October 21, 2013


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Abstracts

New article by Drs. Susan Slaughter & Carole Estabrooks
Optimizing the mobility of residents with dementia: a pilot study promoting healthcare aide uptake of a simple mobility innovation in diverse nursing home settings
Slaughter S, Estabrooks C.
BMC Geriatrics 2013;13(1):110

Almost 90 percent of nursing home residents have some type of mobility limitation. Many spend most of their waking hours lying in bed or sitting. Such inactivity can negatively affect residents’ health and general well-being. This pilot study aimed to assess (1) the effect of the sit-to-stand activity on mobility outcomes of nursing home residents, (2) the effect of an audit-and-feedback intervention on uptake of the sit-to-stand activity by healthcare aides, and (3) the contextual factors influencing uptake of the sit-to-stand activity by healthcare aides. Methods This quasi-experimental pilot study was conducted in two nursing homes in western Canada. Twenty-six residents with dementia completed the sit-to-stand activity with 56 healthcare aides during daily care; separately, 71 healthcare aides completed a research use and context survey. Preliminary mobility feedback was presented to healthcare aides in one site. Resident mobility was measured using the 30-second sit-to-stand test. Healthcare aide uptake of the activity was measured using documentation flowsheets and a survey-based measure. Context was measured using the Alberta Context Tool. Mobility and uptake outcomes were analyzed over time and by site with analysis of covariance. Spearman and Pearson correlations were used to correlate context data with research use. Results Residents who more frequently completed the sit-to-stand activity were more likely to maintain or improve mobility compared with those who completed it less frequently (F=4.46; p=0.046, after adjustment for age). Uptake for one site was significantly different from the other (t-score=2.67; p=0.01, after adjustment for resident covariates). The audit-and-feedback intervention was associated with increased uptake of the activity from pre-intervention to post-intervention (t-score=-2.48; p=0.02). More context domains correlated significantly with aides’ use of conceptual research and information sources in one site than the other. Conclusions The sit-to-stand activity is a promising means to maintain or improve transfer ability of nursing home residents with dementia. In the nursing home with initially weak uptake, strengthened uptake followed an audit-and-feedback intervention. Activity participation was higher in the site with stronger correlations between context and measured research use. Results are sufficiently promising to warrant proceeding with a full clinical trial.

CALL FOR ABSTRACTS:
25th International Nursing Research Congress
24-28 July 2014 Hong Kong
DEADLINE: 13 December 2013

The Honor Society of Nursing, Sigma Theta Tau International’s research priorities are advancing healthy communities through health promotion; preventing disease and recognizing social, economic, and political determinants; implementing evidence-based practice; targeting the needs of vulnerable populations such as the chronically ill and poor; and developing nurses’ capacity for research.

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Publications

KT
Health Care Administration and Organization
Health Care Innovation and Quality Assurance
Aging

KT

Implementation of evidence-based practice across medical, nursing, pharmacological and allied healthcare professionals: a questionnaire survey in nationwide hospital settings.
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Weng YH, Kuo KN, Yang CY, Lo HL, Chen C, Chiu YW.
Implementation science : IS 2013 Sep 24;8(1):112

Implementation of evidence-based practice (EBP) is regarded as core competence to improve healthcare quality. In the current study, we investigated the EBP of six groups of professionals: physicians, nurses, pharmacists, physical therapists, technicians, and other allied healthcare personnel. METHODS: A structured questionnaire survey of regional hospitals throughout Taiwan was conducted by post in 2011. RESULTS: In total, 6,160 returned questionnaires, Physicians and pharmacists were more aware of EBP than were the other professional groups (p < 0.001). Positive attitudes toward and beliefs in EBP were significantly lower among nurses than in the other groups (p < 0.001). Physicians had more sufficient knowledge and skills of EBP than did the other professionals (p < 0.001); in addition, they implemented EBP for clinical decision-making more often and perceived fewer personal barriers to EBP (p < 0.001). Multivariate logistic regression analyses showed that EBP implementation was associated with the following characteristics of participants: EBP training, having a faculty position, academic degree, one’s profession, and perceptions (beliefs, attitudes, knowledge, skills and barriers).

How contexts and issues influence the use of policy-relevant research syntheses: a critical interpretive synthesis. Canada-flat-icon
Non UofA Access
Moat KA, Lavis JN, Abelson J.
The Milbank quarterly 2013 Sep;91(3):604-648

Evidence briefs have emerged as a promising approach to synthesizing the best available research evidence for health system policymakers and stakeholders. An evidence brief may draw on systematic reviews and many other types of policy-relevant information, including local data and studies, to describe a problem, options for addressing it, and key implementation considerations. We conducted a systematic review to examine the ways in which context- and issue-related factors influence the perceived usefulness of evidence briefs among their intended users. METHODS: We used a critical interpretive synthesis approach to review both empirical and nonempirical literature and to develop a model that explains how context and issues influence policymakers’ and stakeholders’ views of the utility of evidence briefs prepared for priority policy issues. We used a “compass” question to create a detailed search strategy and conducted electronic searches in CINAHL, EMBASE, HealthSTAR, IPSA, MEDLINE, OAIster (gray literature), ProQuest A&I Theses, ProQuest (Sociological Abstracts, Applied Social Sciences Index and Abstracts, Worldwide Political Science Abstracts, International Bibliography of Social Sciences, PAIS, Political Science), PsychInfo, Web of Science, and WilsonWeb (Social Science Abstracts). Finally, we used a grounded and interpretive analytic approach to synthesize the results. FINDINGS: Of the 4,461 papers retrieved, 3,908 were excluded and 553 were assessed for “relevance,” with 137 included in the initial sample of papers to be analyzed and an additional 23 purposively sampled to fill conceptual gaps. Several themes emerged: (1) many established types of “evidence” are viewed as useful content in an evidence brief, along with several promising formatting features; (2) contextual factors, particularly the institutions, interests, and values of a given context, can influence views of evidence briefs; (3) whether an issue is polarizing and whether it is salient (or not) and familiar (or not) to actors in the policy arena can influence views of evidence briefs prepared for that issue; (4) influential factors can emerge in several ways (as context driven, issue driven, or a result of issue-context resonance); (5) these factors work through two primary pathways, affecting either the users or the producers of briefs; and (6) these factors influence views of evidence briefs through a variety of mechanisms. CONCLUSIONS: Those persons funding and preparing evidence briefs need to consider a variety of context- and issue-related factors when deciding how to make them most useful in policymaking. © 2013 Milbank Memorial Fund.

