New Article by Greta Cummings
Nursing theory and concept development: A theoretical model of clinical nurses’ intentions to stay in their current positions
Cowden TL, Cummings GG.
Journal of advanced nursing 2012 Jan 19
Aim. We describe a theoretical model of staff nurses’ intentions to stay in their current positions. Background. The global nursing shortage and high nursing turnover rate demand evidence-based retention strategies. Inconsistent study outcomes indicate a need for testable theoretical models of intent to stay that build on previously published models, are reflective of current empirical research and identify causal relationships between model concepts. Data Sources. Two systematic reviews of electronic databases of English language published articles between 1985-2011. Discussion. This complex, testable model expands on previous models and includes nurses’ affective and cognitive responses to work and their effects on nurses’ intent to stay. The concepts of desire to stay, job satisfaction, joy at work, and moral distress are included in the model to capture the emotional response of nurses to their work environments. The influence of leadership is integrated within the model. Implications for nursing. A causal understanding of clinical nurses’ intent to stay and the effects of leadership on the development of that intention will facilitate the development of effective retention strategies internationally. Testing theoretical models is necessary to confirm previous research outcomes and to identify plausible sequences of the development of behavioral intentions. Conclusion. Increased understanding of the causal influences on nurses’ intent to stay should lead to strategies that may result in higher retention rates and numbers of nurses willing to work in the health sector. © 2012 Blackwell Publishing Ltd.
New Article by Alison Hutchinson
Using the Promoting Action on Research Implementation in Health Services Framework to Guide Research Use in the Practice Setting
Hutchinson AM, Wilkinson JE, Kent B, Harrison MB.
Worldviews on evidence-based nursing / Sigma Theta Tau International, Honor Society of Nursing 2012 Mar;9(1):59-61.
In this article, we describe the Promoting Action on Research Implementation in Health Services (PARIHS) framework, and examine its potential for guiding educators and clinicians in their endeavors to integrate evidence into practice.
Call for Abstracts
Margaret Scott Wright Research Day
Deadline May 15, 2012
Co-presented by the University of Calgary Faculty of Nursing, the University of Alberta Faculty of Nursing, and the Mu Sigma Chapter of Sigma Theta Tau, the Margaret Scott Wright Research Day honours an outstanding nurse who was also a scholar, researcher, and model of leadership for twenty-first century nursing. Dr. Scott Wright’s excellent research, combined with her persistent and unwavering ability to instill respect for the discipline and profession of nursing, affirmed her commitment to nursing practice, scholarship, and research. This year’s conference is titled Making a Difference: Nursing Research in Action. Abstracts of original research, or of extensive systematic literature reviews are invited for oral or poster presentations.
Grants & Awards
CIHR: Summer Program in Aging (SPA 2012) – Call for Applications
Vancouver Island, May 6 to 11, 2012. Deadline March 15, 2012
CIHR invites applications from research trainees at the Masters, Doctoral and Postdoctoral levels, who are studying aging or technology as it relates to human aging. Also invited to apply are those doing post-graduate clinical training that includes a program of research in aging. The aim of the Summer Program in Aging (SPA), offered by the CIHR Institute of Aging, is to provide a program of advanced research training that crosses disciplines, sectors, institutions, and geography.
CIHR: Planning Grants : Spring 2012 Competition
The maximum amount per grant is $25,000 for up to one year. Deadline June 15, 2012
Activities may focus on, but are not limited to, the following:
- Activities that assist potential teams of researchers, knowledge-users and/or partners in working together to identify research questions or emerging issues and priorities that could form the basis of a grant application;
- Stakeholder consultations, including citizen engagement activities, regarding needs, gaps and opportunities in the health research landscape, priority policy issues and/or priority research questions, where such common understanding is currently lacking or requires further development;
- Initial planning and discussion of a research project among potential team members including researchers, knowledge-users and/or partners to assess the viability of the research project and the partnership;
- Conducting an environmental scan or preliminary synthesis of relevant literature, activities or programs;
- Early-stage planning to determine possible commercial viability of a discovery;
- Opportunities for knowledge exchange involving stakeholder linkages (to inform practice, care, and/or policy) that could potentially lead to an application to a funding opportunity;
- Gatherings of partners, health researchers, and/or knowledge users where the main objective is to facilitate regional/national and/or international collaboration among individuals or groups from a variety of backgrounds (for example, building new and existing multi-sectored partnerships that include a significant number of participants from outside the conventional scientific community, consensus meetings, networking and partnership development events) interested in applying to a funding opportunity.
CIHR: Dissemination Events : Spring 2012 Competition
The maximum amount per grant is $25,000 for up to one year. Deadline June 15, 2012
The specific objective of this funding opportunity is to support events/activities that contribute to the dissemination, exchange and uptake of research evidence.
- Education of groups such as patients, health professionals, community organizations, policy-makers, the general public;
- Knowledge dissemination that will inform practice, clinical care, partnership best practices, policy and decision making;
- Dissemination and/or discussion of research findings at scientific meetings, workshops, conferences, congresses or symposia.
Post-Doctoral Fellowship Opportunity – University of Western Ontario
Available funding for one year: $40,000, starting in July 2012, September 2012 or January 2013.
We are pleased to announce a postdoctoral scholar opportunity in the field of Knowledge Translation (KT), an interactive process of knowledge exchange between health researchers and knowledge users. Given that the health system is broad in scope it is important to systematically investigate how definitions and applications of knowledge translation might differ by setting and focus. Community-based organizations, including public health departments, community health centres, civil sector organizations and local authorities face a distinctive set of challenges and concerns related to engaging in the knowledge translation process, suggesting a unique perspective on knowledge translation in these settings. The postdoctoral scholar will work closely with two supervisors with programs of research related to community settings. Dr. Anita Kothari has been involved in testing KT interventions in public health practice, Ontario Early Years Centres and homecare. Her work is based on the premise that KT is a social process involving interaction among knowledge users, where knowledge is broadly defined. Based on intervention studies examining the health-care response to violence against women and children, Dr. Nadine Wathen has conducted KT studies in the area of family violence, gender and mental health. Expectations: The accepted scholar(s) will be expected to complete progress reports every 6 months and meet with supervisors regularly; it is assumed that the scholar(s) will reside within driving distance of London, Ontario. They will also be expected to hold national or provincial funding or be in the process of applying for external funding. Please send a covering letter, names of three references and a copy of your CV by email to Drs. Anita Kothari and Nadine Wathen. The deadline for applications is June 1, 2012. Candidates will be interviewed shortly thereafter by telephone. More information about postdoctoral studies at Western is available here.
