CALL FOR ABSTRACTS: The Quality Worklife-Quality Healthcare Collaborative’s 7th Annual Summit
June 12, 2013 Niagara Falls, ON
DEADLINE Friday December 7, 2012
The 2013 QWQHC Summit will address questions such as:
- How can person and family-centered work environments enhance efficiency, productivity and quality?
- What challenges does person and family-centered care present for employee satisfaction and organizational success more broadly? How can these challenges be met?
- How can healthcare organizations engage all stakeholders (including managers, clinicians, other frontline staff, patients and their families) to create effective, responsive systems of care
- What do workplace health promotion and prevention programs look like when they are person and familycentered? What can we learn from existing programs?
- Where are the opportunities for evaluation and measurement? What needs to be evaluated and how? Where has evaluation been done well?
- What are the key enablers of person and family-centered quality work environments? What is the role of leadership?
Submissions from varied individual domains and collaborative efforts are encouraged; this may include viewpoints from quality, professional practice, physicians, inter-professional collaboration, human resources, organizational development, occupational health and safety, and many other perspectives that impact or are impacted by quality of worklife.
CALL FOR CASE STUDIES IN RESEARCH METHODS: SAGE Cases in Methodology
SAGE is looking to commission 500 original case studies in research methods. Please get in touch if you would like to write or submit a case.
- Would you like to have a year’s free access to all the content and tools on SAGE Research Methods (SRM)
- Are you an academic, post-doc or doctoral student involved in research?
- Do you want to drive up the usage and discoverability of the published outputs from your research and raise the profile and impact of your research?
- Do you have, or can you write, a case study around your research project(s) or about a particular method used in the course of your research?
If so, SAGE is interested in hearing from you and would be interested in publishing your case study in its new methods cases collection provisionally titled SAGE Cases in Methodology.
What is SAGE Cases in Methodology?
SAGE Cases in Methodology will comprise of a unique collection of over 500 case studies for use in the teaching of research methods. We want the cases to be drawn from around the world, from established academics, from post-docs and from PhD students, working across a wide spectrum of academic disciplines and working with the widest range of different research methods. The goal of the collection is to provide students and faculty with short usable examples of methods in action and research in action drawn from real research projects that can support teaching and learning in research methods.
CALL FOR PRESENTATIONS: TeamSTEPPS® National Conference 2013
June 12-13, 2013 Dallas, TX
DEADLINE Friday December 21, 2012
We’re looking for original ideas that can help others implement TeamSTEPPS at their organization. For this year’s TeamSTEPPS National Conference, we are seeking speakers who have had experience with TeamSTEPPS to deliver their story in new, innovative, and engaging ways that promote learning.
Presentations should highlight program models, practical solutions, knowledge, skills, tools, and connections to help participants impact their organization. The National Conference serves as an “incubator for new ideas.” Please assist us in creating a quality educational experience for our attendees!
We are accepting and considering presentations or poster sessions across a wide array of topics. Examples include, but are not limited to:
CALL FOR ABSTRACTS: Culture, Health, & Wellbeing International Conference
24-26 June 2013 Bristol, UK
DEADLINE December 21, 2012
We welcome submissions of abstracts relating to any of the themes. We are not prescriptive about the scope of these themes and recognise that there are lively debates around definitions of culture and the arts, the social determinants of health, wellbeing and health inequalities. We particularly welcome abstracts that provoke new ways of researching, conceptualising and creating and will encourage delegates to question assumptions and learn about different approaches to current issues and areas of practice. As well as addressing the themes we are interested in abstracts that:
Inform the development or effectiveness of arts and health practice
Advance understanding of participants’ experiences of participatory arts for health/wellbeing (including artists’ experiences)
Advance knowledge and understanding of the role and impact of arts and culture on health and wellbeing
Inform the development of health, arts and cultural policy in relation to health and wellbeing
Advance the development of methodologies for arts and health research
CALL FOR ABSTRACTS: Canadian Society for Epidemiology and Biostatics Conference
June 24-27 St. John’s, NF
DEADLINE 11:59AM (EST) on Friday, January 25, 2013
The theme of the 2013 CSEB Biennial Conference is “From Genes to Global Health: Epidemiology Methods Across This Spectrum” to reflect the diversity of disciplines and research that epidemiology and biostatistics encompasses. The conference will feature workshops on methods and topical issues, plenary speakers representative of the broad spectrum of epidemiological and biostatistical disciplines, concurrent sessions of oral presentations and poster presentations.
Grants & Awards
CIHR: President’s Fund
The President’s Fund provides small grants in non-traditional areas and where there are no other possible opportunities for funding from CIHR, according to established eligibility criteria. CIHR contributes to these initiatives to help fulfill its role in raising awareness of the importance and value of health research to the health of Canadians, the health system and the economy. The President’s Fund grants are intended to:
- support organizations and initiatives whose goal is consistent with CIHR’s vision, mandate and strategic directions;
- provide financial assistance for events that will increase CIHR’s visibility such as conferences, workshops or other events where the objectives of the event align with the interests of CIHR overall and not individual Institutes;
- provide special, one-time grants to support health research activities where the request falls outside of CIHR’s regular funding programs.
Action-oriented study circles facilitate efforts in nursing homes to “go from feeding to serving”: conceptual perspectives on knowledge translation and workplace learning.
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Journal of aging research 2012;2012:627371
Background. Action-oriented study circles (AOSC) have been found to improve nutrition in 24 nursing homes in Sweden. Little, however, is known about the conceptual use of knowledge (changes in staffs’ knowledge and behaviours). Methods. Qualitative and quantitative methods, structured questionnaires for evaluating participants’ (working in nursing homes) experiences from study circles (n = 592, 71 AOSC) and for comparisons between AOSC participants (n = 74) and nonparticipants (n = 115). Finally, a focus group interview was conducted with AOSC participants (in total n = 12). Statistical, conventional, and directed content analyses were used. Results. Participants experienced a statistically significant increase in their knowledge about eating and nutrition, when retrospectively comparing before participating and after, as well as in comparison to non-participants, and they felt that the management was engaged in and took care of ideas regarding food and mealtimes to a significantly greater extent than non-participants. The use of AOSC was successful judging from how staff members had changed their attitudes and behaviours toward feeding residents. Conclusions. AOSC facilitates professional development, better system performance, and, as shown in previous studies, better patient outcome. Based on a collaborative learning perspective, AOSC manages to integrate evidence, context, and facilitation in the efforts to achieve knowledge translation in a learning organisation. This study has implications also for other care settings implementing AOSC.
Challenges in implementing government-directed VTE guidance for medical patients: a mixed methods study.
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Basey AJ, Krska J, Kennedy TD, Mackridge AJ.
BMJ open 2012 Nov 6;2(6):10.1136/bmjopen-2012-001668. Print 2012
Implementing venous thromboembolism (VTE) risk assessment guidance on admission to hospital has proved difficult worldwide. In 2010, VTE risk assessment in English hospitals was linked to financial sanctions. This study investigated possible barriers and facilitators for VTE risk assessment in medical patients and evaluated the impact of local and national initiatives. SETTING: Acute Medical Unit in one English National Health Service university teaching hospital. METHODS: This was a mixed methods study; National Research Ethics Service approval was granted. Data were collected over four 1-week periods; November 2009 (1), January 2010 (2), April 2010 (3) and April 2011 (4). Case notes for all medical patients admitted during these periods were reviewed. Thirty-six staff were observed admitting 71 of these patients; 24 observed staff participated in a structured interview. RESULTS: 876 case notes were reviewed. In total, 82.1% of patients had one or more VTE risk factors and 25.3% one or more bleeding risks. VTE risk assessment rose from a baseline of 6.9-19.6%, following local initiatives, and to 98.7% following financially sanctioned government targets. A similar increase in appropriate prescribing of prophylaxis was seen, but inappropriate prescribing also rose. No staff observed in period 1 conducted VTE risk assessment, risk-assessment forms were largely ignored or discarded during period 2; and electronic recording systems available during period 3 were not accessed. Few patients were asked any VTE-related questions in periods 1, 2 or 3. Interviewees’ actual knowledge of VTE risk was not related to perceived knowledge level. Eight of the 24 staff interviewed were aware of national policies or guidance: none had seen them. Principal barriers identified to risk assessment were: involvement of multiple staff in individual admissions; interruptions; lack of policy awareness; time pressure and complexity of tools. CONCLUSIONS: National financial sanctions appear effective in implementing guidance, where other local measures have failed.