Knowledge translation strategies to improve the use of evidence in public health decision making in local government: intervention design and implementation plan
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Armstrong R, Waters E, Dobbins M, Anderson L, Moore L, Petticrew M, et al.
Implementation science : IS 2013 Oct 9;8(1):121

Knowledge translation strategies are an approach to increase the use of evidence within policy and practice decision-making contexts. In clinical and health service contexts, knowledge translation strategies have focused on individual behavior change, however the multi-system context of public health requires a multi-level, multi-strategy approach. This paper describes the design of and implementation plan for a knowledge translation intervention for public health decision making in local government. METHODS: Four preliminary research studies contributed findings to the design of the intervention: a systematic review of knowledge translation intervention effectiveness research, a scoping study of knowledge translation perspectives and relevant theory literature, a survey of the local government public health workforce, and a study of the use of evidence-informed decision-making for public health in local government. A logic model was then developed to represent the putative pathways between intervention inputs, processes, and outcomes operating between individual-, organizational-, and system-level strategies. This formed the basis of the intervention plan. RESULTS: The systematic and scoping reviews identified that effective and promising strategies to increase access to research evidence require an integrated intervention of skill development, access to a knowledge broker, resources and tools for evidence-informed decision making, and networking for information sharing. Interviews and survey analysis suggested that the intervention needs to operate at individual and organizational levels, comprising workforce development, access to evidence, and regular contact with a knowledge broker to increase access to intervention evidence; develop skills in appraisal and integration of evidence; strengthen networks; and explore organizational factors to build organizational cultures receptive to embedding evidence in practice. The logic model incorporated these inputs and strategies with a set of outcomes to measure the intervention’s effectiveness based on the theoretical frameworks, evaluation studies, and decision-maker experiences. CONCLUSION: Documenting the design of and implementation plan for this knowledge translation intervention provides a transparent, theoretical, and practical approach to a complex intervention. It provides significant insights into how practitioners might engage with evidence in public health decision making. While this intervention model was designed for the local government context, it is likely to be applicable and generalizable across sectors and settings.Trial registration: Australia New Zealand Clinical Trials Register ACTRN12609000953235.

Dissemination and implementation of evidence-based practices for child and adolescent mental health: A systematic review
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Novins DK, Green AE, Legha RK, Aarons GA.
Journal of the American Academy of Child and Adolescent Psychiatry 2013 Oct;52(10):1009-1025.e18

Of 14,247 citations initially identified, 73 articles drawn from 44 studies met inclusion criteria. The articles were classified by implementation phase (exploration, preparation, implementation, and sustainment) and specific implementation factors examined. These factors were divided into outer (i.e., system level) and inner (i.e., organizational level) contexts. RESULTS: Few studies used true experimental designs; most were observational. Of the many inner context factors that were examined in these studies (e.g., provider characteristics, organizational resources, leadership), fidelity monitoring and supervision had the strongest empirical evidence. Albeit the focus of fewer studies, implementation interventions focused on improving organizational climate and culture were associated with better intervention sustainment as well as child and adolescent outcomes. Outer contextual factors such as training and use of specific technologies to support intervention use were also important in facilitating the implementation process. CONCLUSIONS: The further development and testing of dissemination and implementation strategies is needed to more efficiently move EBPs into usual care. Copyright © 2013 American Academy of Child and Adolescent Psychiatry.

Exploring sources of knowledge utilized in practice among Jordanian registered nurses.
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Al-Ghabeesh SH, Abu-Moghli F, Salsali M, Saleh M.
Journal of evaluation in clinical practice 2013 Oct;19(5):889-894

Rationale, aims and objectives  Understanding sources of knowledge used in everyday practice is very helpful in improving the quality of health care services. There is a consensus in the literature that nurses mostly relied in their practice on experiential knowledge gained through their interactions with other members of health care professionals and patients. The general aim of this study is to explore the sources of knowledge Jordanian registered nurses use during their practice. Method  A descriptive correlational design was used to collect data from 539 Jordanian registered nurses from 10 hospitals using a self-administered questionnaire. Results  The mean year of experience of the sample was 7.08 years. Of the 615 questionnaires distributed, 555 were returned. This yields a response rate of 87.6%. Results revealed that the top five ranked sources used by Jordanian registered nurses include: the information that nurses learned during nursing education, personal experience in nursing over time, what was learned through providing care to patients, information gained through discussion between physicians and nurses about patients, and information from policy and procedure manuals. Conclusion  Jordanian registered nurses recognize the value of research and that research utilization (RU) is an important issue and must not be ignored. The study has many implications for practice, education and research. Health care managers and decision makers need to play a more visible and instrumental role in encouraging RU to improve patients’ quality of life. © 2012 John Wiley & Sons Ltd.

How to define ‘best practice’ for use in Knowledge Translation research: a practical, stepped and interactive process.
Non UofA Access
Bosch M, Tavender E, Bragge P, Gruen R, Green S.
Journal of evaluation in clinical practice 2013 Oct;19(5):763-768

Defining ‘best practice’ is one of the first and crucial steps in any Knowledge Translation (KT) research project. Without a sound understanding of what exactly should happen in practice, it is impossible to measure the extent of existing gaps between ‘desired’ and ‘actual’ care, set implementation goals, and monitor performance. The aim of this paper is to present a practical, stepped and interactive process to develop best practice recommendations that are actionable, locally applicable and in line with the best available research-based evidence, with a view to adapt these into process measures (quality indicators) for KT research purposes. Methods  Our process encompasses the following steps: (1) identify current, high-quality clinical practice guidelines (CPGs) and extract recommendations; (2) select strong recommendations in key clinical management areas; (3) update evidence and create evidence overviews; (4) discuss evidence and produce agreed ‘evidence statements’; (5) discuss the relevance of the evidence with local stakeholders; and (6) develop locally applicable actionable best practice recommendations, suitable for use as the basis of quality indicators. Conclusions  Actionable definitions of local best practice are a prerequisite for doing KT research. As substantial resources go into rigorously synthesizing evidence and developing CPGs, it is important to make best use of such available resources. We developed a process for efficiently developing locally applicable actionable best practice recommendations from existing high-quality CPGs that are in line with current research evidence. © 2012 John Wiley & Sons Ltd.

