L. D. Aloisio, J. Baumbusch, C. A. Estabrooks, et al.
J Nurs Manag 2019 Sep 17
To identify demographic-, individual-, and organizational-level predictors of job satisfaction among managers in residential long-term care (LTC) facilities. BACKGROUND: Job satisfaction predicts turnover among managers in LTC settings. However, factors affecting job satisfaction among LTC facility managers remain poorly understood. METHODS: A secondary analysis of data from Phase 2 of the Translating Research in Elder Care program including 168 managers (unit managers, directors of care, and facility administrators) from 76 residential LTC homes in three Canadian provinces. Michigan Organizational Assessment Questionnaire Job Satisfaction Subscale was used to measure job satisfaction. Predictors of job satisfaction determined using general estimating equations. RESULTS: The efficacy subscale of burnout was positively predicted job satisfaction at the individual level (B = .104, p = .046). At the organizational level, social capital (B = .224 p = .018), adequate orientation (B = .166, p = .015), and leadership (B = .155, p = .018) were associated with higher job satisfaction. CONCLUSIONS: These data suggest that improving LTC managers’ self-perceived efficacy, leadership, social capital, and adequate orientation may enhance their job satisfaction. IMPLICATIONS FOR NURSING MANAGEMENT: Predictors of managers’ job satisfaction are modifiable and therefore may be amenable to intervention.
WS Barkema, GA Heckman, SE Slaughter, N. Carrier, CO Lengyel and HH Keller.
Jour Nursing Home Res 2019;5:49-55.
Frailty is common in long-term care (LTC) and leads to decreased survival. Certain diagnoses (asthma, heart failure (HF)), Chronic Obstructive Pulmonary Disease (COPD), depressive symptoms and chronic renal failure) are associated with frailty. Objective: This study investigated food and fluid intake of residents with certain diagnoses and if the conditions were independently associated with food intake. Design & participants: Cross-sectional study with 633 participants’ where three days of weighed food and fluid intake were observed. T-tests and multiple linear regression were used to analyze associations between energy, protein, fluid and Mean Adequacy Ratio (MAR) and diagnoses and their multi-morbidity. Covariates included age, BMI, sex, cognition, eating challenges, therapeutic diets, total medications, modified diet texture, malnutrition, oral health status affecting food intake and dysphagia risk. Results: Diet quality was moderate (MAR = 0.78- 0.80) and mean daily energy, protein and fluid were 1554 (±295) kcal, 57.4 (±13.0) grams, and 1102 (±383) ml respectively. Diagnoses were not associated with energy, protein or fluid intake or MAR after adjusting for covariates. However, significantly higher fluid intake was seen in residents with HF (p=0.014) and multiple selected diagnoses (p =0.011) as compared to those without. Conclusion: Diagnoses were found to be irrelevant for explaining food and fluid intake of LTC residents. Other covariates, potential symptoms of the condition (e.g., dysphagia), were associated with intake, suggesting that the stage of frailty may be more relevant than the diagnoses leading to frailty with respect to food intake.
Mandy M. Archibald and Shannon D. Scott.
Nursing Open 2019.
Digital, art‐ and story‐based resources can be viable and engaging knowledge translation strategies in health care. Understanding the usability of these approaches can help maximize their impact. The aim of this work is to understand what aspects of ‘My Asthma Diary’, an art‐based digital knowledge translation tool for parents of children with asthma, has an impact on usability. Design: Sequential explanatory mixed methods pilot study. Methods: Eighteen parents of children with asthma reviewed ‘My Asthma Diary’ in a paediatric emergency department and completed a usability questionnaire. Follow‐up interviews were conducted with five parents and analysed with qualita‐ tive description. Results: We identified four themes which complemented the quantitative results: (a) the eBooks are relatable and mirror personal experience; (b) the digital format is convenient and easy to navigate; (c) the narrative structure aids learning; and (d) the narrative and illustrations are synergistic. We summarize core usability considera‐ tions for subsequent research and creative knowledge translation tool development in other contexts
S. Dahlke, K. F. Hunter, M. Reshef Kalogirou, K. Negrin, M. Fox and A. Wagg.
Can J Aging 2019 Sep 13:1-13
Interprofessional collaboration is understood to improve efficiencies and quality of care but is associated with challenges such as professionals’ differing routines, knowledge, and identities, as well as professional hierarchies and time constraints. Given these challenges, there is limited understanding of how professionals collaborate effectively in providing patient-centred care. This study, with a convergence triangulation mixed-methods study design, explored interprofessional staffs’ perceptions of interprofessional collaboration and patient-centred care when working with hospitalized older adults. Thirty-six staff responded to a survey which included the Patient-Centred Care measure and the Modified Index of Interdisciplinary Collaboration; we also interviewed 14 nursing staff. Although all scores suggested a high value was placed on interprofessional collaboration, scores were low related to activities that facilitated team processes. We identified three themes from the data: knowing the patient/family, functional needs, and communication processes. Staff identified daily rounds with interprofessional teams as supportive of interprofessional collaboration and patient-centred-care.
Y. H. Tou, M. F. Liu, S. R. Chen, P. H. Lee, L. M. Kuo and P. C. Lin.
J Nurs Manag 2019 Sep 17
Missed care by nursing aides in long-term care facilities affects the resident’s quality of care, and therefore, requires attention. AIMS: 1) To identify the frequencies and reasons for missed care by nursing aides in long-term care facilities; 2) To clarify the correlation between missed care and the characteristics of nursing aides and facilities. METHODS: A cross-sectional study was conducted, wherein 184 nursing aides and 80 registered nurses were recruited from 10 long-term care facilities. RESULTS: 1) The most frequently missed item of care by nursing aides was assistance with body cleaning (30.4%). 2) Among all participants, 90.2%, 89.8%, and 64% indicated poor communication, labour shortages, and material resource insufficiencies, respectively, as the reason for missed care. 3) Participants who perceived staff to be insufficient missed care tasks more frequently than those who perceived staff to be sufficient (p < 0.05). CONCLUSIONS: Missed handover and insufficient nursing aides on duty were identified as the primary reasons for missed care. IMPLICATIONS FOR NURSING MANAGERS: Handover as a nursing process should be improved to promote accuracy and continuity. Flexibility in human resources should be maintained to respond adequately to resident’s emergencies, thereby ensuring effective completion of the job.
