January 26, 2015


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TREC research in national headlines

Article in National Post
Nursing home health-care aides need more training, suffer ‘worrisome’ burnout: study

Interview on CBC’s The Current with Anna Maria Tremonti
Study of Health Care Aides show high job satisfaction but poor pay and burnout

Abstracts

New article from KUSP
Who is Looking After Mom and Dad? Unregulated Workers in Canadian Long-Term Care Homes
Non UofA Access
Estabrooks CA, Squires JE, Carleton HL, Cummings GG, Norton PG.
Canadian journal on aging 2014 Dec 19:1-13

Older adults living in residential long-term care or nursing homes have increasingly complex needs, including more dementia than in the past, yet we know little about the unregulated workforce providing care. We surveyed 1,381 care aides in a representative sample of 30 urban nursing homes in the three Canadian Prairie provinces and report demographic, health and well-being, and work-related characteristics. Over 50 per cent of respondents were not born in Canada and did not speak English as their first language. They reported moderately high levels of burnout and a strong sense of their work’s worth. Few respondents reported attending educational sessions. This direct caregiver workforce is poorly understood, has limited training or standards for minimum education, and training varies widely across provinces. Workplace characteristics affecting care aides reflect factors that precipitate burnout in allied health professions, with implications for quality of care, staff health, and staff retention.

New article by Dr. Shannon Scott
A protocol for a systematic review of the use of process evaluations in knowledge translation research
Non UofA Access
Scott SD, Rotter T, Hartling L, Chambers T, Bannar-Martin KH.
Systematic reviews 2014 Dec 23;3(1):149-4053-3-149

Experimental designs for evaluating knowledge translation (KT) interventions for professional behavior change can provide strong estimates of intervention effectiveness but offer limited insight how the intervention worked or not. Furthermore, trials provide little insight into the ways through which interventions lead to behavior change and how they are moderated by different facilitators and barriers. As a result, the ability to generalize the findings from one study to a different context, organization, or clinical problem is severely compromised. Consequently, researchers have started to explore the causal mechanisms in complementary studies (process evaluations) alongside experimental designs for evaluating KT interventions. This study focuses on improving process evaluations by synthesizing current evidence on process evaluations conducted alongside experimental designs for evaluating KT interventions. METHODS/DESIGN: A medical research librarian will develop and implement search strategies designed to identify evidence that is relevant to process evaluations in health research. Studies will not be excluded based on design. Included studies must contain a process evaluation component aimed at understanding or evaluating a KT intervention targeting professional behavior change. Two reviewers will perform study selection, quality assessment, and data extraction using standard forms. Disagreements will be resolved through discussion or third party adjudication. Data to be collected include study design, details about data collection approaches and types, theoretical influences, approaches to evaluate intervention dose delivered, intervention dose received, intervention fidelity, intervention reach, data analysis, and study outcomes. This study is not registered with PROSPERO. DISCUSSION: There is widespread acceptance that the generalizability of quantitative trials of KT interventions would be significantly enhanced to other contexts, health professional groups, and clinical conditions through complementary process evaluations alongside trials. This systematic review will serve as a ‘state of the science’ on methodological approaches to process evaluations and will allow us to: 1) take stock of current research approaches and 2) develop concrete recommendations for knowledge users (e.g., quality consultants and health services researchers) designing future KT process evaluations.

New article by Dr. Lars Wallin:
Local politico-administrative perspectives on quality improvement based on national registry data in Sweden: a qualitative study using the Consolidated Framework for Implementation Research.
Non UofA Access
Fredriksson M, Eldh A, Vengberg S, Dahlstrom T, Halford C, Wallin L, et al.
Implementation science 2014 Dec 28;9(1):777

Through a national policy agreement, over 167 million Euros will be invested in the Swedish National Quality Registries (NQRs) between 2012 and 2016. One of the policy agreement¿s intentions is to increase the use of NQR data for quality improvement (QI). However, the evidence is fragmented as to how the use of medical registries and the like lead to quality improvement, and little is known about non-clinical use. The aim was therefore to investigate the perspectives of Swedish politicians and administrators on quality improvement based on national registry data. Methods Politicians and administrators from four county councils were interviewed. A qualitative content analysis guided by the Consolidated Framework for Implementation Research (CFIR) was performed. Results The politicians¿ and administrators¿ perspectives on the use of NQR data for quality improvement were mainly assigned to three of the five CFIR domains. In the domain of intervention characteristics, data reliability and access in reasonable time were not considered entirely satisfactory, making it difficult for the politico-administrative leaderships to initiate, monitor, and support timely QI efforts. Still, politicians and administrators trusted the idea of using the NQRs as a base for quality improvement. In the domain of inner setting, the organizational structures were not sufficiently developed to utilize the advantages of the NQRs, and readiness for implementation appeared to be inadequate for two reasons. Firstly, the resources for data analysis and quality improvement were not considered sufficient at politico-administrative or clinical level. Secondly, deficiencies in leadership engagement at multiple levels were described and there was a lack of consensus on the politicians role and level of involvement. Regarding the domain of outer setting, there was a lack of communication and cooperation between the county councils and the national NQR organizations. Conclusions The Swedish experiences show that a government-supported national system of well-funded, well-managed, and reputable national quality registries needs favorable local politico-administrative conditions to be used for quality improvement; such conditions are not yet in place according to local politicians and administrators.

New article by Dr. Kim Fraser
Factors that Affect Quality of Life from the Perspective of People with Dementia: A Metasynthesis.
Non UofA Access
O’Rourke HM, Duggleby W, Fraser KD, Jerke L.
Journal of the American Geriatrics Society 2015 Jan;63(1):24-38

To comprehensively and systematically identify, appraise, and synthesize qualitative research findings on factors that affect quality of life from the perspective of people with dementia. DESIGN: Systematic review and metasynthesis of primary qualitative studies in published and gray literature that aimed to identify factors that influence quality of life from the perspective of people with dementia. Expert-developed search strategies were applied in nine electronic databases. Reference lists of included articles and literature reviews identified during the search were reviewed. Structured inclusion criteria were applied to screen 5,625 titles and abstracts to identify 11 qualitative studies published from 1975 to April 2012. Two independent reviewers appraised study quality. SETTING: Primary study recruitment sites included long-term care and community-based settings in the United Kingdom, the United States, Canada, the Netherlands, Ireland, Australia, and Japan. PARTICIPANTS: A combined sample of 345 people with mild, moderate, and severe dementia. MEASUREMENTS: The primary studies used interview and focus group methods. Findings from primary studies were synthesized using techniques of taxonomic analysis, constant comparison, and importing concepts. RESULTS: Four factors and the experience of connectedness or disconnectedness within each factor influenced quality of life according to people with dementia. These factors, and the terms that represent connectedness and disconnectedness, were relationships (together vs alone), agency in life today (purposeful vs aimless), wellness perspective (well vs ill), and sense of place (located vs unsettled). Happiness and sadness were key outcomes of good and poor quality of life, respectively. CONCLUSION: The four factors identified potentially modifiable areas to improve quality of life for people with dementia, even in the context of worsening cognitive function.

CALL FOR ABSTRACTS:
3rd Biennial Society for Implementation Research Collaboration
24-26 September Seattle WA
DEADLINE 13 February

Presentations on conceptual models of implementation are welcomed, particularly if they have been tested and offer an innovative and efficient approach to implementation. Abstracts addressing the following topics are encouraged:
• Fidelity assessment of multiple EBPs
• Analysis of qualitative data
• Use of electronic health records or administrative data (i.e. existing program resources to promote evaluation)
• (Continuous) Quality Improvement or examples of iterative small scale trials of change
• Use of decision support tools
• Hybrid designs (effectiveness-implementation hybrids)
• Community-led evaluations (stakeholder involvement to reduce burden and increase relevance)
• Models/methods for reducing turnover
• Models/methods that expedite implementation and planning for sustainment, looking beyond training
• Methods that can rapidly inform health care practice
• Technological solutions: Machine learning, textual analysis, strategies for managing big data
• Training efficiency: How low can you go? Or how can you do it differently to keep the bar high?
• Adaptive and SMART designs
• Matching models of implementation to system needs and capacities
• Use of computer-based/online implementation methodologies

CALL FOR ABSTRACTS:
KT Canada Annual Scientific Meeting
11-12 May Halifax NS
DEADLINE 16 February

Speakers include:
-Prof. Richard Lilford, Professor of Public Health, Director of W-CAHRD, Director of NIHR CLAHRC WM, University of Warwick
-Dr. Edward Fottrell, Institute for Global Health, University College London
-Dr. Andreas Laupacis, Executive Director, Li Ka Shing Knowledge Institute, St. Michael’s Hospital

CALL FOR ABSTRACTS:
CAG2015
23-25 October Calgary AB
DEADLINE 15 April

CAG2015 is your opportunity to share your research and other work in the field of aging with your national and international colleagues from a diverse spectrum of disciplines. Abstracts are welcomed from all disciplines and all interests in aging, including research, practice, policy and related areas. International submissions are encouraged.

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Grants & Awards

Collaborative Opportunities in Europe: Invitation to ERA-CAN+ Information Session
Information sessions: Regina 2 February 08:00-10:45 & Vancouver 3 February 08:00-10:45

Horizon 2020 is a multi-year (2014-2020) program for science and technology funded by the European Commission. With a budget of almost €80 billion (CAD $118 billion) Horizon 2020 forms a central part of the EU’s economic policy agenda. The program’s main goals are to encourage scientific excellence, increase the competitiveness of industries, and develop solutions to societal challenges in Europe and abroad. You are invited to attend the upcoming information sessions on Horizon 2020 opportunities for Canadians. These sessions will explain the structure of research funding in Europe and provide information on upcoming funding opportunities and the mechanisms by which Canadians can participate. Numerous Canadian partners will be on hand to share their expertise on these topics. Participants also will have the opportunity to learn about current and developing collaborations between Canadian and European researchers and innovators.