Testing the Consolidated Framework for Implementation Research on health care innovations from South Yorkshire.
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Ilott I, Gerrish K, Booth A, Field B.
Journal of evaluation in clinical practice 2013 Oct;19(5):915-924

RATIONALE, AIMS AND OBJECTIVES: There is an international imperative to implement research into clinical practice to improve health care. Understanding the dynamics of change requires knowledge from theoretical and empirical studies. This paper presents a novel approach to testing a new meta theoretical framework: the Consolidated Framework for Implementation Research. METHOD: The utility of the Framework was evaluated using a post hoc, deductive analysis of 11 narrative accounts of innovation in health care services and practice from England, collected in 2010. A matrix, comprising the five domains and 39 constructs of the Framework was developed to examine the coherence of the terminology, to compare results across contexts and to identify new theoretical developments. RESULTS: The Framework captured the complexity of implementation across 11 diverse examples, offering theoretically informed, comprehensive coverage. The Framework drew attention to relevant points in individual cases together with patterns across cases; for example, all were internally developed innovations that brought direct or indirect patient advantage. In 10 cases, the change was led by clinicians. Most initiatives had been maintained for several years and there was evidence of spread in six examples. Areas for further development within the Framework include sustainability and patient/public engagement in implementation. CONCLUSION: Our analysis suggests that this conceptual framework has the potential to offer useful insights, whether as part of a situational analysis or by developing context-specific propositions for hypothesis testing. Such studies are vital now that innovation is being promoted as core business for health care. © 2012 John Wiley & Sons Ltd.

NCCHPP: Planning Knowledge Sharing in the Context of a Health Impact Assessment Canada-flat-icon
September 2013

Those in charge of the Health Impact Assessment must be able to organize appropriate knowledge-sharing activities, taking into account stakeholder profiles, the decision-making context and the resources available.

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Health Care Administration and Organization

The satisfaction with the quality of dementia care and the health, burnout and work ability of nurses: A longitudinal analysis of 50 German nursing homes.
Non UofA Access
Schmidt SG, Dichter MN, Bartholomeyczik S, Hasselhorn HM.
Geriatric nursing (New York, N.Y.) 2013 Oct 13

The increasing prevalence of residents with dementia in Nursing Homes (NH) leads to a demanding work with high physical and psychological workloads. This study focuses on NH nurses and their satisfaction with quality of care for residents with dementia (SQCD) and its impact on nurses’ general health, burnout and work ability. METHOD: Two-wave (2007/2009) self-report questionnaire data of 305 nurses (RNs and nurses’ aides) from 50 German NHs. RESULTS: 58.6% (2007) and 64.9% (2009) of the respondents reported satisfaction with the quality of care of the dementia residents. However, when dissatisfied, this was perceived as substantial work stressor and was adversely associated with nurses’ individual resource outcomes. Those nurses who between 2007 and 2009 had become dissatisfied or were dissatisfied at both measurements showed the most adverse scorings for burnout, general health and work ability. DISCUSSION: The findings imply that in NHs, SQCD may be a relevant work factor with substantial impact on nurses’ core resources. Copyright © 2013 Mosby, Inc. All rights reserved.

CIHI: Regulated Nurses, 2012 Canada-flat-icon
October 2013

Regulated Nurses, 2012 highlights current trends in nursing practice across a variety of demographic, education, mobility and employment characteristics. This series highlights data from the three groups of regulated nursing professionals in Canada: registered nurses (RNs, including nurse practitioners or NPs), licensed practical nurses (LPNs) and registered psychiatric nurses (RPNs).

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Health Care Innovation and Quality Assurance

Staffing, Quality, and Productivity in the Nursing Home.
Non UofA Access
Schnelle JF, Karuza J, Katz PR.
Journal of the American Medical Directors Association 2013 Oct 2.

This editorial discuses several articles in this issue on the connection between LTC staffing and health care quality and productivity.

Feasibility and Acceptability of a Delirium Prevention Program for Cognitively Impaired Long Term Care Residents: A Participatory Approach. Canada-flat-icon
Non UofA Access
Voyer P, McCusker J, Cole MG, Monette J, Champoux N, Vu M, et al.
Journal of the American Medical Directors Association 2013 Oct 2

In this participatory action research study, researchers conducted a total of 3 implementation cycles to evaluate the feasibility and acceptability of a new delirium prevention program (DPP) for cognitively impaired residents in long term care (LTC) settings. Researchers interviewed 95 health care staff to obtain feedback on their use of the DPP and then modified the DPP and tested the changes in the next implementation cycle. Our results indicated that the DPP was feasible and that health care staff would accept it under certain conditions. We found there were 4 keys to successful implementation of the DPP: support for the program from both the administration and the users; effective clinician leadership to ensure proper delivery of the DPP (format, content and values) and its appropriate adaptation to the LTC facility’s internal culture and policies; a sense of ownership among the DPP users; and, last, practical hands-on training as well as theoretical training for staff. Copyright © 2013 American Medical Directors Association, Inc.

