S. E. Slaughter, J. M. Morrison-Koechl, H. Chaudhury, C. O. Lengyel, N. Carrier and H. H. Keller.
Int Psychogeriatr 2020 Jan 9:1-11
Given the increased risk of malnutrition in residential care homes, we studied how specific aspects of the mealtime environment are associated with residents’ eating challenges and energy intake in general and dementia care units of these homes. DESIGN: Cross-sectional study. PARTICIPANTS: 624 residents and 82 dining rooms. SETTING: 32 residential care homes across Canada. MEASUREMENTS: Eating challenges were measured using the Edinburgh Feeding Evaluation in Dementia Questionnaire (Ed-FED-q). Energy intake was estimated over nine meals. Physical, social, person-centered, functional, and homelike aspects of the mealtime environment were scored using standardized, valid measures. Effects of interactions between dining environment scores and eating challenges on daily energy intake were assessed using linear regression. RESULTS: More eating challenges were associated with decreased energy intake on the general (beta = -36.5, 95% confidence interval [CI] = -47.8, -25.2) and dementia care units (beta = -19.9, 95% CI = -34.6, -5.2). Among residents living on general care units, the functional (beta = 48.5, 95% CI = 1.8, 95.2) and physical (beta = 56.9, 95% CI = 7.2, 106.7) environment scores were positively and directly associated with energy intake; the social and person-centered aspects of the mealtime environment moderated the relationship between eating challenges and energy intake. CONCLUSIONS: Resident eating challenges were significantly associated with energy intake on both dementia care and general care units; however on general care units, when adjusting for eating challenges, the functional and physical aspects of the environment also had a direct effect on energy intake. Furthermore, the social and person-centered aspects of the dining environment on general care units moderated the relationship between eating challenges and energy intake. Dementia care unit environments had no measurable effect on the association between resident eating challenges and energy intake.
As a signature area of research and teaching excellence, Intersections of Gender (a.k.a. RIG) recognizes the existing extensive intersectional gender expertise of the University of Alberta community. To fulfill our priorities of further nurturing intersectional gender research, we invite faculty members (continuing as well as ATS faculty), postdoctoral fellows, and graduate students to become formally affiliated with RIG.
The primary goals of the RIG Affiliate Program are to:
-promote existing areas of intersectional gender research expertise;
-build new networks and collaboration among researchers from across all disciplines and Faculties at the University of Alberta;
-foster engagement in RIG activities; and
-formalize researchers’ relationship with RIG.
21-22 October, Sydney, Australia
DEADLINE 26 April
The Evidence and Implementation Summit 2020 #EIS2020 is an evolution of the Australasian Implementation Conference and the Global Evidence and Implementation Summit in 2018. EIS 2020 will mark 10 years since the creation of the event series; and since its inception, continues to be one of the leading evidence and implementation events on the global calendar.
We invite all those working to improve health and social care for older Canadians living with frailty and/or support their caregivers to submit your initiative for an opportunity to be highlighted at the National Conference on Frailty on September 21-22 at the Westin Nova Scotian, Halifax.
The Canadian Frailty Network (CFN) is looking to fund knowledge translation and real-world implementation proposals aimed to empower remote Indigenous communities to enable them to improve care for, and support their elders to remain in their home or communities. CFN will only fund proposals that are co-created/co-designed in close partnership with Indigenous community members. Proposals must focus on the scale or spread of a prior health and/or social care initiative shown to be effective in a smaller context.
The Public Health Agency of Canada (PHAC) is pleased to invite eligible organizations to submit applications for targeted awareness raising initiatives, including how to:
-prevent or delay onset
-reduce stigma, including stigmatizing behaviours
-encourage and support communities to be more dementia-inclusive
CIHR’s Institute of Health Services and Policy Research (IHSPR), in partnership with the Institute of Aging (IA), Institute of Circulatory and Respiratory Health (ICRH), the Institute of Infection and Immunity (III), the Institute of Nutrition, Metabolism and Diabetes (INMD), the Institute of Neurosciences, Mental Health and Addiction (INMHA), the Institute of Population and Public Health (IPPH), the Healthy Cities Research Initiative (HCRI), the Michael Smith Foundation for Health Research (MSFHR), Fonds de recherche du Québec – Santé (FRQS) and Mitacs.
Images of Research (IOR) is an opportunity for current University of Alberta graduate students and postdoctoral fellows from all disciplines to capture, share, and present the essence of their research in one image.
This competition and its month-long exhibition showcase and preserve graduate and postdoctoral research in print and digital form, foster engagement, and support graduate students’ and postdoctoral fellows’ academic and career endeavours.
Z. Landis-Lewis, J. Kononowech, W. J. Scott, et al.
Implement Sci 2020 Jan 21;15(1):7-019-0950-y
User-centered design (UCD) methods are well-established techniques for creating useful artifacts, but few studies illustrate their application to clinical feedback reports. When used as an implementation strategy, the content of feedback reports depends on a foundational audit process involving performance measures and data, but these important relationships have not been adequately described. Better guidance on UCD methods for designing feedback reports is needed. Our objective is to describe the feedback report design method for refining the content of prototype reports. METHODS: We propose a three-step feedback report design method (refinement of measures, data, and display). The three steps follow dependencies such that refinement of measures can require changes to data, which in turn may require changes to the display. We believe this method can be used effectively with a broad range of UCD techniques. RESULTS: We illustrate the three-step method as used in implementation of goals of care conversations in long-term care settings in the U.S. Veterans Health Administration. Using iterative usability testing, feedback report content evolved over cycles of the three steps. Following the steps in the proposed method through 12 iterations with 13 participants, we improved the usability of the feedback reports. CONCLUSIONS: UCD methods can improve feedback report content through an iterative process. When designing feedback reports, refining measures, data, and display may enable report designers to improve the user centeredness of feedback reports.
J. H. Shin, E. M. Kim and J. Y. Lee.
J Korean Acad Nurs 2019 Dec;49(6):783-794
This study identified factors related to the quality of care in nursing homes, and elicited consensus opinions from experts on nursing homes. METHODS: A Delphi questionnaire was developed based on a review of the literature using the keywords “nursing homes,” “workforce,” and “quality of care.” A total of two Delphi surveys were conducted with 14 experts. The important and urgent factors related to the quality of care for nursing home residents emerged. RESULTS: A consensus was achieved on the important and urgent factors relating to the quality of care. The related factors were grouped into four sections: Organizational Characteristics, Staffing Characteristics, the Long-Term Care Market and Legal and Policy Issues, and Nursing Processes. In total, 23 items were important factors and 26 items were urgent factors relating to the quality of care. In addition, the unanimous advocacy by the experts for increased hours per resident day for registered nurses (RNs, 41 minutes 59 seconds) was much higher than the current hours per resident day of RNs in Korea. CONCLUSION: To provide optimal care for residents in nursing homes in Korea, the mandatory and essential placement of RNs with professional knowledge and skills is paramount.