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Publications

KT
Health Care Administration and Organization
Health Care Innovation and Quality Assurance
Research Practice and Methodology
Aging

KT

Collaborating with front-line healthcare professionals: the clinical and cost effectiveness of a theory based approach to the implementation of a national guideline.
Non UofA Access
Taylor N, Lawton R, Moore S, Craig J, Slater B, Cracknell A, et al.
BMC health services research 2014 Dec 21;14(1):648

Clinical guidelines are an integral part of healthcare. Whilst much progress has been made in ensuring that guidelines are well developed and disseminated, the gap between routine clinical practice and current guidelines often remains wide. A key reason for this gap is that implementation of guidelines typically requires a change in the behaviour of healthcare professionals ? but the behaviour change component is often overlooked. We adopted the Theoretical Domains Framework Implementation (TDFI) approach for supporting behaviour change required for the uptake of a national patient safety guideline to reduce the risk of feeding through misplaced nasogastric tubes.MethodsThe TDFI approach was used in a pre-post study in three NHS hospitals with a fourth acting as a control (with usual care and no TDFI). The target behavior identified for change was to increase the use of pH testing as the first line method for checking the position of a nasogastric tube. Repeat audits were undertaken in each hospital following intervention implementation. We used Zou?s modified Poisson regression approach with robust standard errors to estimate risk ratios for the use of pH testing. The projected return on investment (ROI) was also calculated.ResultsFollowing intervention implementation, the use of pH first line increased significantly across intervention hospitals [risk ratio (95%CI) ranged from 3.1 (1.14 to8.43) p?<?.05, to 8.14 (3.06 to21.67) p?<?.001] compared to the control hospital, which remained unchanged [risk ratio (CI)?=?.77 (.47-1.26) p?=?.296]. The estimated savings and costs in the first year were ?2.56 million and ?1.41 respectively, giving an ROI of 82%, and this was projected to increase to 270% over five years.ConclusionThe TDFI approach improved the uptake of a patient safety guideline across three hospitals. The TDFI approach is clinically and cost effective in comparison to the usual practice.

Climate for evidence informed health system policymaking in Cameroon and Uganda before and after the introduction of knowledge translation platforms: a structured review of governmental policy documents.
Non UofA Access
Ongolo-Zogo P, Lavis JN, Tomson G, Sewankambo NK.
Health research policy and systems 2015 Jan 1;13(1):2-4505-13-2

There is a scarcity of empirical data on African country climates for evidence-informed health system policymaking (EIHSP) to backup the longstanding reputation that research evidence is not valued enough by health policymakers as an information input.Herein, we assess whether and how changes have occurred in the climate for EIHSP before and after the establishment of two Knowledge Translation Platforms housed in government institutions in Cameroon and Uganda since 2006. METHODS: We merged content analysis techniques and policy sciences analytical frameworks to guide this structured review of governmental policy documents geared at achieving health Millennium Development Goals. We combined i) a quantitative exploration of the usage statistics of research-related words and constructs, citations of types of evidence, and budgets allocated to research-related activities; and (ii) an interpretive exploration using a deductive thematic analysis approach to uncover changes in the institutions, interests, ideas, and external factors displaying the country climate for EIHSP. Descriptive statistics compared quantitative data across countries during the periods 2001-2006 and 2007-2012. RESULTS: We reviewed 54 documents, including 33 grants approved by global health initiatives. The usage statistics of research-related words and constructs showed an increase over time across countries. Varied forms of data, information, or research were instrumentally used to describe the burden and determinants of poverty and health conditions. The use of evidence syntheses to frame poverty and health problems, select strategies, or forecast the expected outcomes has remained sparse over time and across countries. The budgets for research increased over time from 28.496 to 95.467 million Euros (335%) in Cameroon and 38.064 to 58.884 million US dollars (155%) in Uganda, with most resources allocated to health sector performance monitoring and evaluation. The consistent naming of elements pertaining to the climate for EIHSP features the greater influence of external donors through policy transfer. CONCLUSIONS: This structured review of governmental policy documents illustrates the nascent conducive climate for EIHSP in Cameroon and Uganda and the persistent undervalue of evidence syntheses. Global and national health stakeholders should raise the profile of evidence syntheses (e.g., systematic reviews) as an information input when shaping policies and programmes.

How long does biomedical research take? Studying the time taken between biomedical and health research and its translation into products, policy, and practice
Non UofA Access
Hanney SR, Castle-Clarke S, Grant J, Guthrie S, Henshall C, Mestre-Ferrandiz J, et al.
Health research policy and systems 2015 Jan 1;13(1):1-4505-13-1

The time taken, or ‘time lags’, between biomedical/health research and its translation into health improvements is receiving growing attention. Reducing time lags should increase rates of return to such research. However, ways to measure time lags are under-developed, with little attention on where time lags arise within overall timelines. The process marker model has been proposed as a better way forward than the current focus on an increasingly complex series of translation ‘gaps’. Starting from that model, we aimed to develop better methods to measure and understand time lags and develop ways to identify policy options and produce recommendations for future studies. METHODS: Following reviews of the literature on time lags and of relevant policy documents, we developed a new approach to conduct case studies of time lags. We built on the process marker model, including developing a matrix with a series of overlapping tracks to allow us to present and measure elements within any overall time lag. We identified a reduced number of key markers or calibration points and tested our new approach in seven case studies of research leading to interventions in cardiovascular disease and mental health. Finally, we analysed the data to address our study’s key aims. RESULTS: The literature review illustrated the lack of agreement on starting points for measuring time lags. We mapped points from policy documents onto our matrix and thus highlighted key areas of concern, for example around delays before new therapies become widely available. Our seven completed case studies demonstrate we have made considerable progress in developing methods to measure and understand time lags. The matrix of overlapping tracks of activity in the research and implementation processes facilitated analysis of time lags along each track, and at the cross-over points where the next track started. We identified some factors that speed up translation through the actions of companies, researchers, funders, policymakers, and regulators. Recommendations for further work are built on progress made, limitations identified and revised terminology. CONCLUSIONS: Our advances identify complexities, provide a firm basis for further methodological work along and between tracks, and begin to indicate potential ways of reducing lags.

Can Learning Collaboratives Support Implementation by Rewiring Professional Networks?
Non UofA Access
Bunger AC, Hanson RF, Doogan NJ, Powell BJ, Cao Y, Dunn J.
Administration and Policy in Mental Health 2014 Dec 27

This study examined how a learning collaborative focusing on trauma-focused CBT (TF-CBT) impacted advice-seeking patterns between clinicians and three key learning sources: (1) training experts who share technical knowledge about TF-CBT, (2) peers from other participating organizations who share their implementation experiences, and (3) colleagues from their own agency who provide social and professional support. Based on surveys administered to 132 clinicians from 32 agencies, participants’ professional networks changed slightly over time by forming new advice-seeking relationships with training experts. While small, these changes at the clinician-level yielded substantial changes in the structure of the regional advice network.

Practice Context Affects Efforts to Improve Diabetes Care for Primary Care Patients: A Pragmatic Cluster Randomized Trial.
Non UofA Access
Dickinson LM, Dickinson WP, Nutting PA, Fisher L, Harbrecht M, Crabtree BF, et al.
Journal of general internal medicine 2014 Dec 4

Efforts to improve primary care diabetes management have assessed strategies across heterogeneous groups of patients and practices. However, there is substantial variability in how well practices implement interventions and achieve desired outcomes. OBJECTIVE: To examine practice contextual features that moderate intervention effectiveness. DESIGN: Secondary analysis of data from a cluster randomized trial of three approaches for implementing the Chronic Care Model to improve diabetes care. PARTICIPANTS: Forty small to mid-sized primary care practices participated, with 522 clinician and staff member surveys. Outcomes were assessed for 822 established patients with a diagnosis of type 2 diabetes who had at least one visit to the practice in the 18 months following enrollment. MAIN MEASURES: The primary outcome was a composite measure of diabetes process of care, ascertained by chart audit, regarding nine quality measures from the American Diabetes Association Physician Recognition Program: HgA1c, foot exam, blood pressure, dilated eye exam, cholesterol, nephropathy screen, flu shot, nutrition counseling, and self-management support. Data from practices included structural and demographic characteristics and Practice Culture Assessment survey subscales (Change Culture, Work Culture, Chaos). KEY RESULTS: Across the three implementation approaches, demographic/structural characteristics (rural vs. urban + .70(p = .006), +2.44(p < .001), -.75(p = .004)); Medicaid: <20 % vs. ≥20 % (-.20(p = .48), +.75 (p = .08), +.60(p = .02)); practice size: <4 clinicians vs. ≥4 clinicians (+.56(p = .02), +1.96( p < .001), +.02(p = .91)); practice Change Culture (high vs. low: -.86(p = .048), +1.71(p = .005), +.34(p = .22)), Work Culture (high vs. low: -.67(p = .18), +2.41(p < .001), +.67(p = .005)) and variability in practice Change Culture (high vs. low: -.24(p = .006), -.20(p = .0771), -.44(p = .0019) and Work Culture (high vs. low: +.56(p = .3160), -1.0(p = .008), -.25 (p = .0216) were associated with trajectories of change in diabetes process of care, either directly or differentially by study arm. CONCLUSIONS: This study supports the need for broader use of methodological approaches to better examine contextual effects on implementation and effectiveness of quality improvement interventions in primary care settings.

Implementing a Transitional Care Program to Reduce Hospital Readmissions Among Older Adults.
Non UofA Access
Hung D, Leidig RC.
Journal of nursing care quality 2014 Dec 5

This research examines the early implementation of an evidence-based intervention, adapted from the Coleman Care Transitions Intervention and community-based models, aimed at reducing preventable hospital readmissions among older adults. To better understand program implementation, we conducted and analyzed in-depth interviews on the basis of the Promoting Action on Research Implementation in Health Services conceptual framework. Contextual factors, evidence support for the intervention, and facilitation techniques should be taken into account when implementing transitional care programs.