A Creative Approach to the Development of an Agenda for Knowledge Utilization: Outputs from the 11th International Knowledge Utilization Colloquium (KU 11)
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Wilkinson JE, Rycroft-Malone J, Davies HT, Mccormack B.
Worldviews on Evidence-Based Nursing 2012;9(4):195-199
A group of researchers and practitioners interested in advancing knowledge utilization met as a colloquium in Belfast (KU 11) and used a “world café” approach to exploit the social capital and shared understanding built up over previous events to consider the research and practice agenda. We considered three key areas of relevance to knowledge use: (1) understanding the nature of research use, influence and impact; (2) blended and collaborative approaches to knowledge production and use; and (3) supporting sustainability and spread of evidence-informed innovations. The approach enabled the development of artifacts that reflected the three areas and these were analyzed using a creative hermeneutic approach. The themes that emerged and which are outlined in this commentary are not mutually exclusive. There was much overlap in the discussions and therefore of the themes, reflecting the complex nature of knowledge translation work. The agenda that has emerged from KU 11 also reflects the participatory and creative approach in which the meeting was structured and focused, and therefore emphasizes the processual, relational and contingent nature of some of the challenges we face. The past 20 years has seen an explosion in activity around understanding KU, and we have learned much about the difficulties. Whilst the agenda for the next decade may be becoming clearer, colloquia such as KU 11, using creative and engaging approaches, have a key role to play in dissecting, articulating and sharing that agenda. In this way, we also build an ever-expanding international community that is dedicated to working towards increasing the chances of success for better patient care. © 2012 Sigma Theta Tau International.
Getting the message across: principles for developing brief-Knowledge Transfer (b-KT) communiqués.
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Work (Reading, Mass.) 2012;41(4):477-481
This feature article on knowledge transfer presents principles and strategies to support the development of short communiqués to end-users. PARTICIPANTS: Formal and informal knowledge brokers are the targeted users of the strategies. METHODS: Research studies and conceptual literature in knowledge transfer informed the development of brief-Knowledge Transfer (b-KT) principles. Principles are explained and a sample of how they informed the development of KIT-Tip Sheets is offered to promote ways to use principles in knowledge dissemination. RESULTS: b-KT principles can be used as a framework to guide the development of short communiqués by knowledge brokers in work practice but also in the health, social and rehabilitation domains. In addition, these principles promote the participation of end-users in the development of knowledge transfer. CONCLUSIONS: Formal evaluation is needed on the use of these principles in achieving the uptake and use of knowledge by end-users.
Roadmap for a participatory research-practice partnership to implement evidence.
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Harrison MB, Graham ID.
Worldviews on evidence-based nursing 2012 Dec;9(4):210-220
Background: Our research team has undertaken implementation of evidence in the form of practice guideline recommendations for populations in hospital, community, and long-term care settings with diverse provider and patient populations (people with chronic wounds, e.g., pressure and leg ulcers, heart failure, stroke, diabetes, palliative care, cancer, and maternity care). Translating evidence into clinical practice at the point of care is a complex and often overwhelming challenge for the health system as well as for individual practitioners. Purpose: To ensure that best available evidence is integrated into practice, “local evidence” needs to be generated and this process accomplishes a number of things: it focuses all involved on the “same page,” identifies important facilitating factors as well as barriers, provides empirical support for planning, and in itself is a key aspect of implementation. In doing this work, we developed a roadmap, the Queen’s University Research Roadmap for Knowledge Implementation (QuRKI) that outlines three major phases of linked research and implementation activity: (1) issue identification/clarification; (2) solution building; and (3) implementation, evaluation, and nurturing the change. In this paper, we describe our practical experience as researchers working at point-of-care and how research can be used to facilitate the implementation of evidence. An exemplar is used to illustrate the fluid interplay of research and implementation activities and present the range of supporting research. Implications: QuRKI serves as a guide for researchers in the formation of a strategic alliance with the practice community for undertaking evidence-informed reorganization of care. Using this collaborative approach, researchers play an integral role in focusing on, and using evidence during all discussions. We welcome further evaluation of its usefulness in the field. © 2012 Sigma Theta Tau International.
IPADS: The Implementation of Patient Decision Making Support Interventions into Routine Clinical Practice
Elwyn G, Dipl-Psych IS, Tietbohl C, MllnfSc MM, Edwards AGK, Clay K, Legare F, van der Weijden T, Lewis C, Wexler R, Frosch D.
Two decades of research has established the positive effect of using patient-targeted decision support interventions: patients gain knowledge, greater understanding of probabilities and increased confidence in decisions. Yet, despite their efficacy, their effectiveness in routine practice has yet to be established and widespread adoptions had not occurred. The aim of this review was to search for and analyze the findings of published peer-reviewed studies that investigated the effectiveness of strategies, methods or approaches to implement patient-targeted DESIs into routine clinical studies. 17 studies were included and subjected to data extraction. The results point to significant challenges to the implementation of patient decision support using this model, including indifference on the part of health care professionals. This indifference stemmed from a reported lack of confidence in the content of DESIs and concern about disruption to established workflows, ultimately contributing to organisational inertia regarding their adoption.
Health Care Administration & Organization
Characterizing hazards and injuries among home care workers.
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Wipfli B, Olson R, Wright RR, Garrigues L, Lees J.
Home healthcare nurse 2012 Jul-Aug;30(7):387-393
This project extends research on hazardous exposures and injuries among home care workers. Historical data from Oregon home care workers were analyzed to identify the most common lost time injuries and contributing factors, and 7 focus groups were conducted with workers (n = 53) to gather data on demographics, health, and perceptions of occupational hazards. Results indicate that workers are at particular risk for back, knee, and shoulder injuries during client and material moving tasks and that workers’ self-reported task exposures and risk perceptions are highly aligned with injury data.
Comparisons of self-ratings on managerial competencies, research capability, time management, executive power, workload and work stress among nurse administrators.
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Kang CM, Chiu HT, Hu YC, Chen HL, Lee PH, Chang WY.
Journal of nursing management 2012 Oct;20(7):938-947
Aims To assess the level of and the differences in managerial competencies, research capability, time management, executive power, workload and work-stress ratings among nurse administrators (NAs), and to determine the best predictors of managerial competencies for NAs. Background Although NAs require multifaceted managerial competencies, research related to NAs’ managerial competencies is limited. Method A cross-sectional survey was conducted with 330 NAs from 16 acute care hospitals. Managerial competencies were determined through a self-developed questionnaire. Data were collected in 2011. Results All NAs gave themselves the highest rating on integrity and the lowest on both financial/budgeting and business acumen. All scores for managerial competencies, research capability, time management and executive power showed a statistically significant correlation. The stepwise regression analysis revealed that age; having received NA training; having completed a nursing project independently; and scores for research capability, executive power and workload could explain 63.2% of the total variance in managerial competencies. Conclusion The present study provides recommendations for future administrative training programmes to increase NAs’ managerial competency in fulfilling their management roles and functions. Implications for Nursing Management The findings inform leaders of hospitals where NAs need to develop additional competencies concerning the type of training NAs need to function proficiently.© 2012 Blackwell Publishing Ltd.