G. Ottoboni, R. Chattat, C. Camedda, et al.
Aging Clin Exp Res 2019 Nov;31(11):1675-1683
Advance care planning may be beneficial for nursing home residents, but its implementation is suboptimal in several countries. AIMS: To investigate knowledge of, attitudes towards, and experience with advance care planning of nursing home staff members in Italy. METHODS: Cross-sectional survey involving all healthcare professionals working in 12 Italian nursing homes. Statistical analyses investigated interactions between participants’ characteristics, knowledge, attitudes and frequency of advance care planning discussion with residents. RESULTS: Of the 185 participants (80.5% female, mean age 43.6 +/- 9.2 years), 29.7% reported that they had heard of advance care planning, but their actual knowledge was suboptimal. Participants had positive attitudes towards advance care planning, and most of them clearly recognized its benefits. Apprehension about upsetting the patient or their family, or that patients were not ready for these conversations were the main concerns. Only 16% of respondents discussed advance care planning at least sometimes, usually upon patient/family input. Greater knowledge was significantly correlated with more positive attitudes towards advance care planning. The issues of healthcare professionals’ knowledge and training in advance care planning, and of knowledge and awareness of advance care planning in patients, their families, and the general population were considered either main barriers or facilitators. DISCUSSION: Nursing home staff members’ concerns towards advance care planning seemed to be related to a misconception about patient and family willingness to discuss it. CONCLUSIONS: A multifaceted strategy including educational and training programmes and the increase of public awareness is needed to implement advance care planning in Italian nursing homes.
J. Weiss, N. Tumosa, E. Perweiler, et al.
J Am Geriatr Soc 2020 Jan 22
The US Department of Health and Human Services and the Foundation for the National Institutes of Health, through private sector support, sponsored the National Research Summit on Dementia Care: Building Evidence for Services and Supports (Summit) in 2017. Various workgroups were asked to address topics of interest in dementia care and develop recommendations addressing the goals of the Summit. Workforce education and training was identified to be a key issue. As a result, a Workforce Development Workgroup (the Workgroup) was created and addressed two of the Summit’s goals. The first goal is to improve the quality of care and support provided to persons living with dementia and those who care for them. The second goal is to accelerate the development, evaluation, translation, implementation, and scaling-up of evidence-based and evidence-informed services for persons living with dementia, their families, and caregivers. In this article, the Workgroup identified gaps in educating and training a dementia-capable workforce. The Workgroup consisted of an interprofessional team with expertise in dementia workforce development from academia, professional organizations, and the federal government. Four recommendations are presented concerning research topics that will advance the education and training of a dementia-capable workforce, which includes health professions students, faculty, practitioners, direct care workers, persons living with dementia, and those who care for them.
S. Fashaw, L. Chisholm, V. Mor, et al.
J Am Geriatr Soc 2020 Jan 22
Previous research suggests black nursing home (NH) residents are more likely to receive inappropriate antipsychotics. Our aim was to examine how NH characteristics, particularly the racial and socioeconomic composition of residents, are associated with the inappropriate use of antipsychotics. DESIGN: This study used a longitudinal approach to examine national data from Long-Term Care: Facts on Care in the US (LTCFocUS.org) between 2000 and 2015. We used a multivariate linear regression model with year and state fixed effects to estimate the prevalence of inappropriate antipsychotic use at the NH level. SETTING: Free-standing NHs in the United States. PARTICIPANTS: The sample consisted of 12 964 NHs. MEASUREMENTS: The outcome variable was inappropriate antipsychotic use at the facility level. The primary indicator variables were whether a facility had high proportions of black residents and the percentage of residents with Medicaid as their primary payer. RESULTS: NHs with high and low proportions of blacks had similar rates of antipsychotic use in the unadjusted analyses. NHs with high proportions of black residents had significantly lower rates of inappropriate antipsychotic use (beta = -2; P < .001) in the adjusted analyses. Facilities with high proportions of Medicaid-reliant residents had higher proportions of inappropriate use (beta = .04; P < .001). CONCLUSION: Findings from this study indicate a decline in the use of antipsychotics. Although findings from this study indicated facilities with higher proportions of blacks had lower inappropriate antipsychotic use, facility-level socioeconomic disparities continued to persist among NHs. Policy interventions that focus on reimbursement need to be considered to promote reductions in antipsychotic use, specifically among Medicaid-reliant NHs.
D. Disalvo, T. Luckett, A. Bennett, P. Davidson and M. Agar.
Int J Clin Pharm 2019 Aug;41(4):950-962
Medication reviews by pharmacists have been shown to identify and reduce drug-related problems in long-term care residents. Objective To explore pharmacist perspectives of the Australian Government funded pharmacist-conducted residential medication management review and its role improving the quality and safety of prescribing in long-term care, in particular for those living with advanced dementia. Setting Australian Long-term care pharmacists. Method A qualitative research methodology approach using semi-structured interviews was used, with participants pharmacists with Residential Medication Management Review experience. Interviews were recorded, transcribed and coded utilising a meta-model of Physician-Community Pharmacy Collaboration in medication review. Main outcome measure Pharmacists’ perspectives on the Residential Medication Management Review and how to improve the quality of reviews for residents with advanced dementia. Results Fifteen accredited pharmacists participated. The majority believed that the Residential Medication Management Review had the potential to improve the quality and safety of medicines but highlighted systemic issues that worked against collaborative practice. Participants emphasised the importance of three-way collaboration between general practitioners, pharmacists and nursing staff and highlighted key strategies for its optimisation. Conclusion Incorporating avenues for greater communication between team members can improve collaboration between health professionals and ultimately the quality of medication reviews.
T. Quasdorf and S. Bartholomeyczik.
Dementia (London) 2019 Aug;18(6):1976-1993.
