October 8, 2019

We will provide insights in the theoretical background and key concepts of a Narrative Care approach, such as narrative cultures, narrative curiosity, narrative co-composition and narrative reflective practice. BACKGROUND: Care understood as narrative practice underscores the importance of experiences and how these shape identities. Important to the quality of care in institutional care settings is the ability of care providers to cope with complexities and uncertainties in older adults’ stories, which can be realised by attending to ways that foster and co-compose evolving and forward-looking narratives. Recognising these ongoing co-compositions means that persons living in institutional care settings and care providers live, tell, retell and relive their experiences. A change in the current institutional culture is necessary to implement care as narrative practice. To support such a change, approaches are needed that foster a focus on experiences and relationships and make relational ethics central to care. METHODS: The proposed Narrative Care approach is the result of an iterative development process involving a literature review, interviews with, and observations of, care providers, dialogues with an advisory committee, and consultation with experts. MAIN CONTRIBUTIONS: The proposed Narrative Care approach aims to help care providers (a) to recognise the importance of curiosity in a person’s verbal and embodied narratives-especially for those living with dementia; (b) to take note of individual experiences in all of their complexity and uncertainty; (c) to respect these narratives; (d) to open up spaces to co-compose new narratives; and (e) to allow care providers to engage in narrative reflective practices that shape who they are and are becoming. CONCLUSION: The introduced approach responds to the need of implementing strategies to think and work narratively in institutional care settings. IMPLICATIONS FOR PRACTICE: Narrative Care has the potential to reshape task-oriented, technical notions of care. Concepts such as embodied narratives, relational ethics, narrative co-composition and narrative reflective practice must be integrated in the education of all care providers.

To summarise the available evidence on the factors influencing communication about frailty in the primary care setting. METHODS: We conducted a scoping review, searching five electronic databases (PubMed, Scopus, CINAHL, PsycINFO, and ProQuest) for studies addressing communication about frailty in primary care practice. Reference list and grey literature searching was conducted to identify additional articles. A narrative descriptive method was used to synthesise the findings. RESULTS: The search identified 3185 articles and 37 were included in the review. We identified five categories of factors influencing communication about frailty at the consumer, healthcare provider, and system levels: (1) consumer perceptions, information needs, and communication preferences; (2) healthcare providers’ knowledge, capacities, and attitudes; (3) clinical communication skills and training; (4) availability of information and communication technologies; and (5) care coordination, collaboration, and case management. CONCLUSION: Findings offer considerations for the design and delivery of initiatives to improve communication about frailty in primary care both at the local clinical level and at the broader level of healthcare service delivery. PRACTICE IMPLICATIONS: Healthcare providers and systems require practical, evidence-informed guidance regarding the development of a systematic approach to the quality and timing of communication about frailty in healthcare encounters.

EDITORIAL
Co-creative approaches to knowledge production: what next for bridging the research to practice gap? [Open Access]
Metz, Allison; Boaz, Annette; Robert, Glenn
RESEARCH
Co-creative technical assistance: essential functions and interim outcomes [Open Access]
Yazejian, Noreen; Metz, Allison; Morgan, Jenille; Louison, Laura; Bartley, Leah; Fleming, William Oscar; Haidar, Lama; Schroeder, Jennifer
Towards a heart and soul for co-creative research practice: a systemic approach [Open Access]
Nicholas, Graeme; Foote, Jeff; Kainz, Kirsten; Midgley, Gerald; Prager, Katrin; Zurbriggen, Cristina
Building trust and sharing power for co-creation in Aboriginal health research: a stakeholder interview study [Open Access]
Sherriff, Simone Louise; Miller, Hilary; Tong, Allison; Williamson, Anna; Muthayya, Sumithra; Redman, Sally; Bailey, Sandra; Eades, Sandra; Haynes, Abby
DEBATE
Drawing straight lines along blurred boundaries: qualitative research, patient and public involvement in medical research, co-production and co-design [Open Access]
Louise, Locock; Annette, Boaz
PRACTICE
Key issues in co-creation with stakeholders when research problems are complex [Open Access]
Bammer, Gabriele
An experimental evaluation tool for the Public Innovation Lab of the Uruguayan government [Open Access]
Zurbriggen, Cristina; Lago, Mariana González

Supporting gender equity for women working in geriatrics is important to the growth of geriatrics across disciplines and is critical in achieving our vision for a future in which we are all able to contribute to our communities and maintain our health, safety, and independence as we age. Discrimination can have a negative impact on public health, particularly with regard to those who care for the health of older Americans and other vulnerable older people. Women working in the field of geriatrics have experienced implicit and explicit discriminatory practices that mirror available data on the entire workforce. In this position article, we outline strategic objectives and accompanying practical recommendations for how geriatrics, as a field, can work together to achieve a future in which the rights of women are guaranteed and women in geriatrics have the opportunity to achieve their full potential. This article represents the official positions of the American Geriatrics Society.