Net benefits: assessing the effectiveness of clinical networks in Australia through qualitative methods.
Cunningham FC, Ranmuthugala G, Westbrook JI, Braithwaite J.
Implementation science : IS 2012 Nov 2;7(1):108
BACKGROUND: In the 21st century, government and industry are supplementing hierarchical, bureaucratic forms of organization with network forms, compatible with principles of devolved governance and decentralization of services. Clinical networks are employed as a key health policy approach to engage clinicians in improving patient care in Australia. With significant investment in such networks in Australia and internationally, it is important to assess their effectiveness and sustainability as implementation mechanisms. METHODS: In two purposively selected, musculoskeletal clinical networks, members and stakeholders were interviewed to ascertain their perceptions regarding key factors relating to network effectiveness and sustainability. We adopted a three-level approach to evaluating network effectiveness: at the community, network, and member levels, across the network lifecycle. RESULTS: Both networks studied are advisory networks displaying characteristics of the ‘enclave’ type of non-hierarchical network. They are hybrids of the mandated and natural network forms. In the short term, at member level, both networks were striving to create connectivity and collaboration of members. Over the short to medium term, at network level, both networks applied multi-disciplinary engagement in successfully developing models of care as key outputs, and disseminating information to stakeholders. In the long term, at both community and network levels, stakeholders would measure effectiveness by the broader statewide influence of the network in changing and improving practice. At community level, in the long term, stakeholders acknowledged both networks had raised the profile, and provided a ‘voice’ for musculoskeletal conditions, evidencing some progress with implementation of the network mission while pursuing additional implementation strategies. CONCLUSIONS: This research sheds light on stakeholders’ perceptions of assessing clinical network effectiveness at community, network, and member levels during the network’s timeline, and on the role of networks and their contribution. Overall, stakeholders reported positive momentum and useful progress in network growth and development, and saw their networks as providing valuable mechanisms for meeting instrumental goals and pursuing collaborative interests. Network forms can prove their utility in addressing ‘wicked problems,’ and these Australian clinical networks present a practical approach to the difficult issue of clinician engagement in state-level implementation of best practice for improving patient care and outcomes.
The match between institutional elderly care management research and management challenges – a systematic literature review.
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Kokkonen K, Rissanen S, Hujala A.
Health research policy and systems / BioMed Central 2012 Nov 8;10(1):35
BACKGROUND: Elderly care practice and its management together with policy and research play a crucial role in responding to increasing challenges in institutional care for elderly people. Successful dialogue between these is necessary. The purpose of this systematic literature review is to compare how institutional elderly care management research meets the care challenges currently emphasized in international long-term care policy documents. METHODS: This paper was based on a systematic literature review. After screening 1971 abstracts using inclusion/exclusion criteria, 58 refereed articles published between 2000 and 2010 remained for analysis. The articles were analyzed using theory-based content analysis by comparing the results to the framework based on analysis of international long-term care management policy documents. RESULTS: The current challenges of long-term care management identified from policy documents were Integrated Care Management, Productivity Management, Quality Management, Workforce Management and ICT Management. The research on institutional elderly care management responded somewhat to the challenges mentioned in policy documents. However, some of the challenges were studied broadly and some were paid only minor attention. Further, only few studies focused on the core items of challenges addressed in policy documents. CONCLUSIONS: Institutional care management research needs to focus more on challenges in integrated care, productivity, ICT and division of labor. Managers, researchers and policy-makers should assume more active collaborative roles in processes of research, policymaking and policy implementation. In addition managers’ and policymakers’ scientific literacy needs to be enhanced.
Job role quality and intention to leave current facility and to leave profession of direct care workers in Japanese residential facilities for elderly.
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Nakanishi M, Imai H.
Archives of Gerontology and Geriatrics 2012 Jan-Feb;54(1):102-108
The aim of the present study is to examine job role quality relating to intention to leave current facility and to leave profession among direct care workers in residential facilities for elderly in Japan. Direct care workers completed a paper questionnaire on October 2009. From 746 facilities in three prefectures (Tokyo, Shizuoka, and Yamagata) 6428 direct care workers with complete data were included in the analyses. The Job Role Quality (JRQ) scale was translated into Japanese language to assess job role quality. Hierarchical multiple regression analysis showed that intention to leave current facility was primarily associated with job role quality: poor skill discretion, high job demand, and poor relationship with supervisor. Intention to leave profession was primarily associated with poor skill discretion. The results of the present study imply the strategies to direct care worker retention for each facility and policy efforts. Each facility can implement specific strategies such as enhanced variety of work and opportunity for use of skills, adequate job allocation, and improvement of supervisor-employee relationship in work place. Policy efforts should enhance broader career opportunities in care working such as advanced specialization and authorized medical practice. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.
Job satisfaction and associated variables among nurse assistants working in residential care.
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Wallin AO, Jakobsson U, Edberg AK.
International psychogeriatrics / IPA 2012 Dec;24(12):1904-1918
Background: While the work situation for nurse assistants in residential care is strenuous, they themselves often state that they are satisfied with their job. More knowledge is clearly needed of the interrelationship of variables associated with job satisfaction. This study aims to investigate job satisfaction and explore associated variables among nurse assistants working in residential care. Methods: A total of 225 respondents completed a questionnaire measuring general job satisfaction, satisfaction with nursing-care provision and measures concerning person-centered care, work climate, leadership, and health complaints. Job satisfaction was the outcome measure and comparisons were made among those reporting low, moderate, and high levels of job satisfaction; multiple regression analyses were used to explore associated variables. Results: The caring climate and personalized care provision were associated with general job satisfaction. High levels of satisfaction with nursing-care provision were also associated with the general work climate, organizational and environmental support, and leadership. Low job satisfaction was mainly associated with health complaints. Conclusions: Nurse assistants working in a positive work climate, caring climate, with a positive attitude to their leaders, who receive organizational and environmental support, provide person-centered care and experience a higher degree of job satisfaction. It seems essential, however, to include both general and context-specific measures when investigating job satisfaction in this field as they reveal different aspects of the nurse assistant’s work situation.
Better Interprofessional Teamwork, Higher Level of Organized Care, and Lower Risk of Burnout in Acute Health Care Teams Using Care Pathways: A Cluster Randomized Controlled Trial.
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Deneckere S, Euwema M, Lodewijckx C, Panella M, Mutsvari T, Sermeus W, et al.
Medical care 2012 Nov 3
Effective interprofessional teamwork is an essential component for the delivery of high-quality patient care in an increasingly complex medical environment. The objective is to evaluate whether the implementation of care pathways (CPs) improves teamwork in an acute hospital setting. DESIGN AND MEASURES:: A posttest-only cluster randomized controlled trial was performed in Belgian acute hospitals. Teams caring for patients hospitalized with a proximal femur fracture and those hospitalized with an exacerbation of chronic obstructive pulmonary disease, were randomized into intervention and control groups. The intervention group implemented a CP. The control group provided usual care. A set of team input, process, and output indicators were used as effect measures. To analyze the results, we performed multilevel statistical analysis. RESULTS:: Thirty teams and a total of 581 individual team members participated. The intervention teams scored significantly better in conflict management [β=0.30 (0.11); 95% confidence interval (CI), 0.08 to 0.53]; team climate for innovation [β=0.29 (0.10); 95% CI, 0.09 to 0.49]; and level of organized care [β=5.56 (2.05); 95% CI, 1.35 to 9.76]. They also showed lower risk of burnout as they scored significantly lower in emotional exhaustion [β=-0.57 (0.21); 95% CI, -1.00 to -0.14] and higher in the level of competence (β=0.39; 95% CI, 0.15 to 0.64). No significant effect was found on relational coordination. CONCLUSIONS:: CPs are effective interventions for improving teamwork, increasing the organizational level of care processes, and decreasing risk of burnout for health care teams in an acute hospital setting. Through this, high-performance teams can be built.