Dementia Care Mapping is an internationally applied method for enhancing person-centred care for people with dementia in nursing homes. Recent studies indicate that leadership is crucial for the successful implementation of Dementia Care Mapping; however, research on this topic is rare. This case study aimed to explore the influence of leadership on Dementia Care Mapping implementation in four nursing homes. Twenty-eight interviews with project coordinators, head nurses and staff nurses were analysed using qualitative content analysis. Nursing homes that failed to implement Dementia Care Mapping were characterised by a lack of leadership. The leaders of successful nursing homes promoted person-centred care and were actively involved in implementation. While overall leadership performance was positive in one of the successful nursing homes, conflicts related to leadership style occurred in the other successful nursing homes. Thus, it is important that leaders promote person-centred care in general and Dementia Care Mapping in particular. Furthermore, different types of leadership can promote successful implementation.
Cara L. Mulhall, Jonathan M. C. Lam, Patrick S. Rich, L. G. Dobell and Anna Greenberg.
Journal of the American Medical Directors Association 2020 01/20
The province of Ontario in Canada is an example of a jurisdiction that is using a specific quality improvement mechanism, known as â€œaudit and feedback,â€ to help clinicians enhance the care they provide to long-term care (LTC) home residents. This program, launched in 2015, is unique in that the reports are provided across an entire jurisdiction. These reports were co-designed with clinicians, including medical directors, scientists, and other stakeholders, and are updated regularly to maintain their relevance to medical practice in LTC. The data for the reports is calculated using record linkage with available administrative data sources. The reports are updated with new data 4 times each year and emailed directly to physicians who have requested their report. The reports are designed to have an overall dashboard summarizing the practice level data with a comparison to all physicians in Ontario. More detailed information on their data such as trend data and resources for quality improvement are found in subsequent pages of the report. These reports are a tool to support physicians in quality improvement efforts in their LTC practice. We believe the role of a medical director is very important in both the uptake and use of these reports as the medical director would act as a trusted advisor who can influence quality of care overall within an LTC home. We are also testing a new format for delivering the reports in an interactive online format that enables more options for viewing practice data. Initial evaluation of these reports shows that there is a statistically significant impact on reducing the prescription of antipsychotic medications in LTC homes. In future, we hope to see a larger effect on the latest topic included in the reports: antibiotic prescribing.
M. Z. Raban, C. Gasparini, L. Li, M. T. Baysari and J. I. Westbrook.
BMJ Open 2020 Jan 9;10(1):e028494-2018-028494
There are high levels of inappropriate antibiotic use in long-term care facilities (LTCFs). Our objective was to examine evidence of the effectiveness of interventions designed to reduce antibiotic use and/or inappropriate use in LTCFs. DESIGN: Systematic review and meta-analysis. DATA SOURCES: MEDLINE, Embase and CINAHL from 1997 until November 2018. ELIGIBILITY CRITERIA: Controlled and uncontrolled studies in LTCFs measuring intervention effects on rates of overall antibiotic use and/or appropriateness of use were included. Secondary outcomes were intervention implementation barriers from process evaluations. DATA EXTRACTION AND SYNTHESIS: Two reviewers independently applied the Cochrane Effective Practice and Organisation of Care group’s resources to classify interventions and assess risk of bias. Meta-analyses used random effects models to pool results. RESULTS: Of include studies (n=19), 10 had a control group and 17 had a high risk of bias. All interventions had multiple components. Eight studies (with high risk of bias) showed positive impacts on outcomes and included one of the following interventions: audit and feedback, introduction of care pathways or an infectious disease team. Meta-analyses on change in the percentage of residents on antibiotics (pooled relative risk (RR) (three studies, 6862 residents): 0.85, 95% CI: 0.61 to 1.18), appropriateness of decision to treat with antibiotics (pooled RR (three studies, 993 antibiotic orders): 1.10, 95% CI: 0.64 to 1.91) and appropriateness of antibiotic selection for respiratory tract infections (pooled RR (three studies, 292 orders): 1.15, 95% CI: 0.95 to 1.40), showed no significant intervention effects. However, meta-analyses only included results from intervention groups since most studies lacked a control group. Insufficient data prevented meta-analysis on other outcomes. Process evaluations (n=7) noted poor intervention adoption, low physician engagement and high staff turnover as barriers. CONCLUSIONS: There is insufficient evidence that interventions employed to date are effective at improving antibiotic use in LTCFs. Future studies should use rigorous study designs and tailor intervention implementation to the setting.
J. G. Carpenter, K. Lam, A. Z. Ritter and M. Ersek.
J Am Med Dir Assoc 2020 Jan 7
Despite recommendations to integrate palliative care into nursing home care, little is known about the most effective ways to meet this goal. OBJECTIVE: To examine the characteristics and effectiveness of nursing home interventions that incorporated multiple palliative care domains (eg, physical aspects of care-symptom management, and ethical aspects-advance care planning). DESIGN: Systematic review. METHODS: We searched MEDLINE via PubMed, Embase, CINAHL, and Cochrane Library’s CENTRAL from inception through January 2019. We included all randomized and nonrandomized trials that compared palliative care to usual care and an active comparator. We assessed the type of intervention, outcomes, and the risk of bias. RESULTS: We screened 1167 records for eligibility and included 13 articles. Most interventions focused on staff education and training strategies and on implementing a palliative care team. Many interventions integrated advance care planning initiatives into the intervention. We found that palliative care interventions in nursing homes may enhance palliative care practices, including processes to assess and manage pain and symptoms. However, inconsistent outcomes and high or unclear risk of bias among most studies requires results to be interpreted with caution. CONCLUSIONS AND IMPLICATIONS: Heterogeneity in methodology, findings, and study bias within the existing literature revealed limited evidence for nursing home palliative care interventions. Findings from a small group of diverse clinical trials suggest that interventions enhanced nursing home palliative care and improved symptom assessment and management processes.
J. Puxty, R. A. Brander, S. Murphy and V. Byrnes.
World Health Popul 2019 Dec;18(1):61-67
The Bridges to Care for Long-Term Care research project aimed to facilitate improvements in outcomes for long-term care residents through the provision of knowledge-to-practice and quality improvement resources by trained facilitators. Point-of-care staff reported improved communication and collaboration, improved use of scope of practice and implementation of best practice knowledge. Overall, participating long-term care homes demonstrated an enhanced capacity for common care issues of the elderly (pneumonia, falls, bacteriuria and behavioural and psychological symptoms of dementia) and the ability to effectively engage in quality improvement processes with efficient and effective use of healthcare resources.