The 2020 CADTH Symposium will be held at the Sheraton Centre Toronto Hotel in Toronto, Ontario from April 19 to 21, 2020. The theme is Decision-Making in an Age of Uncertainty. Topics relevant to this theme include, but are not limited to:
methods to address uncertainty
disinvestment
innovative payment schemes
decision-making by patients, clinicians, and policy-makers
implementation issues
managing uncertainty.
The CADTH Symposium is widely considered a “must attend” event for anyone with an interest in the assessment, uptake, and management of drugs and medical devices in Canada. The CADTH Symposium typically attracts 750 to 900 delegates from across Canada and beyond, including health researchers; health economists; senior leaders from government, regional health authorities, hospitals, and other facilities; clinicians and patients; students; and industry representatives. With the Symposium in 2020 being held in Toronto for the very first time, we are anticipating 1,000 to 1,200 delegates. As one of the major health technology assessment conferences in the world, the CADTH Symposium offers a unique opportunity for delegates to learn from local, national, and international experts, and to share expertise and knowledge.

Using research findings in clinical practice is a cornerstone in improving the quality of care, but nurses face different barriers in doing so. PURPOSE: The purpose was to explore barriers to research utilization in clinical practice as perceived by nurses. METHOD: A cross-sectional survey was done using a convenience sampling method in a single specialist hospital in Saudi Arabia. The Barriers to Research Utilization questionnaire was used to collect data. RESULTS: The mean overall score (out of 4) for the Barriers questionnaire was 2.67 (SD = 0.47). The 3 most reported barriers were lack of time, physician cooperation, and other staff support. Nurses working in pediatric and maternity units reported more barriers. CONCLUSION: Clinical setting factors are those most perceived by nurses as barriers to integrating research into practice. Reforms in the clinical areas should take place to overcome these barriers.

Bespoke electronic information management systems are being used for large-scale implementation delivery of population health programs. They record sites reached, coordinate activity, and track target achievement. However, many systems have been abandoned or failed to integrate into practice. We investigated the unusual endurance of an electronic information management system that has supported the successful statewide implementation of two evidence-based childhood obesity prevention programs for over 5 years. Upwards of 80% of implementation targets are being achieved. METHODS: We undertook co-designed partnership research with policymakers, practitioners, and IT designers. Our working hypothesis was that the science of getting evidence-based programs into practice rests on an in-depth understanding of the role programs play in the ongoing system of local relationships and multiple accountabilities. We conducted a 12-month multisite ethnography of 14 implementation teams, including their use of an electronic information management system, the Population Health Information Management System (PHIMS). RESULTS: All teams used PHIMS, but also drew on additional informal tools and technologies to manage, curate, and store critical information for implementation. We identified six functions these tools performed: (1) relationship management, (2) monitoring progress towards target achievement, (3) guiding and troubleshooting PHIMS use, (4) supporting teamwork, (5) evaluation, and (6) recording extra work at sites not related to program implementation. Informal tools enabled practitioners to create locally derived implementation knowledge and provided a conduit between knowledge generation and entry into PHIMS. CONCLUSIONS: Implementation involves knowing and formalizing what to do, as well as how to do it. Our ethnography revealed the importance of hitherto uncharted knowledge about how practitioners develop implementation knowledge about how to do implementation locally, within the context of scaling up. Harnessing this knowledge for local use required adaptive and flexible systems which were enabled by informal tools and technologies. The use of informal tools also complemented and supported PHIMS use suggesting that both informal and standardized systems are required to support coordinated, large-scale implementation. While the content of the supplementary knowledge required to deliver the program was specific to context, functions like managing relationships with sites and helping others in the team may be applicable elsewhere.

Audit and feedback (A&F) is more effective if it facilitates action planning, but little is known about how best to do this. We developed an electronic A&F intervention with an action implementation toolbox to improve pain management in intensive care units (ICUs); the toolbox contained suggested actions for improvement. A head-to-head randomised trial demonstrated that the toolbox moderately increased the intervention’s effectiveness when compared with A&F only. OBJECTIVE: To understand the mechanisms through which A&F with action implementation toolbox facilitates action planning by ICUs to increase A&F effectiveness. METHODS: We extracted all individual actions from action plans developed by ICUs that received A&F with (n = 10) and without (n = 11) toolbox for 6 months and classified them using Clinical Performance Feedback Intervention Theory. We held semi-structured interviews with participants during the trial. We compared the number and type of planned and completed actions between study groups and explored barriers and facilitators to effective action planning. RESULTS: ICUs with toolbox planned more actions directly aimed at improving practice (p = 0.037) and targeted a wider range of practice determinants compared to ICUs without toolbox. ICUs with toolbox also completed more actions during the study period, but not significantly (p = 0.142). ICUs without toolbox reported more difficulties in identifying what actions they could take. Regardless of the toolbox, all ICUs still experienced barriers relating to the feedback (low controllability, accuracy) and organisational context (competing priorities, resources, cost). CONCLUSIONS: The toolbox helped health professionals to broaden their mindset about actions they could take to change clinical practice. Without the toolbox, professionals tended to focus more on feedback verification and exploring solutions without developing intentions for actual change. All feedback recipients experienced organisational barriers that inhibited eventual completion of actions. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02922101 . Registered on 26 September 2016.