Health Care Innovation and Quality Assurance
Mandatory quality reports in Germany from the hospitals’ point of view: a cross-sectional observational study.
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Auras S, de Cruppe W, Blum K, Geraedts M.
BMC health services research 2012 Oct 31;12(1):378
BACKGROUND: Public reporting of hospital quality is to enable providers, patients and the public to make comparisons regarding the quality of care and thus contribute to informed decisions. It stimulates quality improvement activities in hospitals and thus positively impacts treatment results. Hospitals often use publicly reported data for further internal or external purposes. As of 2005, German hospitals are obliged to publish structured quality reports (QR) every two years. This gives them the opportunity to demonstrate their performance by number, type and quality in a transparent way. However, it constitutes a major burden to hospitals to generate and publish data required, and it is yet unknown if hospitals feel adequately represented and at the same time consider the effort appropriate. This study assesses hospital leaders’ judgement about the capability of QR to put legally defined aims effectively and efficiently into practice. It also explores the additional purposes hospitals use their QR for. METHODS: In a cross-sectional observational study, a representative random sample out of 2,064 German hospitals (N=748) was invited to assess QR via questionnaire; 333 hospitals participated. We recorded the suitability of QR for representing number, type and quality of services, the adequacy of cost and benefits (6-level Likert scales) and additional purposes QR are used for (free text question). For representation purposes, the net sample was weighted for hospital size and hospital ownership (direct standardization). Data was analyzed descriptively and using inferential statistics (chi-2 test) or for the purpose of generating hypotheses. RESULTS: German hospitals rated the QR as suitable to represent the number of services but less so for the type and quality of services. The cost-benefit ratio was seen as inadequate. There were no significant differences between hospitals of different size or ownership. Public hospitals additionally used their reports for mostly internal purposes (e.g. comparison with competitors, quality management) whereas private ones used them externally (e.g. communication, marketing) (p=0.024, chi-2 test, hypotheses-generating level). CONCLUSIONS: German hospitals consider the mandatory QR as only partially capable to put the legally defined aims effectively and efficiently into practice. In order for public reporting to achieve its potentially positive effects, the QR must be more closely aligned to the needs of hospitals.
Quality of care in Icelandic nursing homes measured with Minimum Data Set quality indicators: Retrospective analysis of nursing home data over 7 years
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Hjaltadottir I, Ekwall AK, Nyberg P, Hallberg IR.
International journal of nursing studies 2012 Nov;49(11):1342-1353
The increasing need for long-term care as well as diminished financial resources may compromise the quality of care of older people. Thus the need for clinically based quality of care monitoring to guide development of long-term services has been pointed out. OBJECTIVES: The aim of this study was to investigate trends in quality of care during 2003-2009 as reflected in the Minimum Data Set quality indicator outcome in Icelandic nursing homes and to investigate the association of Minimum Data Set quality indicators with residents’ health status (health stability, pain, depression and cognitive performance) and functional profile (activities of daily living and social engagement). DESIGN: Retrospective analysis of nursing home data over 7 years. METHODS: The sample used for analysis was 11,034 Minimum Data Set assessments of 3694 residents living in Icelandic nursing homes in 2003-2009. Minimum Data Set quality indicators were used to measure quality of care. The chi-square test for trend and multivariate logistic regression were used to analyse the data. RESULTS: The mean age of residents during the period of the study ranged from 82.3 (SD 9.1) to 85.1 (SD 8.3) and women accounted for from 65.2% to 67.8%. Findings for 16 out of 20 quality indicators indicated a decline in quality of care (p<0.05), although in 12 out of 20 indicators the prevalence was lower than 25%. One quality indicator showed improvement, i.e. for "Bladder and bowel incontinence without a toileting plan" from 17.4% in 2003 decreasing to 11.5% in 2009 (p<0.001). Residents' health and functional status partially explain the increased prevalence of the quality indicators over time. CONCLUSION: Further developments in quality of care in Icelandic nursing homes need to be monitored as well as the association between residents' health and functional status and the Minimum Data Set quality indicator outcome. The areas of care where the Minimum Data Set quality indicators showed need for improvement included treatment of depression, number of medications, resident activity level and behavioural symptoms. Copyright © 2012 Elsevier Ltd. All rights reserved.
Nurse managers’ narratives of organizational change in the English National Health Service.
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Journal of nursing management 2012 Oct;20(7):858-867
Aims To investigate nurse managers’ accounts of organizational change. Background While the importance of the ward manager role in delivering quality care is recognized, less is known about ward managers’ involvement in change. Methods Face to face qualitative narrative interviews were conducted. They were audio recorded, transcribed verbatim and analysed thematically. Results Managers were experiencing change that was occurring at an increasing rate. They reported that being effective communicators was central to their approach to managing change. The hybrid nature of the role informed their approach to change and enabled them to initiate and control it to a degree at ward/department level. They did not base their management approach on theory and focused activity more on the practical and contextual nature of change. Implications for nursing management Organizational change has attracted a great deal of attention in research terms; however, there are few studies that examine nurse managers’ experiences of change. The accumulated expertise and experience of this group of staff is an untapped resource in terms of mobilizing organizational change in hospitals in England. More attention to work-based learning and support would assist managers in their role. © 2012 Blackwell Publishing Ltd.
Creating an organizational culture for evidence-informed decision making
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Ward M, Mowat D.
Healthcare Management Forum 2012;25(3):146-150
A public health department in Ontario, Canada, set a 10-year strategic direction for evidence-informed decision making, defined as the systematic application of research evidence to program decisions. The multifaceted approach has identified eight key lessons for leadership, funding, infrastructure, staff development, partnerships, and change management. Results after 4 years include systematic and transparent application of research to >15 program decisions and, increasingly, evidence-informed decision making as a cultural norm. © 2012 Canadian College of Health Leaders.
Transforming environments: Care-based settings: Veterans health administration: A model for transforming nursing home care
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Journal of Housing for the Elderly 2012;26(1-3):183-204
The Veterans Health Administration nursing homes, now called Community Living Centers (CLCs), are engaged in systematic transformation of their environments and their care and work practices. A brief history of nursing home care for Veterans illustrates the competing values that influence CLCs. Monitoring data show that CLCs have reduced institutional features, improved the personalization of care, and empowered direct care staff. Although CLCs differ in many respects from community nursing homes, their experiences offer valuable lessons for culture change, underline the complementary importance of top-level commitment and grassroots engagement, and offer untapped opportunities for research in environmental gerontology. © Taylor & Francis Group, LLC.
Nursing home culture change: what does it mean to nurses?
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Research in gerontological nursing 2012 Oct;5(4):264-273
The purpose of this study was to explore, from the perspectives of licensed nurses, the organizational culture, work environment, and factors influencing culture change in two nursing homes participating in the Wellspring Program. All licensed nurses ≥ 0.25 full-time equivalent from two nursing homes were invited to complete the Organizational Culture Inventory and the Work Environment Scale. A subset of respondents was invited to participate in subsequent interviews. Data indicated unresolved conflict, low employee satisfaction, high work demands, and managerial control in the workplace. Qualitatively, three categories emerged: Confusion over culture change, role, and documentation; Conflict over the integration of traditional care with a resident-centered model; and Commitment to providing quality nursing care to the resident. To ensure the successful implementation of culture change, consideration must be given to clarity of communication, anticipation of role conflict, and building on the underlying strength of job commitment. Copyright 2012, SLACK Incorporated.