S. J. Hakonsen, P. U. Pedersen, A. Bygholm, C. N. Thisted and M. Bjerrum.
BMC Health Serv Res 2019 Sep 6;19(1):642-019-4450-1
Malnutrition is a comprehensive challenge for the nursing home, home care- and home nursing sector. Nutritional care and the subsequent documentation are a common and multifaceted healthcare practice that requires that the healthcare professionals possess complex combinations of competencies in order to deliver high-quality care and treatment. The purpose of this study was to investigate how a varied group of healthcare professionals’ perceive their own competencies within nutrition and documentation and how organizational structures influence their daily work and the quality of care provided. METHODS: Two focus groups consisting of 14 healthcare professionals were conducted. The transcribed focus group interviews was analyzed using the qualitative content analysis approach. RESULTS: Six categories were identified: 1) Lack of uniform and systematic communication affect nutritional care practices 2) Experience-based knowledge among the primary workforce influences daily clinical decisions, 3) Different attitudes towards nutritional care lead to differences in the quality of care 4) Differences in organizational culture affect quality of care, 5) Lack of clear nutritional care responsibilities affect how daily care is performed and 6) Lack of clinical leadership and priorities makes nutritional care invisible. CONCLUSIONS: The six categories revealed two explanatory themes: 1) Absent inter- and intra-professional collaboration and communication obstructs optimal clinical decision-making and 2) quality deterioration due to poorly-established nutritional care structure. Overall, the two themes explain that from the healthcare professionals’ point of view, a visible organization that allocates resources as well as prioritizing and articulating the need for daily nutritional care and documentation is a prerequisite for high-quality care and treatment. Furthermore, optimal clinical decision making among the healthcare professionals are compromised by imprecise and unclear language and terminology in the patients’ healthcare records and also a lack of clinical guidelines and standards for collaboration between different healthcare professionals working in nursing homes, home care or home nursing. The findings of this study are beneficial to support organizations within these settings with strategies focusing on increasing nutritional care and documentation competencies among the healthcare professionals. Furthermore, the results advocate for the daily involvement and support of leaders and managers in articulating and structuring the importance of nutritional care and treatment and the subsequent documentation.
J. Daly Lynn, J. Rondon-Sulbaran, E. Quinn, A. Ryan, B. McCormack and S. Martin.
Dementia (London) 2019 Oct-Nov;18(7-8):2371-2435.
Health and social care provision needs to change in order to meet the needs of an increase in the number of people living with dementia. Environmental design, technology and assistive devices have the potential to complement care, help address some of the challenges presented by this growing need and impact on the lived experience of this vulnerable population. This systematic review was undertaken to identify the research on the use of electronic assistive technology within long-term residential care settings. A total of 3229 papers published from the inception of each of the databases up until May 2016 were retrieved from searches in four major databases. Sixty-one were identified to be included in the review. The inclusion criteria were: original peer reviewed journals; an electronic assistive technology intervention; with residents or tenants living with dementia or their family or paid caregivers; in supported living environments or residential care. The data extracted from the included studies focused on the methodology, technology, outcomes and the role of people living with dementia within the research. Overall, an extensive variety of technical interventions were found, with a broad range of methodological heterogeneity to explore their effect. Additionally, wide-spanning outcomes to support the potential of technology solutions and the challenges presented by such intervention were found.
L. Liao, L. D. Xiao, H. Chen, et al.
J Nurs Manag 2019 Sep 18
To determine nursing home staff experiences in mentorship programmes, and staff perceptions of the enablers and barriers to implement mentorship programmes. BACKGROUND: Mentorship programmes are perceived as playing an important role in improving the quality of care in nursing homes. However, little is known about research conducted around the world on staff experiences of these types of programmes. EVALUATION: A search for studies published from the earliest available date to April 2019 was undertaken. Two reviewers performed data extraction and an appraisal of eight studies using tools from the Joanna Briggs Institute. A pragmatic meta-aggregative approach was applied to synthesise the findings. The qualitative research that was included was analysed to identify 63 findings that were organised into 12 categories and combined into three syntheses. KEY ISSUES: The implementation of effective mentorship programmes is influenced by three factors: mentor capability, opportunity in the mentorship programmes, and motivation in the mentorship programmes. CONCLUSIONS: There are a number of studies of nursing home staff experiences of mentorship programmes. However, systematic reviews that synthesise findings in this field are lacking. It is crucial to tailor the programme design to suit each unique nursing home care setting. We identified barriers and enablers, and learned that no barriers are insurmountable. IMPLICATIONS FOR NURSING MANAGEMENT: Findings will inform nurse managers of an ideal environment for the implementation of a successful mentorship programme. Nursing homes need to establish and sustain mentorship programmes to help improve workforce capacity in delivering high-quality care for residents.
K. R. Powell, G. L. Alexander, R. Madsen and C. Deroche.
JMIR Aging 2019 Mar 5;2(1):e11449
According to the National Center for Health Statistics, there are over 1.7 million nursing home residents in the United States. Nursing home residents and their family members have unique needs and stand to benefit from using technology empowering them to be more informed and engaged health care consumers. Although there is growing evidence for benefits of patient-facing technologies like electronic patient portals on patient engagement in acute and outpatient settings, little is known about use of this technology in nursing homes. OBJECTIVE: The purpose of this study was to report findings from a secondary analysis of data from a national nursing home study of information technology (IT) adoption, called IT sophistication. We describe the extent to which nursing homes (n=815) allow residents or their representatives to access technology including electronic health records, patient portals, and health information-exchange systems as well as the ability of the residents or representatives to self-report data directly into the electronic health record. METHODS: We used descriptive statistics and regression techniques to explore relationships between information technology adoption (IT sophistication) and residents’ or their representatives’ access to technology. Covariates of location, bed size, and ownership were added to the model to understand their potential influence on the relationship between IT sophistication and resident access to technology. RESULTS: Findings revealed that resident access to technology was a significant predictor of the nursing home IT sophistication (P<.001). The inclusion of covariates-nursing home location, bed size, and ownership-with their interactions produced a nonsignificant effect in the model. Residents’ or their representatives’ use of electronic health records and personal health records were both significant predictors of overall IT sophistication (P<.001). CONCLUSIONS: As nursing homes continue to progress in technological capabilities, it is important to understand how increasing IT sophistication can be leveraged to create opportunities to engage residents in their care. Understanding the impact of health information technology on outcomes and which technologies make a difference will help nursing home administrators make more informed decisions about adoption and implementation.