CIHR: Catalyst Grant : Health Services and Systems for an Aging Population
Registration Deadline June 15, 2012, maximum amount per grant is $ 100,000 for up to one year
The Institute of Aging is embarking on a strategic initiative to address national research and knowledge exchange priorities associated with Health Services and Systems for an Aging Population (HSSAP).
It is expected that HSSAP-funded research will:
- address the complex functional, social and medical needs of older persons, in a coordinated and integrated manner;
- address aging as a continuum throughout which health service and care requirements change;
- treat the older patient as a whole person within a social context, recognizing that aging is neither a collection of diseases, nor a disease itself.
Exploring knowledge exchange: a useful framework for practice and policy.
Ward V, Smith S, House A, Hamer S.
Social science & medicine (1982) 2012 Feb;74(3):297-304
Knowledge translation is underpinned by a dynamic and social knowledge exchange process but there are few descriptions of how this unfolds in practice settings. This has hampered attempts to produce realistic and useful models to help policymakers and researchers understand how knowledge exchange works. This paper reports the results of research which investigated the nature of knowledge exchange. We aimed to understand whether dynamic and fluid definitions of knowledge exchange are valid and to produce a realistic, descriptive framework of knowledge exchange. Our research was informed by a realist approach. We embedded a knowledge broker within three service delivery teams across a mental health organisation in the UK, each of whom was grappling with specific challenges. The knowledge broker participated in the team’s problem-solving process and collected observational fieldnotes. We also interviewed the team members. Observational and interview data were analysed quantitatively and qualitatively in order to determine and describe the nature of the knowledge exchange process in more detail. This enabled us to refine our conceptual framework of knowledge exchange. We found that knowledge exchange can be understood as a dynamic and fluid process which incorporates distinct forms of knowledge from multiple sources. Quantitative analysis illustrated that five broadly-defined components of knowledge exchange (problem, context, knowledge, activities, use) can all be in play at any one time and do not occur in a set order. Qualitative analysis revealed a number of distinct themes which better described the nature of knowledge exchange. By shedding light on the nature of knowledge exchange, our findings problematise some of the linear, technicist approaches to knowledge translation. The revised model of knowledge exchange which we propose here could therefore help to reorient thinking about knowledge exchange and act as a starting point for further exploration and evaluation of the knowledge exchange process. Copyright © 2011 Elsevier Ltd. All rights reserved
Evidence-based practice: SLTs under siege or opportunity for growth? The use and nature of research evidence in the profession.
McCurtin A, Roddam H.
International journal of language & communication disorders / Royal College of Speech & Language Therapists 2012 Jan-Feb;47(1):11-26
BACKGROUND: Speech and language therapists are encouraged to be evidence-based practitioners in contemporary clinical practice. This apparently signifies their commitment to ‘good’ practice. An examination of evidence-based practice (EBP) and its adoption in clinical practice is therefore warranted. AIMS: This paper aims to explore EBP, specifically research evidence, as related to the field of speech and language therapy (SLT), using profession specific and cross-disciplinary examples. It asks the reader to consider whether research evidence contributes positively to SLT practice, or adds to the demands placed on clinicians? METHODS & PROCEDURES: A review of the literature on the nature and use of research evidence in the field of speech and language therapy and related health professions was undertaken using multiple databases (Cochrane, Medline, Cinahl, BioMed, Trip, Dare) and the following up of references provided within texts and articles. This paper asks the reader to consider the topic from the perspective of the nature of research produced, the barriers perceived, and the use of research evidence by SLTs and the allied health professions. Outcomes & Results: The uptake of research evidence in the profession is similar to other health professions and continues to be problematic. There are multiple reasons why this is so, originating from both the nature and use of research. CONCLUSIONS & IMPLICATIONS: Research evidence is one of the pillars of EBP. Despite problems with the nature and use of such evidence, it has a positive contribution to make to clinical practice as it provides for a scientific touchstone. However, it may be that the speech and language therapist and not the research evidence is the primary pivot upon which scientific practice is based. © 2011 Royal College of Speech and Language Therapists.
Examining nurses’ attitudes regarding the value, role, interest, and experience in research in an acute care hospital.
Examining nurses’ attitudes regarding the value, role, interest, and experience in research in an acute care hospital.
Riley JK, Hill AN, Krause LB, Leach LB, Lowe TJ.
Journal for nurses in staff development : JNSD : official journal of the National Nursing Staff Development Organization 2011 Nov-Dec;27(6):272-279
This study examined nurses’ attitudes regarding the value of and their role, interest, and experience in research in an acute care hospital. A correlational design explored the relationship between attitudes about nursing research, involvement, educational background, and experience. The results indicated an increasing level of value and interest in research for those nurses with greater educational attainment, certified specialty, previously taken research course, research experience, and a nursing position in education. The findings suggest that additional education and guided projects are needed for those nurses with little or no previous research experience.
Building capacity for evidence informed decision making in public health: a case study of organizational change.
Peirson L, Ciliska D, Dobbins M, Mowat D.
BMC public health 2012 Feb 20;12(1):137
BACKGROUND: Core competencies for public health in Canada require proficiency in evidence informed decision making (EIDM). However, decision makers often lack access to information, many workers lack knowledge and skills to conduct systematic literature reviews, and public health settings typically lack infrastructure to support EIDM activities. This research was conducted to explore and describe critical factors and dynamics in the early implementation of one public health unit’s strategic initiative to develop capacity to make EIDM standard practice.