The dynamic sustainability framework: addressing the paradox of sustainment amid ongoing change.
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Chambers DA, Glasgow RE, Stange KC.
Implementation science 2013 Oct 2;8(1):117

BACKGROUND: Despite growth in implementation research, limited scientific attention has focused on understanding and improving sustainability of health interventions. Models of sustainability have been evolving to reflect challenges in the fit between intervention and context. DISCUSSION: We examine the development of concepts of sustainability, and respond to two frequent assumptions —‘voltage drop,’ whereby interventions are expected to yield lower benefits as they move from efficacy to effectiveness to implementation and sustainability, and ‘program drift,’ whereby deviation from manualized protocols is assumed to decrease benefit. We posit that these assumptions limit opportunities to improve care, and instead argue for understanding the changing context of healthcare to continuously refine and improve interventions as they are sustained. Sustainability has evolved from being considered as the endgame of a translational research process to a suggested ‘adaptation phase’ that integrates and institutionalizes interventions within local organizational and cultural contexts. These recent approaches locate sustainability in the implementation phase of knowledge transfer, but still do not address intervention improvement as a central theme. We propose a Dynamic Sustainability Framework that involves: continued learning and problem solving, ongoing adaptation of interventions with a primary focus on fit between interventions and multi-level contexts, and expectations for ongoing improvement as opposed to diminishing outcomes over time. SUMMARY: A Dynamic Sustainability Framework provides a foundation for research, policy and practice that supports development and testing of falsifiable hypotheses and continued learning to advance the implementation, transportability and impact of health services research.

Social network diagnostics: a tool for monitoring group interventions
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Gesell SB, Barkin SL, Valente TW.
Implementation science 2013 Oct 1;8(1):116

Many behavioral interventions designed to improve health outcomes are delivered in group settings. To date, however, group interventions have not been evaluated to determine if the groups generate interaction among members and how changes in group interaction may affect program outcomes at the individual or group level. METHODS: This article presents a model and practical tool for monitoring how social ties and social structure are changing within the group during program implementation. The approach is based on social network analysis and has two phases: collecting network measurements at strategic intervention points to determine if group dynamics are evolving in ways anticipated by the intervention, and providing the results back to the group leader to guide implementation next steps. This process aims to initially increase network connectivity and ultimately accelerate the diffusion of desirable behaviors through the new network. This article presents the Social Network Diagnostic Tool and, as proof of concept, pilot data collected during the formative phase of a childhood obesity intervention. RESULTS: The number of reported advice partners and discussion partners increased during program implementation. Density, the number of ties among people in the network expressed as a percentage of all possible ties, increased from 0.082 to 0.182 (p 0.05) in the discussion network. CONCLUSIONS: The observed two-fold increase in network density represents a significant shift in advice partners over the intervention period. Using the Social Network Tool to empirically guide program activities of an obesity intervention was feasible.

Evaluating the effectiveness of a multifaceted, multilevel continuous quality improvement program in primary health care: developing a realist theory of change
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Schierhout G, Hains J, Si D, Kennedy C, Cox R, Kwedza R, et al.
Implementation science 2013 Oct 8;8(1):119

We elicited key informants’ interpretations of factors explaining patterns of change in delivery of guideline-scheduled services over three or more years of a wide-scale CQI project, and inductively analyzed these interpretations to propose fine-grained realist hypotheses about what works for whom and in what circumstances. Data were derived from annual clinical audits from 36 health centers operating in diverse settings, quarterly project monitoring reports, and workshops with 12 key informants who had key roles in project implementation. We abstracted potential context-mechanism-outcome configurations from the data, and based on these, identified potential program-strengthening strategies. RESULTS: Several context-specific, mechanism-based explanations for effectiveness of this CQI project were identified. These were collective valuing of clinical data for improvement purposes; collective efficacy; and organizational change towards a population health orientation. Health centers with strong central management of CQI, and those in which CQI efforts were more dependent on local health center initiative and were adapted to resonate with local priorities were both favorable contexts for collective valuing of clinical data. Where health centers had prior positive experiences of collaboration, effects appeared to be achieved at least partly through the mechanism of collective efficacy. Strong community linkages, staff ability to identify with patients, and staff having the skills and support to take broad ranging action, were favorable contexts for the mechanism of increased population health orientation.

Development of a theory-based instrument to identify barriers and levers to best hand hygiene practice among healthcare practitioners
Non UofA Access
Dyson J, Lawton R, Jackson C, Cheater F.
Implementation science 2013 Sep 23;8(1):111

A comprehensive list of barriers and levers to hand hygiene were categorised to the Theoretical Domains Framework (TDF) in a Delphi survey. These items formed the basis of an instrument that was tested to establish validity and reliability. The relationship between self-reported compliance with hand hygiene and barriers and levers to hand hygiene was also examined along with compliance according to where the barriers and levers fit within the domains of the TDF framework. RESULTS: A 33-item instrument that tested well for internal consistency (alpha = 0.84) and construct validity (chi2/df = 1.9 [p < 0.01], RMSEA = 0.05 and CFA = 0.84) was developed. The relationship between self-reported compliance with hand hygiene moderately correlated with barriers identified by participants (total barrier score) (r = 0.41, n = 276, p <0.001). The greater the number of barriers reported, the lower the level of compliance. A one-way between groups multivariate analysis of variance was performed to investigate differences between those adopting high or low compliance with hand hygiene. Compliance was highest for this sample of participants among practitioners with high levels of motivation, strong beliefs about capabilities, when there were positive social influences, when hand hygiene was central to participants’ sense of professional identity and was easier to remember to do.

The PROCESS study: a protocol to evaluate the implementation, mechanisms of effect and context of an intervention to enhance public health centres in Tororo, Uganda.
Non UofA Access
Chandler CI, Diliberto D, Nayiga S, Taaka L, Nabirye C, Kayendeke M, et al.
Implementation science 2013 Sep 30;8(1):113

The PROCESS study will use mixed methods to evaluate the processes, mechanisms of change, and context of the PRIME intervention by addressing five objectives. First, to develop a comprehensive logic model of the intervention, articulating the project’s hypothesised pathways to trial outcomes. Second, to evaluate the implementation of the intervention, including health worker training, health centre management tools, and the supply of artemether-lumefantrine (AL) and rapid diagnostic tests (RDTs) for malaria. Third, to understand mechanisms of change of the intervention components, including testing hypotheses and interpreting realities of the intervention, including resistance, in context. Fourth, to develop a contextual record over time of factors that may have affected implementation of the intervention, mechanisms of change, and trial outcomes, including factors at population, health centre and district levels. Fifth, to capture broader expected and unexpected impacts of the intervention and trial activities among community members, health centre workers, and private providers. Methods will include intervention logic mapping, questionnaires, recorded consultations, in-depth interviews, focus group discussions, and contextual data documentation.