Person-centered Care Practices and Quality in Department of Veterans Affairs Nursing Homes: Is There a Relationship?
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Sullivan JL, Shwartz M, Burgess JF,Jr, Pekoz EA, Christiansen CL, Gerena-Melia M, et al.
Medical care 2012 Nov 3
OBJECTIVE: To examine variation in culture change to a person-centered care (PCC) model, and the association between culture change and a composite measure of quality in 107 Department of Veterans Affairs nursing homes. METHODS:: We examined the relationship between a composite quality measure calculated from 24 quality indicators (QIs) from the Minimum Data Set (that measure unfavorable events), and PCC summary scores calculated from the 6 domains of the Artifact of Culture Change Tool, using 3 different methods of calculating the summary scores. We also use a Bayesian hierarchical model to analyze the relationship between a latent construct measuring extent of culture change and the composite quality measure. RESULTS:: Using the original Artifacts scores, the highest performing facility has a 2.9 times higher score than the lowest. There is a statistically significant relationship between the composite quality measure and each of the 3 summary Artifacts scores. Depending on whether original scores, standardized scores, or optimal scores are used, a facility at the 10th percentile in terms of culture change compared with one at the 90th percentile has 8.0%, 8.9%, or 10.3% more QI events. When PCC implementation is considered as a latent construct, 18 low performance PCC facilities have, on an average, 16.3% more QI events than 13 high performance facilities. CONCLUSIONS:: Our results indicate that culture change to a PCC model is associated with higher Minimum Data Set-based quality. Longitudinal data are needed to better assess whether there is a causal relationship between the extent of culture change and quality.
Weaving a Multimethodology and Mixed Methods Praxis Into Randomized Control Trials to Enhance Credibility
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Qualitative Inquiry 2012 December 01;18(10):876-889
Most disciplines within the health and social sciences regard randomized control trials (RCTs) as the “gold standard” of evidence-based practice (EBP). The move toward mixed methods within evidence-based research has proven daunting to many researchers, and few best practices for RCT mixed methods studies currently exist. This article provides some strategies for incorporating mixed methods into RCT designs. Furthermore, the author argues for the value of also infusing a multimethodological approach into RCT mixed methods projects to further offer research strategies for enhancing the credibility of RCT research findings through, for example, incorporating participants’ lived experiences and methodological reflexivity into the research process. The bulk of this article presents four case studies that analyze how researchers in diverse fields have taken a multimethodological praxis into account in their RCT mixed methods projects, including the integration of a mixed methods multimethodological component into RCT research designs. The author also addresses the missed opportunities in these studies to maximize the validity of RCT projects by using mixed methods and multimethodological designs.
Challenges in Synthesizing and Interpreting the Evidence from a Systematic Review of Multifactorial Interventions to Prevent Functional Decline in Older Adults.
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Lin JS, Whitlock EP, Eckstrom E, Fu R, Perdue LA, Beil TL, et al.
Journal of the American Geriatrics Society 2012 Nov;60(11):2157-2166
A systematic review of multifactorial assessment and management interventions to prevent functional decline in older adults was undertaken for the U.S. Preventive Services Task Force. It was not possible to determine net benefit because of heterogeneity of studies, including how older adults were selected and their risk of functional decline; the broad spectrum and multifactorial nature of interventions evaluated; the suboptimal and inconsistent use of outcomes measured; and the inconsistent and inadequate reporting of data that might allow comparison of populations, interventions, and outcomes between studies. This review process illustrated the complexities encountered when synthesizing and interpreting the evidence in geriatric research and methods of reviewing complex interventions and multiple interrelated health outcomes. This article summarizes the review findings, focusing on methodological challenges, and offers suggestions to researchers on the design, reporting, and analysis of trials that would help address these challenges and allow for better interpretation of evidence in the future. © 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.
A systematic integrated literature review of systematic integrated literature reviews in nursing
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Im EO, Chang SJ.
The Journal of nursing education 2012 Nov;51(11):632-640
As faculty members, we frequently find that first-year doctoral students in nursing are confused about how to conduct a systematic integrated literature review. This could be due to its vague definition and a lack of recent literature that provides directions for conducting a systematic integrated literature review. This article aims to provide directions for conducting a systematic integrated literature review by identifying the essential components of published literature reviews in nursing. To achieve this goal, the literature was searched by using the keywords nursing, systematic, and review in multiple databases. A total of 267 articles were selected and are included in this systematic integrated literature review. The articles were then sorted by study design and analyzed in six areas of interests. Finally, a practical guideline for conducting systematic integrated literature reviews is proposed based on the analysis of the literature.
Staff interaction strategies that optimize delivery of transitional care in a skilled nursing facility: a multiple case study.
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Toles M, Barroso J, Colon-Emeric C, Corazzini K, McConnell E, Anderson RA.
Family & community health 2012 Oct-Dec;35(4):334-344
After hospitalization, more than 1.5 million older adults each year receive postacute care in skilled nursing facilities (SNFs). Transitional care services, designed to prepare older SNF patients (and their family caregivers) for their transitions from an SNF to home, have rarely been studied. Thus, we conducted a longitudinal, multiple case study of transitional care provided in an SNF to explore the care processes and staff interaction strategies that SNF staff members used to optimize delivery of transitional care. Using qualitative data from 89 interviews, 118 field observations, and 70 chart, or document reviews, we observed that transitional care services were not solely formalized processes, but rather were embedded in the interactions among older adult patients, their family caregivers, and members of interdisciplinary care teams. We found, moreover, that staff member interactions with patients and family caregivers increased the capacity of patient care teams for optimizing patient-centered care, information exchange, and coordination of transitional care
Nonpharmacological management of apathy in dementia: a systematic review.
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Brodaty H, Burns K.
The American Journal of Geriatric Psychiatry 2012 Jul;20(7):549-564
Apathy is one of the most challenging and prevalent behavioral symptoms of dementia. It is associated with increased disability and caregiver frustration as well as reduced quality of life, rehabilitation outcomes and survival after nursing home admission. A literature search to set criteria yielded 56 nonpharmacological intervention studies with outcomes relevant to apathy in dementia. Studies were rated according to quality and categorized into 7 groups: exercise, music, multisensory, animals, special care programming, therapeutic activities and miscellaneous. Despite a lack of methodological rigor, it is apparent that nonpharmacological interventions have the potential to reduce apathy. This review indicates that therapeutic activities, particularly those provided individually, have the best available evidence for effectiveness in dementia. Recommendations are provided for quality research.
A multilevel analysis of aggressive behaviors among nursing home residents.
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Journal of gerontological social work 2012 Nov;55(8):708-720
Individual and organizational characteristics associated with aggressive behavior among nursing home residents were examined among a sample of 5,494 residents from 23 facilities using the Minimum Data Set 2.0 and the Organizational Social Context scale. On admission, some individual level variables (age, sex, depression, activities of daily life [ADL] impairments, and cognitive impairments) and no organizational level variables were associated with aggressive behaviors. Over time, aggressive behaviors were linked with some individual characteristics (age, sex, and ADL impairments) and several organizational level variables (stressful climates, less rigid cultures, more resistant cultures, geographic location, facility size and staffing patterns). Findings suggest multi-faceted change strategies are needed.
Medication incident reporting in residential aged care facilities: Limitations and risks to residents’ safety.
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Tariq A, Georgiou A, Westbrook J.