METHODS: This qualitative case study was conducted in one public health unit in Ontario, Canada between 2008 and 2010. In-depth information was gathered from two sets of semi-structured interviews and focus groups (n = 27) with 70 members of the health unit, and through a review of 137 documents. Thematic analysis was used to code the key informant and document data. RESULTS: The critical factors and dynamics for building EIDM capacity at an organizational level included: clear vision and strong leadership, workforce and skills development, ability to access research (library services), fiscal investments, acquisition and development of technological resources, a knowledge management strategy, effective communication, a receptive organizational culture, and a focus on change management. CONCLUSION: With leadership, planning, commitment and substantial investments, a public health department has made significant progress, within the first two years of a 10-year initiative, towards achieving its goal of becoming an evidence informed decision making organization.
Health Care Administration & Organization
Clinical competency, self-efficacy, and job satisfaction: perceptions of the staff nurse.
Tyler S, Bourbon E, Cox S, Day N, Fineran C, Rexford D, et al.
Journal for nurses in staff development : JNSD : official journal of the National Nursing Staff Development Organization 2012 Jan-Feb;28(1):32-35
This descriptive study obtained survey data that explored the perception of staff nurses regarding their clinical competency, self-efficacy, and job satisfaction. The purpose of this study was to identify nursing professional development issues, data that can then be used to develop evidence-based educational programs.
Professional nursing burnout and irrational thinking: a replication study.
Balevre PS, Cassells J, Buzaianu E.
Journal for nurses in staff development : JNSD : official journal of the National Nursing Staff Development Organization 2012 Jan-Feb;28(1):2-8
This expanded (n = 648) replication study examines job-related burnout in practicing nurses in relation to five maladaptive thinking patterns at eight northeast Florida hospitals. Data supported the hypothesis that maladaptive thinking patterns may be related to nurses’ burnout thoughts and behaviors. The focus of this research spotlights the individual nurse’s thoughts, emotions, and actions and suggests that these burnout tendencies can be mitigated if not changed.
Toward human resource management in inter-professional health practice: linking organizational culture, group identity and individual autonomy.
The International journal of health planning and management 2012 Feb 6
The literature on team and inter-professional care practice describes numerous barriers to the institutionalization of inter-professional healthcare. Responses to slow institutionalization of inter-professional healthcare practice have failed to describe change variables and to identify change agents relevant to inter-professional healthcare practice. The purpose of this paper is to (1) describe individual and organizational level barriers to collaborative practice in healthcare; (2) identify change variables relevant to the institutionalization of inter-professional practice at individual and organizational levels of analysis; and (3) identify human resource professionals as change agents and describe how the strategic use of the human resource function could transform individual and organizational level change variables and therefore facilitate the healthcare system’s shift toward inter-professional practice. A proposed program of institutionalization includes the following components: a strategic plan to align human resource functions with organizational level inter-professional healthcare strategies, activities to enhance professional competencies and the organizational position of human resource personnel, activities to integrate inter-professional healthcare practices into the daily routines of institutional and individual providers, activities to stand up health provider champions as permanent leaders of inter-professional teams with human resource professionals as consultants and activities to bring all key players to the table including health providers. Copyright © 2012 John Wiley & Sons, Ltd.
Building personal and professional resources of resilience and agility in the healthcare workplace.
Pipe TB, Buchda VL, Launder S, Hudak B, Hulvey L, Karns KE, et al.
Stress and health : journal of the International Society for the Investigation of Stress 2012 Feb;28(1):11-22
This article describes the rationale, implementation and results of a pilot study evaluating the personal and organizational impact of an educational intervention on the stress of health team members. The compelling imperative for the project was to find a positive and effective way to address the documented stress levels of healthcare workers. Pilot study of oncology staff (n=29) and healthcare leaders (n=15) exploring the impact of a positive coping approach on Personal and Organizational Quality Assessment-Revised (POQA-R) scores at baseline and 7 months using paired t-tests. Personal and organizational indicators of stress decreased in the expected directions in both groups over the time intervals. The majority of POQA-R categories were statistically significantly improved in the oncology staff, and many of the categories were statistically significantly improved in the leadership group. The findings from this project demonstrate that stress and its symptoms are problematic issues for hospital and ambulatory clinic staff as evidenced by baseline measures of distress. Further, a workplace intervention was feasible and effective in promoting positive strategies for coping and enhancing well-being, personally and organizationally. Copyright © 2011 John Wiley & Sons, Ltd.
Designing and Implementing Research on a Statewide Quality Improvement Initiative: The DIAMOND Study and Initiative.
Lauren Crain A, Solberg LI, Unutzer J, Ohnsorg KA, Maciosek MV, Whitebird RR, et al.
Medical care 2012 Feb 8
OBJECTIVE: To demonstrate a rigorous methodology that optimally balanced internal validity with generalizability to evaluate a statewide collaborative that implemented an evidence-based, collaborative care model for depression management in primary care. STUDY DESIGN AND SETTING: Several operational features of the DIAMOND (Depression Improvement Across Minnesota, Offering a New Direction) Initiative suggested that the DIAMOND Study use a staggered implementation design with repeated cross-sections of patients across clinical settings. A multilevel recruitment strategy elicited virtually complete study participation from the medical groups, clinics, and health plans that coordinated efforts to deliver and reimburse DIAMOND care. Patient identification capitalized on large health plan claims databases to rapidly identify the population of patients newly treated for depression in DIAMOND clinics. RESULTS: The staggered implementation design and multilevel recruitment strategy made it possible to evaluate DIAMOND by holding confounding factors constant and accurately identifying an intent-to-treat population of patients treated for depression without intruding on or requiring effort from their clinics. CONCLUSIONS: Recruitment and data collection from health plans, medical groups and clinics, and patients ensured a representative, intent-to-treat sample of study-enrolled patients. Separating patient identification from care delivery reduced threats of selection bias and enabled comparisons between the treated population and study sample. A key challenge is that intent-to-treat patients may not be exposed to DIAMOND which dilutes the effect size but offers realistic expectations of the impact of quality improvement in a population of treated patients.
