, time and resources and a commitment from service providers and managers. RELEVANCE TO CLINICAL PRACTICE: Staff who undertake life-story work with residents need to be equipped with the skills to recognise and manage the challenges and issues that may potentially arise. Further research into the successful implementation of life-story work and how it can be resourced is required. This article is protected by copyright. All rights reserved.
H. Oba, S. Sato, H. Kazui, Y. Nitta, T. Nashitani and A. Kamiyama.
Int Psychogeriatr 2018 Jan;30(1):87-94
There are some existing barriers posed by neuropsychological tests that interfere with the assessment of cognitive functioning by staff who work in long-term care facilities. The purpose of this study was to investigate the feasibility of assessing cognitive function through conversation. METHODS: A total of 100 care staff was randomly selected as participants. Each staff member evaluated cognitive function in one to three residents using the Conversational Assessment of Neurocognitive Dysfunction (CANDy), which is a screening test for dementia using conversation. Other scales used were the Mini-Mental State Examination (MMSE), Behavioral Pathology in Alzheimer’ s Disease (BEHAVE-AD), and quality-of-life questionnaire for the elderly with dementia (QOL-D). RESULTS: A total of 80 care staff members and 158 residents were analyzed. When the CANDy involved an evaluation based on face-to-face communication, it demonstrated significant correlations with the MMSE, BEHAVE-AD, and several indices of the QOL-D (e.g. negative affect and actions, communication ability, restless, and spontaneity and activity). In contrast, when the CANDy involved an evaluation based on an impression of a typical conversation, it only demonstrated significant relationships with the MMSE and the spontaneity and activity index of the QOL-D. CONCLUSIONS: Conversational assessment is a useful means to assess cognitive functioning and to promote interactions between residents and care staff in long-term care facilities.
K. M. Abbott, L. R. Bangerter, S. Humes, R. Klumpp and K. Van Haitsma.
Gerontologist 2018 Nov 3;58(6):1126-1135
Background and Objectives: U.S. Nursing homes (NH) are shifting toward a person-centered philosophy of care, where staff understand each residents preferences, goals and values, and seek to honor them throughout the care delivery process. Social interactions are a major component of life and while low rates of social interactions are typically found among NH residents, little research has examined resident preferences for specific types of social interactions. The purpose of this study is to explore, from the perspective of the NH resident, barriers to social contact preferences and situations when social preferences change. Research Design and Methods: Two interviews were conducted with 255 NH residents 3 months apart, recruited from 32 NHs using 13 social-contact items from the Preferences for Everyday Living Inventory-NH. Results: Content analysis of 1,461 spontaneous comments identified perceived barriers to preference fulfillment along with reasons why residents would change their mind about the importance of a preference (situational dependencies). Nearly 50% of social preferences for choosing a roommate, having regular contact with friends, giving gifts, and volunteering were associated with barriers. Social preferences were likely to change based upon the quality of the social interaction and the resident’s level of interest. Discussion and Implications: Knowledge of barriers regarding social preferences can inform care efforts vital to advancing the delivery of person-centered care. In addition, understanding the reasons why NH resident preferences change based upon context can help providers with staff training leading to individualized care and develop meaningful social programs that are in line with resident preferences.