To compare publicly available information on aged care systems in 7 countries to determine the degree of transferability for research on aged care between these countries. DESIGN: A cross-country comparative analysis. SETTING: Aged care systems in 7 countries classified as liberal welfare states (Australia, Canada, Japan, New Zealand, Switzerland, United Kingdom, and United States). MEASURES: This study involved the search and review of international data sets, government reports and national statistics, and relevant peer-reviewed literature. Information was extracted for 24 variables at the macro (societal), meso (organizational), and micro (individual) levels to enable a multilevel comparison of aged care systems in each country. RESULTS: The structured search identified 63 relevant documents. All 7 countries included in the review were overall generally comparable across the 3 domains with some expected variations. Comparison of information was not possible for all variables owing to a paucity of publicly available information reported in a consistent manner. Using Australia as a reference point, Canada and New Zealand were the most comparable with Australia, followed by the United Kingdom, United States, and Switzerland. Japan was the least comparable country with Australia based on the variables considered. CONCLUSIONS AND IMPLICATIONS: This is the most recent collation and detailed comparison of national-level information on aged care systems in countries classified as liberal welfare states. This information provides policy makers in these countries the data necessary to determine the degree contemporary research findings from another country are transferable to their local aged care system. Efforts to improve the health, well-being, and quality of care for older people continue to be hampered by the overall paucity of consistently reported standardized data to enable valid international comparisons. Optimal use of standardized data also requires developing explicit criteria to describe the key factors to be considered in determining transferability of an intervention from 1 country to another.

Practice transformation efforts in healthcare, like the patient-centred medical home model in primary care, have spurred the development of multiple quality improvement (QI) and implementation strategies to support effective change. Nonetheless, uncertainty about how to implement and sustain change in complex healthcare settings continues to pose significant challenges. Even when practices are receptive, limited QI expertise, constrained resources, and associated staff morale and burnout can impact success. Although efforts among clinicians to improve primary care by embracing a culture of QI continue, healthcare systems are increasingly hiring additional personnel, like practice facilitators, with key performance improvement skills to promote and support change.

This study aimed to illuminate nurses’ experience of continence care for older people receiving home care, either in their own home or in an assisted living facility. BACKGROUND: Registered Nurses (RNs) have a major role to play in identifying and establishing appropriate actions regarding continence care for older people. However, the crucial nursing care pathway for continence care is commonly described as poor. METHODS: Interviews were conducted with 11 RNs providing home care, and the transcribed texts were analysed using inductive content analysis. RESULT: The impressions of RNs were categorised according to four themes: perceptions of continence care, an open approach to continence care, the need for personalised aid fittings and the importance of teamwork in continence care. Key findings were the importance of teamwork; the need for nurses to embrace leadership at the point of care and be more visible in terms of the provision of direct care; substantiation that evidence-based interventions, such as scheduled toileting and prompted voiding, should constitute the norm in continence care within the context of home care; and the need for nurses to support the right of older persons to receive an assessment of their continence problems, deemed to be the minimum standard of quality care. CONCLUSION: The provision of continence care that is based on key nursing standards, such as evidence-based and person-centred care, as well as individualised continence care that is based on evidenced-based guidelines, would ensure an improvement in the continence care that is presently on offer to older people. IMPLICATIONS FOR PRACTICE: Nurses need to embrace leadership at the point of care and to be more visible with the provision of direct care in order to improve continence care for older people receiving home care.

In French care facilities for dependent aged people (NHDAP), prevalence of pain among residents with dementia is high, and source of behavior disturbances and quality of life impairment. However, in spite of many international expert statements, pain remains under-assessed and under-managed in these patients. Certified nursing assistants (CNA) are on the front-line in NHDAP to detect the presence of pain in residents with communication difficulties, while they received little training for pain management and directives for specific care. Moreover, no studies were presently devoted to the impact of demographic and socio-professional determinants of CNA on pain assessment. In our study, we assessed the presence and intensity of pain in cognitively impaired residents in NHDAP, by CNA performing as a pair for the morning care. 42 pairs were recruited and independently completed a standardized behavioral assessment for pain (Doloplus scale) as well as a numeric rating scale. CNA personal characteristics were investigated to analyse the determinants of potential assessment discrepancies between each of the pairs. Presence of pain was detected in 51.1 to 91.1% of the patients depending on the tool and analysis criteria. In 28.9% important discrepancies were observed in the pain assessment between the CNA pairs, which could be related to professional status and prior use of the observational assessment. These inter-rater discrepancies should be reduced providing clear pain assessment guidelines for CNA in NHDAP, and further studies should be completed to figure out the role of CNA personal determinants in the patients’ pain assessment.

This cross-sectional multilevel study aims at investigating the associations between psychosocial working conditions of different workplace levels and perceived physical exertion among eldercare workers. Data were obtained from the ‘Danish Observational Study of Eldercare work and musculoskeletal disorderS’ (DOSES) study, including 536 eldercare workers, nested in 126 wards and 20 nursing homes. Psychosocial working conditions were measured by the Copenhagen Psychosocial Questionnaire (COPSOQ). The physical workload was measured with a self-administered scale (0-10) rating perceived physical exertion. Multilevel linear mixed models were used to determine associations of psychosocial conditions between nursing homes, wards, and workers with physical exertion. Most of the variance in the perceived physical exertion was explained by differences between workers (83%), but some variance was explained by wards (11%) and nursing homes (6%). Workers employed in nursing homes with low influence (p = 0.01) and poor leadership (p = 0.02), and in wards with high quantitative demands (p = 0.03), high work pace (p < 0.001), and low justice (p = 0.01) were at increased risk of reporting higher physical exertion. The strongest associations were found for low influence, low quality of leadership, and high work pace at nursing homes and ward levels. In conclusion, improving specific psychosocial working conditions at nursing home and ward levels may be of particular importance to reduce excessive physical workload in eldercare workers.