The effects of leadership and ward factors on job satisfaction in nursing homes: a multilevel approach.
Havig AK, Skogstad A, Veenstra M, Romoren TI.
Journal of clinical nursing 2011 Dec;20(23-24):3532-3542
To examine (1) the relationships between job satisfaction and task- and relationship-oriented leadership and (2) the direct and moderating effects on job satisfaction of three ward-level factors: workload, use of teams and staff stability. BACKGROUND: Job satisfaction in nursing homes is vital to meeting the challenges related to recruitment and turnover.
DESIGN: Cross-sectional design. METHOD: A multilevel analysis approach was used to recognise a hierarchal structure of determined factors and to capture variation in job satisfaction at the individual and ward level. A questionnaire was sent to 444 registered nurses, auxiliary nurses and unskilled nursing assistants. Structured interviews were administered to 40 ward managers and 13 directors, and 900 hours of field observations was conducted in 40 nursing home wards throughout Norway. RESULTS: We found a significant relationship between job satisfaction and task-oriented and relationship-oriented leadership styles, with a stronger effect for task orientation. The effect of the two leadership styles varied significantly across wards. Furthermore, staff stability had both a significant positive direct effect and a moderating effect on job satisfaction, whereas the two other ward-level predictors yielded no significant contributions. CONCLUSION: The relatively stronger effect of task-oriented leadership on job satisfaction, particularly in wards with low staff stability, is in contrast to most previous studies and suggests that there may be specific conditions in nursing homes that favour the use of this leadership style. The varying effect of both leadership styles indicates that staff in different nursing home wards could benefit from the use of different leadership styles. RELEVANCE TO CLINICAL PRACTICE: The study highlights the importance of using different leadership behaviour and the importance of high staff stability to ensure job satisfaction among nursing home personnel.
Health Care Innovation & Quality Assurance
Does information matter? Competition, quality, and the impact of nursing home report cards.
Grabowski DC, Town RJ.
Health services research 2011 Dec;46(6pt1):1698-1719
OBJECTIVE: We evaluate the effects of the Nursing Home Quality Initiative (NHQI), which introduced quality measures to the Centers for Medicare and Medicaid Services’ Nursing Home Compare website, on facility performance and consumer demand for services. DATA SOURCES: The nursing home Minimum Data Set facility reports from 1999 to 2005 merged with facility-level data from the On-Line Survey, Certification, and Reporting System. STUDY DESIGN: We rely on the staggered rollout of the report cards across pilot and nonpilot states to examine the effect of report cards on market share and quality of care. We also exploit differences in nursing home market competition at baseline to identify the impacts of the new information on nursing home quality. RESULTS: The introduction of the NHQI was generally unrelated to facility quality and consumer demand. However, nursing homes facing greater competition improved their quality more than facilities in less competitive markets. CONCLUSIONS: The lack of competition in many nursing home markets may help to explain why the NHQI report card effort had a minimal effect on nursing home quality. With the introduction of market-based reforms such as report cards, this result suggests policy makers must also consider market structure in efforts to improve nursing home performance. © Health Research and Educational Trust.
Redesigning the ICU nursing discharge process: a quality improvement study.
Chaboyer W, Lin F, Foster M, Retallick L, Panuwatwanich K, Richards B.
Worldviews on evidence-based nursing / Sigma Theta Tau International, Honor Society of Nursing 2012 Feb;9(1):40-48
PURPOSE: To evaluate the impact of a redesigned intensive care unit (ICU) nursing discharge process on ICU discharge delay, hospital mortality, and ICU readmission within 72 hours. METHODS: A quality improvement study using a time series design and statistical process control analysis was conducted in one Australian general ICU. The primary outcome measure was hours of discharge delay per patient discharged alive per month, measured for 15 months prior to, and for 12 months after the redesigned process was implemented. The redesign process included appointing a change agent to facilitate process improvement, developing a patient handover sheet, requesting ward staff to nominate an estimated transfer time, and designing a daily ICU discharge alert sheet that included an expected date of discharge. RESULTS: A total of 1,787 ICU discharges were included in this study, 1,001 in the 15 months before and 786 in the 12 months after the implementation of the new discharge processes. There was no difference in in-hospital mortality after discharge from ICU or ICU readmission within 72 hours during the study period. However, process improvement was demonstrated by a reduction in the average patient discharge delay time of 3.2 hours (from 4.6 hour baseline to 1.0 hours post-intervention). CONCLUSIONS: Involving both ward and ICU staff in the redesign process may have contributed to a shared situational awareness of the problems, which led to more timely and effective ICU discharge processes. The use of a change agent, whose ongoing role involved follow-up of patients discharged from ICU, may have helped to embed the new process into practice. ©2011 Sigma Theta Tau International.
The science of quality improvement implementation: developing capacity to make a difference.
Alexander JA, Hearld LR.
Medical care 2011 Dec;49 Suppl:S6-20
BACKGROUND: Quality improvement (QI) holds promise to improve quality of care; however, organizations often struggle with its implementation. It has been recommended that practitioners, managers, and researchers attempt to increase systematic understanding of the structure, practices, and context of organizations that facilitate or impede the implementation of QI innovations. OBJECTIVES: To critically review the empirical research on QI implementation in health care organizations. RESEARCH DESIGN: A literature review of 107 studies that examined the implementation of QI innovations in health care organizations. Studies were classified into 4 groups based on the types of predictors that were assumed to affect implementation (content of QI innovation, organizational processes, internal context, and external context). RESULTS: Internal context and organizational processes were the most frequently studied categories. External context and organizational process categories exhibited the highest rate of positive effects on QI implementation. CONCLUSIONS: The review revealed several important gaps in the QI implementation literature. Studies often lacked clear conceptual frameworks to guide the research, which may hinder efforts to compare relationships across studies. Studies also tended to adopt designs that were narrowly focused on independent effects of predictors and did not include holistic frameworks to capture interactions among the many factors involved in implementation. Other design limitations included the use of cross-sectional designs, single-source data collection, and potential selection bias among study participants.