The Society for Implementation Research Collaboration Instrument Review Project: a methodology to promote rigorous evaluation.
Non UofA Access
Lewis CC, Stanick CF, Martinez RG, Weiner BJ, Kim M, Barwick M, et al.
Implementation science 2015 Jan 8;10(1):2

Identification of psychometrically strong instruments for the field of implementation science is a high priority underscored in a recent National Institutes of Health working meeting (October 2013). Existing instrument reviews are limited in scope, methods, and findings. The Society for Implementation Research Collaboration Instrument Review Project’s objectives address these limitations by identifying and applying a unique methodology to conduct a systematic and comprehensive review of quantitative instruments assessing constructs delineated in two of the field¿s most widely used frameworks, adopt a systematic search process (using standard search strings), and engage an international team of experts to assess the full range of psychometric criteria (reliability, construct and criterion validity). Although this work focuses on implementation of psychosocial interventions in mental health and health-care settings, the methodology and results will likely be useful across a broad spectrum of settings. This effort has culminated in a centralized online open-access repository of instruments depicting graphical head-to-head comparisons of their psychometric properties. This article describes the methodology and preliminary outcomes.Methods The seven stages of the review, synthesis, and evaluation methodology include (1) setting the scope for the review, (2) identifying frameworks to organize and complete the review, (3) generating a search protocol for the literature review of constructs, (4) literature review of specific instruments, (5) development of an evidence-based assessment rating criteria, (6) data extraction and rating instrument quality by a task force of implementation experts to inform knowledge synthesis, and (7) the creation of a website repository.ResultsTo date, this multi-faceted and collaborative search and synthesis methodology has identified over 420 instruments related to 34 constructs (total 48 including subconstructs) that are relevant to implementation science. Despite numerous constructs having greater than 20 available instruments, which implies saturation, preliminary results suggest that few instruments stem from gold standard development procedures. We anticipate identifying few high-quality, psychometrically sound instruments once our evidence-based assessment rating criteria have been applied. Conclusions The results of this methodology may enhance the rigor of implementation science evaluations by systematically facilitating access to psychometrically validated instruments and identifying where further instrument development is needed.

Barriers that prevent implementation of research findings in nursing: Education-research hospitals case.
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Ay F, Gencturk N, Turan Miral M.
International journal of nursing practice 2014 Dec;20(6):646-654

Using research results in nursing practices and basing nursing practices to evidence have been viewed as an important factor in increasing care quality. The aim of this research was to identify the barriers arising from utilizing research findings perceived by nurses. The research was conducted with participation of 748 nurses. The study is descriptive in nature, and the ‘Barriers Scale’ and a question form developed by the researchers were used as data collection instruments. The data were gathered through face-to-face interviews after the necessary permissions were taken. A total of 54.3% of the nurses are ≤ 30 years old, and 49.6% of them are graduates of high school-foundation degree. The nurses (63.8%) indicated the most important barrier as ‘there is not enough time to read about research at work’. According to the results of this study, providing the nurses with both financial and information support after graduation is an important factor in facilitating research and using research results. Depending on the results of our study, we recommend that the number of publications in nursing and the opportunities of access to these publications be increased, and there should be more management support for research, and nurses should be provided with time. © 2013 Wiley Publishing Asia Pty Ltd.

Effects of a demand-led evidence briefing service on the uptake and use of research evidence by commissioners of health services: protocol for a controlled before and after study.
Non UofA Access
Wilson PM, Farley K, Thompson C, Chambers D, Bickerdike L, Watt IS, et al.
Implementation science 2015 Jan 9;10(1):7

Clinical Commissioning Groups (CCGs) are mandated to use research evidence effectively to ensure optimum use of resources by the National Health Service (NHS), both in accelerating innovation and in stopping the use of less effective practices and models of service delivery. We intend to evaluate whether access to a demand-led evidence service improves uptake and use of research evidence by NHS commissioners compared with less intensive and less targeted alternatives.Methods/design This is a controlled before and after study involving CCGs in the North of England. Participating CCGs will receive one of three interventions to support the use of research evidence in their decision-making: 1) consulting plus responsive push of tailored evidence; 2) consulting plus an unsolicited push of non-tailored evidence; or 3) standard service unsolicited push of non-tailored evidence. Our primary outcome will be changed at 12 months from baseline of a CCGs ability to acquire, assess, adapt and apply research evidence to support decision-making. Secondary outcomes will measure individual clinical leads and managers¿ intentions to use research evidence in decision making. Documentary evidence of the use of the outputs of the service will be sought. A process evaluation will evaluate the nature and success of the interactions both within the sites and between commissioners and researchers delivering the service.Discussion The proposed research will generate new knowledge of direct relevance and value to the NHS. The findings will help to clarify which elements of the service are of value in promoting the use of research evidence. Those involved in NHS commissioning will be able to use the results to inform how best to build the infrastructure they need to acquire, assess, adapt and apply research evidence to support decision-making and to fulfil their statutory duties under the Health and Social Care Act.

The Quality, Implementation, and Evaluation Model: A Clinical Practice Model for Sustainable Interventions.
Non UofA Access
Talsma A, McLaughlin M, Bathish M, Sirihorachai R, Kuttner R.
Western journal of nursing research 2014 Jun 2;36(7):929-946

Major efforts have been directed toward the implementation of sustainable quality improvement. To date, progress has been noted using various metrics and performance measures; however, successful implementation has proven challenging. The Quality, Implementation, and Evaluation (QIE) model, derived from Donabedian’s structure component, presents a framework for implementation of specific activities. The QIE model consists of Policy, Patient Preparedness, Provider Competency, and Performance and Accountability, to guide specific practice initiatives. The implementation of alcohol-based pre-operative skin prep was evaluated in a sample of 17 hospitals and demonstrated that hospitals actively engaged in the components of the model demonstrated a significantly higher use of alcohol-based skin preparation agent than hospitals that did not engage in QIE model activities. The QIE model presents a powerful and actionable implementation model for mid-level management and clinical leadership. Future studies will further evaluate the impact of the specific components of the QIE model. © The Author(s) 2014.

Who does it first? The uptake of medical innovations in the performance of thrombolysis on ischemic stroke patients in Germany: a study based on hospital quality data.
Non UofA Access
Scholten N, Pfaff H, Lehmann HC, Fink GR, Karbach U.
Implementation science 2015 Jan 13;10(1):10

Since 2000, systemic thrombolysis has been the only approved curative and causal treatment for acute ischemic stroke. In 2009, the guidelines of the German Society for Neurology were updated and the therapeutic window for performing thrombolysis was extended. The implementation of new therapies is influenced by many factors. We analyzed the factors at the organizational level that influence the implementation of thrombolysis in stroke patients.MethodsThe data published by the majority of German hospitals in their structured quality reports was assessed. We calculated a regression model in order to measure the influence of hospital/department-level characteristics (e.g., teaching status, ownership, location, and number of hospital beds) on the implementation of thrombolysis in 2006 (this is the earliest point in time that can be analyzed on this data basis). In order to measure the effect of the guideline update in 2009 on the thrombolysis rate (TR) change between 2008 and 2010, we performed a Wilcoxon signed-rank test and utilized a regression model.ResultsIn 2006, 61.5% of a total of 286 neurology departments performed systemic thrombolysis to treat ischemic strokes. The influencing factors for the use of systemic thrombolysis in 2006 were the existence of a stroke unit (+) and a hospital size of between 500 and 1,000 beds (¿). A significant increase of the mean departmental TR (thrombolysis rate) from 6.7% to 9.2% between 2008 and 2010 was observed after the guideline update in 2009. For the departments performing thrombolysis in 2008 and 2010, our analysis could not show any additional influencing factors on a structural level that would explain the TR rise during the period 2008¿2010.ConclusionsBecause ischemic stroke patients benefit from systemic thrombolysis, it is necessary to examine possible barriers at the organizational level that hinder the implementation. Our data shows that, organizational factors have an influence on the implementation of thrombolysis. However, the recent guideline update resulted in a TR rise that occurred at all hospitals, regardless of the measured structural conditions, as our analysis could not identify any structural factors that might have influenced the TR after the guideline update.

Effects of organizational context on Lean implementation in five hospital systems.
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Harrison MI, Paez K, Carman KL, Stephens J, Smeeding L, Devers KJ, et al.
Health care management review 2014 Dec 23

Despite broad agreement among researchers about the value of examining how context shapes implementation of improvement programs and projects, limited attention has been paid to contextual effects on implementation of Lean. PURPOSE:: To help reduce gaps in knowledge of effects of intraorganizational context, we researched Lean implementation initiatives in five organizations and examined 12 of their Lean rapid improvement projects. All projects aimed at improving clinical care delivery. METHODOLOGY/APPROACH:: On the basis of the literature on Lean, innovation, and quality improvement, we developed a framework of factors likely to affect Lean implementation and outcomes. Drawing on the framework, we conducted semistructured interviews and applied qualitative codes to the transcribed interviews. Available documents, data, and observations supplemented the interviews. We constructed case studies of Lean implementation in each organization, compared implementation across organizations, and compared the 12 projects. FINDINGS:: Intraorganizational characteristics affecting organization-wide Lean initiatives and often also shaping project outcomes included CEO commitment to Lean and active support for it, prior organizational capacity for quality improvement-based performance improvement, alignment of the Lean initiative with the organizational mission, dedication of resources and experts to Lean, staff training before and during projects, establishment of measurable and relevant project targets, planning of project sequences that enhance staff capabilities and commitment without overburdening them, and ensuring communication between project members and other affected staff. Dependence of projects on inputs of new information technology was a barrier to project success. Incremental implementation of Lean produced reported improvements in operational efficiency and occasionally in care quality. However, even under the relatively favorable circumstances prevailing in our study sites, incremental implementation did not readily change organizational culture. PRACTICE IMPLICATIONS:: This study should alert researchers, managers, and teachers of management to ways that contexts shape Lean implementation and may affect other types of process redesign and quality improvement.