D. Smith, L. Bugeja, N. Cunningham and J. E. Ibrahim.
Gerontologist 2018 Nov 3;58(6):e369-e383
The dramatic growth in the older adults (65 years+) has created an equivalent increase in the number of nursing home (NH) residents. NH residents often lack physical and cognitive abilities, making them particularly vulnerable to assault. Although sexual assault is among one of the most shocking types of assault, it is also the least acknowledged, detected, and reported type of assault against NH residents. This systematic review examines victim/perpetrator sociodemographic and relationship characteristics as well as the forensic characteristics of sexual assaults occurring in NH. Design and Methods: A 7 database systematic search of studies published between January 1, 1949 and October 26, 2015 was conducted that examined sexual assaults in NH. Articles reporting on sexual assault in NH and other institutional settings were eligible. Community-dwelling populations and studies not describing sexual assault or physical aspects of sexual assault were excluded. Sexual assault was not restricted to a single definition, study method, or country. Results: Fifteen studies met inclusion criteria. Sexual assault was the least reported type of assault in NH. Victims of sexual assault were likely to be females with cognitive or physical impairments. Perpetrators were likely to be male residents, although staff members were also substantiated. Forensic characteristics and investigative data were limited. Study limitation included inconsistencies between study purposes and small sample sizes. Implications: This review highlights a gap in knowledge regarding sexual assaults in NH and demonstrates a need for better staff training in detecting, examining, and managing sexual assaults in NH.
J. D. Kasper, J. L. Wolff and M. Skehan.
Gerontologist 2018 Nov 23
Meeting individual preferences for long-term services and supports (LTSS) is a policy priority that has implications for quality of care. Evidence regarding preferences is sparse. In addition, little is known regarding whether preferences and care arrangements match for those receiving care, and implications for quality of life. Research Design and Methods: A random sample (n = 1,783 in 2012) of National Health and Aging Trends Study participants were asked the best care option for someone 80+ who needs help with personal care and mobility. Analyses examine variations in care preferences, the relationship of preferences to care arrangements, and the association of matched preference and care arrangements to quality of life indicators. Results: Care preferences vary by demographics. Equal proportions (3 in 10) of older adults chose assisted living or continuing care retirement communities (CCRC), care in own home with family help, and care in own home with paid help, as the best options. Persons in assisted living/CCRC settings were significantly more likely to choose this option as best. Only 1 in 3 older persons receiving care are in arrangements that match preferences. No association with quality of life indicators was found. Discussion and Implications: Aging in place remains the care preference of a majority, but close to one-third chose assisted living/CCRC, suggesting preferences are evolving. Aligning care preferences and arrangements is a policy goal, but many do not achieve a match and there remain gaps in understanding trajectories in preferences and care arrangements and implications for quality of life.
S. Gonella, I. Basso, V. Dimonte, et al.
J Am Med Dir Assoc 2018 Nov 20
Less aggressive end-of-life (EOL) care has been observed when health care professionals discuss approaching EOL and preferences about life-sustaining treatments with nursing home (NH) residents or their families. We performed a comprehensive systematic review to evaluate the association between health care professionals-residents and health care professionals-family EOL conversations and EOL care outcomes. DESIGN: Systematic review with meta-analysis. SETTING AND PARTICIPANTS: Seven databases were searched in December 2017 to find studies that focused on health care professionals-residents (without oncologic disease) and health care professionals-family EOL conversations and aimed to explore the impact of EOL conversations on resident’s or family’s EOL care outcomes. MEASURES: Random effects meta-analyses with subsequent quality sensitivity analysis and meta-regression were performed to assess the effects of EOL conversations on the decision to limit or withdraw life-sustaining treatments. A funnel plot and Eagger test were used to assess publication bias. RESULTS: 16 studies were included in the qualitative and 7 in the quantitative synthesis. Health care professionals-family EOL conversations were positively associated with the family’s decision to limit or withdraw life-sustaining treatments (odds ratio = 2.23, 95% confidence interval: 1.58-3.14). The overall effect of health care professionals-family EOL conversations on the family’s decision to limit or withdraw life-sustaining treatments remained stable in the quality sensitivity analysis. In the meta-regression, family members with a higher level of education were less influenced by EOL conversations with health care professionals when making decisions about limiting or withdrawing life-sustaining treatments. No publication bias was detected (P = .4483). CONCLUSIONS/IMPLICATIONS: This systematic review shows that EOL conversations promote palliative care. Structured conversations aimed at exploring NH resident preferences about EOL treatment should become routine. NH administrators should offer health care professionals regular training on EOL conversations, and resident-centered care that involves residents and their families in a shared decision-making process at EOL needs to be promoted.
