April 6, 2021

Knowledge Translation in Nursing and Healthcare provides authoritative guidance on the implementation of evidence-informed practice, covering issue identification and clarification, solution building and implementation, evaluation, and sustainment. Integrating theory, empirical research, and experiential knowledge, this hands-on resource assists nurses and healthcare practitioners in collecting quality evidence, transforming it into a useable, customized recommendation, and then applying best practice in various point-of-care settings.

Written by highly experienced implementation researchers working with practitioners, the book demonstrates how the synthesis and translation of evidence supports improvement of existing care and service delivery models, and produces increased benefit for both patients and health services. Examples drawn from the authors’ first-hand experience—such as pressure injury prevention in acute care, transition of care for people with heart failure, and community leg ulcer care—illustrate the use of best practice in addressing care and quality issues. This important reference and guide:

Outlines a planning framework that activates research and evidence in practice settings, moving knowledge into action and sustaining the use of best practice
Introduces the framework that enables effective evidence-informed methodology and decision-making
Features numerous illustrative field examples of both successful and unsuccessful implementations in a variety of practical situations
Offers perspectives on best practice implementation from experienced practitioners and researchers
Knowledge Translation in Nursing and Healthcareis a must-have for those wanting to implement, evaluate, and sustain best practice in the delivery of evidence-informed healthcare to patients, families, and communities.

The Integrated Knowledge Translation Research Network (IKTRN) is pleased to present the fourth volume of our casebook series. This edition includes 10 cases describing how knowledge users and researchers partnered to achieve their research goals, the challenges of these collaborations and the benefits of an integrated knowledge translation (IKT) approach.

Key findings
-COVID-19 cases among residents of LTC and retirement homes increased by nearly two-thirds during Wave 2 compared with Wave 1.
-Compared with pre-pandemic years, in Wave 1, LTC residents had fewer physician visits; fewer hospital transfers; and less contact with friends and family, which is associated with higher rates of depression.
-In all provinces where it could be measured, the total number of resident deaths was higher than normal during this period, even in places with fewer COVID-19 deaths.
-Provincial and national inquiries (to date) on COVID-19 in LTC have made similar recommendations and speak to long-standing concerns in the sector.

An internationally renowned researcher in knowledge translation and a professor in the School of Nursing, Janet Squires leads national and international research teams aiming to reduce the gaps between research and clinical practice. Working with experts from Canada, Australia, the U.S., Great Britain, Sweden and New Zealand, she analyzes the role of context in knowledge translation, specifically, the impact of the physical and social environments in which health care is offered. Her work has influenced health care providers’ practices in this country and around the world.

The year 2021 marks an important demographic milestone as it is the first year that Canada’s largest cohort, the baby-boomers, begin turning 75. As a larger share of the baby boomers move into the ages associated with higher care needs, this will result in rapid growth in demand for home and long-term care. Yet, the health system is already struggling to meet current needs for home and long-term care. As demand is set grow very rapidly over the next decade, meeting this demand will become even more challenging. This report highlights these challenges by quantifying the looming costs of providing care to our seniors and explores policy solutions that are aimed at offering improvements while creating system efficiencies.
In our baseline scenario, we estimate the current demand for care. This means those who are receiving care, those who are on a waitlist for long-term care and those who are relying exclusively on informal home care but who would like professional care. This unmet demand represents an estimated 20.4 percent of long-term care demand and 7.7 per cent of home care demand. Despite the challenges meeting today’s need for care, demand for long-term care, is expected to reach 606,000 patients in 2031, up from 380,000 in 2019. Similarly, demand for home care will increase to roughly 1.8 million patients in 2031, up from close to 1.2 million in 2019. This increase is projected to result in the total cost of care rising from $29.7 billion in 2019 to $58.5 billion in 2031. The cumulative cost of providing this care over 2021 to 2031 is pegged at $490.6 billion.
While this represents a substantial funding requirement, there are policy solutions that can not only lower the cost of care, but also provide care that is aligned with patient needs. Long-term care utilization has been on a downward trend in recent years, which is in line with patients’ preference to remain at home. If we can sustain that trend, by making better use of home care, we can move 37,000 Canadians out of long-term care, saving the health care system an estimated $794 million a year by 2031. In addition, we estimate that there are currently more than 9,405 patients in hospitals waiting to be transferred to other levels of care. If we can shift some of these people to home care and long-term care, we could save an additional $1.4 billion per year by 2031.
While these policy solutions can better meet care needs and also create system savings, they are simply unable to counter the significant jump in future costs that is forthcoming from our aging demographics. Nor is it likely that any other policy solution will be able to quell the rise in demand. The results of this analysis are clear. Costs for care are increasing rapidly. Policymakers and other stakeholders will need to quickly decide how they will handle this rapid rise in care needs.