E. M. White, L. H. Aiken, D. M. Sloane and M. D. McHugh.
Geriatr Nurs 2019 Sep 3
The objective of this cross-sectional study was to examine the relationships between work environment, care quality, registered nurse (RN) burnout, and job dissatisfaction in nursing homes. We linked 2015 RN4CAST-US nurse survey data with LTCfocus and Nursing Home Compare. The sample included 245 Medicare and Medicaid-certified nursing homes in four states, and 674 of their RN employees. Nursing homes with good vs. poor work environments, had 1.8% fewer residents with pressure ulcers (p = .02) and 16 fewer hospitalizations per 100 residents per year (p = .05). They also had lower antipsychotic use, but the difference was not statistically significant. RNs were one-tenth as likely to report job dissatisfaction (p < .001) and one-eighth as likely to exhibit burnout (p < .001) when employed in good vs. poor work environments. These results suggest that the work environment is an important area to target for interventions to improve care quality and nurse retention in nursing homes.
A. Siren, A. Amilon, G. K. Larsen and L. Mehlsen.
Disabil Rehabil Assist Technol 2019 Sep 5:1-7
Assistive technologies in care work are expected to alleviate the challenges related to population aging, namely the pressure on public budgets and a shortage of care professionals. This study examines how various stakeholders view the potentials of assistive technology in an institutionalized care setting in Denmark. Method: Using ethnographic field observations, interviews, and document analysis, we explore the residents’, the staff’s, and the municipality’s perspectives on the technologies and analyze whether they live up to the stated expectations. Results: We identify three parallel narratives representing each of the stakeholder’s perspectives. The municipality’s triple-win narrative emphasizes expected gains in terms of efficiency, improved working conditions, and better quality of care. The staff’s ambiguity narrative contains both negative views regarding the motive for using technologies to save resources and positive accounts of how technologies have reduced work-related pain. The residents’ limited agency narrative reflects an internalization of the staff’s perspectives. Conclusions: We conclude that, despite both the staff and the municipality highlighting the residents’ well-being and comfort as important outcomes of assistive technologies, the residents’ wishes have limited influence on whether and, if so, how assistive technologies are used. IMPLICATIONS FOR REHABILITATION Different stakeholders’ views on assistive technology vary and are closely connected to their respective institutional interests and roles. These perspectives are important for a successful implementation of assistive technologies. Understanding the positions of staff and older care recipients, and differentiating between their respective perspectives can help both scholars and product developers understand the potentials and risks of AT in a more nuanced way.
T. Krick, K. Huter, D. Domhoff, A. Schmidt, H. Rothgang and K. Wolf-Ostermann.
BMC Health Serv Res 2019 Jun 20;19(1):400-019-4238-3
The existence, usage and benefits of digital technologies in nursing care are relevant topics in the light of the current discussion on technologies as possible solutions to problems such as the shortage of skilled workers and the increasing demand for long-term care. A lack of good empirical overviews of existing technologies in the present literature prompted us to conduct this review. Its purpose was to map the field of digital technologies for informal and formal care that have already been explored in terms of acceptance, effectiveness and efficiency (AEE), and to show the scope of the used methods, target settings, target groups and fields of support. METHODS: A systematic literature search was conducted using Medline, Scopus, CINAHL, Cochrane Library, ACM Digital Library, IEEE Xplore, the Collection of Computer Science Bibliographies, GeroLit and CareLit. In addition, project websites were manually screened for relevant publications. RESULTS: Seven hundred fifteen papers were included in the review. Effectiveness studies have been most frequently performed for ICT, robots and sensors. Acceptance studies often focussed on ICT, robots and EHR/EMR. Efficiency studies were generally rare. Many studies were found to have a low level of evidence. Experimental designs with small numbers and without control groups were the most common methods used to evaluate acceptance and effectiveness. Study designs with high evidence levels were most commonly found for ICT, robots and e-learning. Technologies evaluated for informal caregivers and children or indicated for formal care at home or in cross-sectoral care were rare. CONCLUSION: We recommend producing high-quality evaluations on existing digital technologies for AEE in real-life settings rather than systematic reviews with low-quality studies. More focus should be placed on research into efficiency. Future research should be devoted to a closer examination of the applied AEE evaluation methods. Policymakers should provide funding to enable large-scale, long-term evaluations of technologies in the practice of care, filling the research gaps for technologies, target settings and target groups identified in this review.
A. A. Jennings, M. Linehan and T. Foley.
BMC Fam Pract 2018 Oct 10;19(1):166-018-0853-z
Pain in people with dementia is underdiagnosed and undertreated. General practitioners (GPs) play a pivotal role in dementia care but their perspectives on pain in people with dementia remains under-researched. The aim of this study was to explore GPs’ knowledge and attitudes towards pain assessment and management in people with dementia. METHODS: This was a descriptive cross-sectional study. A questionnaire was adapted from a previous study and piloted with 5 GPs. The questionnaire was posted to a census sample of all GPs in Cork city and county in the southern region of Ireland. The questionnaire collected demographic information, responses to a series of Likert-type statements assessing GPs’ knowledge and attitudes, and provided an opportunity for the GP to give qualitative feedback on their experiences of managing pain in dementia. SPSS v25 was used for statistical analysis. Qualitative responses were thematically analysed. RESULTS: Of the 320 questionnaires posted, 157 completed questionnaires were returned (response rate of 49%). The sample was representative of GPs nationally in terms of years in GP practice and practice location. Over two-thirds (108/157) of respondents had a nursing home commitment. Only 10% of respondents (16/157) were aware of any dementia-specific pain assessment tools. The larger the nursing home commitment of the GP the more likely they were to be familiar with these tools (p = 0.048). The majority of respondents (113/157) believed people with dementia could not self-report pain. Respondents were uncertain about the safety of using opioid medications to treat pain in people with dementia with only 51.6% agreeing that they were safe. The qualitative comments highlighted the importance the GPs placed on surrogate reports of pain, GPs’ uncertainty regarding the value of formal pain assessment tools and the challenges caused by under-resourcing in general practice. CONCLUSION: This study has highlighted aspects of pain assessment and management in dementia that GPs find challenging. Guidance on pain assessment and management in people with dementia do not appear to be translating into clinical practice. The findings will inform educational interventions being developed by our research team as part of the implementation of the Irish national dementia strategy. The knowledge and attitudes of general practitioners to the assessment and management of pain in people with dementia.