T. McConnell, P. Best, T. Sturm, et al.
Dementia (London) 2018 Nov 23:1471301218814393
Involving people with dementia in decision-making is widely accepted as a means of empowering them to lead more independent lives and have more meaningful roles in shaping their care. However, there is a need to conduct rigorous evaluations of empowerment-driven services and policies in order to develop a deeper understanding about how to optimise successful implementation. This paper presents the results of an evaluation of Dementia Northern Ireland, an organisation initiated and led by people with dementia. We used a realist evaluation approach that comprised interviews with 15 people with dementia, three staff and two board members, ethnographic observations, along with documentary analysis to identify ‘what works, for whom, under what circumstances’. The analysis used realist logic to build up context-mechanism-outcome configurations. The Dementia Northern Ireland service model of empowerment revolved around the formation and maintenance of social groups of people with dementia. Facilitators, recruited and selected by people with dementia, supported six groups, consisting of one to four members with mild to moderate cognitive impairment. Facilitators helped expand empowerment groups, facilitate decision-making, awareness raising and consultation opportunities with group members. The ‘Empowerment Groups’ appeared to lead to the development of a shared social identity and a sense of collective strength as indicated by interview and observational data demonstrating an activist mentality among group members to challenge the stigma surrounding dementia. Group members also reported improved quality of life. Widespread implementation of the empowerment model has the potential to lead to reduced stigma and greater social inclusion, increased involvement of people with dementia as active co-producers of policy and service development, better services and support. This case study of Dementia Northern Ireland illustrates that there are boundaries and challenges to empowerment in terms of requiring additional support from staff without dementia. However, despite these challenges, empowerment-driven organisations can and should be committed to involving members in lead roles and key decision-making.
L. S. Larsen, B. H. Blix and T. Hamran.
Dementia (London) 2018 Nov 23:1471301218814641
The current Western health policy of ageing in place relies on a triad collaboration among patients, healthcare service providers and family caregivers. Such collaborations presuppose involvement in a vague juridical landscape. This article explores family caregivers’ experiences with involvement in and influence on nursing home decision-making processes for persons with dementia. The data consist of 12 in-depth interviews with family caregivers. Using positioning theory, we demonstrate how family caregivers strive to balance their assumed duty to care for the person with their needs to care for themselves. Their involvement (or non-involvement) in the complex decision-making process is demonstrated through the following seven positions: (1) self-condemning determiner, (2) dominant, (3) proponent, (4) saluting, (5) pending, (6) prisoner, and (7) stooge. Furthermore, we discuss why expedient positions are more available for some individuals and the consequences of family caregivers’ various positions on the healthcare policy aims of collaboration and equal healthcare services.
Thursday 29 November 2018 13:00-14:00
Presenter: Dr. Heather Gainforth
Dr. Gainforth will discuss her experiences of conducting research in partnership with communities using an integrated knowledge translation (IKT) approach. She will outline theories and frameworks underlying her work as well as recommendations for fostering partnership. Finally, she will discuss her emerging research program that aims to develop our scientific understanding of quality research partnerships and build capacity for developing and maintaining meaningful partnerships between researchers and research users.
By the end of this webinar, you will be able to:
• Develop an understanding of the current evidence related to fostering research partnerships
• Discuss recommendations for developing meaningful research partnerships.
KT Canada Thursday 13 December 10:00-11:00
Presenters: Linda Wilhelm and Dr. Meghan Elliott
1) To recognize ways in which stakeholder priorities may change over time;
2) To appreciate the perceived significance of research engagement;
3) To recognize novel opportunities for meaningful patient engagement in trainees’ research
Tuesday 4 December 13:00-14:30 ECHA 2-140 Cost: $35
Together with attendees we will discuss: (1) forms of stakeholder engagement and why engagement needs to start prior to designing a research project. We will critically reflect on various concepts, such as inform, consult, engage, empower;(2) how to identify and engage key stakeholder agendas in mapping out a research program; (3) accommodating stakeholder agendas while maintaining methodological rigor; (4) strategies for maintaining stakeholder engagement throughout the research and policy cycles; and (5) how stakeholder engagement can contribute to partnership development and support continuing research relationships. We will share examples from our work as brief case studies to provoke discussion.