Healthcare technologies, quality improvement programs and hospital organizational culture in Canadian hospitals. Canada-flat-icon
Non UofA Access
Tyagi RK, Cook L, Olson J, Belohlav J.
BMC health services research 2013 Oct 13;13(1):413

A cross-sectional study of Canadian hospitals was conducted in 2010. The sample consisted of hospital administrators that were selected by provincial review boards. The questionnaire consisted of 3 sections: 20 healthcare technology items, 16 quality improvement program items and 63 culture items. RESULTS: Rasch model analysis revealed that a hierarchy existed among the healthcare technologies based upon the difficulty of implementation. The results also showed a significant relationship existed between the ability to implement healthcare technologies and the number of quality improvement programs adopted. In addition, culture within a hospital served a mediating role in quality improvement programs adoption.

Successful implementation of clinical practice guidelines for pressure risk management in a home nursing setting.
Non UofA Access
Kapp S.
Journal of evaluation in clinical practice 2013 Oct;19(5):895-901

This paper reports an initiative which promoted evidence-based practice in pressure risk assessment and management among home nursing clients in Melbourne, Australia. Aim and objectives  The aim of this study was to evaluate the introduction and uptake of the Australian Wound Management Association Guidelines for the Prediction and Prevention of Pressure Ulcers. Method  In 2007 a pilot study was conducted. Nurse perspectives (n=21) were obtained via survey and a client profile (n=218) was generated. Audit of the uptake and continued use of the pressure risk screening tool, during the pilot study and later once implemented as standard practice organizational wide, was conducted. Results  Nurses at the pilot site successfully implemented the practice guidelines, pressure risk screening was adopted and supporting resources were well received. Most clients were at low risk of pressure ulcer development. The pilot site maintained and extended their pilot study success, ensuring more than 90% of clients were screened for pressure risk over the 18 months which followed. All other sites performed less well initially, however subsequently improved, meeting the pilot sites success after 18 months. Two years later, the organization continues to screen more than 90% of all clients for pressure risk. Conclusion  Implementation of clinical practice guidelines was successful in the pilot project and pressure risk screening became a well-adopted practice. Success continued following organizational wide implementation. Pilot study findings suggest it may be prudent to monitor the pressure ulcer risk status of low risk clients so as to prevent increasing risk and pressure ulcer development among this group.© 2012 John Wiley & Sons Ltd.

Are the Dutch long-term care organizations getting better? A trend study of quality indicators between 2007 and 2009 and the patterns of regional influences on performance.
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Winters-Van Der Meer S, Kool RB, Klazinga NS, Huijsman R.
International journal for quality in health care 2013 Oct;25(5):505-514

We performed trend analyses on the indicators of clients of 2115 long-term care organizations. We used multivariate analyses to determine the difference in national performance between 2007 and 2009 and to calculate the influence of the region on the performance of 2009. RESULTS: The national performance on client-related indicators for somatic care and home care increased and for psycho-geriatric care the quality performance became worse. The professional indicators for intramural care improved between 2007 and 2009. Region influences the performance. In general, organizations in the west of the Netherlands performed worse than other regions (with exception of home care).

The Change Foundation: Health System Navigators: Band-Aid or Cure? Canada-flat-icon
September 2013

Health System Navigators: Band-Aid or Cure? marks the first Foundation/PANORAMA report reflecting on ways to advance patient-centred care in Ontario. Are navigators a potential solution or another “work around” for an overly complicated system? The report covers the history and scope of health system navigators and key benefits and challenges. In Canada, the role was introduced to help cancer patients and underserved populations.

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Aging

Constructing and Identifying Predictors of Frailty among Homeless Adults-A Latent Variable Structural Equations Model Approach
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Salem BE, Nyamathi A, Brecht L, Phillips LR, Mentes J, Sarkisian C, et al.
Archives of Gerontology and Geriatrics

Homeless urbanites are a heterogeneous population with unique health and social service needs. The study examined situational, behavioral, health-related and resource indicators in terms of their direct impact on frailty, hypothesized as a latent variable. Using structural equation modeling (SEM), a model was tested with 150 homeless men and women, ages 40 to 73, from three homeless day center drop-in sites on Skid Row and one residential drug treatment (RDT) facility that works with homeless parolees and probationers. In bivariate analyses with the latent construct frailty, months homeless (p< .01), female gender (p< .05), education (p< .05), comorbid conditions (p< .001), nutrition (p< .001), resilience (p< .001), health care utilization (p< .01), and falls (p< .001) were significantly associated with frailty. In the final path model, significant predictors of frailty included educational attainment (p<.01), comorbid conditions (p<.001), nutrition (p<.001), resilience (p<.001), and falls (p<.01).

The Nursing Home Effect: A Case Study of Residents With Potential Dementia and Emergency Department Visits
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de Souto Barreto P, Lapeyre-Mestre M, Mathieu C, Piau C, Bouget C, Cayla F, et al.
Journal of the American Medical Directors Association 2013 Sep 28

OBJECTIVES: The burden of potential dementia cases without formal diagnosis on the health care system is almost unknown. This study examined the impact of potential dementia without formal diagnosis on the rate of visits to hospital emergency department (ED) of nursing home (NH) residents. DESIGN: Cross-sectional study. SETTING: NHs (175) located in France. PARTICIPANTS: A total of 5684 subjects who were living in the NH for at least 1 year. MEASUREMENTS: Information on NHs’ characteristics and on NH residents’ health was recorded by NH staff. Participants were divided in 3 groups according to their dementia status: diagnosed dementia, potential dementia without formal diagnosis, and nondementia. The outcome measure was a binary variable: ED visits in the last 12 months (yes vs no). A mixed-effects logistic regression was performed on ED visits accounting for the random effects of living in a particular NH. RESULTS: From the 5684 participants, 1036 had been seen in the ED. Adjusted odds ratio (AOR) showed that having a potential dementia without formal diagnosis, compared with a diagnosed dementia, was associated with an increased probability of ED visits (AOR = 1.25, 95% confidence interval: 0.99-1.59, P = .061); however, when a random NH effect was entered into the model, the association between potential dementia without formal diagnosis and ED visits disappeared (AOR = 1.22, 95% confidence interval: 0.95-1.57, P = .11). CONCLUSION: The association of potential dementia without formal diagnosis with ED visits varies across NHs. This intra-NH aspect (eg, organization and care habits) should be taken into account when examining the rates of hospitalization and possibly the use of health care services in general among NH residents. Copyright © 2013 American Medical Directors Association, Inc.