A cluster-randomized controlled knowledge translation feasibility study in Alberta community pharmacies using the PARiHS framework: study protocol Canada-flat-icon
Rosenthal M, Tsuyuki R, Houle S.
Pilot and Feasibility Studies 2015;1(1):2

Despite evidence of benefit for pharmacist involvement in chronic disease management, the provision of these services in community pharmacy has been suboptimal. The Promoting Action on Research Implementation in Health Services (PARiHS) framework suggests that for knowledge translation to be effective, there must be evidence of benefit, a context conducive to implementation, and facilitation to support uptake. We hypothesize that while the evidence and context components of this framework are satisfied, that uptake into practice has been insufficient because of a lack of facilitation. This protocol describes the rationale and methods of a feasibility study to test a facilitated pharmacy practice intervention based on the PARiHS framework, to assist community pharmacists in increasing the number of formal and documented medication management services completed for patients with diabetes, dyslipidemia, and hypertension. Methods A cluster-randomized before-after design will compare ten pharmacies from within a single organization, with the unit of randomization being the pharmacy. Pharmacies will be randomized to facilitated intervention based on the PARiHS framework or usual practice. The Alberta Context Tool will be used to establish the context of practice in each pharmacy. Pharmacies randomized to the intervention will receive task-focused facilitation from an external facilitator, with the goal of developing alternative team processes to allow the greater provision of medication management services for patients with diabetes, hypertension, and dyslipidemia. The primary outcome will be a process evaluation of the needs of community pharmacies to provide more clinical services, the acceptability and uptake of modifications made, and the willingness of pharmacies to participate. Secondary outcomes will include the change in the number of formal and documented medication management services in the aforementioned chronic conditions provided 6 months before, versus after, the intervention between the two groups, and identification of feasible quantitative outcomes for evaluating the effect of the intervention on patient care outcomes. Results To date, the study has identified and enrolled the ten pharmacies required and initiated the intervention process. Conclusion This study will be the first to examine the role of facilitation in pharmacy practice, with the goal of scalable and sustainable practice change. Trial registration Clinicaltrials.gov identifier NCT02191111.

Nurses as boundary-spanners in reducing avoidable hospitalizations among nursing home residents.
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Abrahamson K, Mueller C, Davila HW, Arling G.
Research in gerontological nursing 2014 Sep-Oct;7(5):235-243

An increasing number of nursing home quality improvement efforts are aimed at reducing avoidable hospitalizations of residents. The current study focused on the experiences of nursing home nurses as “boundary-spanners” in the implementation of initiatives aimed at this effort. In-depth, semi-structured interviews were conducted with 76 nursing staff members within 38 nursing homes. Data were analyzed using thematic analysis and an inductive category development approach. Nursing staff described multiple scenarios where they had acted to negotiate the hospitalization decision and described themselves as working both within the nursing home boundary and within the larger system of external stakeholders to avoid a hospital transfer. There is potential for role overload and strain, as nurses are required to provide for complex medical needs within facilities designed to encourage relationship-driven, home-like care. Future efforts to reduce avoidable hospitalizations may benefit by ensuring needed resources are in place to provide clinically complex care and by making efforts to reduce the challenges that emerge when nurses are in the position to span the boundary between the nursing home and outside stakeholders. Copyright 2014, SLACK Incorporated.

Leadership and organizational change for implementation (LOCI): a randomized mixed method pilot study of a leadership and organization development intervention for evidence-based practice implementation.
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Aarons GA, Ehrhart MG, Farahnak LR, Hurlburt MS.
Implementation science 2015 Jan 16;10(1):11

Leadership is important in the implementation of innovation in business, health, and allied health care settings. Yet there is a need for empirically validated organizational interventions for coordinated leadership and organizational development strategies to facilitate effective evidence-based practice (EBP) implementation. This paper describes the initial feasibility, acceptability, and perceived utility of the Leadership and Organizational Change for Implementation (LOCI) intervention. A transdisciplinary team of investigators and community stakeholders worked together to develop and test a leadership and organizational strategy to promote effective leadership for implementing EBPs.MethodsParticipants were 12 mental health service team leaders and their staff (n¿=¿100) from three different agencies that provide mental health services to children and families in California, USA. Supervisors were randomly assigned to the 6-month LOCI intervention or to a two-session leadership webinar control condition provided by a well-known leadership training organization. We utilized mixed methods with quantitative surveys and qualitative data collected via surveys and focus groups with LOCI trainees.ResultsQuantitative and qualitative analyses support the LOCI training and organizational strategy intervention in regard to feasibility, acceptability, and perceived utility, as well as impact on leader and supervisee-rated outcomes.ConclusionsThe LOCI leadership and organizational change for implementation intervention is a feasible and acceptable strategy that has utility to improve staff-rated leadership for EBP implementation. Further studies are needed to conduct rigorous tests of the proximal and distal impacts of LOCI on leader behaviors, implementation leadership, organizational context, and implementation outcomes. The results of this study suggest that LOCI may be a viable strategy to support organizations in preparing for the implementation and sustainment of EBP.

Strategic Analytics: Towards Fully Embedding Evidence in Healthcare Decision-Making
Garay J, Cartagena R, Vahit Esensoy A, Handa K, Kane E, Kaw N, Sadat S.
Healthcare Quarterly 2015 05/01;17:23-27

Cancer Care Ontario (CCO) has implemented multiple information technology solutions and collected health-system data to support its programs. There is now an opportunity to leverage these data and perform advanced end-to-end analytics that inform decisions around improving health-system performance. In 2014, CCO engaged in an extensive assessment of its current data capacity and capability, with the intent to drive increased use of data for evidence-based decision-making. The breadth and volume of data at CCO uniquely places the organization to contribute to not only system-wide operational reporting, but more advanced modelling of current and future state system management and planning. In 2012, CCO established a strategic analytics practice to assist the agency’s programs contextualize and inform key business decisions and to provide support through innovative predictive analytics solutions. This paper describes the organizational structure, services and supporting operations that have enabled progress to date, and discusses the next steps towards the vision of embedding evidence fully into healthcare decision-making.

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Health Care Administration and Organization

Nurses’ shift length and overtime working in 12 European countries: the association with perceived quality of care and patient safety.
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Griffiths P, Dall’Ora C, Simon M, Ball J, Lindqvist R, Rafferty AM, et al.
Medical care 2014 Nov;52(11):975-981

Despite concerns as to whether nurses can perform reliably and effectively when working longer shifts, a pattern of two 12- to 13-hour shifts per day is becoming common in many hospitals to reduce shift to shift handovers, staffing overlap, and hence costs. OBJECTIVES: To describe shift patterns of European nurses and investigate whether shift length and working beyond contracted hours (overtime) is associated with nurse-reported care quality, safety, and care left undone. METHODS: Cross-sectional survey of 31,627 registered nurses in general medical/surgical units within 488 hospitals across 12 European countries. RESULTS: A total of 50% of nurses worked shifts of ≤ 8 hours, but 15% worked ≥ 12 hours. Typical shift length varied between countries and within some countries. Nurses working for ≥ 12 hours were more likely to report poor or failing patient safety [odds ratio (OR)=1.41; 95% confidence interval (CI), 1.13-1.76], poor/fair quality of care (OR=1.30; 95% CI, 1.10-1.53), and more care activities left undone (RR=1.13; 95% CI, 1.09-1.16). Working overtime was also associated with reports of poor or failing patient safety (OR=1.67; 95% CI, 1.51-1.86), poor/fair quality of care (OR=1.32; 95% CI, 1.23-1.42), and more care left undone (RR=1.29; 95% CI, 1.27-1.31). CONCLUSIONS: European registered nurses working shifts of ≥ 12 hours and those working overtime report lower quality and safety and more care left undone. Policies to adopt a 12-hour nursing shift pattern should proceed with caution. Use of overtime working to mitigate staffing shortages or increase flexibility may also incur additional risk to quality.

Relationships of organizational social capital with the presence of “gossip and slander,” “quarrels and conflicts,” sick leave, and poor work ability in nursing homes.
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Kiss P, De Meester M, Kristensen TS, Braeckman L.
International archives of occupational and environmental health 2014 Nov;87(8):929-936

This study aimed to explore the associations of organizational social capital (OSC) with the presence of “gossip and slander,” the presence of “conflicts and quarrels,” sick leave prevalence, and prevalence of poor work ability in frontline working personnel of nursing homes. METHODS: A total of 239 subjects (81 % participation), working in 11 different nursing homes, took part in a cross-sectional questionnaire study. Following end points were considered, they are as follows: prevalence of “gossip and slander,” “conflicts and quarrels,” sick leave, and poor work ability. Associations with OSC were explored at individual level (binomial log-linear regression analysis) and on group level (Kendall’s tau correlation coefficients). RESULTS: Significant associations were found between OSC and “gossip and slander,” sick leave, and poor work ability, both in the individual- and group-level analyses. The associations showed a higher significance level in the group-level analyses, with the strongest association found between mean OSC of the workplace and the prevalence of poor work ability at the workplace (τ = -0.722; p = 0.002). CONCLUSIONS: This study demonstrated significant associations of OSC with three end points that are relevant within the framework of well-being at work in nursing homes. The results are suggestive that OSC should be treated as a characteristic of the entire workplace, rather than as an individually experienced characteristic. The strikingly strong association between OSC and prevalence of poor work ability is suggestive for an important role of OSC within the context of maintaining work ability.