To synthesize the findings of qualitative research exploring the experiences of being involved in intergenerational interventions in older people’s care settings. DESIGN: A meta-synthesis of the qualitative literature, employing Sandelowski and Barroso’s method, was conducted. DATA SOURCES: Eight databases were searched in March 2017. REVIEW METHODS: The PRISMA statement was used for reporting the different phases of the literature search and the Critical Appraisal Skills Programme qualitative research checklist was used as an appraisal framework. Data synthesis was conducted using Sandelowski and Barroso’s method. RESULTS: Four qualitative studies were included in the meta-synthesis. Thematic analysis revealed four themes: ‘Recreating the family’; ‘Building intergenerational empathy and respect’; ‘Uplifting and energizing’; and ‘Engagement risks and challenges’. CONCLUSION: The meta-synthesis strengthens the evidence that intergenerational interventions can be positive. However, it also shows that there may also be some negative aspects if not planned or managed carefully.

An increasing number of post-acute care patients are admitted to skilled nursing facilities (SNFs) with behavioral symptoms such as wandering and rejecting care, which can interfere with care and place a patient at risk of social isolation or injury. This study examines whether increasing the qualifications of social service staff through using a greater proportion of qualified social workers (QSWs) instead of paraprofessionals improves patients’ behavioral symptoms and reduces the use of antipsychotic medications. DESIGN: Secondary data analysis of national data drawn from the Minimum Data Set, Medicare Beneficiary Summary File, and Certification and Survey Provider Enhanced Reporting surveys. SETTING AND PARTICIPANTS: Newly admitted, Medicare fee-for-service patients aged >/=65 years who received post-acute care after a hospitalization from 2011-2015 (1,201,096 patient admissions in 5383 unique SNFs). METHODS: A regression discontinuity approach is used to identify how changes in the qualifications of social service staffing affect changes in patient outcomes, through exploiting a federal regulation that requires 1 full-time QSW for SNFs with at least 121 beds. RESULTS: SNFs with a greater proportion of QSWs improved behavioral symptoms that affected residents or others and reduced the use of antipsychotic medications. Marginally significant improvements were also found in patients’ rejecting care, wandering, and having any behavioral symptoms. There was no statistically significant change in delusions. CONCLUSIONS AND IMPLICATIONS: Although the focus of most research and effects on improving patient outcomes in SNFs has focused on nursing staff, our results underscore the importance of staffing in social services. Specifically, social service staff with higher qualifications are integral to improving care through reducing patients’ behavioral symptoms and avoiding the use of antipsychotic medications. It may be time for SNFs to revisit efforts to improve staffing in social services.

Hospitalization for nursing home residents is a national concern. Studies suggest the majority of hospital transfers are avoidable,1-3 often resulting from poor care processes such as lack of early illness detection, adverse event occurrences, and poor communication between nursing home staff, providers, and residents/families about goals of care.1,2,4 Efforts supported by the Centers for Medicare and Medicaid Services are underway in the United States to reduce avoidable hospitalizations for nursing home residents.5 In 2012, the University of Missouri Sinclair School of Nursing was one of 7 sites across the United States selected for their evidence-based model called the Missouri Quality Initiative (MOQI), based on the nationally recognized Quality Improvement Program of Missouri (QIPMO).6 The goal of the MOQI was to work with 16 nursing homes in the Midwestern United States who had higher than national averages of hospitalization rates to change their systems of care delivery so that reduced hospital transfers could be achieved.6 Since 2012, the MOQI has achieved a 30% reduction in all-cause admissions following full implementation.7

The aim of the current study is to describe the extended design of the Living Arrangements for people with Dementia (LAD)-study. BACKGROUND: The demand for long-term care in care homes increases with the growing number of people with dementia. However, quality of care in care homes needs improvement. It is important to monitor quality of care in care homes for the purposes of conducting scientific research, providing input for policy and promoting practice improvement. DESIGN: The Living Arrangements for people with Dementia -study monitors changes in – quality of – care in care homes since 2008. With its extended design, the Living Arrangements for people with Dementia -study now also focuses on additional topics that are considered to improve quality of care: implementation of person-centered care, involvement of family carers and volunteers and reducing psychotropic drugs and physical restraints using a multidisciplinary approach. METHODS: The data collection of the Living Arrangements for people with Dementia -study entails an interview with the manager and questionnaires are completed by care staff, family carers, volunteers and multidisciplinary team members. This study is partly funded by the Dutch Ministry of Health, Welfare and Sports, grant number 323088 and partly funded by the participating care homes. DISCUSSION: Results of the Living Arrangements for people with Dementia -study will shed more light on variables related to quality of care in care homes for people with dementia. IMPACT: Based on the obtained information, appropriate efforts to improve quality of care can be discussed and implemented. Furthermore, the results of this study guide policy making, because it expands knowledge about the effects of changing policies and exposes topics that need further attention.