Skilled nursing facility admissions of nursing home residents with advanced dementia.
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Givens JL, Mitchell SL, Kuo S, Gozalo P, Mor V, Teno J.
Journal of the American Geriatrics Society 2013 Oct;61(10):1645-1650

OBJECTIVES: To describe the extent to which hospitalized nursing home (NH) residents with advanced dementia were admitted to a skilled nursing facility (SNF) after a qualifying hospitalization and to identify resident and nursing home characteristics associated with a greater likelihood of SNF admissions. DESIGN: Cohort study using data from the Minimum Data Set, Medicare claims, and the On-line Survey Certification of Automated Records. SETTING: United States, 2000-2006. PARTICIPANTS: Nursing home residents with advanced dementia aged 65 and older with a 3-day hospitalization (N = 4,177). MEASUREMENTS: The likelihood of SNF admission after hospitalization was calculated. Resident and nursing home factors associated with SNF admission were identified using hierarchical multivariable logistic regression. RESULTS: Sixty-one percent of residents with advanced dementia were admitted to a SNF after their hospitalization. Percutaneous endoscopic gastrostomy (PEG) tube placement during hospitalization was strongly associated with SNF admission (adjusted odds ratio (AOR) = 2.31, 95% confidence interval (CI) = 1.85-2.88), as was better functional status (AOR = 1.21, 95% CI = 1.05-1.38). The presence of diabetes mellitus was associated with lower likelihood of SNF admission (AOR = 0.85, 95% CI = 0.73-0.99). Facility features significantly associated with SNF admission included more than 100 beds (AOR = 1.25, 95% CI = 1.07-1.46), being part of a chain (AOR = 1.31, 95% CI = 1.14-1.50), urban location (AOR = 1.21, 95% CI = 1.03-1.41), and for-profit status (AOR = 1.28, 95% CI = 1.09-1.51).© 2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society.

Nursing home staff’s views on residents’ dignity: a qualitative interview study.
Non UofA Access
Oosterveld-Vlug MG, Pasman HR, van Gennip IE, Willems DL, Onwuteaka-Philipsen BD.
BMC health services research 2013 Sep 16;13(1):353

A qualitative descriptive interview study was designed, in which in-depth interviews were performed with 13 physicians and 15 nurses. They expressed their views on the personal dignity of 30 recently admitted nursing home residents on the general medical wards of four nursing homes in The Netherlands. Interviews were transcribed and analyzed following the principles of thematic analysis. RESULTS: According to both physicians and nurses, physical impairment and being dependent on others threatened the residents’ dignity. Whether or not this led to a violation of an individual resident’s dignity, depended – in staff’s opinion – on the resident’s ability to show resilience and to keep his/her individuality. Staff mentioned treating residents with respect and taking care of their privacy as most important elements of dignity-conserving care and strived to treat the residents as they would like to be treated themselves. They could often mention aspects that were important for a particular resident’s dignity. But, when asked what they could contribute to a particular resident’s dignity, they often mentioned general aspects of dignity-conserving care, which could apply to most nursing home residents. By attempting to give dignity-conserving care, physicians and nurses often experienced conflicting values in daily care and barriers caused by the lack of resources.

Resident and family perceptions of the nurse practitioner role in long term care settings: a qualitative descriptive study. Canada-flat-icon
Non UofA Access
Ploeg J, Kaasalainen S, McAiney C, Martin-Misener R, Donald F, Wickson-Griffiths A, et al.
BMC nursing 2013 Sep 27;12(1):24

The study applied a qualitative descriptive approach. In-depth individual and focus group interviews were conducted with 35 residents and family members from four LTC settings that employed a NP. Conventional content analysis was used to identify themes and sub-themes. RESULTS: Two major themes were identified: NPs were seen as providing resident and family-centred care and as providing enhanced quality of care. NPs established caring relationships with residents and families, providing both informational and emotional support, as well as facilitating their participation in decision making. Residents and families perceived the NP as improving availability and timeliness of care and helping to prevent unnecessary hospitalization.

Exploring nursing assistants’ roles in the process of pain management for cognitively impaired nursing home residents: a qualitative study.
Non UofA Access
Liu JY.
Journal of advanced nursing 2013 Sep 16

Nursing assistants provide most of the direct care to residents and represent the major taskforce in nursing homes. They may develop specialized knowledge of residents’ pain experience that enables them to play both a pivotal role in pain assessment and possibly a supporting role in pain treatment. Currently, there is a lack of research into nursing assistants’ functions in pain management. DESIGN: This is a descriptive, exploratory qualitative study. METHODS: Forty-nine nursing assistants were recruited from 12 nursing homes, 12 of them participating in semi-structured individual interviews and 37 in 8 semi-structured focus groups. All interviews were carried out from May to September 2010. Data collected via both data collection methods were transcribed verbatim and analysed by content analysis. RESULTS: Nursing assistants were found to play four roles in the pain management process: (1) pain assessor; (2) reporter; (3) subordinate implementing prescribed medications; and (4) instigator implementing non-pharmacological interventions.