The run chart: a simple analytical tool for learning from variation in healthcare processes.
Perla RJ, Provost LP, Murray SK.
BMJ quality & safety 2011 Jan;20(1):46-51
BACKGROUND: Those working in healthcare today are challenged more than ever before to quickly and efficiently learn from data to improve their services and delivery of care. There is broad agreement that healthcare professionals working on the front lines benefit greatly from the visual display of data presented in time order. AIM: To describe the run chart-an analytical tool commonly used by professionals in quality improvement but underutilised in healthcare. METHODS: A standard approach to the construction, use and interpretation of run charts for healthcare applications is developed based on the statistical process control literature. DISCUSSION: Run charts allow us to understand objectively if the changes we make to a process or system over time lead to improvements and do so with minimal mathematical complexity. This method of analyzing and reporting data is of greater value to improvement projects and teams than traditional aggregate summary statistics that ignore time order. Because of its utility and simplicity, the run chart has wide potential application in healthcare for practitioners and decision-makers. Run charts also provide the foundation for more sophisticated methods of analysis and learning such as Shewhart (control) charts and planned experimentation.
The effect of a complementary e-learning course on implementation of a quality improvement project regarding care for elderly patients: a stepped wedge trial.
van de Steeg L, Langelaan M, Ijkema R, Wagner C.
Implementation science : IS 2012 Mar 2;7(1):13
BACKGROUND: Delirium occurs frequently in elderly hospitalised patients and is associated with higher mortality, increased length of hospital stay, functional decline, and admission to long-term care. Healthcare professionals frequently do not recognise delirium, indicating that education can play an important role in improving delirium care for hospitalised elderly. Previous studies have indicated that e-learning can provide an effective way of educating healthcare professionals and improving quality of care, though results are inconsistent. Methods and design This stepped wedge cluster randomized trial will assess the effects of a complementary delirium e-learning course on the implementation of quality improvement initiative, which aims to enhance the recognition and management of delirium in elderly patients. The trial will be conducted in 18 Dutch hospitals and last 11 months. Measurements will be taken in all participating wards using monthly record reviews, in order to monitor delivered care. These measurements will include the percentage of elderly patients who were screened for the risk of developing delirium, use of the Delirium Observation Screening scale, use of nursing or medical interventions, and the percentage of elderly patients who were diagnosed with delirium. Data regarding the e-learning course will be gathered as well. These data will include user characteristics, information regarding use of the course, delirium knowledge before and after using the course, and the attitude and intentions of nurses concerning delirium care. Setting The study will be conducted in internal medicine and surgical wards of eighteen hospitals that are at the beginning stages of implementing the Frail Elderly Project in the Netherlands. DISCUSSION: Better recognition of elderly patients at risk for delirium and subsequent care is expected from the introduction of an e-learning course for nurses that is complementary to an existing quality improvement project. This trial has the potential to demonstrate that e-learning can be a vital part of the implementation process, especially for quality improvement projects aimed at complex health issues such as delirium. The study will contribute to a growing body of knowledge concerning e-learning and the effects it can have on knowledge as well as delivered care. Trial registration The Netherlands National Trial Register (NTR). Trial number: NTR 2885.
Exploring the interpersonal-, organization-, and system-level factors that influence the implementation and use of an innovation — synoptic reporting — in cancer care.
Urquhart R, Porter GA, Grunfeld E, Sargeant J.
Implementation science : IS 2012 Mar 1;7(1):12
The dominant method of reporting findings from diagnostic and surgical procedures is the narrative report. In cancer care, this report inconsistently provides the information required to understand the cancer and make informed patient care decisions. Another method of reporting, the synoptic report, captures specific data items in a structured manner and contains only items critical for patient care. Research demonstrates that synoptic reports vastly improve the quality of reporting. However, synoptic reporting represents a complex innovation in cancer care, with implementation and use requiring fundamental shifts in physician behaviour and practice, and support from the organization and larger system. The objective of this study is to examine the key interpersonal, organizational, and system-level factors that influence the implementation and use of synoptic reporting in cancer care. METHODS: This study involves three initiatives in Nova Scotia, Canada, that have implemented synoptic reporting within their departments/programs. Case study methodology will be used to study these initiatives (the cases) in-depth, explore which factors were barriers or facilitators of implementation and use, examine relationships amongst factors, and uncover which factors appear to be similar and distinct across cases. The cases were selected as they converge and differ with respect to factors that are likely to influence the implementation and use of an innovation in practice. Data will be collected through in-depth interviews, document analysis, observation of training sessions, and examination/use of the synoptic reporting tools. An audit will be performed to determine/quantify use. Analysis will involve production of a case record/history for each case, in-depth analysis of each case, and cross-case analysis, where findings will be compared and contrasted across cases to develop theoretically informed, generalisable knowledge that can be applied to other settings/contexts. Ethical approval was granted for this study. DISCUSSION: This study will contribute to our knowledge base on the multi-level factors, and the relationships amongst factors in specific contexts, that influence implementation and use of innovations such as synoptic reporting in healthcare. Such knowledge is critical to improving our understanding of implementation processes in clinical settings, and to helping researchers, clinicians, and managers/administrators develop and implement ways to more effectively integrate innovations into routine clinical care.
Lean in British Columbia’s Health Sector
BC Ministry of Health, Sept 2011
Lean is an approach to systematically eliminating waste in organizational processes in order to improve quality and productivity, and reduce costs. At the heart of Lean in health care is the mapping of a patient’s journey through the system in order to identify steps that are of value to the patient, and those that add no value (i.e., are waste). Examples of waste in health care are duplicate tests, patient waits, and underutilization of staff skills and knowledge. Once wasteful activities are identified and removed, remaining steps are made more efficient and integrated so that services flow smoothly. The next stage in Lean is the pursuit of continuous improvement by repeating the cycle so that processes are more and more streamlined.