S. Shrapnel, E. Dent and C. Nicholson.
Aging Clin Exp Res 2019 Nov;31(11):1695-1698
Hospital Emergency Departments (EDs) experience high presentation rates from older adults residing in Aged Care Facilities (ACFs), yet very few intervention studies have addressed the care needs of this population group. We designed and implemented a nurse-led model of care for older adults from ACFs, and determined its impact on patient outcomes. METHODS: This 12-month pre-post intervention study was conducted during 2013-2014, with follow-up during 2015-2016. Participants included all older adults presenting from ACFs to the ED of Mater Hospital Brisbane (MHB), Australia. Frailty status was determined using the Clinical Frailty Scale (CFS). RESULTS: All participants were frail (n = 1130), with 19% severely frail, 55% very-severely frail, and 26% terminally ill. The intervention resulted in several improvements in patient outcomes, including significant reductions in ward admissions and 28-day representation rates. CONCLUSION: Significant improvements can be achieved by integration of an acute frail older person service into an ED.
W. E. Norton and D. A. Chambers.
Implement Sci 2020 Jan 9;15(1):2-019-0960-9
De-implementing inappropriate health interventions is essential for minimizing patient harm, maximizing efficient use of resources, and improving population health. Research on de-implementation has expanded in recent years as it cuts across types of interventions, patient populations, health conditions, and delivery settings. This commentary explores unique aspects of de-implementing inappropriate interventions that differentiate it from implementing evidence-based interventions, including multi-level factors, types of action, strategies for de-implementation, outcomes, and unintended negative consequences. We highlight opportunities to continue to advance research on the de-implementation of inappropriate interventions in health care and public health.
R. Leontjevas, L. Hooijschuur, M. Smalbrugge, R. T. C. M. Koopmans and D. L. Gerritsen.
Int Psychogeriatr 2020 Jan 17:1-10
The Act in case of Depression program showed effects on the quality of life and depression in nursing home (NH) residents. We aimed to explore the effects of this complex multidisciplinary program on job satisfaction, job demands, and autonomy in nursing home staff. DESIGN: Four data points from a stepped-wedge cluster-randomized trial on patient outcomes were used for secondary analyses on staff outcomes. SETTING: Sixteen dementia special care and 17 somatic care units in Dutch NHs.Participants were 717 (90.1%) care staff or trainees, 34 (4.3%) paramedical staff, and 45 (5.7%) other staff members.Intervention describes procedures for nursing staff, activity therapists, psychologists, and physicians. It contains evidence-based pathways for depression assessment, treatment, and monitoring treatment results. RESULTS: Mixed models for intention-to-treat analyses showed no significant changes in job demands, job satisfaction, or autonomy. Models corrected for the ratio of unit residents who received, when indicated, a specific program component revealed reduced job demands and improved job satisfaction and autonomy when treatment procedures were used. A better use of assessment procedures was associated with increased job demands, while conducting monitoring procedures was associated with increased job demands and decreased autonomy. CONCLUSIONS: Components of complex care programs may affect the staff outcomes in opposite directions and, taken together, produce a zero-sum or a statistically insignificant effect. While implementing treatment protocols affecting patients directly can also improve job outcomes such as satisfaction and autonomy and decrease job demands, it is possible that other procedures of complex programs may have unfavorable effects on job outcomes. It is important to account for specific components of complex interventions when evaluating intervention effects.
J. Gilbert, L. Ward and K. Gwinner.
Dementia (London) 2019 Aug;18(6):2140-2157.
The concept of quality nursing care in a dementia specific unit is perceived as being subject to the interpretation of individuals, nurses and healthcare organisations. As the number of dementia diagnoses increases, understanding what constitutes quality nursing care within dementia specific care units is vital to inform policy makers and healthcare organisations globally. Efforts to identify quality nursing care and improve dementia care within dementia specific care units, may significantly reduce the financial and emotional burden of care-giving and improve the quality of life for individuals living with dementia. This scoping review aimed to examine current literature to gain an understanding of what constitutes quality nursing care in a dementia specific care unit. Design and methods Five electronic databases (CINAHL, MEDLINE, ProQuest, Social Sciences Citation Index and Ovid) were used to search for articles published in English between 2011 and 2016 focusing on a definition of quality nursing care within dementia specific care units. Findings: Twenty journal articles were identified. From these articles, two content themes were identified: Challenges in the provision of quality nursing care in dementia specific care units, and Standardised approach to quality nursing care in a dementia specific care unit. The articles contained the following research designs, controlled pre-test and post-test design (n = 1), focus group interviews (n = 1), cross sectional survey (n = 6), semi structured interviews (n = 3), narrative review (n = 1), survey (n = 2), literature review (n = 3), systematic review (n = 1), and prospective longitudinal cohort study (n = 2). Conclusions The concept of quality nursing care in a dementia specific unit remains subject to the interpretation of individuals, nurses and healthcare organisations, with current literature unable to provide a clear definition. Further research into what constitutes quality nursing care in dementia specific care units is recommended.
T. Austin, S. Chreim and A. Grudniewicz.
BMC Health Serv Res 2020 Jan 17;20(1):47-020-4897-0
Readiness is a critical precursor of successful change; it denotes whether those involved in the change are motivated and empowered to participate in the change. Research on readiness tends to focus on frontline providers or individuals in non-managerial positions and offers limited attention to individuals in middle management positions who are expected to lead frontline providers in change implementation. Yet middle-level managers are also recipients of changes that are planned and decreed by those in higher positions. This study sought to examine both frontline provider and middle manager readiness for change in the context of primary care program integration. METHODS: Using a qualitative case study approach, we examined how frontline providers and middle managers experienced six readiness factors: discrepancy, appropriateness, valence, efficacy, fairness and trust in management. Data were collected through documents, meeting observation and semi-structured interviews with frontline providers and middle managers involved in the change. RESULTS: The findings highlighted similarities and differences in readiness experiences of frontline providers and middle managers. Across both types of participants, we found that the notion of valence should be expanded to consider individuals’ evaluation of benefits to patients and the health system; efficacy applies to both content and process of change; fairness and trust in management findings require further exploration to determine their appropriateness to be incorporated in models of readiness for change; and trust in management (or lack of trust) has a cascading influence across the levels in the organization. CONCLUSIONS: Our study makes a contribution by nuancing and extending conceptualizations of individual readiness factors, and by highlighting the central role of middle manager readiness for change. Implications of the study include the need to consider readiness factors prior to the implementation of change and the importance of fostering readiness throughout all levels of the organization.