A mixed methods study of the work patterns of full-time nurse practitioners in nursing homes. Canada-flat-icon
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Martin-Misener R, Donald F, Wickson-Griffiths A, Akhtar-Danesh N, Ploeg J, Brazil K, et al.
Journal of clinical nursing 2014 Dec 19

Nurse practitioners were introduced in Canadian nursing homes a decade ago on a pilot basis. In recent years, government and nursing home sector interest in the role has grown along with the need for data to inform planning efforts. DESIGN: The study used a sequential mixed methods design using a national survey followed by case studies. METHODS: A national survey of nurse practitioners included demographic items and the EverCare Nurse Practitioner Role and Activity Scale. Following the survey, case studies were conducted in four nursing homes. Data were collected using individual and focus group interviews, document reviews and field notes. RESULTS: Twenty-three of a target population of 26 nurse practitioners responded to the survey, two-thirds of whom provided services in nursing homes with one site and the remainder in nursing homes with as many as four sites. On average, nurse practitioners performed activities in communicator, clinician, care manager/coordinator and coach/educator subscales at least three to four times per week and activities in the collaborator subscale once a week. Of the 43 activities, nurse practitioners performed daily, most were in the clinician and communicator subscales. Case study interviews involved 150 participants. Findings complemented those of the survey and identified additional leadership activities. CONCLUSION: Nurse practitioners undertake a range of primary health care and advanced practice activities which they adapt to meet the unique needs of nursing homes. RELEVANCE TO CLINICAL PRACTICE: Knowledge of work patterns enables nursing homes to implement the full range of nurse practitioner roles and activities to enhance resident and family care. © 2014 John Wiley & Sons Ltd.

The first year: employment patterns and job perceptions of nursing assistants in a rural setting
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Meyer D, Raffle H, Ware LJ.
Journal of nursing management 2014 Sep;22(6):769-778

The aim of this study was to follow rural certified nursing assistants (CNAs) (n=123) in the United States for 1 year post-training to identify retention and turnover issues in the long-term care (LTC) setting by exploring the CNAs’ perceptions of the LTC work experience. BACKGROUND: Turnover among CNAs impacts the quality of care, imposes a financial burden on facilities and taxpayers, and creates increased stress and workloads on those who remain. METHOD: A longitudinal survey design was used to track individuals completing CNA training for 1 year. RESULTS: At 1 year post-training, 53.7% of respondents currently worked in LTC, 30.9% worked in LTC and left, and the remaining 15.4% never worked in LTC. CONCLUSION: While the training site does not appear to impact retention, the first 6 months of employment appear critical. The CNAs cited pay as a reason for leaving LTC, but better pay did not characterize the jobs taken by the CNAs who left. Implications for nursing management. This study highlights the importance of the first 6 months of employment to retention and provides practical information for nurse managers evaluating the resource-effectiveness of hosting training programmes. Additionally, the key issues influencing retention were identified and practical suggestions for nurse managers to improve retention are provided. © 2012 John Wiley & Sons Ltd.

Nurse assistants’ experience of an intervention focused on a palliative care approach for older people in residential care.
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Beck I, Tornquist A, Edberg AK.
International journal of older people nursing 2014 Jun;9(2):140-150

Nurse assistants working in residential care facilities need support to ensure that they provide high-quality care for the residents and support for relatives, from admission to bereavement. AIM: The aim was to describe the nurse assistants’ experience of how an intervention with a palliative care approach, had influenced them in their work in residential care for older people. PARTICIPANTS: Fourteen nurse assistants working in three different municipal residential care facilities. METHODS: Data were collected by means of semi-structured individual interviews following an intervention consisting of study circles combined with workshops. The data were analysed using content analysis. RESULT: The nurse assistants felt that, through the intervention, they had gained insight into their understanding of the importance of quality of care. This included an increased awareness of, and respect for, residents’ and relatives’ needs, and an increased understanding of the importance of the outcome of encounters with residents and their relatives. After the intervention, they also felt there was increased openness and understanding between colleagues. However, the nurse assistants also expressed frustration over obstacles to implementing a palliative care approach, such as lack of resources and supportive leadership. CONCLUSION: The nurse assistants felt that the intervention was positive and encouraged them to provide more person-centred care within the framework of a palliative care approach. Although the intervention was intended to involve and support the management, it was not sufficient. Nurse assistants described lack of resources and supportive leadership. There is, therefore, a need to place greater emphasis on leadership and their support of nurse assistants so that they can provide high-quality care. IMPLICATIONS FOR PRACTICE: To support nurse assistants in the provision of care, clear leadership and opportunities to discuss and reflect on issues associated with care, including systematic improvement work in practice, appear to be essential to ensure high-quality care. © 2012 Blackwell Publishing Ltd.

The associations among the ethical climate, the professional practice environment and individualized care in care settings for older people.
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Suhonen R, Stolt M, Gustafsson ML, Katajisto J, Charalambous A.
Journal of advanced nursing 2014 Jun;70(6):1356-136

To investigate the associations among the ethical climate, professional practice environment and individualized nursing care in care settings for older people. BACKGROUND: The quality of care provision is affected by organizational environments, such as ethical climate and professional practice environment. Although, the association between professional practice environment and individualized nursing care has been pointed out, we know that little is known about how ethical climate is associated with the level of individualized nursing care delivery. DESIGN: A cross-sectional explorative and correlational survey design. METHODS: The study was conducted in 62 units in the vicinity of a Finnish city using a sample of nurses (N = 874, response rate 58%) who worked clinically with older people in different care settings in 2012. Survey data were collected using the Hospital Ethical Climate Survey, Revised Professional Practice Environment scale and Individualised Care Scale-B. Data were analysed statistically using descriptive statistics, correlation coefficients (Pearson) and multiple stepwise regression analyses. RESULTS: Statistically significant correlations were found among the variables, ethical climate and individualized care and between individualized care and all professional practice environment sub-scales. Multiple stepwise regression showed associations among individualized care, ethical climate and internal work motivation, control over practice and leadership and autonomy. CONCLUSIONS: The study provided better understanding of the complex concept of individualized care by taking into consideration the ethical climate and the practice environment and their associations. To increase individualization in care provision, efforts need to be directed towards organizational aspects requiring the support of nursing leaders.

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Health Care Innovation and Quality Assurance

Overcoming resistance to culture change: nursing home administrators’ use of education, training, and communication.
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Tyler DA, Lepore M, Shield RR, Looze J, Miller SC.
Gerontology & geriatrics education 2014;35(4):321-336

Nursing home culture change is becoming more prevalent, and research has demonstrated its benefits for nursing home residents and staff-but little is known about the role of nursing home administrators in culture change implementation. The purpose of this study was to determine what barriers nursing home administrators face in implementing culture change practices, and to identify the strategies used to overcome them. The authors conducted in-depth individual interviews with 64 administrators identified through a nationally representative survey. Results showed that a key barrier to culture change implementation reported by administrators was staff, resident, and family member resistance to change. Most nursing home administrators stressed the importance of using communication, education and training to overcome this resistance. Themes emerging around the concepts of communication and education indicate that these efforts should be ongoing, communication should be reciprocal, and that all stakeholders should be included.

Shared decision making in chronic care in the context of evidence based practice in nursing.
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Friesen-Storms JH, Bours GJ, van der Weijden T, Beurskens AJ.
International journal of nursing studies 2015 Jan;52(1):393-402

In the decision-making environment of evidence-based practice, the following three sources of information must be integrated: research evidence of the intervention, clinical expertise, and the patient’s values. In reality, evidence-based practice usually focuses on research evidence (which may be translated into clinical practice guidelines) and clinical expertise without considering the individual patient’s values. The shared decision-making model seems to be helpful in the integration of the individual patient’s values in evidence-based practice. We aim to discuss the relevance of shared decision making in chronic care and to suggest how it can be integrated with evidence-based practice in nursing. We start by describing the following three possible approaches to guide the decision-making process: the paternalistic approach, the informed approach, and the shared decision-making approach. Implementation of shared decision making has gained considerable interest in cases lacking a strong best-treatment recommendation, and when the available treatment options are equivalent to some extent. We discuss that in chronic care it is important to always invite the patient to participate in the decision-making process. We delineate the following six attributes of health care interventions in chronic care that influence the degree of shared decision making: the level of research evidence, the number of available intervention options, the burden of side effects, the impact on lifestyle, the patient group values, and the impact on resources. Furthermore, the patient’s willingness to participate in shared decision making, the clinical expertise of the nurse, and the context in which the decision making takes place affect the shared decision-making process. A knowledgeable and skilled nurse with a positive attitude towards shared decision making – integrated with evidence-based practice – can facilitate the shared decision-making process. We conclude that nurses as well as other health care professionals in chronic care should integrate shared decision making with evidence-based practice to deliver patient-centred care. Copyright © 2014 Elsevier Ltd. All rights reserved.

Caring for people with dementia in residential aged care: Successes with a composite person-centered care model featuring Montessori-based activities.
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Roberts G, Morley C, Walters W, Malta S, Doyle C.
Geriatric nursing (New York, N.Y.) 2014 Dec 11

Person-centered models of dementia care commonly merge aspects of existing models with additional influences from published and unpublished evidence and existing government policy. This study reports on the development and evaluation of one such composite model of person-centered dementia care, the ABLE model. The model was based on building the capacity and ability of residents living with dementia, using environmental changes, staff education and organizational and community engagement. Montessori principles were also used. The evaluation of the model employed mixed methods. Significant behavior changes were evident among residents of the dementia care Unit after the model was introduced, as were reductions in anti-psychotic and sedative medication. Staff reported increased knowledge about meeting the needs of people with dementia, and experienced organizational culture change that supported the ABLE model of care. Families were very satisfied with the changes. Copyright © 2014 Elsevier Inc. All rights reserved.