Opening up healthcare innovation
AIM Advanced Institute of Management Research
One key direction in which healthcare innovation can open up lies in harnessing the innovation potential of patients and their carers.We already know of many examples where patients have been a key source of innovation; in today’s environment the challenge is to find ways of scaling this to help deal with the innovation crisis. One powerful route is opened up via interactive web-based platforms which build and mobilise communities with common interests. This report discusses the potential of Web 2.0 interactive platforms and provides examples of several which appear to offer considerable additional traction in developing innovative solutions to the healthcare issues faced by such patients.
Health Care in Canada
Health Care Council of Canada: Turning what we know into action: A commentary on the National Symposium on Patient Engagement
Turning what we know into action: A report on the National Symposium on Patient Engagement, is based on key learnings from our National Symposium on Patient Engagement in October 2011. The commentary calls for the inclusion of the patient voice when designing, planning and delivering health care services in Canada.
Research Methodology and Practice
Discussing study limitations in reports of biomedical studies- the need for more transparency.
Puhan MA, Akl EA, Bryant D, Xie F, Apolone G, Ter Riet G.
Health and quality of life outcomes 2012 Feb 23;10(1):23
ABSTRACT: Unbiased and frank discussion of study limitations by authors represents a crucial part of the scientific discourse and progress. In today’s culture of publishing many authors or scientific teams probably balance ‘utter honesty’ when discussing limitations of their research with the risk of being unable to publish their work. Currently, too few papers in the medical literature frankly discuss how limitations could have affected the study findings and interpretations. The goals of this commentary are to review how limitations are currently acknowledged in the medical literature, to discuss the implications of limitations in biomedical studies, and to make suggestions as to how to openly discuss limitations for scientists submitting their papers to journals. This commentary was developed through discussion and logical arguments by the authors who are doing research in the area of hedging (use of language to express uncertainty) and who have extensive experience as authors and editors of biomedical papers. We strongly encourage authors to report on all potentially important limitations that may have affected the quality and interpretation of the evidence being presented. This will not only benefit science but also offers incentives for authors: If not all important limitations are acknowledged readers and reviewers of scientific articles may perceive that the authors were unaware of them. Authors should take advantage of their content knowledge and familiarity with the study to prevent misinterpretations of the limitations by reviewers and readers. Articles discussing limitations help shape the future research agenda and are likely to be cited because they have informed the design and conduct of future studies. Instead of perceiving acknowledgment of limitations negatively, authors, reviewers and editors should recognize the potential of a frank and unbiased discussion of study limitations that should not jeopardize acceptance of manuscripts.
An agenda for research on the sustainability of public health programs.
Scheirer MA, Dearing JW.
American Journal of Public Health 2011 Nov;101(11):2059-2067
Funders of programs in public health and community health are increasingly concerned about the sustainability of changes they initiate. Despite a recent increase in sustainability research and evaluation, this literature has not developed a widely used paradigm for conducting research that can accumulate into generalizable findings. We provide guidance for research and evaluation of health program sustainability, including definitions and types of sustainability, specifications and measurements of dependent variables, definitions of independent variables or factors that influence sustainability, and suggestions for designs for research and data collection. We suggest viewing sustainability research as a further stage in the translation or dissemination of research-based interventions into practice. This perspective emphasizes ongoing relationships with earlier stages of a broader diffusion framework, including adoption and implementation processes.
Does the world need a scientific society for research on how to improve healthcare?
Wensing M, Grimshaw JM, Eccles MP.
Implementation science : IS 2012 Feb 29;7:10
In this editorial, we reflect on the arguments for starting a scientific society focused on research on how to improve healthcare. This society would take an inclusive approach to what constitutes healthcare. For instance, it should include mental health healthcare, treatment for substance abuse, the work of allied health professions, and preventive healthcare. The society would be open to researchers from all traditions. Thus, we take an inclusive approach to what constitutes scientific research, as long as it uses rigorous methods, is focused on improving healthcare, and aims at knowledge that can be transferred across settings. The society would primarily target scientific researchers but would invite others with an interest in this area of research, regardless of their discipline, position, field of application, or group affiliation (e.g., improvement science, behavioral medicine, knowledge translation). A society would need fruitful collaboration with related societies and organizations, which may include having combined meetings. Special links may be developed with one or more journals. A website to provide information on relevant resources, events, and training opportunities is another key activity. It would also provide a voice for the field at funding agencies, political arenas, and similar institutions. An organizational structure and financial resources are required to develop and run these activities. Our aim is to start an international debate, to discover if we can establish a shared vision across academics and stakeholders engaged with creating scientific knowledge on how to improve healthcare. We invite readers to express their views in the online questionnaire accessed by following the URL link provided at the end of the editorial.
Against Quantiles: categorization of continuous variables in epidemiologic research, and its discontents.
Vickers AJ, Bennette C.
BMC medical research methodology 2012 Feb 29;12(1):21
BACKGROUND: Quantiles are a staple of epidemiologic research: in contemporary epidemiologic practice, continuous variables are typically categorized into tertiles, quartiles and quintiles as a means to illustrate the relationship between a continuous exposure and a binary outcome. DISCUSSION: In this paper we argue that this approach is highly problematic and present several potential alternatives. We also discuss the perceived drawbacks of these newer statistical methods and the possible reasons for their slow adoption by epidemiologists. SUMMARY: The use of quantiles is often inadequate for epidemiologic research with continuous variables.
Person-centred care and job satisfaction of caregivers in nursing homes: a systematic review of the impact of different forms of person-centred care on various dimensions of job satisfaction.
van den Pol-Grevelink A, Jukema JS, Smits CH.