We know that research evidence is not adequately being used in healthcare, public health, social services… The gap between research and practice is often referred to as the “leaky pipeline”; it takes about 17 years for research to be used on the frontlines and up to 85% of research dollars are being wasted in the process. Implementation science examines how we can close this gap. Unfortunately there is a growing divide between implementation science and implementation practice. That’s because it’s hard to apply implementation science. Organizations are attempting to implement evidence-based practices, but struggling to achieve the expected outcomes. They are using evidence about “what works”, but not using evidence on “how to implement”. We need more examples of how implementation science is being applied in practice. The purpose of Implementation in Action is to shine a spotlight on these examples.
In Fall 2016, Behavioural Supports Ontario’s (BSO) Knowledge Translation and Communications Advisory reignited a conversation on language with intentions of fulfilling one of its terms of reference objectives: to critically reflect and provide recommendations regarding language and communications used by BSO and its key stakeholder
Research funders impose length limits on applications for practical reasons: to discourage epic submissions, and to ease the burden on reviewers. It’s also true that concise ideas are generally stronger ideas. But sticking to these limits can often seem a difficult and frustrating task. Jonathan O’Donnell offers advice to researchers looking to find a little more space in their applications. These range from simple pointers that make for an improved proposal, such as ditching the passive voice and exploiting simple formatting functions, to more desperate moves, such as compressing references lists or resorting to the ampersand.
A multi-author blog collective is an effective way for a university or other knowledge-based institution to host discussion and debate. As part of a series previewing their book Communicating Your Research with Social Media, Amy Mollett, Cheryl Brumley, Chris Gilson and Sierra Williams look at how to set up an institution-based multi-author blog platform; from planning all the way to launch.
This webcast serves as a pre-conference session ahead of the 2018 Online KT Conference and provides an overview of basic information about knowledge translation (KT) for participants who are new to the field, and a review for those with more experience. The presentation focuses on practices that help move research to impact. The Co-produced Pathway to Impact framework introduces the role of stakeholders and research partners, KT planning, co-production (integrated KT), dissemination (end of grant KT) as well as research impact and impact assessment. Real life examples and interactive elements will reinforce the KT concepts throughout the webcast.
We’re looking for a recent PhD graduate in a research-related discipline who ideally has an understanding of frailty, and Canadian healthcare for older adults. Canadian Frailty Network (CFN) is seeking a Postdoctoral Fellow, to coordinate a Network initiative to develop minimum common outcome measures and data elements (COMs/CDEs) with respect to older adults living with frailty. Recent PhD graduates in a research-related discipline are eligible.
In producing evidence to guide care decision, our intent is to maximize utilization of data obtained by standardizing the COMs/CDEs measured in all frailty research and knowledge translation studies. This initiative will include broad consultations with citizens, researchers and clinicians to reach consensus on appropriate COMs/CDEs, using a modified Delphi approach. This project will facilitate the conduct of relevant, generalizable and healthcare-context-interpretable frailty research.
The Postdoctoral Fellow will coordinate this initiative under the direction of the CFN Scientific Director. The successful candidate will be expected to produce high-quality products for publication and CFN use, and will work closely with Assistant Scientific Director Dr. Perry Kim and Research and KT Manager Dr. Amanda Lorbergs, as well as Dr. Muscedere.
This 2-year post-doctoral fellowship focuses on implementation science research. The post-doctoral fellow will work on a NIH-funded national implementation study in The Bahamas; the goal is to develop theory-driven implementation strategies to increase sustained teacher implementation fidelity of youth evidence-based intervention, and thereby increase the public health impact of evidence-based interventions in schools. The fellow will also have opportunities to work on mHealth intervention and suicide prevention projects.