Inappropriate antipsychotic prescribing is a key quality indicator by which clinical outcomes might be monitored and improved in long-term care (LTC), but limited evidence exists on the most effective strategies for reducing inappropriate antipsychotic use. OBJECTIVES: The objective of the study was to evaluate a multicomponent approach to reduce inappropriate prescribing of antipsychotics in LTC. DESIGN: A prospective, stepped-wedge study design was used to evaluate the effect of the intervention. SETTINGS AND PARTICIPANTS: Interdisciplinary staff at 10 Canadian LTC facilities. METHODS: The intervention consisted of an educational in-service, provision of evidence-based tools to assess and monitor neuropsychiatric symptoms (NPS) in dementia, and monthly interprofessional team meetings. The primary outcome was the proportion of residents receiving an antipsychotic without a diagnosis of psychosis using a standardized antipsychotic quality indicator. RESULTS: The weighted mean change in inappropriate antipsychotic prescribing rate from baseline to 12-month follow-up was -4.6% [standard deviation (SD) = 2.8%, P < .0001], representing a 16.1% (SD = 17.0) relative reduction. After adjusting for site, the odds ratio for the inappropriate antipsychotic prescribing quality indicator at 12 months compared to baseline was 0.73 (95% confidence interval = 0.48-0.94; chi-square = 6.59; P = .01). There were no significant changes in related quality indicators, including falls, restraint use, or behavioral symptoms. CONCLUSIONS AND IMPLICATIONS: This multicomponent intervention was effective in reducing inappropriate antipsychotic prescribing in LTC without adversely affecting other domains related to quality of care, and offers a practical means by which to improve the care of older adults with dementia in LTC.

In this paper, individually reported long-term care (LTC) quality indicators have been supplemented with the composite Qindex measure and applied to 614 homes in Ontario, Canada. This study (1) describes the overall quality performance of LTC homes across five years (2012-2017) and (2) determines if organizational factors impact quality performance. The results demonstrate significant, continuous sector-wide improvement in overall quality performance (as assessed by the Qindex) over time and significant differences in quality based on home size, operator size and ownership. This paper positions the Qindex, a global metric of quality, as a valuable tool for quality measurement and management in the LTC sector.

InterRAI is a non-profit international consortium of clinicians and scientists who have developed the Minimum Data Set (MDS) 2.0 assessment to systematically identify the health status and care plan of residents in Long-Term Care (LTC). However, LTC staff often fail to realize the clinical utility of this information, viewing it as “data collection for funding purposes” and an administrative task adding to the daily workload. This article reports how one research institute and senior living organization work together to use MDS 2.0 and other information to support better care for residents, plan resource allocation and staffing models, and conduct applied research for older Canadians. A multi-level approach is described on how MDS 2.0 provides a robust infrastructure at the individual, team, organizational, and system levels. Long-term care stakeholders can do much more to unleash the full potential of this powerful tool, and other healthcare sectors can take advantage of this approach.

Integration of acute and palliative care services for long-term care (LTC) residents reduces the morbidity and mortality associated with avoidable hospitalizations while contributing to healthcare system sustainability. This paper explores patient, provider and system factors contributing to potentially avoidable emergency room visits from LTC homes, based on our clinical and quality improvement work in the Greater Toronto Area and Calgary, as well as reviews the existing literature. Commonalities are used to identify key elements for developing an integrated healthcare delivery system to manage acute medical changes in LTC residents and minimize the need for in-patient hospitalization.

This guide was developed by the Australian Institute of Family Studies to help child and family service agencies implement new evidence-based programs or practices in their work. It includes recommendations for the 4 stages of project implementation: engaging stakeholders, planning and preparing, initiating and refining, and scaling up.

Despite the availability of high-quality clinical practice guidelines, pressure ulcers (PU) continue to develop among older adults in acute and long-term health-care facilities. Except during acute medical crisis or near end-of-life, most PUs are preventable and their development is a health-care quality indicator. The aim of this study was to understand which factors facilitate pressure ulcer prevention among adults over 65 years-of-age receiving care in health-care facilities. METHOD: A critical literature review from three scholarly databases examined components of organisational culture associated with PU prevention. Research papers involving adults >65 years-of-age who were admitted to acute and long-term health-care facilities with PU prevention programmes between 2010 and 2017 were included. A secondary manual search included literature discussing health-care organisational culture, with a total of 41 articles reviewed. RESULTS: Based on a synthesis of this literature, the Factors Facilitating Pressure Ulcer Prevention Model was developed to depict five multilevel factors for PU prevention among older adults in health-care facilities. These five factors are: senior leadership, education, ongoing quality improvement, clinical practice, and unit level champions. CONCLUSION: Ongoing prioritisation of these factors sustains PU prevention and assists health-care facilities to redefine their culture, expand education programmes, and promote accountability to improve health outcomes of older adults receiving care.

“Organizational readiness for change” is critical to successfully managing change in healthcare organizations. Yet healthcare and nursing studies about this relatively new concept are few and lack clear criteria on what comprises “organizational readiness for change.” PURPOSE: This study assessed organizational (hospital) readiness for change, as perceived by registered nurses in two types of hospital in Jordan. METHODS: Using a quantitative research design, the researcher collected data from a convenience sample of 153 nurses from one major government hospital and one major private hospital. The response rate was 64%. RESULTS: The lowest means, indicating unreadiness for change, were reported for the following items: having developed plans for expanding ambulatory care or enhancing continuity of care, including nurses on all committees, and involving them in policy development and strategic planning efforts. The only difference between the types of hospitals in terms of readiness for change was the use of “collaboration and multidisciplinary work”: the governmental hospital was more ready than the private hospital in this regard. IMPLICATIONS FOR PRACTICE AND NURSE LEADERS: To prepare for change, nurse leaders should initiate interventions to enhance organizational readiness and facilitate the integration of change, such as continuing education courses for staff and focus on teamwork, open communication, total quality management, strategic planning, advanced nursing practice and participatory management, especially shared decision-making and policy development. Successful leaders support employees’ creative ideas, focus on the timing of the change, and provide training on change management.