International journal of geriatric psychiatry 2012 Mar;27(3):219-229
OBJECTIVE: The positive effects of person-centred care on older clients have been demonstrated. However, relatively little is known about the effect that giving person-centred care has on caregivers. This literature review examines the job satisfaction of caregivers who deliver person-centred care in nursing homes. DESIGN: The research questions are: Do the various forms of person-centred care affect job satisfaction differently? Which particular dimensions of job satisfaction have been evaluated in studies on person-centred care, and does their sensitivity to person-centred care differ? Using the search engines Pubmed, Cinahl, Psychinfo and Embase up to August 2010, 46 efficacy studies were found, seven of which satisfied our criteria. RESULTS: Emotion-oriented care, snoezelen, and small-scale care most often show positive effects on job satisfaction. Person-centred care has been shown to have positive effects on general job satisfaction, job demands at psychogeriatric wards, emotional exhaustion and personal accomplishment. CONCLUSIONS: Taking into account the fair-to-moderate quality of the studies included, it is concluded that there are limited indications that person-centred care has a positive effect on a number of dimensions of caregivers’ job satisfaction. Further study is required to expand and to support these tentative conclusions.
Predicting nursing facility residents’ quality of life using external indicators.
Degenholtz HB, Kane RA, Kane RL, Bershadsky B, Kling KC.
Health services research 2006 Apr;41(2):335-356
PURPOSE: A newly developed brief measure of nursing facility (NF) resident self-reported quality of life (QOL) has been proposed for inclusion in a modified version of the minimum data set (MDS). There is considerable interest in determining whether it is possible to develop indicators of QOL that are more convenient and less expensive than direct, in-person interviews with residents. DESIGN AND METHODS: QOL interview data from 2,829 residents living in 101 NFs using a 14-item version of a longer instrument were merged with data from the MDS and the Online Survey and Certification Automated Record (OSCAR). Bivariate and multivariate hierarchical linear modeling were used to assess the association of QOL with potential resident and facility level indicators.
RESULTS: Resident and facility level indicators were associated with self-reported QOL in the expected direction. At the individual resident level, QOL is negatively associated with physical function, visual acuity, continence, being bedfast, depression, conflict in relationships, and positively associated with social engagement. At the facility level, QOL is negatively associated with citations for failing to accommodate resident needs or providing a clean, safe environment. The ratio of activities staff to residents is positively associated with QOL. This study did not find an association between QOL and either use of restraints or nurse staff levels. Approximately 9 percent of the total variance in self-reported QOL can be attributed to differences among facilities; 91 percent can be attributed to differences among residents. Resident level indicators explained about 4 percent of the variance attributable to differences among residents, and facility factors explained 49 percent of the variance attributable to differences among NFs. However, the different variables explained only 10 percent of the variance in self-reported QOL. IMPLICATIONS: A brief self-report measure of NF resident QOL is consistently associated with measures that can be constructed from extant data sources. However, the level of prediction possible from these data sources does not justify reliance on external indicators of resident QOL for policy purposes.
Effects of the Program of All-inclusive Care for the Elderly on hospital use.
The Gerontologist 2011 Dec;51(6):774-785
PURPOSE OF THE STUDY: This study evaluates the effects of the Program of All-Inclusive Care for the Elderly (PACE) on hospital use. PACE’s capitated financing creates incentives to reduce the use of costly services. Furthermore, its emphasis on preventative care and regular monitoring by provides a mechanism for reducing unnecessary hospital use while maintaining quality of care. DESIGN AND METHODS: This study builds on previous research by comparing hospital use by PACE enrollees with a comparison group of frail community-dwelling older adults selected through propensity score matching over a 2-year period. Outcomes are estimated using regression adjustment with the 2-part model. RESULTS: The results suggest that PACE effectively controls hospital use among community-dwelling frail elderly persons. PACE enrollees spent an estimated average of 0.2 days in the hospital per month alive compared with an estimated average of 0.8 days in the hospital per month alive by comparison subjects or an estimated PACE effect of 0.6 days in the hospital per month alive per enrollee. IMPLICATIONS: These results have implications for long-term care policy and service delivery. PACE provides a model for reducing unnecessary hospitalizations and rehospitalization through effective care management. The benefits of reduced hospital use are savings that offset the cost of an expanded set of services while maintaining quality.
Thresholds for Minimum Data Set Quality Indicators Developed and Applied in Icelandic Nursing Homes.
Hjaltadottir I, Hallberg IR, Ekwall AK.
Journal of nursing care quality 2012 Feb 10
A modified Delphi method was used to determine thresholds for Minimum Data Set quality indicators for Icelandic nursing homes. The thresholds were then applied to quality outcomes in Icelandic nursing homes for the year 2009. The thresholds indicate areas of good or poor care and can be used for planning services. Icelandic nursing homes seem to be doing best in incontinence and nutritional care. However, improvement is needed in care practices for depression, medication, and activity.
Victim or initiator? Certified nursing assistants’ perceptions of resident characteristics that contribute to resident-to-resident violence in nursing homes.
Sifford-Snellgrove KS, Beck C, Green A, McSweeney JC.
Research in gerontological nursing 2012 Jan;5(1):55-63
The purpose of this portion of a larger qualitative study was to explore certified nursing assistants’ (CNAs) perceptions of the characteristics of both the victims and initiators of resident-to-resident violence (RRV) to identify resident characteristics that influence development of RRV. Findings gained from semi-structured interviews revealed that CNAs perceive initiators of RRV to be “more with it” and to have “strong personalities,” a “short fuse,” and “life history” that make them prone to inflict harm on other residents. CNAs described victims of RRV using phrases such as, “they don’t know,” “can’t communicate,” and “gets around good.” The results also revealed that, in some situations, residents who were usually even tempered might strike out with violence if exposed to triggers over time. This study provides the first detailed description of nursing home residents who initiate violence against other residents. Knowledge gained from this study may be useful in generating models of RRV-a precursor to developing interventions for its prevention.
Nursing Home Staffing Standards and Staffing Levels in Six Countries.
Harrington C, Choiniere J, Goldmann M, Jacobsen FF, Lloyd L, McGregor M, et al.