BMC geriatrics 2012 Nov 2;12(1):67
BACKGROUND: Medication incident reporting (MIR) is a key safety critical care process in residential aged care facilities (RACFs). Retrospective studies of medication incident reports in aged care have identified the inability of existing MIR processes to generate information that can be used to enhance residents’ safety. However, there is little existing research that investigates the limitations of the existing information exchange process that underpins MIR, despite the considerable resources that RACFs’ devote to the MIR process. The aim of this study was to undertake an in-depth exploration of the information exchange process involved in MIR and identify factors that inhibit the collection of meaningful information in RACFs. METHODS: The study was undertaken in three RACFs (part of a large non-profit organisation) in NSW, Australia. A total of 23 semi-structured interviews and 62 hours of observation sessions were conducted between May to July 2011. The qualitative data was iteratively analysed using a grounded theory approach. RESULTS: The findings highlight significant gaps in the design of the MIR artefacts as well as information exchange issues in MIR process execution. Study results emphasized the need to: a) design MIR artefacts that facilitate identification of the root causes of medication incidents, b) integrate the MIR process within existing information systems to overcome key gaps in information exchange execution, and c) support exchange of information that can facilitate a multi-disciplinary approach to medication incident management in RACFs. CONCLUSIONS: This study highlights the advantages of viewing MIR process holistically rather than as segregated tasks, as a means to identify gaps in information exchange that need to be addressed in practice to improve safety critical processes.
Estimating length of stay in publicly-funded residential and nursing care homes: a retrospective analysis using linked administrative data sets.
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Steventon A, Roberts A.
BMC health services research 2012 Oct 31;12(1):377
BACKGROUND: Information about how long people stay in care homes is needed to plan services, as length of stay is a determinant of future demand for care. As length of stay is proportional to cost, estimates are also needed to inform analysis of the long-term cost effectiveness of interventions aimed at preventing admissions to care homes. But estimates are rarely available due to the cost of repeatedly surveying individuals. METHODS: We used administrative data from three local authorities in England to estimate the length of publicly-funded care homes stays beginning in 2005 and 2006. Stays were classified into nursing home, permanent residential and temporary residential. We aggregated successive placements in different care home providers and, by linking to health data, across periods in hospital. RESULTS: The largest group of stays (38.9%) were those intended to be temporary, such as for rehabilitation, and typically lasted 4 weeks. For people admitted to permanent residential care, median length of stay was 17.9 months. Women stayed longer than men, while stays were shorter if preceded by other forms of social care. There was significant variation in length of stay between the three local authorities. The typical person admitted to a permanent residential care home will cost a local authority over [pound sign]38,000, less payments due from individuals under the means test. CONCLUSIONS: These figures are not apparent from existing data sets. The large cost of care home placements suggests significant scope for preventive approaches. The administrative data revealed complexity in patterns of service use, which should be further explored as it may challenge the assumptions that are often made.
Forced relocation between nursing homes: Residents’ health outcomes and potential moderators
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Holder JM, Jolley D.
Reviews in Clinical Gerontology 2012;22(4):301-319
That transfer of older people from one institution to another is detrimental to well-being, health and survival has been reported for 50 years. This has led to fear, anger and legal challenges when closures occur. Previous reviews identified accounts of relocation followed by adverse outcomes and others where problems were avoided or benefits claimed. This paper reviews the last twelve years of literature on health outcomes following involuntary relocation between nursing homes. Reports of post-move mortality, physical or psychological health suggest and confirm that relocation without preparation carries higher risk of poor outcomes than moves that are orderly and include preparation. The literature on the care home closure process, admissions and individual transfers offers insights into practices that might help minimize adverse outcomes. A number of agencies have produced helpful guidelines. How these are implemented needs to be monitored and linked to in-depth studies of sample closures. © Copyright 2012 Cambridge University Press.
Educational needs of health care providers working in long-term care facilities with regard to pain management.
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Tousignant-Laflamme Y, Tousignant M, Lussier D, Lebel P, Savoie M, Lalonde L, et al.
Pain research & management 2012 Sep-Oct;17(5):341-346
The prevalence of chronic pain ranges from 40% to 80% in long-term care facilities (LTCF), with the highest proportion being found among older adults and residents with dementia. Unfortunately, pain in older adults is underdiagnosed, undertreated, inadequately treated or not treated at all. A solution to this problem would be to provide effective and innovative interdisciplinary continuing education to health care providers (HCPs). OBJECTIVE: To identify the educational needs of HCPs working in LTCF with regard to pain management. METHODS: A qualitative research design using the nominal group technique was undertaken. Seventy-two HCPs (21 physicians⁄pharmacists, 15 occupational⁄physical therapists, 24 nurses and 21 orderlies) were recruited from three LTCF in Quebec. Each participant was asked to provide and prioritize a list of the most important topics to be addressed within a continuing education program on chronic pain management in LTCF. RESULTS: Forty topics were generated across all groups, and six specific topics were common to at least three out of the four HCP groups. Educational need in pain assessment was ranked the highest by all groups. Other highly rated topics included pharmacological treatment of pain, pain neurophysiology, nonpharmacological treatments and how to distinguish pain expression from other behaviours. CONCLUSION: The present study showed that despite an average of more than 10 years of work experience in LTCF, HCPs have significant educational needs in pain management, especially pain assessment. These results will help in the development of a comprehensive pain management educational program for HCPs in LTCF.
Aged Residential Care Health Utilisation Study (ARCHUS): a randomised controlled trial to reduce acute hospitalisations from residential aged care.
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Foster SJ, Boyd M, Broad JB, Whitehead N, Kerse N, Lumley T, et al.
BMC geriatrics 2012 Sep 13;12:54-2318-12-54
For residents of long term care, hospitalisations can cause distress and disruption, and often result in further medical complications. Multi-disciplinary team interventions have been shown to improve the health of Residential Aged Care (RAC) residents, decreasing the need for acute hospitalisation, yet there are few randomised controlled trials of these complex interventions. This paper describes a randomised controlled trial of a structured multi-disciplinary team and gerontology nurse specialist (GNS) intervention aiming to reduce residents’ avoidable hospitalisations. METHODS/DESIGN: This Aged Residential Care Healthcare Utilisation Study (ARCHUS) is a cluster- randomised controlled trial (n = 1700 residents) of a complex multi-disciplinary team intervention in long-term care facilities. Eligible facilities certified for residential care were selected from those identified as at moderate or higher risk of resident potentially avoidable hospitalisations by statistical modelling. The facilities were all located in the Auckland region, New Zealand and were stratified by District Health Board (DHB). INTERVENTION: The intervention provided a structured GNS intervention including a baseline facility needs assessment, quality indicator benchmarking, a staff education programme and care coordination. Alongside this, three multi-disciplinary team (MDT) meetings were held involving a geriatrician, facility GP, pharmacist, GNS and senior nursing staff. OUTCOMES: Hospitalisations are recorded from routinely-collected acute admissions during the 9-month intervention period followed by a 5-month follow-up period. ICD diagnosis codes are used in a pre-specified definition of potentially reducible admissions. DISCUSSION: This randomised-controlled trial will evaluate a complex intervention to increase early identification and intervention to improve the health of residents of long term care. The results of this trial are expected in early 2013. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry: ACTRN 12611000187943.
A palliative care educational intervention for frontline nursing home staff: the IMPRESS project.
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Wen A, Gatchell G, Tachibana Y, Tin MM, Bell C, Koijane J, et al.
Journal of gerontological nursing 2012 Oct;38(10):20-5; quiz 26-7
The purpose of this study was to examine nursing home staff perceptions of end-of-life (EOL) care skills after an educational intervention. IMPRESS (IMproving PRofessional Education and Sustaining Support) was a quality improvement EOL care educational intervention (six lectures on core palliative care concepts) for frontline nursing home staff at five community nursing homes. Questionnaires were completed to evaluate frequency of application of palliative care skills before and after the educational series. Nursing home staff reported applying palliative care skills significantly more frequently after the intervention. A significant dose-response association was noted between number of inservice sessions attended and improvement in scores: Scores increased 0.04 points for staff who attended two of the six sessions, 0.12 for four sessions attended, and 0.46 for five to six sessions attended (p = 0.03). The results indicate that frontline nursing home staff who attend inservice sessions on core palliative care topics can significantly increase self-reported application of palliative care skills. Copyright 2012, SLACK Incorporated.