C. Laker, M. Cella, F. Callard and T. Wykes.
J Psychiatr Ment Health Nurs 2019 Nov 22
WHAT IS KNOWN ON THE SUBJECT?: To date, improvements on U.K. acute mental health wards have been difficult to sustain. The barriers to change may be context dependent. Mental health wards are volatile workplaces with service user violence/aggression, frequent staff and patient changes, and ongoing service improvements. The evidence suggests that burnout affects staff perceptions of barriers to change, and ward climate affects burnout. As two potentially important, independent predictors of staff perceptions of barriers to change, the impact of ward climate and burnout on how staff regard changes should be considered. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Elements of ward climate such as high numbers of incidents and temporary staff independently worsened mental health staff perceptions of barriers to change, in addition to negative impacts from burnout and occupational status. How staff perceived ward climate was also linked their perceptions of barriers to change; however, burnout was no longer a significant consideration with these variables. Staff with low job satisfaction and high interaction anxiety also had low confidence regarding changes. Staff with low job satisfaction were also demotivated towards changes. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Ward climate is clearly an important factor in how nurses view organizational changes. In this study, nurses’ perceptions of barriers to change were worse if they viewed ward climate negatively, or if temporary staff and incident numbers were high. Staff perceptions of ward climate and barriers to change should be assessed, ahead of service changes. Developing change strategies based on such information is likely to produce better implementation outcomes. Specifically, targeting staff confidence and motivation (which are barriers to change) may improve how staff regard their ward climate. Abstract Introduction To create successful change programmes for mental health wards, it is necessary to understand which aspects of ward climate prevent change. Question Does ward climate influence mental health nurse’s perceptions of barriers to change? Method Random-effects models were used to test whether the following ward climate variables influenced the outcome measure “staff perceptions of barriers to change” (VOCALISE) and its subscales (powerlessness/confidence/demotivation): (a) Perceptions of ward climate (VOTE: subscales included work intensity/job satisfaction/interaction anxiety). (b) Ward climate indicators (incidents/detention under the Mental Health Act (2007)/staffing/bed pressure). As known predictors of VOCALISE, burnout (Maslach Burnout Inventory) and occupational status were included in the models. Results Perceptions of ward climate (VOTE), incidents, temporary staff, occupational status and burnout significantly and negatively affected perceptions of barriers to change (VOCALISE). Staff with low job satisfaction (VOTE) and high interaction anxiety (VOTE) also had low confidence (VOCALISE). Staff with low job satisfaction (VOTE) were also demotivated (VOCALISE). Discussion Ward climate is an important predictor of how staff regard service changes in mental health wards. Implications for practice Staff perceptions of ward climate and barriers to change should be assessed ahead of service changes to identify pressures that impede progress and lower morale.
Y. Duan, C. A. Mueller, F. Yu and K. M. Talley.
Res Gerontol Nurs 2020 Jan 22:1-15
Culture change is intended to transform nursing homes from impersonal institutions into person-centered homes. Despite a growing interest in studying culture change, empirical evidence for its effects on quality of life (QOL) has not been synthesized. The current integrative review examined how QOL outcomes were measured in culture change studies and analyzed the current evidence for culture change effects on QOL. Guided by a conceptual framework, this review systematically searched for literature in multiple databases and identified 11 eligible studies. QOL measures varied across studies, ranging from overall perception of life to specific measures associated with physical and psychosocial well-being. Overall, culture change demonstrated a positive trend in benefiting QOL. Although inconsistent evidence existed for most QOL measures, relatively consistent evidence was found to support positive effects on resident satisfaction and autonomy. Rigorous designs are needed for future studies to generate strong evidence.
S. Saal, H. Klingshirn, K. Beutner, et al.
Trials 2019 Jul 9;20(1):411-019-3522-1
Acquired joint contractures have a significant impact on functioning and quality of life in nursing home residents. There is very limited evidence on measures for prevention and treatment of disability due to joint contractures. We have developed the PECAN intervention (Participation Enabling CAre in Nursing) to improve social participation in nursing home residents. A cluster-randomised pilot trial was conducted to assess the feasibility of study procedures in preparation for a main trial according to the UK Medical Research Council (MRC) framework. METHODS: Nursing homes in two regions of Germany were randomly allocated either to the intervention or optimised standard care (control group). All residents with joint contractures aged > 65 years were eligible for the study. The residents’ data were collected through structured face-to-face interviews by blinded assessors at baseline, after 3 and 6 months. The primary outcome was social participation, measured by a subscale of the PaArticular Scales. Secondary outcomes included activities and instrumental activities of daily living, health-related quality of life, falls and fall-related consequences. Data on the trial feasibility were collected via documentation forms. RESULTS: Seven out of 12 nursing homes agreed to participate and remained in the trial. Of 265 residents who fulfilled the inclusion criteria, 129 were randomised either to the intervention (n = 64) or control group (n = 65) and analysed. A total of 109 (85%) completed the trial after 6 months. The mean age was 85.7 years (SD 7.0), 80% were women. The severity of the residents’ disability differed across the clusters. The completion rate was high (> 95%), apart from the Instrumental Activities of Daily Living Scale. Some items of the PaArticular Scales were not easily understood by residents. The frequency of falls did not differ between study groups. CONCLUSION: Our data confirmed the feasibility of the overall study design. We also revealed the need to improve the procedures for the recruitment of residents and for data collection before implementation into a main trial. The next step will be an adequately powered main trial to assess the effectiveness and cost-effectiveness of the intervention. TRIAL REGISTRATION: German clinical trials register, ID: DRKS00010037 . Registered on 12 February 2016.