Increased scrutiny of Ontario’s long-term care sector appears to be improving quality of care, but new enforcement measures could make it harder for some facilities to meet government expectations.
Starting in January 2019, long-term care homes that fail to follow orders to comply with provincial quality standards will face fines up to $10 000 each time those orders are reissued, plus $500 for each additional inspection required until the problem is resolved. The minister of health and long-term care will have new powers to suspend an operator’s licence until concerns are addressed. In the most egregious cases, the government can prosecute operators and fine them up to $200 000 for a first offence and $500 000 for subsequent offences.
Y. H. Jeon, A. N. Casey, K. Vo, K. Rogers, B. Poole and J. Fethney.
Aust Health Rev 2019 Apr;43(2):133-141
To ascertain Australian multistate prevalence and incidence of five commonly collected clinical indicators of aged-care home quality and to measure associations between these clinical indicators and levels of care needs and consumer and staff satisfaction. Methods A retrospective analysis of national audit data collected from 426 facilities between 2015 and 2016 was performed. Regression models were used to examine associations between five clinical indicators (falls, pressure injury, physical restraint, unplanned weight loss and polypharmacy) and level of care needs measured by the Aged Care Funding Instrument (ACFI) and consumer and care staff survey responses. Results With the exception of polypharmacy, commonly collected negative clinical outcomes were rare events. Compared with care homes with /=75% high-ACFI residents reported the highest rates of polypharmacy (odds ratio 1.48, 95% confidence interval 1.39 – 1.57). Falls, unplanned weight loss and pressure injury were inversely associated with satisfaction scores adjusted for residents’ level of care needs. Conclusions This first Australian study of multistate clinical indicator data suggests interpretation of clinical indicators of aged-care home quality requires consideration of the level of residents’ care needs. What is known about the topic? Many Australian aged-care providers use quality indicators (QI) through benchmarking companies or in-house programs. The five most widely used aged-care clinical QIs in Australia are falls, pressure injury, physical restraint, unplanned weight loss and polypharmacy. Prevalence and incidence of these QIs are highly variable among Australian studies. A consistent message in the international literature is that residents’ clinical characteristics influence QI outcomes at baseline and may continue to influence outcomes over time. Study of associations between Australian aged-care home characteristics and QI outcomes has been limited. What does this paper add? This is the first Australian study of multistate clinical QI data. It is also the first to consider the level of resident care needs in the interpretation of clinical QI outcomes and exploration of the association between level of consumer and staff satisfaction and QI outcomes. What are the implications for practitioners? Understanding the connections between aged-care home characteristics, consumer and staff perceptions and clinical QIs is crucial in the meaningful interpretation of QI outcomes in context. With the recent introduction of the National Aged Care Quality Indicator Program, it is timely to review national policy, to gauge current quality of care and the measure of care quality in the sector, and to develop directions for possible research to inform and resolve debates regarding the potential influence and unplanned effects that such a program may have.
T. Woodcock, E. G. Liberati and M. Dixon-Woods.
BMJ Qual Saf 2019 Aug 24
Measurement is an indispensable element of most quality improvement (QI) projects, but it is undertaken to variable standards. We aimed to characterise challenges faced by clinical teams in undertaking measurement in the context of a safety QI programme that encouraged local selection of measures. METHODS: Drawing on an independent evaluation of a multisite improvement programme (Safer Clinical Systems), we combined a qualitative study of participating teams’ experiences and perceptions of measurement with expert review of measurement plans and analysis of data collected for the programme. Multidisciplinary teams of frontline clinicians at nine UK NHS sites took part across the two phases of the programme between 2011 and 2016. RESULTS: Developing and implementing a measurement plan against which to assess their improvement goals was an arduous task for participating sites. The operational definitions of the measures that they selected were often imprecise or missed important details. Some measures used by the teams were not logically linked to the improvement actions they implemented. Regardless of the specific type of data used (routinely collected or selected ex novo), the burdensome nature of data collection was underestimated. Problems also emerged in identifying and using suitable analytical approaches. CONCLUSION: Measurement is a highly technical task requiring a degree of expertise. Simply leveraging individual clinicians’ motivation is unlikely to defeat the persistent difficulties experienced by clinical teams when attempting to measure their improvement efforts. We suggest that more structural initiatives and broader capability-building programmes should be pursued by the professional community. Improving access to, and ability to use repositories of validated measures, and increasing transparency in reporting measurement attempts, is likely to be helpful.
G. Sanz-Tamargo, S. Garcia-Cases, A. Navarro and B. Lumbreras.
Expert Opin Drug Saf 2019 Sep 19:1-8
Inappropriate prescription is a problem related to aging and deprescription could be a possible strategy. The aim of this study was to adapt the available evidence on deprescribing to the medication management of older people living in long-term care facilities. Methods: The authors carried out a bibliographic search based on the most prevalent drugs in our context to develop a specific deprescribing intervention. A committee of experts reviewed this intervention which was later validated through an interobserver variability study. Finally, the authors evaluated it in a sample of patients through a controlled before-after study. Results: The authors included 119 subjects living in a public elderly long-term care center and 122 controls living in a center with similar clinical characteristics. The authors evaluated 852 medications, identifying a total of 175 (20.5%) potentially inappropriate medications and 162 (92.5%) drugs were deprescribed (1.4 per patient). The application of the intervention meant an annual saving of 9.525.25 euro. Conclusion: The implementation of a deprescribing intervention aimed at the most prevalent drugs prescribed in a particular setting improves the appropriateness of pharmacotherapy in the patients.