One size does not fit all: a qualitative content analysis of the importance of existing quality improvement capacity in the implementation of Releasing Time to Care: the Productive Ward™ in Saskatchewan, Canada Canada-flat-icon
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Hamilton J, Verrall T, Maben J, Griffiths P, Avis K, Baker G, et al.
BMC health services research 2014 Dec 19;14(1):642

Releasing Time to Care: The Productive WardTM(RTC) is a method for conducting continuous quality improvement (QI). The Saskatchewan Ministry of Health mandated its implementation in Saskatchewan, Canada between 2008 and 2012. Subsequently, a research team was developed to evaluate its impact on the nursing unit environment. We sought to explore the influence of the unit¿s existing QI capacity on their ability to engage with RTC as a program for continuous QI.MethodsWe conducted interviews with staff from 8 nursing units and asked them to speak about their experience doing RTC. Using qualitative content analysis, and guided by the Organizing for Quality framework, we describe the existing QI capacity and impact of RTC on the unit environment. Results The results focus on 2 units chosen to highlight extreme variation in existing QI capacity. Unit B was characterized by a strong existing environment. RTC was implemented in an environment with a motivated manager and collaborative culture. Aided by the structural support provided by the organization, the QI capacity on this unit was strengthened through RTC. Staff recognized the potential of using the RTC processes to support QI work. Staff on unit E did not have the same experience with RTC. Like unit B, they had similar structural supports provided by their organization but they did not have the same existing cultural or political environment to facilitate the implementation of RTC. They did not have internal motivation and felt they were only doing RTC because they had to. Though they had some success with RTC activities, the staff did not have the same understanding of the methods that RTC could provide for continuous QI work.Conclusions RTC has the potential to be a strong tool for engaging units to do QI. This occurs best when RTC is implemented in a supporting environment. One size does not fit all and administrative bodies must consider the unique context of each environment prior to implementing large-scale QI projects. Use of an established framework, like Organizing for Quality, could highlight the distinctive supports needed in particular care environments to increase the likelihood of successful engagement.

Dementia RED (Respect Empathy Dignity): Collaborating to build dementia supportive communities in North Wales – reporting on a pilot project (innovative practice).
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Chalk A, Page S.
Dementia (London, England) 2014 Dec 12

There is increasing interest in developing dementia supportive communities world wide. Dementia RED (Respect Empathy Dignity) is a unique example from North Wales which is based on the twin concepts of people living with dementia as citizens in their community and developing ‘bottom up’ rather than ‘top down’ approaches to dementia supportive communities. Most people with dementia prefer to live at home thus making community connectivity key to maintaining healthy relationships and wellbeing. For those living with dementia, the community plays a pivotal role in providing value, meaning, purpose and acceptance. Building dementia supportive communities helps to raise awareness about dementia in the community through engagement and from identifying champions in the locality to voice issues. Dementia RED is an initiative and service which helps to develop such a philosophy in creating a dementia supportive community. © The Author(s)

Improving the management of disruptive behavior and reducing antipsychotic medications in nursing facility residents.
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Stefanacci RG, Arnicar R, Clark TR, Gerber J, Haimowitz D, Kuhlor A, et al.
The Consultant pharmacist 2014;29(12):797-812

The objective of this work is to improve the management of disruptive behavior in the nursing facility setting through an interdisciplinary team (IDT) approach to reduce the use of antipsychotic medications in accordance with the Centers for Medicare & Medicaid Services initiative. DATA SOURCES, EXTRACTION, AND SYNTHESIS: The process began with a search and review of more than 100 peer-reviewed articles, government, and association resources that focused on the management of disruptive behavior in older adults. While data were limited to the past 10 years, the vast majority of data reviewed were within the past 5 years. This information was reviewed and discussed by all of the coauthors who meet in person at the American Society of Consultant Pharmacists as a work group. This group was tasked with identifying strategies through an IDT to improve the management of disruptive behavior and reduce the use of antipsychotic medications in nursing facility residents. In addition, significant follow-up work was accomplished following the live working session. CONCLUSION: Through an IDT, strategies can be implemented for long-term care residents to prevent and better manage disruptive behavior. These strategies can result in the reduction of the use of antipsychotic medications. The field of long-term care would benefit from further research to identify additional nonpharmacologic and pharmacologic treatments for managing disruptive behavior.

The optimizing patient transfers, impacting medical quality, and improving symptoms: transforming institutional care approach: preliminary data from the implementation of a centers for medicare and medicaid services nursing facility demonstration project.
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Unroe KT, Nazir A, Holtz LR, Maurer H, Miller E, Hickman SE, et al.
Journal of the American Geriatrics Society 2015 Jan;63(1):165-169

The Optimizing Patient Transfers, Impacting Medical Quality, and Improving Symptoms: Transforming Institutional Care (OPTIMISTIC) project aims to reduce avoidable hospitalizations of long-stay residents enrolled in 19 central Indiana nursing facilities. This clinical demonstration project, funded by the Centers for Medicare and Medicaid Services Innovations Center, places a registered nurse in each nursing facility to implement an evidence-based quality improvement program with clinical support from nurse practitioners. A description of the model is presented, and early implementation experiences during the first year of the project are reported. Important elements include better medical care through implementation of Interventions to Reduce Acute Care Transfers tools and chronic care management, enhanced transitional care, and better palliative care with a focus on systematic advance care planning. There were 4,035 long-stay residents in 19 facilities enrolled in OPTIMISTIC between February 2013 and January 2014. Root-cause analyses were performed for all 910 acute transfers of these long stay residents. Of these transfers, the project RN evaluated 29% as avoidable (57% were not avoidable and 15% were missing), and opportunities for quality improvement were identified in 54% of transfers. Lessons learned in early implementation included defining new clinical roles, integrating into nursing facility culture, managing competing facility priorities, communicating with multiple stakeholders, and developing a system for collecting and managing data. The success of the overall initiative will be measured primarily according to reduction in avoidable hospitalizations of long-stay nursing facility residents.
© 2014, Copyright the Authors Journal compilation

Tailored mental health care after nursing home admission: improving transfers of people with dementia with behavioral problems. An explorative study.
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Van Mierlo LD, Bootsma-Van der Wiel A, Meiland FJ, Van Hout HP, Stek ML, Droes RM.
Aging & mental health 2015 Jan 7:1-10

In the Netherlands, many community-dwelling people with dementia and behavioral disturbances and their family caregivers receive mental health care from a community psychiatric nurse (CPN). To promote continuity of care for these persons after moving to a nursing home, a transfer intervention was developed. The aim of this explorative study was to evaluate this intervention and its implementation. Method: A qualitative explorative study design was used. CPNs visited professional nursing home carers, people with dementia and family caregivers six weeks after moving, advised on how to manage behavioral problems of their former clients and provided support to family caregivers. Twenty-two interviews were conducted with participants exposed to the intervention (5 CPNs, 5 family and 12 nursing home carers) and with 11 stakeholders (i.e., nursing home and mental health care managers, professional caregivers) to identify facilitators and barriers to the implementation. Data were collected in 2012 and 2013. Results: The follow-up visit at six weeks met the need for background information of new admitted patients and helped family caregivers close off the period prior to the move. It did not meet the original purpose of providing nursing home staff with advice about problem behaviors on time: six weeks after the move was experienced as too late. Conclusion: The transfer intervention increased the awareness of nursing home staff about personal and behavioral characteristics of residents with dementia and supported caregivers in coping with the new situation. The timing of the intervention could be improved by scheduling it immediately after the move.

Strategies to implement community guidelines on nutrition and their long-term clinical effects in nursing home residents.
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Torma J, Winblad U, Saletti A, Cederholm T.
The journal of nutrition, health & aging 2015;19(1):70-76

Studies on implementation techniques that focus on nutrition in the setting of elderly care are scarce. The aims of this study were to compare two implementation strategies i.e., external facilitation (EF) and educational outreach visits (EOVs), in order to introduce nutritional guidelines (e.g. screening, food quality and mealtime ambience), into a nursing home (NH) setting and to evaluate the clinical outcomes. DESIGN: A controlled study with baseline and follow-up measurements. SETTING: Four NHs. PARTICIPANTS: A total of 101 NH residents. INTERVENTION: The EF was a one-year, multifaceted intervention that included support, guidance, practice audits, and feedback that were provided to two NHs. The EOVs performed at the other NHs consisted of one session of three hours of lectures about the guidelines. Both interventions targeted a team of the unit manager, the head nurse, and 5-10 of the care staff. MEASUREMENTS: The outcomes were nutritional status (Mini Nutritional Assessment-Short Form, MNA-SF), body mass index (BMI), functional ability (Barthel Index, BI), cognitive function (Short Portable Mental Status Questionnaire, SPMSQ, performed in a subgroup of communicative NH residents), health-related quality of life (EQ-5D), and the levels of certain biochemical markers like for example vitamin D, albumin and insulin-like growth factor 1. RESULTS: After a median of 18 months, nutritional parameters (MNA-SF and BMI) remained unchanged in both groups. While there were no differences in most outcomes between the two groups, the cognitive ability of those in the EOV group deteriorated more than in individuals in the EF group (p=0.008). Multiple linear regression analyses indicated that the intervention group assignment (EF) was independently from other potentially related factors associated with less cognitive decline. CONCLUSION: An extended model of implementation of nutritional guidelines, including guidance and feedback to NH staff, did not affect nutritional status but may be associated with a delayed cognitive decline in communicative NH residents.