Experience-based codesign (EBCD) is an approach to health service design that engages patients and healthcare staff in partnership to develop and improve health services or pathways of care. The aim of this systematic review was to examine the use (structure, process and outcomes) and reporting of EBCD in health service improvement activities. METHODS: Electronic databases (MEDLINE, CINAHL, PsycINFO and The Cochrane Library) were searched to identify peer-reviewed articles published from database inception to August 2018. Search terms identified peer-reviewed English language qualitative, quantitative and mixed methods studies that underwent independent screening by two authors. Full texts were independently reviewed by two reviewers and data were independently extracted by one reviewer before being checked by a second reviewer. Adherence to the 10 activities embedded within the eight-stage EBCD framework was calculated for each study. RESULTS: We identified 20 studies predominantly from the UK and in acute mental health or cancer services. EBCD fidelity ranged from 40% to 100% with only three studies satisfying 100% fidelity. CONCLUSION: EBCD is used predominantly for quality improvement, but has potential to be used for intervention design projects. There is variation in the use of EBCD, with many studies eliminating or modifying some EBCD stages. Moreover, there is no consistency in reporting. In order to evaluate the effect of modifying EBCD or levels of EBCD fidelity, the outcomes of each EBCD phase (ie, touchpoints and improvement activities) should be reported in a consistent manner. TRIAL REGISTRATION NUMBER: CRD42018105879.

Showing how engagement adds value for all stakeholders can be an effective motivator for broader implementation of patient engagement. However, it is unclear what methods can best be used to evaluate patient engagement. This paper is focused on ways to evaluate patient engagement at three decision-making points in the medicines research and development process: research priority setting, clinical trial design and early dialogues with regulators and health technology assessment bodies. OBJECTIVE: Our aim was to review the literature on monitoring and evaluation of patient engagement, with a focus on indicators and methods. SEARCH STRATEGY AND INCLUSION CRITERIA: We undertook a scoping literature review using a systematic search, including academic and grey literature with a focus on evaluation approaches or outcomes associated with patient engagement. No date limits were applied other than a cut-off of publications after July 2018. DATA EXTRACTION AND SYNTHESIS: Data were extracted from 91 publications, coded and thematically analysed. MAIN RESULTS: A total of 18 benefits and 5 costs of patient engagement were identified, mapped with 28 possible indicators for their evaluation. Several quantitative and qualitative methods were found for the evaluation of benefits and costs of patient engagement. DISCUSSION AND CONCLUSIONS: Currently available indicators and methods are of some use in measuring impact but are not sufficient to understand the pathway to impact, nor whether interaction between researchers and patients leads to change. We suggest that the impacts of patient engagement can best be determined not by applying single indicators, but a coherent set of measures.

The potential of implementation research in understanding strategies for changing practice is undermined by poor reporting, leaving readers unable to replicate such strategies and unclear whether they apply in the context of their practice. These challenges are particularly pertinent in the complex, diverse world of primary care. The recently published Standards for Reporting Implementation Studies (StaRI) provides a framework for comprehensive reporting of implementation research. A key concept is the consideration and reporting in “dual strands”: on the one hand, the implementation strategy and on the other, the evidence-based intervention. Other requirements are full descriptions of context, strategies and interventions (and how the strategies were adopted or adapted), and evaluation methods, which will require flexible interpretation of journal limit constraints or innovative approaches to supplementary information. The choice is between accepting the unsatisfactory status quo or adopting strategies to improve reporting with a view to optimizing the potential of implementation research to advance primary care.

Based on a rapid review and interviews by the UK’s Health Improvement Studies Institute, this learning report focuses on patient and public involvement in research. It presents reasons for engaging patients in research, barriers to their engagement, and tangible impacts.

This article presents the Resident VIEW (Voicing Importance, Experience, and Well-Being), a measure designed to learn directly from long-term care residents the extent to which they experience support that matters most to them. The Resident VIEW contains 63 items across eight domains developed through cognitive interviews with residents in different types of residential settings (e.g., nursing homes, assisted living, and adult foster care). Residents rate items on both importance and their experience. In total, 258 nursing home residents living in 32 Oregon nursing homes were selected through a two-stage random sampling design and participated in the study. Results demonstrate that what matters most to residents varies, emphasizing the value of asking residents directly about their preferences. The relationship between importance and experience differed by item. Residents who experienced support rated very important within some domains, reported better quality of life and reported lower levels of depressive symptoms than those who did not experience these things. The interaction between importance and experience, however, did not reach statistical significance, suggesting that positive experiences may provide benefit even in some areas that are not perceived as important by residents. Results underscore the value of incorporating the resident perspective into measure development in long-term care.