The process of building nation-wide standards for long-term care homes was launched last week. In the coming months, a committee of about 20 people ranging from researchers to LTC residents and family members will be recruited. There will be virtual town halls. Anyone who wants to share their views can fill out an online survey. “Everything is on the table as far as I am concerned,” said Dr. Samir Sinha, director of geriatrics at Toronto’s Mount Sinai Hospital and director of health policy research at the National Institute on Ageing at Ryerson University, who will be leading the committee. “I want to find people from across the country who want to be part of this process.” By November, a series of draft standards should be ready for public review, with the new standards in place in 2022. The new standards will be developed following requirements set by the Standards Council of Canada and will revise the Health Standard Organization’s existing Long-Term Care Services standard, last updated in 2020.

This article describes the public health impact of Alzheimer’s disease (AD), including incidence and prevalence, mortality and morbidity, use and costs of care, and the overall impact on caregivers and society. The Special Report discusses the challenges of providing equitable health care for people with dementia in the United States. An estimated 6.2 million Americans age 65 and older are living with Alzheimer’s dementia today. This number could grow to 13.8 million by 2060 barring the development of medical breakthroughs to prevent, slow or cure AD. Official death certificates recorded 121,499 deaths from AD in 2019, the latest year for which data are available, making Alzheimer’s the sixth-leading cause of death in the United States and the fifth-leading cause of death among Americans age 65 and older. Between 2000 and 2019, deaths from stroke, heart disease and HIV decreased, whereas reported deaths from AD increased more than 145%. This trajectory of deaths from AD was likely exacerbated in 2020 by the COVID-19 pandemic. More than 11 million family members and other unpaid caregivers provided an estimated 15.3 billion hours of care to people with Alzheimer’s or other dementias in 2020. These figures reflect a decline in the number of caregivers compared with a decade earlier, as well as an increase in the amount of care provided by each remaining caregiver. Unpaid dementia caregiving was valued at $256.7 billion in 2020. Its costs, however, extend to family caregivers’ increased risk for emotional distress and negative mental and physical health outcomes – costs that have been aggravated by COVID-19. Average per-person Medicare payments for services to beneficiaries age 65 and older with AD or other dementias are more than three times as great as payments for beneficiaries without these conditions, and Medicaid payments are more than 23 times as great. Total payments in 2021 for health care, long-term care and hospice services for people age 65 and older with dementia are estimated to be $355 billion. Despite years of efforts to make health care more equitable in the United States, racial and ethnic disparities remain – both in terms of health disparities, which involve differences in the burden of illness, and health care disparities, which involve differences in the ability to use health care services. Blacks, Hispanics, Asian Americans and Native Americans continue to have a higher burden of illness and lower access to health care compared with Whites. Such disparities, which have become more apparent during COVID-19, extend to dementia care. Surveys commissioned by the Alzheimer’s Association recently shed new light on the role of discrimination in dementia care, the varying levels of trust between racial and ethnic groups in medical research, and the differences between groups in their levels of concern about and awareness of Alzheimer’s disease. These findings emphasize the need to increase racial and ethnic diversity in both the dementia care workforce and in Alzheimer’s clinical trials.