I. Baranska, V. Kijowska, Y. Engels, et al.
J Am Med Dir Assoc 2019 Sep 11
To examine factors associated with perceived quality of communication with physicians by relatives of dying residents of long-term care facilities (LTCFs). DESIGN: A cross-sectional retrospective study in a representative sample of LTCFs conducted in 2015. In each LTCF, deaths of residents during the 3 months before the researcher’s visit were reported. Structured questionnaires were sent to the identified relatives of deceased residents. SETTINGS AND PARTICIPANTS: A total of 736 relatives of deceased residents in 210 LTCFs (in Belgium, Finland, Italy, the Netherlands, and Poland). METHODS: The Family Perception of Physician-Family Communication scale (FPPFC) was used to assess the quality of end-of-life (EOL) communication with physicians as perceived by relatives. We applied multilevel linear regression models to find factors associated with the FPPFC score. RESULTS: The quality of EOL communication with physicians was perceived by relatives as higher when the relative spent more than 14 hours with the resident in the last week of the resident’s life (b = 0.205; P = .044), and when the treating physician visited the resident at least 3 times in the last week of the resident’s life (b = 0.286; P = .002) or provided the resident with palliative care (b = 0.223; P = .003). Relatives with higher emotional burden perceived the quality of EOL communication with physicians as lower (b = -0.060; P < .001). These results had been adjusted to countries and LTCF types with physicians employed on-site or off-site of the facility. CONCLUSION: The quality of EOL communication with physicians, as perceived by relatives of dying LTCF residents, is associated with the number of physician visits and amount of time spent by the relative with the resident in the last week of the resident’s life, and relatives’ emotional burden. IMPLICATIONS: LTCF managers should organize care for dying residents in a way that enables frequent interactions between physicians and relatives, and emotional support to relatives to improve their satisfaction with EOL communication.
E. Cote-Boileau, J. L. Denis, B. Callery and M. Sabean.
Health Res Policy Syst 2019 Sep 13;17(1):84-019-0482-6
Innovation has the potential to improve the quality of care and health service delivery, but maximising the reach and impact of innovation to achieve large-scale health system transformation remains understudied. Interest is growing in three processes of the innovation journey within health systems, namely the spread, sustainability and scale-up (3S) of innovation. Recent reviews examine what we know about these processes. However, there is little research on how to support and operationalise the 3S. This study aims to improve our understanding of the 3S of healthcare innovations. We focus specifically on the definitions of the 3S, the mechanisms that underpin them, and the conditions that either enable or limit their potential. We conducted a scoping review, systematically investigating six bibliographic databases to search, screen and select relevant literature on the 3S of healthcare innovations. We screened 641 papers, then completed a full-text review of 112 identified as relevant based on title and abstract. A total of 24 papers were retained for analysis. Data were extracted and synthesised through descriptive and inductive thematic analysis. From this, we develop a framework of actionable guidance for health system actors aiming to leverage the 3S of innovation across five key areas of focus, as follows: (1) focus on the why, (2) focus on perceived-value and feasibility, (3) focus on what people do, rather than what they should be doing, (4) focus on creating a dialogue between policy and delivery, and (5) focus on inclusivity and capacity building. While there is no standardised approach to foster the 3S of healthcare innovations, a variety of practical frameworks and tools exist to support stakeholders along this journey.
E. J. Morrison, J. Middleton, S. Lanza, et al.
Epidemiol Infect 2019 Aug 5;147:e250
Currently no national guidelines exist for the management of scabies outbreaks in residential or nursing care homes for the elderly in the United Kingdom. In this setting, diagnosis and treatment of scabies outbreaks is often delayed and optimal drug treatment, environmental control measures and even outcome measures are unclear. We undertook a systematic review to establish the efficacy of outbreak management interventions and determine evidence-based recommendations. Four electronic databases were searched for relevant studies, which were assessed using a quality assessment tool drawing on STROBE guidelines to describe the quality of observational data. Nineteen outbreak reports were identified, describing both drug treatment and environmental management measures. The quality of data was poor; none reported all outcome measures and only four described symptom relief measures. We were unable to make definitive evidence-based recommendations. We draw on the results to propose a framework for data collection in future observational studies of scabies outbreaks. While high-quality randomised controlled trials are needed to determine optimal drug treatment, evidence on environmental measures will need augmentation through other literature studies. The quality assessment tool designed is a useful resource for reporting of outcome measures including patient-reported measures in future outbreaks.
G. Strauven, K. Vanhaecht, P. Anrys, J. De Lepeleire, A. Spinewine and V. Foulon.
Res Social Adm Pharm 2019 Sep 5
Medication errors in nursing homes are highly prevalent and occur in different stages of the medicines pathway. The application of the SEIPS (System Engineering Initiative for Patient Safety) model facilitates the identification of work system factors that contribute to errors. Therefore, the aim of our research was to investigate in-depth the medicines pathway in nursing homes by using the SEIPS model and to develop a set of key activities and aggregated key interventions to be used as a basis for quality-improvement strategies. METHODS: A variety of qualitative methods, including observations, semi-structured interviews, the development of a flowchart, an expert meeting and a working symposium, were used to identify processes and work system components. Key interventions and activities were developed in three rounds (one development and two validation rounds) across the different research methods to fine-tune the defined key interventions and activities. RESULTS: Our analysis revealed a large variety of tasks as well as persons elements, aspects related to technology and tools, organisational factors and environmental elements that all interact and influence the medicines pathway. The large number of tasks could be linked to eight overarching processes: prescribing, purchase and ordering, delivery, storage, preparation, administration, monitoring and (re-)admission. After three rounds (one development and two validation rounds), a final set of 137 key activities and 27 aggregated key interventions, concretising the eight processes, was obtained. CONCLUSION: The in-depth analysis of processes within the medicines pathway in nursing homes resulted in a set of key activities and aggregated key interventions which may serve as a basis for the nursing home sector and policy makers to enhance a safe and efficient medicines pathway.