An assessment of cultural values and resident-centered culture change in U.S. nursing facilities.
Non UofA Access
Banaszak-Holl J, Castle NG, Lin M, Spreitzer G.
Health care management review 2013 Oct-Dec;38(4):295-305

We collected reports of cultural values using a well-established competing values framework instrument in a random survey of facility administrators and directors of nursing within all states. We received responses from 57% of the facilities that were mailed the survey. Directors of nursing and administrators did not differ significantly in their reports of culture and facility measures combined their responses. FINDINGS: Nursing facilities favored market-focused cultural values on average, and developmental values, key to innovation, were the least common across all nursing homes. Approximately 17% of the facilities reported that all cultural values were strong within their facilities. Only high developmental cultural values were linked to participation in culture change initiatives. Culture change facilities were not different from non-culture change facilities in the promotion of employee focus as organizational culture, as emphasized in group culture values. Likewise, culture change facilities were also not more likely to have hierarchical or market foci than non-culture change facilities.

Outcomes of feeding problems in advanced dementia in a nursing home population.
Non UofA Access
Hanson LC, Ersek M, Lin FC, Carey TS.
Journal of the American Geriatrics Society 2013 Oct;61(10):1692-1697

OBJECTIVES: To describe quality of care for feeding problems in advanced dementia and probability and predictors of weight loss and mortality. MEASUREMENTS: Family reported on quality of feeding care at enrollment and 3 months. Chart reviews at enrollment and 3, 6, and 9 months provided data on feeding problems, treatments, weight loss of more than 5% in 30 days or more than 10% in 6 months, and mortality. Organizational variables were obtained from administrator surveys and publically reported data. RESULTS: Residents with advanced dementia and feeding problems had an average age of 85; 80% had chewing and swallowing problems, 11% weight loss, and 48% poor intake. Family reported feeding assistance of moderate quality; 23% felt the resident received less assistance than needed. Mortality risk was significant; 8% died within 3 months, 17% within 6 months, and 27% within 9 months. Residents with advanced dementia who had stable weight over 3 months had a 5.4% rate of significant weight loss and a 2.1% risk of death over the next 3 months. Residents with advanced dementia and weight loss over 3 months had a 38.9% chance of stabilizing weight over the next 3 months but also had a 19.2% chance of dying. Weight loss was the only independent predictor of death. © 2013, Copyright the Authors Journal compilation

Characteristics and contributions of non-kin carers of older people: a closer look at friends and neighbours. Canada-flat-icon
Non UofA Access
Lapierre T, A., Keating N.
Ageing & Society 2013 11;33(8):1442-1468

This paper investigated the characteristics and contributions of non-kin who care for older adults with a long-term health problem, and investigated friends and neighbours as distinct categories of care providers. Using data from 324 non-kin carers in the 1996 General Social Survey of Canada, this study compared individual and relationship characteristics, care tasks and amount of care provided for the two groups. Interpersonal and socio-demographic characteristics were investigated as mediators of potential differences between friends and neighbours in patterns of care. Results demonstrate that friend and neighbour carers differed on age, marital status, geographical proximity and relationship closeness. Friends were more likely than neighbours to assist with personal care, bills and banking, and transportation. Neighbours were more likely to assist with home maintenance. Friends provided assistance with a greater number of tasks and provided more hours of care per week, suggesting a more prominent role in the care of non-kin than neighbours. Age, income, a minor child in the household, proximity and relationship closeness significantly predicted amount of care provided, and relationship closeness largely explained differences between friends and neighbours.

Statistics Canada: Urinary incontinence and loneliness in Canadian seniors Canada-flat-icon
Gilmour H, Ramage-Morin PL
Health Reports, Vol. 24, no. 10

Data from the 2008/2009 Canadian Community Health Survey-Healthy Aging were used to examine the prevalence of urinary incontinence (UI), as well as the relationship between UI and loneliness, in a sample of people aged 65 or older who resided in private households.

Conference Board of Canada: Future Care for Canadian Seniors—Why it Matters Canada-flat-icon
2013

To provide for the future care needs of today’s and tomorrow’s seniors, Canada must invest its increasingly scarce health dollars in the right type and mix of services. This Conference Board of Canada primer provides an overview of the landscape of care and services outside of hospitals that support aging Canadians, along with a discussion of why it is important to look toward the future of care for Canadian seniors.

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Events

UofA

Open Access Week
21-25 October 2013

Several events are being held:
-Open Access and Transformational Change with Gerald Beasley
Monday 21 Oct 2013 11:30-13:00 (pizza will be served) Education South 170
-60-minute panel discussion entitled, “Open Access: Redefining Impact” (webinar)
Monday 21 Oct 2013 13:00-14:30 Education South 176
– SET YOUR CLOCKS TO 1911: An open-data hackfest sponsored by the University of Alberta Libraries
Tuesday 22 Oct 2013 10:00-17:00 Cameron Lounge, 1st Floor Cameron Library
-ERA & You: Preserving and Profiling Your Work in the University’s Digital Archive
Wednesday 23 Oct 2013 10:00-11:00 WMC 2F102
-OA Panel Discussion with Dr.Michael McNally, Dr.Tami Oliphant, and Dr.Sourayan Mookerj
Wednesday 23 Oct 2013 13:00-14:30 Henderson Hall, Rutherford South
-Data Management Plan
Thursday 24 Oct 2013 11:00-12:15 Cameron Library, 4th Floor Classroom

Benefits of participatory research: Implications of a realist a realist review for public review for public health research and practice
Speaker: Justin Jagosh, PhD
Friday 1 November 2013 9:30–11:00 AM ECHA 3-001

Participatory Research (PR) means the co‐construction of research through partnerships between researchers and people affected by, and/or responsible for action on, issues under study. PR is not a method, but rather a research approach, in which multi‐stakeholder partnerships plan and implement quantitative, qualitative, or mixed methods research to generate health promotion/disease prevention interventions, products and knowledge.

Realist Reviews Workshops
Instructor: Justin Jagosh, PhD
Part 1 Wed 30 October 9:00-12:00 ECHA 4-001
Part 2 Thurs 31 October 9:00-16:00 ECHA 4-001
No cost but register before October 29 by emailing ecopath@ualberta.ca

Part 1: The workshop will cover five areas: (1) understanding the theoretical basis from which the method has been developed; (2) introducing the main concepts used in realist review: middle-range theory, demi-regularities; and context-mechanism-outcome (CMO) configuration, (3) exemplifying various ways these concepts are used in the literature; (4) practicing “hands-on” exercises in CMO configuring and middle-range theory building; and (5) exploring the limitations of the approach.
Part 2: In this advanced workshop, participants will be invited to bring their research ideas and explore how to apply realist methods to them. Recent reporting guidelines (RAMESES project) will be introduced, along with a discussion of advanced topics including: exploring when it is appropriate to use a realist review approach; understanding what consistutes ‘data’ in realist review, discussing the meaning of systemitization, protocol development, quality appraisal in the realist context, and writing realist review grant proposals.