H. Shi, C. Mao, J. Tang and H. Liang.
BMC Geriatr 2020 Jan 21;20(1):20-020-1421-7
Dementia is a serious and growing health problem, and since most people with dementia live at home, caring responsibilities generally fall on family members. Caregivers are often inadequately supported by formal health services and have poorer psychological and physical health. Our study aimed to compare the contributions of publications from different countries, institutions and authors and present a bibliometric analysis to determine the hotspots and trends in research concerning the health of and interventions for family dementia caregivers. METHODS: Studies published during 1988-2018 were extracted from the Science Citation Index Expanded of the Web of Science. Each abstract of publications was evaluated to obtain the basic information. A bibliometric analysis was used to evaluate the number or cooperation networks of publications, countries, institutions, journals, citations, authors, references, and keywords. The resulting articles were analyzed descriptively, and the publication keywords were visualized using VOSviewer. RESULTS: Five hundred forty-two articles were identified. The annual number of relevant publications has steadily increased since approximately 2006. The USA has the highest number of publications (36.2%), followed by the UK (12.9%). China entered the field late, but research conducted in China has rapidly developed. The most productive institution, journal, and author in this field are University College London, the Journal of the American Geriatrics Society, and Orrell M from the UK, respectively. A co-occurrence analysis of the keywords reveals a mainstream research focus on burden, depression, quality of life, and corresponding interventions for people with dementia caregivers. The keywords “psychosocial intervention”, “long-term”, “e-learning/online”, “communication”, and “qualitative research” reflect the latest hotspots, appearing in approximately 2017-2018. CONCLUSION: Our study details the performance statistics, main topics and trends research on the health of and interventions for dementia caregivers from 1988 to 2018 and provides a comprehensive analysis.
H. Munthe-Kaas, H. Nokleby, S. Lewin and C. Glenton.
BMC Med Res Methodol 2020 Jan 17;20(1):11-019-0834-5
Systematic reviews are a key input to health and social welfare decisions. Studies included in systematic reviews often vary with respect to contextual factors that may impact on how transferable review findings are to the review context. However, many review authors do not consider the transferability of review findings until the end of the review process, for example when assessing confidence in the evidence using GRADE or GRADE-CERQual. This paper describes the TRANSFER Approach, a novel approach for supporting collaboration between review authors and stakeholders from the beginning of the review process to systematically and transparently consider factors that may influence the transferability of systematic review findings. METHODS: We developed the TRANSFER Approach in three stages: (1) discussions with stakeholders to identify current practices and needs regarding the use of methods to consider transferability, (2) systematic search for and mapping of 25 existing checklists related to transferability, and (3) using the results of stage two to develop a structured conversation format which was applied in three systematic review processes. RESULTS: None of the identified existing checklists related to transferability provided detailed guidance for review authors on how to assess transferability in systematic reviews, in collaboration with decision makers. The content analysis uncovered seven categories of factors to consider when discussing transferability. We used these to develop a structured conversation guide for discussing potential transferability factors with stakeholders at the beginning of the review process. In response to feedback and trial and error, the TRANSFER Approach has developed, expanding beyond the initial conversation guide, and is now made up of seven stages which are described in this article. CONCLUSIONS: The TRANSFER Approach supports review authors in collaborating with decision makers to ensure an informed consideration, from the beginning of the review process, of the transferability of the review findings to the review context. Further testing of TRANSFER is needed.
Virginia Braun and Victoria Clarke.
Qualitative Research in Sport, Exercise and Health 2019 12/26:1-16
The concept of data saturation, defined as ?information redundancy? or the point at which no new themes or codes ?emerge? from data, is widely referenced in thematic analysis (TA) research in sport and exercise, and beyond. Several researchers have sought to ?operationalise? data saturation and provide concrete guidance on how many interviews, or focus groups, are enough to achieve some degree of data saturation in TA research. Our disagreement with such attempts to ?capture? data saturation for TA led us to this commentary. Here, we contribute to critical discussions of the saturation concept in qualitative research by interrogating the assumptions around the practice and procedures of TA that inform these data saturation ?experiments?, and the conceptualisation of saturation as information redundancy. We argue that although the concepts of data-, thematic- or code-saturation, and even meaning-saturation, are coherent with the neo-positivist, discovery-oriented, meaning excavation project of coding reliability types of TA, they are not consistent with the values and assumptions of reflexive TA. We encourage sport and exercise and other researchers using reflexive TA to dwell with uncertainty and recognise that meaning is generated through interpretation of, not excavated from, data, and therefore judgements about ?how many? data items, and when to stop data collection, are inescapably situated and subjective, and cannot be determined (wholly) in advance of analysis.
Mhairi Campbell, Joanne E. McKenzie, Amanda Sowden, et al.
In systematic reviews that lack data amenable to meta-analysis, alternative synthesis methods are commonly used, but these methods are rarely reported. This lack of transparency in the methods can cast doubt on the validity of the review findings. The Synthesis Without Meta-analysis (SWiM) guideline has been developed to guide clear reporting in reviews of interventions in which alternative synthesis methods to meta-analysis of effect estimates are used. This article describes the development of the SWiM guideline for the synthesis of quantitative data of intervention effects and presents the nine SWiM reporting items with accompanying explanations and examples.
J. A. Palmer, A. M. Smith, R. S. Paasche-Orlow and G. Fitchett.
J Pain Symptom Manage 2020 Jan 7
Dementia marks an increasingly prevalent terminal illness for which palliative care, including spiritual care, could improve quality of life. Research gaps exist in understanding the intersection of dementia, spirituality, and palliative care. OBJECTIVES: We conducted the first scoping review examining the nature and breadth of peer-reviewed studies across these three topics to guide future research. METHODS: The scoping review followed methods from The Joanna Briggs Institute Reviewers’ Manual (2015). We developed a priori a scoping review protocol outlining the Population, Concept and Context for study, data sources, search strategy, inclusion/exclusion criteria, and procedure for screening, extracting, and analyzing data. RESULTS: The final sample consisted of 19 studies with the following themes: Characterizing Spiritual Needs, Preferences, and Resources; Characterizing Palliative or Spiritual Care; Predicting Provision of Spiritual Care; and Assessing Spiritual Care Interventions. Eighteen studies were published in the past decade, and eleven were based in Europe. The majority of studies focused on long-term care settings, grouped stages of dementia or did not specify dementia stage, and investigated interventions indirectly related to spiritual care. Many studies were limited in sample size and in generalizability/ transferability and used less sophisticated research designs. CONCLUSIONS: Research across dementia, spirituality, and palliative care needs to examine distinct stages of dementia, settings beyond long-term care, and formal spiritual care interventions plus utilize rigorous study designs (e.g., randomized clinical trials). Such research could advance practice and policy that enhance quality of life for tens of millions of persons with dementia and their family members worldwide.