To what extent do structural quality indicators of (nutritional) care influence malnutrition prevalence in nursing homes?
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van Nie-Visser NC, Meijers JM, Schols JM, Lohrmann C, Spreeuwenberg M, Halfens RJ.
Clinical nutrition (Edinburgh, Scotland) 2014 Dec 11

Many residents in European healthcare institutions are malnourished, with reported malnutrition prevalence rates of up to 60%. Due to the negative effects of malnutrition it is important to optimize the quality of nutritional care. If structural quality indicators of nutritional care might improve resident care and outcome is not yet known. The aim of this study is to explore whether structural quality indicators for nutritional care influence malnutrition prevalence in Dutch, German and Austrian nursing homes. METHODS: This study follows a cross-sectional, multi-center design. Data were collected by using a standardised questionnaire at resident, ward and institution level. RESULTS: Data from 214 nursing homes (NL = 133, G = 61, A = 20) were analysed. The prevalence of malnutrition varied significantly between the three countries (NL = 18.2% G = 20.1% A = 22.5%). Two structural quality indicators at ward level namely (1) the policy that the care file should include the nutritional intake for each patient and (2) having a weight measurement policy at ward level are predictive for malnutrition prevalence. Furthermore also the variable country was of influence. CONCLUSIONS: A policy of registering nutritional intake in the file of the patient and a policy to assess the patient’s weight regularly have a positive influence on malnutrition prevalence. Copyright © 2014 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism

Demystifying theory and its use in improvement
Davidoff F, Dixon-Woods M, Leviton L, Michie S.
BMJ Quality & Safety 2015

The role and value of theory in improvement work in healthcare has been seriously underrecognised. We join others in proposing that more informed use of theory can strengthen improvement programmes and facilitate the evaluation of their effectiveness. Many professionals, including improvement practitioners, are unfortunately mystified—and alienated—by theory, which discourages them from using it in their work. In an effort to demystify theory we make the point in this paper that, far from being discretionary or superfluous, theory (‘reason-giving’), both informal and formal, is intimately woven into virtually all human endeavour. We explore the special characteristics of grand, mid-range and programme theory; consider the consequences of misusing theory or failing to use it; review the process of developing and applying programme theory; examine some emerging criteria of ‘good’ theory; and emphasise the value, as well as the challenge, of combining informal experience-based theory with formal, publicly developed theory. We conclude that although informal theory is always at work in improvement, practitioners are often not aware of it or do not make it explicit. The germane issue for improvement practitioners, therefore, is not whether they use theory but whether they make explicit the particular theory or theories, informal and formal, they actually use.

AHRQ: Improving Care Delivery Through Lean: Implementation Case Studies (US)
2015

This report presents an introduction to the application of Lean principles in health care settings to improve quality of care, increase efficiency, lower costs, and provide better patient outcomes. Lean is an organizational redesign approach focused on elimination of waste, which is defined as any activity that consumes resources (e.g., staff, time, money, space) without adding value to those being served by the process. In addition to background information and the results of a literature review, the report presents six case studies from five organizations that implemented Lean principles in different types of health care settings. Recommendations are provided for similar organizations wishing to implement Lean in their facilities.

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Research Practice and Methodology

A usability study of two formats of a shortened systematic review for clinicians. Canada-flat-icon
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Perrier L, Kealey MR, Straus SE.
BMJ open 2014 Dec 23;4(12):e005919-2014-005919

The aim of this study was to evaluate the usability of two formats of a shortened systematic review for clinicians. MATERIALS AND METHODS: Usability of the prototypes was assessed using three cycles of iterative testing. 10 participants were asked to complete tasks of locating information or items within two prototypes and ‘think aloud’ while being audio taped. Interviews were also audio recorded and participants completed a systematic usability scale. RESULTS: Revisions were made between each iteration in order to address issues identified by participants. Finding information relating to the number of studies in the meta-analysis, and locating the number of studies in the entire systematic review were revealed as areas needing attention during the usability evaluation. CONCLUSIONS: Iterative testing combined with a multifaceted approach to usability testing offered essential insight into aspects of the prototypes that required modifications. Alterations were made in order to create finalised versions of the two shortened systematic review formats.

Does health intervention research have real world policy and practice impacts: testing a new impact assessment tool.
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Cohen G, Schroeder J, Newson R, King L, Rychetnik L, Milat AJ, et al.
Health research policy and systems 2015 Jan 1;13(1):3-4505-13-3

There is a growing emphasis on the importance of research having demonstrable public benefit. Measurements of the impacts of research are therefore needed. We applied a modified impact assessment process that builds on best practice to 5 years (2003-2007) of intervention research funded by Australia’s National Health and Medical Research Council to determine if these studies had post-research real-world policy and practice impacts. METHODS: We used a mixed method sequential methodology whereby chief investigators of eligible intervention studies who completed two surveys and an interview were included in our final sample (n = 50), on which we conducted post-research impact assessments. Data from the surveys and interviews were triangulated with additional information obtained from documentary analysis to develop comprehensive case studies. These case studies were then summarized and the reported impacts were scored by an expert panel using criteria for four impact dimensions: corroboration; attribution, reach, and importance. RESULTS: Nineteen (38%) of the cases in our final sample were found to have had policy and practice impacts, with an even distribution of high, medium, and low impact scores. While the tool facilitated a rigorous and explicit criterion-based assessment of post-research impacts, it was not always possible to obtain evidence using documentary analysis to corroborate the impacts reported in chief investigator interviews. CONCLUSIONS: While policy and practice is ideally informed by reviews of evidence, some intervention research can and does have real world impacts that can be attributed to single studies. We recommend impact assessments apply explicit criteria to consider the corroboration, attribution, reach, and importance of reported impacts on policy and practice. Impact assessments should also allow sufficient time between impact data collection and completion of the original research and include mechanisms to obtain end-user input to corroborate claims and reduce biases that result from seeking information from researchers only.

Optimal Design and Purposeful Sampling: Complementary Methodologies for Implementation Research.
Non UofA Access
Duan N, Bhaumik DK, Palinkas LA, Hoagwood K.
Administration and Policy in Mental Health 2014 Dec 10

Optimal design has been an under-utilized methodology. However, it has significant real-world applications, particularly in mixed methods implementation research. We review the concept and demonstrate how it can be used to assess the sensitivity of design decisions and balance competing needs. For observational studies, this methodology enables selection of the most informative study units. For experimental studies, it entails selecting and assigning study units to intervention conditions in the most informative manner. We blend optimal design methods with purposeful sampling to show how these two concepts balance competing needs when there are multiple study aims, a common situation in implementation research.

Managing opportunities and challenges of co-authorship.
Non UofA Access
Conn VS, Ward S, Herrick L, Topp R, Alexander GL, Anderson CM, et al.
Western journal of nursing research 2015 Feb;37(2):134-163

Research with the largest impact on practice and science is often conducted by teams with diverse substantive, clinical, and methodological expertise. Team and interdisciplinary research has created authorship groups with varied expertise and expectations. Co-authorship among team members presents many opportunities and challenges. Intentional planning, clear expectations, sensitivity to differing disciplinary perspectives, attention to power differentials, effective communication, timelines, attention to published guidelines, and documentation of progress will contribute to successful co-authorship. Both novice and seasoned authors will find the strategies identified by the Western Journal of Nursing Research Editorial Board useful for building positive co-authorship experiences. © The Author(s) 2014.

Personalized contact strategies and predictors of time to survey completion: analysis of two sequential randomized trials.
Non UofA Access
Dinglas VD, Huang M, Sepulveda KA, Pinedo M, Hopkins RO, Colantuoni E, et al.
BMC medical research methodology 2015 Jan 9;15(1):5-2288-15-5

Effective strategies for contacting and recruiting study participants are critical in conducting clinical research. In this study, we conducted two sequential randomized controlled trials of mail- and telephone-based strategies for contacting and recruiting participants, and evaluated participant-related variables’ association with time to survey completion and survey completion rates. Subjects eligible for this study were survivors of acute lung injury who had been previously enrolled in a 12-month observational follow-up study evaluating their physical, cognitive and mental health outcomes, with their last study visit completed at a median of 34 months previously. METHODS: Eligible subjects were contacted to complete a new research survey as part of two randomized trials, initially using a randomized mail-based contact strategy, followed by a randomized telephone-based contact strategy for non-responders to the mail strategy. Both strategies focused on using either a personalized versus a generic approach. In addition, 18 potentially relevant subject-related variables (e.g., demographics, last known physical and mental health status) were evaluated for association with time to survey completion. RESULTS: Of 308 eligible subjects, 67% completed the survey with a median (IQR) of 3 (2, 5) contact attempts required. There was no significant difference in the time to survey completion for either randomized trial of mail- or phone-based contact strategy. Among all subject-related variables, age ≤40 years and minority race were independently associated with a longer time to survey completion. CONCLUSION: We found that age ≤40 years and minority race were associated with a longer time to survey completion, but personalized versus generic approaches to mail- and telephone-based contact strategies had no significant effect. Repeating both mail and telephone contact attempts was important for increasing survey completion rate. TRIAL REGISTRATION: NCT00719446.

IOM: Sharing Clinical Trial Data: Maximizing Benefits, Minimizing Risk
2015

Although clinical trials generate vast amounts of data, a large por­tion is never published or made available to other researchers. Data sharing could advance scientific discovery and improve clinical care by maximizing the knowl­edge gained from data collected in trials, stimulating new ideas for research, and avoiding unnecessarily duplicative trials. In response to 23 public- and private-sector sponsors in the United States and abroad, the Institute of Medicine (IOM) assembled a committee to develop guiding principles and a practical framework for the responsible sharing of clinical trial data. In its report, Sharing Clinical Trial Data: Maxi­mizing Benefits, Minimizing Risk, the committee concludes that sharing data is in the public interest, but a multi-stakeholder effort is needed to develop a culture, infrastructure, and policies that will foster responsible sharing—now and in the future.

Process evaluation of complex interventions: UK Medical Research Council (MRC) guidance
UK Medical Research Council (MRC)
2014

This document provides researchers, practitioners, funders, journal editors and policy-makers with guidance in planning, designing, conducting and appraising process evaluations of complex interventions. The background, aims and scope are set out in more detail in Chapter 1, which provides an overview of core aims for process evaluation, and introduces the framework which guides the remainder of the document. The guidance is then divided into two core sections: Process Evaluation Theory (Section A)and Process Evaluation Practice (Section B). Section A brings together a range of theories and frameworks which can inform process evaluation, and current debates. Section B provides a more practical ‘how to’ guide. The guidance is written from the perspectives of researchers with experience of process evaluations alongside trials of complex public health interventions (interventions focused upon primary or secondary prevention of disease, or positive health promotion, rather than treatment of illness). However, it is also relevant to stakeholders from other research domains, such as health services or education. This executive summary will provide a brief overview of why process evaluation is necessary, what it is, and how to plan, design and conduct a process evaluation. It signposts readers to chapters of the document in which they will find more detail on the issues discussed.