Non UofA

Harnessing a New Era of Partnerships and Networks in Health Innovation Canada-flat-icon
Ottawa ON 27 November 2013

Research Canada is holding its Annual General Meeting. Speakers from the US and Canada will discuss how to build stronger industry partnerships and more active online communities of health advocates to transform discovery research into commercial innovations and better health care.

Institute for Work & Health: Research informing policy: How to make an impact
Thursday 21 November 2013 Toronto ON 16:30-18:30

Dr. Mieke Koehoorn—senior scientist at the Partnership for Work, Health and Safety at the University of British Columbia will be speaking at the 2013 Alf Nachemson Memorial Lecture. He will talk about the contribution of research to worker health legislation and compensation policy in British Columbia.

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News

Provinces call for improved senior care Canada-flat-icon

“In recognition of Canada’s aging population and growing health care demands, a better continuum of care to support seniors aging at home and in the community is needed” emphasized provincial ministers in a press communique before meeting, Federal Health Minister, Rona Ambrose. In addition “high-quality supports to avoid hospitalization or return home after hospitalization, as well as the importance of proper diagnosis and high quality care for seniors with dementia” are needed.

Doctors worried about patients leaving hospitals too soon Canada-flat-icon

Ottawa clinicians have expressed concern about the findings of a new report that found one in every 100 hospital patients went home before they had been discharged.

Canada’s voluntary census is worthless. Here’s why Canada-flat-icon

Research group at the University of Toronto finds issues with Stats Can’s income data from last census.

Alberta Clinical Research Consortium launches newsletter Canada-flat-icon

This Consortium, which is managed by AIHS, has launched a newsletter. It covers information about clinical trials in Alberta.

Why Hospitals Want Patients to Ask Doctors, ‘Have You Washed Your Hands?’

Despite years of efforts to educate both clinicians and patients, studies show hospital staff on average comply with hand-washing protocols, including cleansing with soap and water or alcohol-based gels, only about 50% of the time.

Dr. Andreas Laupacis is the recipient of the inaugural 2013 CIHR Barer-Flood Prize in Health Services and Policy Research. Canada-flat-icon

Dr. Laupacis is a General Internist. In October 2006, he became Executive Director of the Li Ka Shing Knowledge Institute at St. Michael’s Hospital. Prior to this, he was the President and Chief Executive Officer of the Institute for Clinical Evaluative Sciences (ICES). He is a Professor in the Departments of Medicine and Health Policy Management and Evaluation at the University of Toronto. He also holds a Canada Research Chair in Health Policy and Citizen Engagement.

Home care a top priority for Canadians Canada-flat-icon

But existing home care system is not ready for an aging population

Restructuring Alberta’s health system Canada-flat-icon

There have been major changes at the highest levels of administration and governance of the province’s health system. A review of the recent history of restructuring in Alberta’s health system might be helpful to understand the recent changes.

BioMed Central: Nominate your favourite research for the 2014 Research Awards

Is there an article published in 2013 in a BioMed Central journal that you think should win a Research Award? Is there an individual or institution you think has made a significant contribution to Open Access or Open Data? If so, nominations are now open for you to recommend your favorite 2013 BioMed Central open access research article for the 8th Annual BioMed Central Research Awards.

New Guidelines on Bathing persons with dementia

Just follow the link to view the entire guideline.

Why do personal items go missing in nursing homes? Canada-flat-icon

“Lost” personal items in nursing homes an indignity for residents. We can do better, writes a concerned family member.

Ethics @ CIHR – Annual Update Canada-flat-icon

Get updated on what’s new with ethics at CIHR. Includes, among other things, info on grant recipients and funding opportunities.

Study Finds Second Wives Often Struggle With Stepchildren and Caring for Demented Husbands

Maybe being a trophy wife isn’t all it’s cracked up to be.

Where’s That Advance Care Directive?

Older adults: Got an advance directive? Why, yes. Great, where is it? Ummm. What makes hospital social workers crazy.

Draft Tri-Agency Open Access Policy Canada-flat-icon

NSERC and SSHRC invite institutions, associations, organizations and individuals to provide input on the draft Tri-Agency Open Access Policy before December 13, 2013. The harmonized draft policy is modeled after the Canadian Institutes of Health Research’s (CIHR) Open Access Policy, which remains unchanged and continues to be mandatory

Free data available to Graduate Students Canada-flat-icon

CIHI provides data to qualifying graduate students at no cost through the Graduate Student Data Access Program (GSDAP). Graduate students conducting research can access data through various databases and clinical registries.

How science goes wrong

Scientific research has changed the world. Now it needs to change itself.

Japan has lessons for the UK on dementia

In Japan, politicians and policymakers have focused on educating the public (even the term “dementia” was outlawed) by recruiting and mobilising volunteer dementia “supporters”, and implementing a new national compulsory long-term care insurance system, offering enhanced services for people with dementia.

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Resources

Sleep: a critical but overlooked aspect of dementia management Canada-flat-icon

The Sleep Function Interdisciplinary Group (SAFIG) at the University of Alberta with the help of the CanadianDementia Knowledge Translation Network have created the website Sleep: a critical but overlooked aspect of dementia management. This website reviews the research evidence on the effects that lack of sleep may have on a person with dementia and suggests non-pharmacological ways to get a better sleep.

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Opportunities

Three-year Postdoctoral Prize Research Fellowships in Sociology
Nuffield College, University of Oxford Oxford UK
DEADLINE 4 November 2013

Nuffield College intends to appoint, with effect from 1 September 2014, two Postdoctoral Prize Research Fellows (PPRFs) in Sociology.

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