A comparison of frailty indexes for prediction of adverse health outcomes in an elderly cohort.
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Forti P, Rietti E, Pisacane N, Olivelli V, Maltoni B, Ravaglia G.
Archives of Gerontology and Geriatrics 2012 Jan-Feb;54(1):16-20
This study aimed to compare the predictive accuracy for several frailty-related adverse health outcomes of a cumulative index derived from the Italian population-based elderly cohort of the Conselice Study of Brain Aging (CSBA), which takes into account multiple different domains (demographic, clinical, functional, and nutritional parameters), with that of an index derived from the Study of Osteoporotic Fractures (SOF), modified for application to the CSBA database and henceforth called mSOF, which is exclusively focused on muscular fitness. Data are for 1007 CSBA participants aged ≥ 65 years. Investigated adverse outcomes included 4- and 7-year risk of death and 4-year risk of fractures, falls, disability, hospitalization, and nursing home placement. Accuracy for prediction of these outcomes was investigated using area under the curve (AUC) statistics. CSBA index performed better than mSOF index for prediction of mortality (p<0.001), hospitalization (p=0.002), and nursing home placement (p=0.049). For all outcomes excluding falls, frailty defined by CSBA index had a slightly lower specificity but a much higher sensitivity than frailty defined by mSOF Index. In conclusion, in this elderly cohort, the multidimensional CSBA index is a better predictor of frailty-related adverse health outcomes than the unidimensional mSOF index. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.
A multi-faceted tailored strategy to implement an electronic clinical decision support system for pressure ulcer prevention in nursing homes: A two-armed randomized controlled trial.
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Beeckman D, Clays E, Van Hecke A, Vanderwee K, Schoonhoven L, Verhaeghe S.
International journal of nursing studies 2012 Oct 1
Frail older people admitted to nursing homes are at risk of a range of adverse outcomes, including pressure ulcers. Clinical decision support systems are believed to have the potential to improve care and to change the behaviour of healthcare professionals. OBJECTIVES: To determine whether a multi-faceted tailored strategy to implement an electronic clinical decision support system for pressure ulcer prevention improves adherence to recommendations for pressure ulcer prevention in nursing homes. DESIGN: Two-armed randomized controlled trial in a nursing home setting in Belgium. The trial consisted of a 16-week implementation intervention between February and June 2010, including one baseline, four intermediate, and one post-testing measurement. Primary outcome was the adherence to guideline-based care recommendations (in terms of allocating adequate pressure ulcer prevention in residents at risk). Secondary outcomes were the change in resident outcomes (pressure ulcer prevalence) and intermediate outcomes (knowledge and attitudes of healthcare professionals). SETTING: Random sample of 11 wards (6 experimental; 5 control) in a convenience sample of 4 nursing homes in Belgium. PARTICIPANTS: In total, 464 nursing home residents and 118 healthcare professionals participated. METHODS: The experimental arm was involved in a multi-faceted tailored implementation intervention of a clinical decision support system, including interactive education, reminders, monitoring, feedback and leadership. The control arm received a hard-copy of the pressure ulcer prevention protocol, supported by standardized 30min group lecture. RESULTS: Patients in the intervention arm were significantly more likely to receive fully adequate pressure ulcer prevention when seated in a chair (F=16.4, P=0.003). No significant improvement was observed on pressure ulcer prevalence and knowledge of the professionals. While baseline attitude scores were comparable between both groups [exp. 74.3% vs. contr. 74.5% (P=0.92)], the mean score after the intervention was 83.5% in the experimental group vs. 72.1% in the control group (F=15.12, P<0.001). CONCLUSION: The intervention was only partially successful to improve the primary outcome. Attitudes improved significantly while the knowledge of the healthcare workers remained unsatisfactorily low. Further research should focus on the underlying reasons for these findings. Copyright © 2012 Elsevier Ltd. All rights reserved.
Medical Decision-Making for Older Adults without Family.
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Weiss BD, Berman EA, Howe CL, Fleming RB.
Journal of the American Geriatrics Society 2012 Nov;60(11):2144-2150
Each year in the United States, individuals who lack decision-making capacity because of acute or chronic cognitive impairment are in situations in which important medical decisions must be made for them, but tens of thousands of these individuals have no known family members or designated surrogates available to help with those decisions. Such individuals constitute 16% of patients in intensive care units, 3% of nursing home residents, and a large but unspecified number of individuals in a variety of settings who are facing end-of-life decisions. Several approaches are currently used to aid in medical decision-making for people without families or designated surrogates, including hospital ethics committees, court-appointed surrogate agents, reliance on advance directives if they are available, and even the use of computer-based decision systems. These approaches all have limitations and often result in individuals receiving care that would not have been their preference. Additionally, because clinical care teams must wrestle with uncertainty about best approaches to care, lengths of hospital stay for individuals without family are longer, resulting in higher healthcare costs and potentially more-aggressive interventions than individuals with family experience. This article reviews medical decision-making for older adults without families or designated surrogates and proposes a solution: “health fiduciaries”-a new type of professional trained and certified to act as a surrogate decision-maker for individuals who are unable to make decisions for themselves. © 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.
Comparison of the effectiveness of two protocols for treating nursing home residents with advanced dementia.
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Kovach CR, Simpson MR, Joosse L, Logan BR, Noonan PE, Reynolds SA, et al.
Research in gerontological nursing 2012 Oct;5(4):251-263
The Serial Trial Intervention (STI) is a decision support tool to address the problem of underassessment and undertreatment of pain and other unmet needs of people with dementia. This study compared the effectiveness of the 5-step and 9-step versions of the STI using a two-group repeated measures quasi-experimental design with randomization of 12 matched nursing homes. The sample consisted of 125 residents with moderate to severe dementia. Both the 5- and 9-step STIs significantly decreased discomfort and agitation from pre- to posttest (effect sizes = 0.45 to 0.90). The 9-step version was more effective for comorbid burden and increased cortisol slope (effect sizes = 0.50 and 0.49). Process variables were all statistically significantly improved using the 9-step STI. Nurse time was not different between the two groups. The clinical decision support rules embedded in the STI, particularly the 9-step version, helped nurses change practice and improved resident outcomes. Copyright 2012, SLACK Incorporated.
CD Howe Institute: Long-Term Care for the Elderly: Challenges and Policy Options
Ake Blomqvist, Colin Busby November 8, 2012
Innovative reforms are needed to prepare for the coming surge in demand for long-term care services from aging babyboomers, according to a report released today by the C.D. Howe Institute. In “Long-Term Care for the Elderly: Challenges and Policy Options,” authors Ake Blomqvist and Colin Busby recommend methods to fairly divide costs between care recipients and taxpayers, and to get more value for money. “Reforms should improve efficiency, by reducing waiting lists for beds and enhancing patient choice,” said Blomqvist. “As we see it that means steering more government funds directly to patients, in the form of cash or vouchers, as in the Nordic countries and France, and letting patients choose among home care, private care or waiting for a bed in government-subsidized long-term care facilities.”
The report aims to encourage country preparedness by strengthening or developing policy and implementing it through plans and programmes which enhance dementia care in order to improve the social well-being and quality of life of those living with dementia and their caregivers. The reports includes an overview of global epidemiology and the impact of dementia, national-level approaches to dementia including the role of health and social care systems and workforce, issues around caregiving and caregivers, and awareness raising and advocacy for dementia.