S. Junge, P. Gellert, J. L. O’Sullivan, et al.
Qual Life Res 2020 Jan 18
Our aim was to examine whether quality of life which was repeatedly assessed over time is related with the comprehensive assessment of quality of life (QoL) and thereby to validate a brief QoL assessment. METHOD: This longitudinal study used a comprehensive assessment of quality of life at baseline (QUALIDEM; 37 items) to validate an eight-item version of QUALIDEM to assess momentary quality of life which was repeatedly administered using a tablet device after baseline. In all, 150 people with dementia from 10 long-term facilities participated. Momentary quality of life and comprehensive quality of life, age, gender, activities of daily living (Barthel Index), Functional assessment staging (FAST), and Geriatric Depression (GDS) have been assessed. RESULTS: Comprehensive and momentary quality of life showed good internal consistency with Cronbach’s alpha of .86 and .88 to .93, respectively. For multiple associations of momentary quality of life with the comprehensive quality of life, momentary quality of life was significantly related to comprehensive quality of life (B = .14, CI .08/.20) and GDS (B = – .13, CI – .19/- .06). More specifically, the comprehensive QUALIDEM subscales ‘positive affect’, ‘negative affect’, ‘restlessness’, and ‘social relationships’ showed significant positive associations with momentary quality of life (p < .001). CONCLUSION: We found that momentary quality of life, reliably assessed by tablet, was associated with comprehensive measures of quality of life and depressive symptoms in people with dementia. Broader use of tablet-based assessments within frequent QoL measurements may enhance time management of nursing staff and may improve the care quality and communication between staff and people with dementia.
S. Lim and J. A. Song.
Public Health 2020 Jan 13;181:46-52
People with life-limiting diseases such as dementia are living longer. How to improve the quality of life of those living with dementia is an important challenge for society. Continuity maintenance in older adulthood is a psychosocial adaptation strategy by searching for preference and familiarity, making a sense of connection, and creating coherence. Continuity maintenance is a useful concept for effective dementia care, which could bring psychosocial benefits. This review investigates effective ways of continuity maintenance for people with dementia (PWD). STUDY DESIGN: A rapid realist review (RRR) of a comprehensive range of databases was conducted. METHODS: Realist review methodology provides an explanatory analysis of what works for whom, in what circumstances, and is characterized by its focus on strategies/interventions, contexts, mechanisms, and outcomes. A literature search was conducted using four databases, and articles discussing potential interventions to maintain continuity in PWD were included. Data were extracted on key variables related to contextual factors, mechanisms, and outcomes. RESULTS: Four key themes emerged: (1) maintaining personal identity, (2) maintaining social identity, (3) keeping a familiar environment, and (4) sustaining daily activities. It is hypothesized that these four factors combine and interact to maintain continuity and ultimately lead to psychosocial benefits. CONCLUSIONS: Maintenance of identity, environment, and activities is central to continuity for PWD. The resulting model and program theories respond to the need for a coherent approach to continuity maintenance. Using the foundations created by this RRR, nursing homes may psychosocially improve PWD through maintaining continuity.
M. N. Yoon, C. Ickert, R. Wilson, A. Mihailidis and E. Rochon.
J Clin Nurs 2020 Jan 16
To describe: the proportion of toothbrushing task steps long-term care residents had an opportunity to complete; the duration and quality of toothbrushing by both residents and caregivers; and the feedback caregivers provided. BACKGROUND: Poor oral health is widespread among older adults in long-term care homes, however little is known about their actual oral health practices. DESIGN: Secondary analysis of video recordings METHODS: 58 video-recorded sessions were analyzed from two long-term care homes in Canada. Eligible residents had at least one natural tooth, required oral care assistance, had Alzheimer’s disease and understood English. Eligible caregivers spoke English and had worked for at least 1-year with people with dementia. Toothbrushing success was identified by the resident’s participation in, and completion of, nine toothbrushing steps. Total time spent brushing teeth was calculated by summing the duration of time spent brushing teeth. Quality was described by time spent brushing the facial vs the lingual or occlusal surfaces. Caregiver verbal feedback was pulled from transcripts and analyzed using content analysis. STROBE guidelines were used in reporting this study. RESULTS: The two steps residents most frequently completed or attempted were brushing their teeth (77% complete, 7% attempt) and rinsing their mouth (86% complete, 2% attempt). The average time spent brushing teeth was 60.33 seconds (SD = 35.15). In 66% of observed videos, tooth brushing occurred only on the facial tooth surfaces, with no time spent brushing the lingual or occlusal surfaces. CONCLUSION: Caregivers are supporting residents to independently complete tooth brushing; however, the duration and quality of tooth brushing are not sufficient to ensure optimal oral health. RELEVANCE TO CLINICAL PRACTICE: Clear, detailed guidelines are required to ensure adequate oral care for long-term care residents. Staff need to be aware that all surfaces should be brushed to ensure proper oral health.
A. J. E. Harding, H. Morbey, F. Ahmed, et al.
BMC Geriatr 2019 Mar 27;19(1):94-019-1103-5
Core outcome sets (COS) prioritise outcomes based on their importance to key stakeholders, reduce reporting bias and increase comparability across studies. The first phase of a COS study is to form a ‘long-list’ of outcomes. Key stakeholders then decide on their importance. COS reporting is described as suboptimal and this first phase is often under-reported. Our objective was to develop a ‘long-list’ of outcome items for non-pharmacological interventions for people with dementia living at home. METHODS: Three iterative phases were conducted. First, people living with dementia, care partners, health and social care professionals, policymakers and researchers (n = 55) took part in interviews or focus groups and were asked which outcomes were important. Second, existing dementia trials were identified from the ALOIS database. 248 of 1009 pharmacological studies met the inclusion criteria. Primary and secondary outcomes were extracted from a 50% random sample (n = 124) along with eight key reviews/qualitative papers and 38 policy documents. Third, extracted outcome items were translated onto an existing qualitative framework and mapped into domains. The research team removed areas of duplication and refined the ‘long-list’ in eight workshops. RESULTS: One hundred seventy outcome items were extracted from the qualitative data and literature. The 170 outcome items were consolidated to 54 in four domains (Self-Managing Dementia Symptoms, Quality of Life, Friendly Neighbourhood & Home, Independence). CONCLUSIONS: This paper presents a transparent blueprint for ‘long-list’ development. Though a useful resource in their own right, the 54 outcome items will be distilled further in a modified Delphi survey and consensus meeting to identify core outcomes.