C. R. Kovach, M. Putz, B. Guslek and R. McInnes.
Pain Manag Nurs 2019 Sep 13
Pain, agitation, and thermal discomfort are common symptoms of older adults residing in nursing homes. Nonpharmacologic interventions are recognized as a best practice strategy for people living in nursing homes because of their low adverse effect profile and increased evidence of effectiveness. Warmed blankets have not been empirically tested for use in long-term care. AIMS: The purpose of this quality improvement project was to describe the use of warmed blankets in a nursing home setting and determine if use was associated with changes in pain, agitation, mood, or analgesic use. DESIGN: A pretest posttest design was used along with a comparison of intact groups. SETTINGS: The setting was one 160-bed skilled long-term care facility. PARTICIPANTS/SUBJECTS: There were 141 residents eligible since they did not have a condition that could be worsened by superficial heat. METHODS: Warmed blankets were unfolded and placed over residents with pain, agitation, or thermal discomfort. Short-term pain measures included use of the Revised FACES Pain Scale, the PAINAD (Pain Assessment in Advanced Dementia) scale, and the Brief Agitation Rating Scale. Long-term measures were taken from the electronic medical record. RESULTS: Of the 141 eligible residents, 24.1% (n = 34) received a warmed blanket over the 1- month study period. There were statistically significant decreases in both pain level and agitation among baseline, 20 minutes after application, and the subsequent shift assessments (p < .001). There were also long-term changes in the number of pain complaints (p = .040), severity of pain complaints (p = .009), and as-needed analgesic use (p = .011). There were no statistically significant differences between the treated group and comparison group on any long-term measures. CONCLUSIONS: Warmed blankets are a low-cost intervention with a high potential for bringing comfort to nursing home residents.
J Aging Health 2019 Sep 13:898264319870090
The objective of this review is to outline a comprehensive set of possible design interventions focusing on spatial and environmental design factors influencing positive social interaction, which is one of the key aspects of quality of life (QoL) in long-term care facilities (LTCFs). Methods: This systematic literature review synthesized research evidence from seven databases (after the year 2000) spanning medical and health literature, environmental psychology, architecture, interior design, and evidence-based design literature. Results: The key spatial design characteristics of the facilities shown to affect positive social interaction were as follows: (a) The Physical Environment and Setting; (b) Accessibility, Legibility, and Layout; (c) Social Environment and Network; and (d) Staff-Resident Ratio and Care Philosophy. Conclusion: Several critical spatial design features of the facilities were identified. Spatial design interventions could influence the design decisions for future care facilities and provide designers the guidelines that are generalizable regardless of geographic location of the LTCF.
Isr J Health Policy Res 2019 Mar 7;8(1):28-019-0301-0
Fake bus stops are one strategy to keep persons with dementia (PwD) from wandering. By setting up authentic looking shelters and benches in hallways or gardens, nursing homes create the illusion of bus stops, for the purpose of preventing wandering PwD from leaving the facility and getting lost. By attracting wandering PwD to sit down and wait for the bus, they can be supervised more easily by caregivers. However, concerns are expressed that the use of fake bus stops could cause more harm than good for PwD, due to their deceptive nature and the potential stigmatisation of individuals seated at a fake bus stop. This article discusses the ethical aspects of using fake bus stops and outlines considerations prior to setting up fake bus stops in nursing homes in keeping with good clinical practice in dementia care. Moreover, the article assesses whether or not fake bus stops can be ethically justifiable, and if so, how they can be ethically justified and implemented in Israeli and other facilities for PwD.
A. L. Gilmore-Bykovskyi and N. Rogus-Pulia.
J Nutr Health Aging 2018;22(3):400-406
Dysphagia, or impaired swallowing, is common in nursing home (NH) residents with dementia and contributes to malnutrition and diminished quality of life. Dysphagia also commonly leads to aspiration or passage of food or fluids into the airway, which can result in aspiration pneumonia-a leading cause of death for people with dementia. Currently available interventions for dysphagia aim to modify the risk of aspiration events primarily by modifying diet and positioning to improve the safety of an individual’s swallow. However other potentially modifiable contextual factors relevant to mealtime care within NH settings that may influence the occurrence of aspiration events, such as the nature of caregiving interactions or occurrence of dementia-related behavioral symptoms, have not been examined. To address this gap, we examined the temporal associations between caregiving approach and behavioral symptoms as antecedents to observable indicators of aspiration among nursing home (NH) residents with dementia. DESIGN: Secondary analysis of coded, timed-event behavioral data from 33 video-recorded observations of mealtime interactions between NH residents with dementia and caregivers. SETTING/PARTICIPANTS: Residents with dementia who required assistance with mealtime care (n=12) and nursing assistants (n=8) from Memory Care Units (MCU) in 2 Midwestern NHs. RESULTS: Observable indicators of aspiration were significantly more likely to occur during or following task-centered caregiver actions than person-centered actions (12% likelihood; Yule’s Q 0.89; OR 95% CI 12.70-23.75) and 15-30 seconds after a behavioral symptom (5% likelihood; Yule’s Q 0.65; OR 95% CI 4.18-8.57). CONCLUSIONS: These findings provide compelling preliminary evidence that caregiver approach may influence the occurrence of aspiration. Provided the urgent need for more approaches to mitigate the complications associated with dysphagia in people with dementia, even a moderate reduction in aspiration events may be clinically meaningful. Further, well-designed observational studies with individuals with well-characterized dysphagia are needed to better understand and characterize these relationships, their temporal structures and their impacts on other relevant outcomes such as eating performance and malnutrition.