The purpose of this Editorial is to summarise the key recommendations of the Lancet Commission on Dementia Prevention, Intervention, and Care, reporting on the best available evidence to date on what we can do to prevent and intervene for dementia. We briefly describe the new life-course model of dementia prevention incorporating nine modifiable risk factors and their potential effect in reducing individuals’ risk of dementia. We also summarise the recommendations of the report about which pharmacological, psychological, and social interventions are effective, and improve outcomes for people with dementia and their families. Recent developments highlight that there is good potential for the prevention of dementia. Progress in evidence-based approaches indicate the potential for dementia care to be of high-quality and widely accessible. Acting upon this knowledge now will reduce the global burden of dementia and improve the lives of people living with dementia and their families.

Apathy is one of the most common and pervasive of the behavioral and psychological symptoms of dementia (BPSDs). Apathy has profound consequences for morbidity, mortality, and caregiver burden. Treatment of apathy has been hindered because of poor understanding of the mechanisms underlying this heterogeneous syndrome. Research has demonstrated that apathy is associated with disruption of the frontal-striatal system in individuals with neurodegenerative disease. As with other BPSDs, these neural mechanisms alone do not completely account for the syndrome; individual, caregiver, and environmental factors also contribute to apathy. In this article, we modify a current conceptual model of the factors contributing to BPSDs to examine determinants of apathy. This integrative model provides a more complete and theoretically informed understanding of apathy, allowing for greater insight into potential targets for research, intervention, and care. We end by proposing an agenda for moving the science of BPSDs in general, and apathy in particular, forward.

Care home populations experiencing high levels of multi-morbidity and dementia require support from caregivers to meet their hydration requirements. This article provides an overview of literature related to hydration interventions and highlights gaps in knowledge. SOURCES OF DATA: This paper draws on UK-focused literature from Applied Social Sciences Index and Abstracts (ASSIA), CINAHL, Medline, Proquest Hospital Premium Collection, Cochrane Library and RCN databases on hydration interventions for older people living with multi-morbidity and dementia in care homes. AREAS OF AGREEMENT: Fluid intake is too low in care home residents, and no single hydration intervention is effective in addressing the complex problems that older residents present. AREAS OF CONTROVERSY: There is a lack of consensus about how much fluid an older person should consume daily for optimum health. There is also lack of agreement about what interventions are effective in supporting individuals with complex physical and cognitive problems to achieve daily fluid intake targets. GROWING POINTS: To improve hydration care for residents, care home teams should be competent in the delivery of hydration care, and work closely with integrated multi-professional healthcare specialists to provide proactive case management. AREAS TIMELY FOR DEVELOPING RESEARCH: There is a need for understanding of what hydration practices and processes are effective for care home residents and including these in multi-component interventions.

Sleep disturbance is a common symptom in institutionalized older adults that reduces their quality of life and may contribute to progression of cognitive impairment. While we found that a 7-week combination of resistance training, walking and social activity significantly improved sleep in institutionalized older adults compared with a usual care control group, no one to our knowledge has determined the acute effects of resistance training on same-day sleep in this population. Given the effort required to promote exercise adherence in institutionalized older adults and to obtain a positive training effect, understanding of the acute effects of resistance training on same-day sleep architecture should be elucidated, especially with respect to unintended consequences. This secondary data analysis assessed if resistance training altered the same-day sleep architecture in institutionalized older adults. Forty-three participants (age 81.5 +/- 8.1 years, male = 17, female = 26) had two attended overnight polysomnography tests in their rooms for sleep architecture analysis; one polysomnography with same-day resistance training, one without any resistance training. Resistance training consisted of chest and leg press exercises (three sets, eight repetitions, 80% predicted one-repetition maximum). There were no significant changes in sleep architecture between either polysomnography nights; sleep efficiency (P = 0.71), time in non-rapid eye movement stages (P = 0.50), time in rapid eye movement stages (P = 0.14), time awake (P = 0.56), time until sleep onset (P = 0.47), total sleep stage shifts (P = 0.65) or rapid eye movement sleep stage latency (P = 0.57). Our results show no acute same-day effects of resistance training on sleep architecture in institutionalized older adults. Clinical Trial Registration ClinicalTrials.gov Identifier: NCT00888706.

The clinical symptoms of dementia include difficulty with speech, poor short-term memory, and changes in behavior. These symptoms can affect how the person with dementia understands and performs in social interactions. This qualitative review investigated how people with mild to moderate dementia managed social connections. A systematic search of social science databases retrieved 13 articles; data were synthesized using thematic analysis. Results established the work undertaken by people with dementia to maintain and present a social persona seen as socially acceptable. Interpretations are contextualized within Goffman and Sabat’s theories on “self.” People with dementia were agentic in impression management: undertaking work to maintain recognized social roles, while being aware of when their illness led to others discrediting them. Wider recognition of strategies used to maintain a social self could inform interventions designed to increase capability and confidence in co-managing social connections following dementia diagnosis.

The authors examined associations between physical activity, cognitive function, activities of daily living, and behavioral and psychological dementia symptoms (BPSD) in severe and moderate dementia. METHODS: A cross-sectional study was conducted to assess severe and moderate dementia groups according to the Clinical Dementia Rating. An actigraphy measured physical activity. Other measures included Mini-Mental State Examination, Cognitive Test for Severe Dementia, Hyogo Activities of Daily Living Scale, and Neuropsychiatric Inventory-Nursing Home. RESULTS: Sixty-three participants were assessed (mean age = 89.3 +/- 6.4). Physical activity was not associated with cognitive function among participants with severe dementia, although there was a trend-level association with cognitive function among those with moderate dementia. Physical activity was significantly associated with BPSD, specifically agitation/aggression symptoms, for participants with severe dementia, and there was a trend-level association with anxiety for participants with moderate dementia. CONCLUSIONS: Physical activity appears to be associated with BPSD among individuals in the advanced stages of dementia.