S. Gautam, S. Neville and J. Montayre.
Int J Older People Nurs 2019 Jun;14(2):e12228
To synthesize evidence regarding the spiritual needs and care of older adults living in residential care facilities from the perspectives of older adults and nurses or caregivers. DESIGN: Integrative review of literature. DATA SOURCES: Literature search was conducted using CINAHL Plus with Full Text via EBSCO, Scopus, PubMed, PsychInfo, Web of Science, and ProQuest Social Science Databases from March to December 2017. REVIEW METHODS: This integrative review utilised the Whittemore and Knafl framework and PRISMA in the selection of eligible articles. Quality of the articles was evaluated using the Mixed Method Appraisal Tool. RESULTS: Seven articles were reviewed and analysed. There is limited evidence \and no agreed definition of spiritual needs and care of older adults living in residential care facilities. Spiritual needs of older adults in residential care facilities is a psycho-social, religious and existential construct. Spiritual care in residential care facilities is linked to information gathering, religious guidance, maintaining family connections, providing companionship, discussing end of life issues, and providing counseling. Older adults highly value the role of nurses and caregivers in fulfilling their spiritual needs and providing spiritual care. However, nurses and caregivers perceived arranging a referral to a religious advisor as the main aspect of spiritual care. Therefore, nurses’, caregivers’, and older adults’ views on spiritual care differed to some extent. CONCLUSION: The practical aspects of spiritual needs assessment and spiritual care provision requires further investigation, which is essential to improve the effectiveness of service delivery in residential care facilities.
In their 2019 manifesto, the Conservative party pledged to launch a “Dementia Moonshot” to find a cure for dementia – doubling research funding and speeding up trials for new treatments.
Alzheimer’ Research UK are now calling for action to deliver on those commitments. In this publication, Alzheimer’s UK puts forward the steps government must take to deliver its Moonshot ambition of finding a life-changing treatment for dementia.
Wednesday 27 February Lister Hall, University of Alberta, Edmonton
Educational Fair Dealing: The State of the Nation, A post-truth existence for fair dealing in Canadian post-secondary institutions?, Deconstructing the Guidelines, Re-engaging Canadians with fair dealing: Fandom as stepping stone to copyright literacy
Wednesday 5 February 10:00-11:00 MT
Presenter: Tom Schweizer
brainXchange, Alzheimer Society of Canada
Approximately 80,000 emergency department visits per year are the result of a head injury in an adult over the age of 65. Epidemiological studies have identified increased risk for dementia in head injury patients, however there is scarce neuroimaging evidence to support this direct connection.
We will review the current brain imaging literature on concussion and mTBI and share new findings and will then discuss some of the research linking head injury to dementia and future directions.
Thursday 13 February 10:00-11:00 MT
Presenter: Wendy Gifford
At the end of this presentation the audience will be able to:
1. Describe reasons why disparities in health exist for Indigenous Peoples
2. Understand the resilience of Indigenous peoples and why knowledge translation with Indigenous communities is distinct
3. Describe processes for translating knowledge with Indigenous communities
Ottawa, ON, Trainee & fellow registration: $375 Junior Faculty registration: $925
Presenter: 17-19 June
The Summer Institute is aimed at graduate students, post-doctoral and clinical fellows, and junior faculty who study issues relevant to KT and those who want to learn more about how to advance their research skills in this area. We encourage applications from a wide range of disciplines that span all of CIHR’s research themes (clinical, health services, and population health).
University of Colorado Anschutz Medical Campus
Begins Summer or Fall 2020
D&I science is the study of methods and strategies to facilitate the spread, adoption, implementation, and sustainment of evidence-based practices, interventions and policies in real world and diverse health settings. As a transdisciplinary scientific field, D&I science can address multiple cross-cutting research topics (e.g., reducing disparities in access to and quality of care; use of innovative technologies and data science to improve routine care) and health conditions (e.g., mental health, cancer and cardiovascular disease morbidity and mortality, geriatric care) of high priority. D&I Science also has the potential to make precision health more actionable and relevant and can make the translation of discoveries in this and other high priority areas more rapid.
The D&I Science Graduate Certificate Program is designed to provide pragmatic training to researchers who want to develop competencies in D&I science and practice which can be applied across multiple topic areas and settings in health services, clinical and community health, and public health research. The program is intended to provide researchers with solid foundational skills in D&I science, as well as intermediate and advanced skills in select D&I competency areas.
The Career Development and the Pragmatic Clinical Trials Platforms of the Alberta SPOR SUPPORT Unit (AbSPORU) have collaborated to create a certificate designed to accommodate current professionals in the field of clinical health research. As there is currently no direct pathway to clinical health research roles in Alberta, it has been the vision of numerous leaders in various clinical trials organizations in to create a consolidated training approach to address this gap.
The purpose of this certificate is to integrate currently available training, such as the ACRC recommended training courses, while providing additional content that integrates patient-oriented research with a focus on practical application using real-world and Alberta-specific examples. The certificate content has been organized into a chronological sequence that reflects the progression of a clinical trial, from pre-trial activities to study conclusion
TeamSTEPPS Canada®, developed by the United States Department of Defense and the Agency for Healthcare Research and Quality, improves safety and transforms culture in healthcare through better teamwork, communication, leadership, situational awareness, and mutual support. TeamSTEPPS Canada™ is an evidence-based teamwork system that optimizes patient care by improving communication and teamwork skills among healthcare professionals, including point-of-care staff. It includes a comprehensive set of ready-to-use materials and a training curriculum to integrate teamwork principles into a variety of settings.
The Director, Knowledge Mobilization (Director, KMb) at the Canadian Centre on Substance Use and Addiction (CCSA) will be responsible for leading CCSA’s knowledge mobilization portfolio. The Director, KMb, brings a specialized knowledge in the field and provides guidance and leadership to the team of knowledge brokers. The Director collaborates with other colleagues within CCSA and external partners to support organizational priorities and mobilize the latest evidence in substance use and addiction. The Director, KMb, is a member of CCSA’s Senior Leadership Team as well as its Operations Committee.
The Knowledge Broker / Project Coordinator at the Ontario CLRI at Bruyère will be responsible for developing, implementing and supporting knowledge mobilization activities and for the development and delivery of blended learning opportunities that build on research and evidence-based innovations. These learning opportunities will support sustainable practice change, will be learner-centered and will be tailored to meet the needs of stakeholders in long-term care.