F. Hoffmann, A. Strautmann and K. Allers.
BMC Palliat Care 2019 Sep 10;18(1):77-019-0462-1
Half of nursing home residents (NHR) suffer from dementia. End-of-life hospitalizations are often burdensome in residents with dementia. A systematic review was conducted to study the occurrence of hospitalizations at the end of life in NHR with dementia and to compare these figures to NHR without dementia. METHODS: A systematic literature search in MEDLINE, CINAHL and Scopus was conducted in May 2018. Studies were included if they reported proportions of in-hospital deaths or hospitalizations of NHR with dementia in the last month of life. Two authors independently selected studies, extracted data, and assessed quality of studies. RESULTS: Nine hundred forty-five citations were retrieved; 13 studies were included. Overall, 7 studies reported data on in-hospital death with proportions ranging between 0% in Canada and 53.3% in the UK. Studies reporting on the last 30 days of life (n = 8) varied between 8.0% in the Netherlands and 51.3% in Germany. Two studies each assessed the influence of age and sex. There seem to be fewer end-of-life hospitalizations in older age groups. The influence of sex is inconclusive. All but one study found that at the end of life residents with dementia were hospitalized less often than those without (n = 6). CONCLUSIONS: We found large variations in end-of-life hospitalizations of NHR with dementia, probably being explained by differences between countries. The influence of sex and age might differ when compared to residents without dementia. More studies should compare NHR with dementia to those without and assess the influence of sex and age. TRIAL REGISTRATION: PROSPERO registration number CRD42018104263 .
A. H. Lavan, D. O’Mahony and P. Gallagher.
Eur J Clin Pharmacol 2019 May;75(5):723-731
STOPPFrail criteria highlight instances of potentially inappropriate medications (PIMs) in frailer older adults with poor 1-year survival prognosis. The objectives of this study were to (i) determine the proportion of older adults requiring long-term nursing care in whom STOPPFrail criteria are applicable, (ii) measure the prevalence of STOPPFrail PIMs, and (iii) identify risk factors for PIMs in this cohort. METHODS: We retrospectively reviewed applications for long-term nursing care to nursing homes in the Cork area over a 6-month period. We recorded diagnoses, medications, functional status, cognitive ability, frailty status, and applied STOPPFrail criteria as appropriate. RESULTS: We reviewed 464 applications; 38 were excluded due to incomplete information and 274 patients (64.3%) met STOPPFrail eligibility criteria (median age 83 years (IQR 77.25-88); 233 (54.7%) female). Those STOPPFrail eligible were prescribed 2194 medications (mean 8, (SD 4)), of which 828 (37.7%) were PIMs. At least one PIM was identified in 250 eligible patients (91.2%). The median number of PIMs was 3 (IQR 2-4), the most common being (i) medications without clear indication identified in 47.0% (n = 129) of patients, (ii) long-term high-dose proton pump inhibitors in 31.4% (n = 86), and (iii) statins in 29.6% (n = 81). For every additional medication prescribed, the odds of identifying a PIM increased by 58% (odds ratio 1.58, 95% CI 1.32-1.89, p < 0.001). CONCLUSION: Almost 65% of patients awaiting long-term care are eligible for the application of STOPPFrail criteria with over 90% prescribed at least one PIM. Transition to nursing home care represents an opportunity to review therapeutic appropriateness and goals of prescribed medications.
I. D. Maidment, S. Damery, N. Campbell, et al.
BMC Psychiatry 2018 Oct 19;18(1):340-018-1907-4
“Behaviour that Challenges” is common in people living with dementia, resident in care homes and historically has been treated with anti-psychotics. However, such usage is associated with 1800 potentially avoidable deaths annually in the UK. This study investigated the feasibility of a full clinical trial of a specialist dementia care pharmacist medication review combined with a health psychology intervention for care staff to limit the use of psychotropics. This paper focuses on feasibility; including recruitment and retention, implementation of medication change recommendations and the experiences and expectations of care staff. METHODS: West Midlands care homes and individuals meeting the inclusion criteria (dementia diagnosis; medication for behaviour that challenges), or their personal consultee, were approached for consent. A specialist pharmacist reviewed medication. Care home staff received an educational behaviour change intervention in a three-hour session promoting person-centred care. Primary healthcare staff received a modified version of the training. The primary outcome measure was the Neuropsychiatric Inventory-Nursing Home version at 3 months. Other outcomes included quality of life, cognition, health economics and prescribed medication. A qualitative evaluation explored expectations and experiences of care staff. RESULTS: Five care homes and 34 of 108 eligible residents (31.5%) were recruited, against an original target of 45 residents across 6 care homes. Medication reviews were conducted for 29 study participants (85.3%) and the pharmacist recommended stopping or reviewing medication in 21 cases (72.4%). Of the recommendations made, 57.1% (12 of 21) were implemented, and implementation (discontinuation) took a mean of 98.4 days. In total, 164 care staff received training and 21 were interviewed. Care staff reported a positive experience of the intervention and post intervention adopting a more holistic patient-centred approach. CONCLUSIONS: The intervention contained two elements; staff training and medication review. It was feasible to implement the staff training, and the training appeared to increase the ability and confidence of care staff to manage behaviour that challenges without the need for medication. The medication review would require significant modification for full trial partly related to the relatively limited uptake of the recommendations made, and delay in implementation. TRIAL REGISTRATION: ISRCTN58330068 . Registered 15 October 2017. Retrospectively registered.
P. A. Boyd, S. E. Wilks and J. R. Geiger.
Health Soc Work 2018 May 1;43(2):101-108
The purpose of this study was to conduct psychometric reevaluation of the Bristol Activities of Daily Living Scale (BADL) among a population logistically difficult to observe beyond cross-sectional analysis: nursing home residents with advanced dementia (AD). Data from observation-based measures were collected by nursing home staff at two intervals within a three-month time frame among 43 residents identified with AD via medical records and nursing home staff. Three broad properties of BADL were examined: factor structure, reliability, and validity. Principal components analysis determined underlying components. BADL internal consistency was assessed by Cronbach’s and Guttman coefficients; test-retest reliability was also observed. Convergent validity was assessed by correlating BADL with theoretically linked measures of quality of life (QOL) and social engagement. Compared with the original evaluation, BADL showed inconsistent factor structure at interval 1 but comparable at interval 2. Reliability coefficients at both intervals were robust and comparable to the original evaluation. BADL demonstrated significant convergence with QOL and social engagement. Psychometric potency of BADL was confirmed, suggesting practice applicability with this AD population. Future research calls for further examination of tools to guide effective interventions with this vulnerable population.
The Butterfly Model for long-term residential care has received a great deal of attention recently, especially in the Toronto media.