Journal of nursing scholarship : an official publication of Sigma Theta Tau International Honor Society of Nursing / Sigma Theta Tau 2012 Mar;44(1):88-98
Purpose: This study was designed to collect and compare nurse staffing standards and staffing levels in six counties: the United States, Canada, England, Germany, Norway, and Sweden. Design: The study used descriptive information on staffing regulations and policies as well as actual staffing levels for registered nurses, licensed nurses, and nursing assistants across states, provinces, regions, and countries. Methods: Data were collected from Internet searches of staffing regulations and policies along with statistical data on actual staffing from reports and documents. Staffing data were converted to hours per resident day to facilitate comparisons across countries. Findings: We found wide variations in both nurse staffing standards and actual staffing levels within and across countries, although comparisons were difficult to make due to differences in measuring staffing, the vagueness of standards, and limited availability of actual staffing data. Both the standards and levels in most countries (except Norway and Sweden) were lower than the recommended levels by experts. Conclusions: Our findings demonstrate the need for further attention to nurse staffing standards and levels in order to assure the quality of nursing home care. Clinical Relevance: A high quality of nursing home care requires adequate levels of nurse staffing, and nurse staffing standards have been shown to improve staffing levels. © 2012 Sigma Theta Tau International.
Navigating for success as an academic
ECHA 5-001, April 4, 2012, 12:00-13:00
In this session, we will explore how academics can navigate the journey towards success in a changing and sometimes ambiguous world. What are some barriers and facilitators of success; How can success be defined? How can conflicting and competing agendas and values be reconciled? What communities, cultures, resources, and places are needed to support success best? Featuring panelists:
Mike Belosevic: Professor, Biological Sciences/Public Health Sciences
Tammy Hooper: Associate Professor, Department of Speech and Pathology and Audiology
Katherine Moore: Professor, Faculty of Nursing
Festival of Teaching
March 12-15, 2012
Excellence in teaching deserves to be celebrated; innovation in teaching needs to be shared. Taking time to focus on what happens every day across the academy, the Festival of Teaching celebrates the excellence, enthusiasm, and engagement of our faculty, contract academic staff, and graduate student instructors in teaching.
Making health care safer: learning from social and organisational research conference 2012
June 25-27, 2012 St. Andrews Scotland
A two day conference to explore key questions facing us as researchers, practitioners and policy-makers: questions that address better collective learning, sustainable quality improvement and safer patient care
AIHS: Assessing the impact of research and innovation
June 17-19, 2012 Jasper Park Lodge, Jasper, AB
The evaluation of research performance and innovation impact is a continually evolving science that seeks to answer many questions. The 2012 Making Connections Conference will feature leading international and national experts, and provide researchers, policy-makers, practitioners, and research partners the opportunity to network, debate and explore the art, science, and future directions of this topic.
Thinking Qualitatively Workshop Series (TQ)
June 18-22, Edmonton, AB
This week-long interdisciplinary educational series has been held annually for over a decade now and is aimed at participants from all academic disciplines and for individuals at all stages of their research career. Individuals conducting research in universities and colleges and/or professional settings (e.g., libraries; hospitals; government agencies) are welcome to attend. Thinking Qualitatively allows participants to engage with experts in qualitative inquiry and learn about specific methods, techniques and approaches to qualitative research. The academic program consists of five days of hands-on workshops on such topics as qualitative interviewing, participatory action research, grounded theory, arts-based methods, mixed methods, and much more! Some workshops are introductory sessions, while others would appeal to more experienced researchers.
Project Management Masters Certification Program
March 27-30, 2012, UBC, Vancouver BC $995.00
The PMMC is designed for those seeking professional project management certification. It serves as both a thorough professional education and recognized certification. Those seeking additional credentials such as the PMP®/PgMP®, PMI-SP®, and PMI-RMP® will benefit from this dynamic and interactive work session, while those currently holding credentials will find the certification to be an enhancement as well as the most up to date advanced professional development.
The Institute of Aging of the Canadian Institutes of Health Research (CIHR) has the mandate to support research and build research capacity in the field of aging. The Institute of Aging is currently embarking on a strategic planning process to define our priorities in research on aging and knowledge translation for the next five years (2013-2018).
As a first step in this process, we just launched a web-based survey targeting a broad array of stakeholders engaged in research and knowledge translation on the current, short and long-term issues related to the Canadian aging population. Our philosophy is to make this web based survey as inclusive as possible. We are seeking input on the opportunities and challenges of an aging population and eliciting opinions and diverse points of view on the priority research areas in the coming years. As a stakeholder, your input in this survey is critical. We would very much appreciate if you could devote some of your time to participate in this short (10-15 minutes), four open-ended questions, web-based survey. Your contribution will be important for the subsequent steps of the strategic planning process, to the benefit of us all.
A Winnipeg care home waited six hours to call an ambulance after one of its residents had a stroke earlier this year, a CBC News I-Team investigation has found.
Family members say a long-term care patient at Edmonton General suffered so much neglect that she isn’t likely to survive.
Faced with soaring health care costs and shrinking Medicare and Medicaid financing, nursing home operators are closing some facilities and embracing an emerging model of care that allows many elderly patients to remain in their homes and still receive the medical and social services available in institutions.
AHRQ: Building a Consultation Path for Spreading Innovation in Long-Term Care
Steve Shields, Feb 29, 2012
Short article on strategies used to push for innovation in the long term health care sector.
This toolkit is designed to help communities increase awareness and use of their public reports by consumers and other important audiences. The suggested approaches and template materials are intended for use with the media, both in traditional settings (e.g., printed newspapers, radio broadcasts) and online avenues (e.g., news Web sites, blogs). The materials have been compiled for modification and use by Chartered Value Exchanges and others who produce public reports comparing health care quality, cost, patient experience, and other aspects of value.
Guiding facilitation in the Canadian Context: Enhancing Primary Health Care
Department of Health and Community Services, Province of Newfoundland and Labrador
This guide offers information on the strengths and efficacy of facilitation for leaders and facilitators of change in primary health care (PHC). It grew from the collaboration of Canadian health providers, facilitators, managers and researchers who have observed the benefits of facilitation as a vehicle for PHC renewal.