Presenter: Dr. Carole Estabrooks. Sponsored by the Health Systems Area of Excellence and Carole Estabrooks’ Canada Research Chair. As lunch will be provided please RSVP by November 20th to Bailey Sousa.
Google Apps for Time and Project Management
Wednesday November 21, 2012 eCHA 2-150
In this session we’ll take a tour of Google Apps and how they can be used to support time and project management. This is not a hands-on “click A then B” training session; rather, we’ll explore what’s possible with this set of tools and what tasks are best (or best not) accomplished with them. Bring your own tips and ideas too!
The session will be led by Louisa Fricker, an experienced research coordinator in the Faculty of Nursing (and a MLIS graduate). Louisa also works on projects with two other departments. Although initially reluctant to use Google Apps, she soon discovered that they’re the Best Thing Ever for organizing your work and getting your coworkers to say, “Wow, you are really organized” in a way that is probably mostly a compliment. RSVP: Shelagh K. Genuis or sign up at http://chla-absc.ca/nahla/content/leading-edge-google-apps-time-and-project-management.
Communication Accessibility for People with Complex Communication Needs (CCN)
Tue, November 20, 13:00-15:00 Rm 2-41, Corbett Hall
This presentation will describe the results of a study on the communication accessibility requirements of people with CCN. Implications will be explored in terms of human rights legislation, what businesses, organizations and essential services can do to improve communication access to their goods and services, how disability service providers can support people with CCN in learning about and exercising their accessibility rights and national initiatives to improve accessibility for people with CNN.
Fostering Innovation Through Public Private Sector Partnerships
Toronto, ON Friday November 23, 2012
The University Health Network (UHN) will host their 4th Toronto Research Management Symposium at the MaRS Heritage Building in Toronto. The event features Ontario leaders in research management discussing innovation, development, and the pivotal role of public-private partnerships.
2013 People and Progress Continuing Care Conference – Person Centred Care – The Passion Continues
February 7-8, 2013 Edmonton, AB
Across North America, nursing home culture is changing to become more person-centred. Person-centred care is a philosophy that puts the focus on the person, rather than the task, and includes offering and respecting individuality and choice. Last year’s People and Progress Continuing Care Conference introduced the concept of person-centred care and gave delegates a chance to learn how other organizations have undertaken this culture change. Stories of other organizations strengthen the belief that elders, even the most frail, should be able to have good daily life wherever they might live. As CapitalCare embarks on its own journey toward person-centred care, we have learned that we have much more to learn about transforming our culture, hence the theme: Person Centred Care – The Passion Continues.
AHRQ: Innovations Exchange TweetChat
Tuesday Nov 27, 2012 13:00 MT #AHRQIX
Join Julie Kliger, MPA, BSN, RN, Director of the Integrated Nurse Leadership Program at the University of California San Francisco. She will discuss nurse-led innovations including her own, Nine-Hospital Collaborative Uses Patient Screening Criteria, Fast-Track Diagnosis, and Treatment Protocols to Reduce Sepsis Mortality by More Than 50 Percent.
OHRI Workshop: Exploring the Theoretical Domains Framework in Behaviour Change Research
Monday December 3, 2012 08:45-17:30 Ottawa, ON
Behavior change is key to increasing the uptake of evidence into healthcare practice and improving health outcomes. A variety of psychological theories have been used to explain health care professional behaviours and cognitions. however, the large number of theories and overlapping constructs presents a challenge for knowing how to select and apply theories when exploring specific behaviors. The Theoretical Domains Framework was developed to make theories more accessible for implementation researchers. This workshop is led by Prof. Susan Michie, Prof. Jill Francis, Dr. Denise O’Connor, Dr. Simon French, and Dr. Jeremy Grimshaw.
IHI: Frail Older Adults: Building a Care System
March 20-21, 2013 Denver, CO
The Institute for Healthcare Improvement (IHI) is offering a new seminar called Frail Older Adults: Building a Care System. Over the course of two days, our expert faculty will provide participants with a community-based, systems approach for providing reliable, efficient care that is person-centered and reduces unnecessary costs. While many people can envision as ideal state, this program offers tools, best practices, real-world examples, and the “how-to” knowledge that each participant can bring back to their organization to implement to begin to see real change. This systems approach provides the foundation and supports for great care—a system that can bring together all the ingredients and continue to evolve as more and more of our older population lives with the multiple challenges of frailty.
Strategic planning has earned a bad reputation within many organizations, principally because it is perceived as a top down, non-value added process that often does not lead to transformational changes. Typically organizations try to accomplish too many strategic goals, and strategic plans are often developed but not as effectively executed as they could be. There is often a gap between strategy and action in traditional planning approaches and employees can end up feeling disengaged from key strategic initiatives. Leaders within Saskatchewan’s healthcare system are overcoming these shortcomings through the adoption of hoshin kanri, a management process that helps senior leaders focus and align their organizations around a few key goals.
Preventfalls.ca is an innovative new website aimed at reducing serious injuries caused by falls in older adults and children, the two groups that are at highest risk. Preventfalls.ca includes information about what puts people at risk and gives information about what they can do to stay on their feet.
Journal of Research in Nursing seeks 2 Editorial Board Members
DEADLINE December 9, 2012
The Journal of Research in Nursing is a leading peer reviewed journal that contributes knowledge to health and social care policy and nursing practice. Each issue contains a variety of papers and reviews within a specific theme, with contributions from experts in the field. Applications are invited for membership of the JRN Editorial Board. The Board is currently seeking to make two appointments, as part of its programme of refreshment.
CIHR: Moving into action: We know what practices we want to change, now what? An implementation guide for health care practitioners
Developed by S.A. Castiglione, RN, MSc(A) & J.A. Ritchie RN, PhD, March 28, 2012
You may have already encountered this scenario or one similar:You are concerned about a specific practice that exists in your clinical setting involving a unique patient population. Your concern leads you to search the literature, a typical approach to your inquiry that you’ve done numerous times before. Your search yields a clinical practice guideline and other types of evidence dealing with the issue at hand, and you think “Eureka! Now I know exactly what we should be doing!”
This excitement slowly turns to concern again.
You think: “I know what I want to change, but now what?
How do I get all the staff to adopt this change?”
Many health care practitioners encounter these questions as they consider the intricacies involved in changing health care practitioner behaviour. It was thought at one time that simply presenting the recommendations for change or circulating a memo would change behaviour. If only it was that easy! Rather, translating evidence into practice can be a complex and daunting process. It requires careful thought from the innovation itself to the organizational policies and politics. This guide is intended for all health care professionals as a resource tool for implementation of a practice change based on evidence.
A newly enhanced version of Health Systems Evidence has been launched that gives policymakers, stakeholders and researchers access to more comprehensive evidence on how to strengthen or reform health systems. The service now contains complete inventories of economic evaluations of health system reforms published since 2007, descriptions of health systems around the world, and descriptions of health system reforms. These inventories complement the existing comprehensive inventories of six types of documents related to governance, financial and delivery arrangements in health systems and implementation strategies within health systems. The enhancements to the service were unveiled during a session at the Second Global Symposium on Health Systems Research held in Beijing, China Oc! tober 31 to November 3. Health Systems Evidence, the world’s most comprehensive free access point to syntheses of research evidence about governance, financial and delivery arrangements within health systems, now contains more than 5,000 documents, and has 3,500 registered users from more than 100 countries.
The Cochrane Library has developed an interactive world map displaying all of the countries with access to the Library. When you click on a selected country, data is displayed such as rank, percentage of full text downloads and the country’s most downloaded Cochrane Reviews. This sounds boring, but it’s actually fun (if you’re a geek). Who would have guessed that the most popular Cochrane review in Mexico would be about the efficacy of Chinese herbs to treat heart disease?