Based on 10 years of international, interdisciplinary research and on a recent study conducted for the City of Toronto, this webinar considers the central principles in popular models for care, the evidence that supports them and recommendations related to them.
Thursday, 10 October 10:00-11:00 MT
Presenter: Nancy Salbach
1. To describe development of a theory-based toolkit to facilitate adoption of an evidence-informed approach to walking evaluation post-stroke by physical therapists
2. To summarize the results of a multi-site uncontrolled mixed methods study that examined practice change after provision of the toolkit
3. To discuss the implications of findings for implementation science in the context of stroke rehabilitation
Tuesday 8 October 16:00 Edmonton Clinic Health Academy (ECHA) – Room 1-182
Presenter: Sube Banerjee
Dr Banerjee is active in health system development and works with industry and governments on health systems, policy and strategies to improve health for older adults with complex needs and those with dementia. An active researcher, he focusses on quality of life in dementia, evaluation of new treatments and services, and the interface between policy, research and practice. He has been awarded national and international awards for work in policy and research in dementia.
Thursday 10 October 12:00 Edmonton Clinic Health Academy (ECHA) – Room 1-182
Presenter: Kate de Medeiros
Kate de Medeiros (Associate Professor, the Robert H. and Nancy J. Blayney Professor Gerontology), received her PhD in gerontology from the University of Maryland Baltimore County in 2006. Her research interests are concerned with cultural structures affecting the experience of aging and the construction of self such as autobiographical writing, as well as personhood in people with dementia. In 2008, de Medeiros received one of only four Brookdale Leadership in Aging Research. Her research has also been funded by the Alzheimer’s Association and the National Institute of Aging. In addition to numerous research articles, she recently published Narrative Gerontology in Research and Practice.
This FREE online course is all about human-centred design, the process of design thinking and its application in health + care.
This course will give you the foundation to begin a project using the tools and skills of a designer. Not ready for that big project? Don’t fret! We will provide you with many insights, tips, tricks and tools that you can use in your everyday work.
Oct 16: Introduction to Design
Oct 23: Starting with Empathy
Oct 30: The User Journey
Nov 06: Ideation and Analogies
Nov 13: Prototypes
Nov 20: Testing + Feedback
Nov 27: Bringing it All Together
During each one-hour session you will work on your health + care problem with the advice and teaching of our exciting roster of speakers who have each been making great strides in the world of design thinking. You will also have the opportunity for one-on-one coaching with Design Lab consultants.
1. To develop an understanding of the need for, and utility of rapid reviews as useful knowledge synthesis product;
2. To develop an appreciation of rapid reviews by detailing their underlying methodology;
3. To explore practical issues that have emerged from our experiences in conducting rapid reviews as part of our centre’s knowledge synthesis services and methods research.
Department of Health Services Research and Policy at the Australian National University, Canberra, Australia
DEADLINE: 13 October
The Department of Health Services Research and Policy at the Australian National University, Canberra, Australia, is seeking to appoint an economist/health economist with expertise in economic evaluation to join our team to work on a number of research projects as part of the newly established Health Policy Lab.
Experience also in policy field experiments or economic laboratory experiments or realist synthesis and evaluation, or implementation science would be advantageous.
This is an excellent opportunity for a highly motivated researcher to join and make a significant contribution to a growing and vibrant multidisciplinary team, work to deliver high quality research designed to have impact, based at one of the world’s top universities.
Nova Scotia Health Authority and IWK Health Centre, Halifax, NS
DEADLINE: Open until filled
A postdoctoral fellowship is available under the supervision of Christine Chambers, PhD RPsych in the area of children’s pain management with a focus on knowledge translation and patient engagement.
Dr. Christine Chambers is the Canada Research Chair (Tier 1) in Children’s Pain and a Killam Professor in Pediatrics and Psychology and Neuroscience at Dalhousie University. She is the Principal Investigator of the “It Doesn’t Have To Hurt” research lab in the Centre for Pediatric Pain Research at the IWK Health Centre (www.itdoesnthavetohurt.ca). She is also the Scientific Director of a national knowledge mobilization network, Solutions for Kids in Pain/Solutions pour la douleur chez les enfants (SKIP) (www.kidsinpain.ca). Her research focuses on the developmental, psychological, and social influences on children’s pain and spans knowledge generation (e.g., original studies), synthesis (e.g., systematic review, guidelines), and translation (e.g., policy, public outreach).
The postdoctoral fellow will participate in ongoing, planned, and new studies within the context of an active and well-networked research team and develop their own independent research program within this context. They will receive experience and training in conducting research, data analysis, grant writing, presentations and manuscript preparation, knowledge translation, science communication and social media, patient engagement, partnership development, guideline and public policy development, student mentorship, and staff management. This position will help prepare the fellow for a clinician-scientist or academic career. Opportunities to become involved with knowledge mobilization activities as part of the Solutions for Kids in Pain (SKIP) network, which is based at Dalhousie University, are also available.
Nova Scotia Health Authority and IWK Health Centre, Halifax, NS
DEADLINE: Open Until Filled
The Research Manager will provide research management support to Dr. Christine Chambers, Canada Research Chair (Tier 1) in Children’s Pain and Killam Professor in the Departments of Pediatrics and Psychology and Neuroscience and will be responsible for the general management and administration of the “It Doesn’t Have To Hurt” research lab, based in the Centre for Pediatric Pain Research at the IWK Health Centre. The Research Manager will also work with other members of the lab including a multidisciplinary team of trainees (e.g., post-doctoral fellows, graduate students, undergraduate students, medical students), staff (e.g., research associates, research coordinators, research assistants, volunteers, etc.), patient partners, and other stakeholders. Responsibilities will include (but are not limited to), grant and financial management (e.g., account management, budgeting and forecasting, funding transfers, research expense management and reimbursements, invoices, etc.), lab equipment and facilities management, lab meetings and event coordination, lab communications (e.g., team updates, website, social media), staff, student, patient partner, volunteer management (e.g., HR, payroll, onboarding), maintenance and organization of files and record-keeping (both paper and electronic), travel organization and reimbursements, and project development and coordination, etc.