There is a strong connection between hearing loss and cognitive health, particularly in older adults. Prevalence rates of hearing loss and dementia both increase with age, and researchers have found higher rates of dementia in individuals with greater degrees of hearing loss.

In this webinar, we will explore the connections between hearing loss and cognitive health, and will discuss potential treatment options and strategies for individuals experiencing hearing loss.

The field of public health is continuously evolving. The KB Mentoring Program helps public health professionals develop the knowledge and skills they need to integrate the best available evidence into practice: evidence-informed decision making. EIDM not only results in increased transparency and accountability, it also provides a basis for informed decision making, particularly during times of uncertainty and fiscal restraint.
Please contact Claire Howarth at howartce@mcmaster.ca or (905) 525-9140 ext. 20460 for more information on the KB Mentoring Program or to register your group for this program.

In this case study, Maya will share her team’s experiences engaging with patient and public partners across Canada in her project titled Primary Care Interventions and Strategies to Mitigate Emergency Room Overcrowding – a Knowledge Synthesis”. Maya was awarded one of CHI’s Preparing for Research by Engaging Patient and Public Partners (PREPPP) awards in Fall 2017 to conduct pre-grant engagement. Her project has since received funding from CIHR and the Manitoba Medical Services Foundation.

META provides a tailored, individualized learning experience. You have the flexibility to register for the workshops that best meet your learning needs and interests. META workshops will take place on the University of Alberta campus in the Edmonton Clinic Health Academy (ECHA) building. META pragmatic workshops are organized into two broad streams: knowledge synthesis and knowledge translation and implementation.

This 2.5-day workshop is designed to build your capacity to mobilize, launch and sustain Collective Impact Initiatives by providing you with theory, resources and opportunities to practice with – and learn from – your peers.

Collective Impact: Leading Theory to Action is specially designed for backbone staff and/or consultants and facilitators supporting Collective Impact efforts. Participants of this workshop will walk away with a solid foundation of Collective Impact and a CI Facilitation Toolkit to share back to their leadership tables and volunteer base to help take their Collective Impact initiative to the next level. As a bonus, participants will also have an opportunity to connect to a peer group of Collective Impact practitioners who are advancing the field and will be able to learn together at the workshop itself as well as after the workshop in a peer-led Community of Practice.

Bring your Collective Impact ideas, challenges, tools and resources. Over these two and a half days of deep learning, we will build our Collective Impact learning capacity and benefit from the wisdom of the field.

LGBTQ+ aging in Canada: What can we learn from the CLSA? presented by Dr. Arne Stinchcombe, assistant professor in the Master of Applied Gerontology (MAG) program at Brock University, and Dr. Kimberley Wilson, assistant professor in Adult Development & Aging in the Department of Family Relations and Applied Nutrition at the University of Guelph.

As part of Canada’s Strategy for Patient-Oriented Research (SPOR), the CIHR suggests a list of elements to consider when paying patient partners. The target audiences for the list of considerations are both researchers and patient partners

KT Pathways is a learning tool to assess your strengths and areas for further development in KT.
For KT beginners, KT Pathways is a way to learn about all the different skills involved in KT (they may be different than you think!). The assessment results will direct you to tools and resources specifically tailored for you.
For the KT pro, KT Pathways will help further your growth in the field with up-to-date tools and resources. This tool can help you identify areas for further professional development and increase your KT knowledge and skills.

The Trajectories project goal is to develop measures that describe the last year of life for long-term care (nursing home) residents. These measures will reflect the priorities identified by our key stakeholder groups (decision makers, care staff, and residents and their family/friend caregivers) and will be developed using routinely collected data in long-term care homes. The Research Associate will conduct analysis of (completed) focus group and interview data, conduct additional on-line and in-person focus groups, and provide support for the research team.

The Research Associate will be responsible for
Analysing the qualitative data (lead role),
Organizing and conducting the remaining focus groups (both in-person and on-line),
Searching, compiling, and analyzing the relevant scientific literature,
Writing/contributing to research manuscripts and related knowledge translation materials,
Preparing and presenting research findings,
Organizing and participating in research team meetings,
Supporting research administration activities (such as writing and keeping REB documents up to date), and
Supervising undergraduate and graduate students involved in project related work.

The Knowledge Broker, working with research and policy analysts, national priority advisors, and communications advisors, draws on the existing body of knowledge or evidence from research and other sources, and works with key stakeholders to provide tailored, evidence-informed guidance and practical tools to facilitate desired changes in practice, programs or policies. Through facilitating collaborative efforts of stakeholders and partners, the Knowledge Broker encourages the application of this evidence in practice, program and policy development and implementation, using effective knowledge mobilization approaches.

The Knowledge Translation (KT) Specialist is responsible for designing, implementing, and evaluating projects to support the movement of best practice evidence into the maternal child practice area to support quality care. The KT specialist is also responsible for engaging with provincial policy specialists, program implementers, and researchers to ensure that the BORN Information System and data is used to support evidence-informed decisions.