INTRODUCTION AND PURPOSE: Residents in long-term care exhibit diminishing senses (hearing, sight, taste, smell or touch). The purpose of this study was to examine the available literature on the impact of sensory interventions on the quality of life of residents living in long-term care settings. METHODS: We conducted a mixed-methods scoping review using Arksey and O’Malley’s framework. Seven databases (Medline (Ovid), PubMed (non-Medline-Ovid), CINAHL (EBSCO), Embase (Ovid), Ageline, PsycINFO (Ovid), Cochrane Central Register of Controlled Trials until 1 December 2020) were searched. Two reviewers independently screened the studies for sensory interventions using a two-step process. Eligible studies underwent data extraction and results were synthesised descriptively. RESULTS: We screened 5551 titles and abstracts. A total of 52 articles met our inclusion criteria. Some interventions involved only one sense: hearing (n=3), sight (n=12), smell (n=4) and touch (n=15). Other interventions involved multiple senses (n=18). We grouped the interventions into 16 categories (music programmes, environmental white noise, bright light interventions, visual stimulations, olfactory stimulations, massages, therapeutic touch, tactile stimulations, physical activity plus night-time programmes, pet therapies, various stimuli interventions, Snoezelen rooms, motor and multisensory based strategies, Namaste care, environmental modifications and expressive touch activities). CONCLUSION: This preliminary review summarised some of the available sensory interventions that will help inform a series of future systematic reviews on each of the specific interventions. The evidence-based knowledge for sensory interventions will also inform a future audit programme for assessing the presence of sensory interventions in long-term care.

BACKGROUND: Research claims that ‘learning by doing’ creates new thinking, often leading to new practice. OBJECTIVES: The aim was to explore and describe the staff learning process from the first to the second year when adopting person-centred care into clinical practice in a nursing home for persons with dementia. METHOD: The data consisted of poster texts from staff and written notes by researchers obtained from the group discussions. The study involved 24 care units (200 staff). Content analysis was chosen as method to explore the learning process. RESULT: The staff described the actions that they took during year 1 and year 2, in which five categories emerged, activities, environment, information, priorities and staff routines. With researchers’ analysis the categories together created the learning process and formed a sub-theme. They further formed an overarching theme from simplicity to complexity and consensus. Staff changes year 1 pertained more to planning and doing, while year 2 changes constituted a larger complexity of person-centred care with reflection, collaborative learning and a mind-set change. CONCLUSION: Staff chose the development area, and the learning process was illuminated by the researchers. This underscores the value to visualise and verbalise the steps of change as well as include these steps in the design of an implementation process. The concept of person-centred care could be viewed on different levels. The findings may contribute to a more comprehensive understanding of staff learning process when implementation of person-centred care. IMPLICATIONS FOR PRACTICE: Making staff’s learning process visible can be a guide for improvement and change from a generic care towards person-centred care. The Regional Board of Research Ethics approved the study (Reg no. 2010/1234-31/5).

BackgroundTranslating research into practice is complex for clinicians, yet essential for high quality patient care. The field of implementation science evolved to address this gap by developing theoretical approaches to guide adoption and sustained implementation of practice changes. Clinicians commonly lack knowledge, time, and resources of how evidence-based practice (EBP) models can guide implementation, contributing to the knowledge-to-practice gap. AimThis paper aimed to equip clinicians and other healthcare professionals with implementation science knowledge, confidence, and models to facilitate EBP change in their local setting and ultimately improve healthcare quality, safety, and population health outcomes. MethodsThe field of implementation science is introduced, followed by application of three select models. Models are applied to a clinical scenario to emphasize contextual factors, process, implementation strategies, and outcome evaluation. Key attributes, strengths, opportunities, and utilities of each model are presented, along with general resources for selecting and using published criteria to best fit clinical needs. Partnerships between implementation scientists and clinicians are highlighted to facilitate the uptake of evidence into practice. Linking evidence to actionKnowledge of implementation science can help clinicians adopt high-quality evidence into their practices. Application-oriented approaches can guide clinicians through the EBP processes. Clinicians can partner with researchers in advancing implementation science to continue to accelerate the adoption of evidence and reduce the knowledge-to-action gap.