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Aging

Unmet support needs of early-onset dementia family caregivers:
a mixed-design study.
Canada-flat-icon
Non UofA Access
Ducharme F, Kergoat MJ, Coulombe R, Levesque L, Antoine P, Pasquier F.
BMC nursing 2014 Dec 19;13(1):49-014-0049-3. eCollection 2014

Though advances in knowledge and diagnostics make it possible today to identify persons with early-onset dementia or a related cognitive disorder much sooner, little is known about the support needs of the family caregivers of these persons. The aim of this study was to document the unmet support needs of this specific group of caregivers. This knowledge is essential to open avenues for the development of innovative interventions and professional services tailored to their specific needs. METHODS: This study was conducted using a mixed research design. Participants were 32 family caregivers in their 50s recruited through memory clinics and Alzheimer Societies in Quebec (Canada). The Family Caregivers Support Agreement (FCSA) tool, based on a partnership approach between caregiver and assessor, was used to collect data in the course of a semi-structured interview, combined with open-ended questions. RESULTS: The unmet support needs reported by nearly 70% of the caregivers were primarily of a psycho-educational nature. Caregivers wished primarily: (1) to receive more information on available help and financial resources; (2) to have their relatives feel valued as persons and to offer them stimulating activities adjusted to their residual abilities; (3) to reduce stress stemming from their caregiver role assumed at an early age and to have the chance to enjoy more time for themselves; and (4) to receive help at the right time and for the help to be tailored to their situation of caregiver of a young person. CONCLUSIONS: Results show numerous unmet support needs, including some specific to this group of family caregivers. Use of the FCSA tool allowed accurately assessing the needs that emerged from mutual exchanges. Avenues for professional innovative interventions are proposed.

Negotiating access to a diagnosis of dementia: Implications for policies in health and social care. Canada-flat-icon
Non UofA Access
Koehn S, Badger M, Cohen C, McCleary L, Drummond N.
Dementia (London, England) 2014 Dec 22

The ‘Pathways to Diagnosis’ study captured the experience of the prediagnosis period of Alzheimer’s disease and related dementias through indepth interviews with 29 persons with dementia and 34 of their family caregivers across four sites: anglophones in Calgary, francophones in Ottawa, Chinese-Canadians in Greater Vancouver and Indo-Canadians in Toronto. In this cross-site analysis, we use the ‘Candidacy’ framework to comprehensively explore the challenges to securing a diagnosis of dementia in Canada and to develop relevant health and social policy. Candidacy views eligibility for appropriate medical care as a process of joint negotiation between individuals and health services, which can be understood relative to seven dimensions: identification of need, navigation, appearances at services, adjudication by providers, acceptance of/resistance to offers, permeability of services and local conditions. Interviewees experienced challenges relative to each of the seven dimensions and these varied in form and emphasis across the four ethno-linguistic groups. © The Author(s)

Assessing the application of non-pharmacological interventions for people with dementia in German nursing homes: feasibility and content validity of the dementia care questionnaire (DemCare-Q).
Non UofA Access
Palm R, Kohler K, Bartholomeyczik S, Holle B.
BMC research notes 2014 Dec 23;7(1):950-0500-7-950

Non-pharmacological interventions are guideline-recommended as initial treatment for people with dementia in nursing homes. In Germany, there is no instrument available to collect standardized data on the application of all of these interventions; an investigation of their use in large-scale samples is not currently possible. This article describes the development and initial testing of a questionnaire (Dementia Care Questionnaire (DemCare-Q)) to assess provided non-pharmacological interventions in residents with dementia in nursing homes that can be completed by nurses. METHODS: The questionnaire development comprised the following steps to achieve content validity and feasibility: a structured content analysis of the German guideline for the care of people with dementia and challenging behavior in nursing homes and a systematic literature review of projects that implemented these; quantitative expert ratings and calculation of content validity indices; qualitative pre-test with future users using cognitive techniques; quantitative pre-test using frequency analysis of item non-response. RESULTS: The developed questionnaire covers seven dementia-specific non-pharmacological interventions in nursing homes. Problematic items could be improved by revising them successively, bringing forth a feasible and content valid version of the DemCare-Q. The DemCare-Q enables researchers to collect data on the application of dementia interventions in German nursing homes in large-scale studies. CONCLUSION: A literature review, expert rating and multi-method pre-test are important steps of questionnaire development. The applied methods ensure content validity and the practicability of the instrument. The publication of this process enhances the transparency of questionnaire design and supports researchers in solving problems in developing questions to assess the application of interventions. Since these are initial steps of questionnaire development, further testing of its reliability is needed.

Mobility is the key! Trends and associations of common care problems in German long-term care facilities from 2008 to 2012.
Non UofA Access
Lahmann NA, Tannen A, Kuntz S, Raeder K, Schmitz G, Dassen T, et al.
International journal of nursing studies 2015 Jan;52(1):167-174

Although enormous efforts have been made in auditing the quality of care, there are only few epidemiological studies available about the actual occurrence of immobility, malnutrition, urinary incontinence, cognitive impairment, falls and pressure ulcers in long-term care facilities. OBJECTIVE: The objective of this study was to provide prevalence estimates of common nursing care problems in long-term care facilities and to investigate any associations between them. DESIGN: Secondary data analysis of five consecutive annual cross-sectional multicenter studies from 2008 to 2012. SETTING: 262 different long-term care facilities throughout Germany. PARTICIPANTS: 14,798 residents older than 18 years who gave informed consent. METHODS: Health conditions were rated based on direct resident examinations according to the current international definitions. Demographic characteristics were compared with available national population statistics. Apart from descriptive statistics, Chi(2) tests were carried out for bivariate and log-regression models were performed for multivariate associations. RESULTS: Prevalence rates were stable over the years with the highest prevalence of 73.5% (95% CI 72.8-74.2) being found for urinary incontinence, for cognitive impairment it was 54.1% (95% CI 53.3-54.9) and for immobility it was 36.5% (95% CI 35.7-37.3). The lowest prevalence rates were established for the risk of malnutrition with 13.0 (95% CI 12.4-13.5), for pressure ulcers with 4.8% (95% CI 4.5-5.1) and for falls (4.4% 95% CI 4.1-4.8). In the multivariate model, immobility was most strongly associated with all of the other conditions. No statistically significant associations were found between pressure ulcers and falls, pressure ulcers and urinary incontinence, pressure ulcers and cognitive impairment and between malnutrition and urinary incontinence. CONCLUSION: Decision-makers and clinical practitioners may primarily focus on the maintenance and enhancement of mobility, because this seems to be the key predictor for many other health conditions in the context of care dependency in the nursing home setting. Copyright © 2014 Elsevier Ltd. All rights reserved.

Exploring the Ecology of Canada’s Publicly Funded Residential Long-Term Care Bed Supply. Canada-flat-icon
Non UofA Access
Sivananthan SN, Doupe M, McGregor MJ.
Canadian journal on aging 2014 Dec 30:1-15

Despite Canada’s increasing population of seniors and the varying long-term care (LTC) strategies that provinces have implemented, little research has focused on understanding the extent to which publicly funded residential LTC bed supply varies across provinces, or the factors influencing this variation. Our study involved an analysis in which we examined the association of three select jurisdictional characteristics with LTC bed supply: population age demographics, provincial wealth, and provincial investments in home care. No significant cross-jurisdictional “ecology” or inter-relatedness was found between the variation in LTC bed supply and any of the examined variables. Interprovincial variation in bed supply also did not statistically influence alternate level of care days specific to LTC waits, suggesting that these days were not influenced simply by differences in LTC bed supply and that other provincial-level factors were in play.

Food security: who is being excluded? A case of older people with dementia in long-term care homes. Canada-flat-icon
Non UofA Access
Vahabi M, Schindel Martin L.
The journal of nutrition, health & aging 2014 Jul;18(7):685-691

To explore the extent of food security among older people, particularly those with cognitive impairments residing in Canadian long-term care homes (LTCHs) through a focused review of literature. METHOD: Databases including Medline, Nursing and Health Sciences (SAGE), Psych Info, Social Sciences Abstract, the Cumulative Index of Nursing and Allied Health Literature (CINAHL) and HealthSTAR were searched for peer-reviewed articles related to food experiences of older individuals in industrialized countries including Canada. Only articles that were published in English between 1997-2012 were included. RESULTS: Sixty two studies met the inclusion criteria. Of those 17 focused on older adults in LTCHs. The review found that food security has rarely been examined among older persons living in LTCHs, and has never been examined within the context of cognitive impairment. While a few studies have focused on residents’ satisfaction with foods that are provided to them in LTCHs, none have explored the extent of food security in this population. Furthermore, food satisfaction surveys in the LTCH are limited to the assessment of foods that are served to residents, and do not capture residents’ food accessibility beyond the food dispensing routines of the organization. Thus, food quality, food preferences, and the traditional meanings and rituals associated with food consumption are not purposefully evaluated. In addition, LTCHs are not required to monitor residents’ food satisfaction using a consistent, regular, and standardized approach and there is no regulation in the LTCH Act that requires LTCHs to assess their residents’ food security. CONCLUSIONS: The findings highlight the need for: 1) expansion of food security research to non-community-based settings including LTCHs; 2) re-conceptualization of food security and modification of measurement tools to assess the extent and determinants of food security among older adults in LTCHs; 3) mandatory monitoring of food security via standardized and regular surveys tailored to meet the unique preferences and needs of the older population, particularly those with dementia; and 4) education of healthcare professionals regarding food security and its assessment in LTCHs.

Frailty in Nursing Homes: The FRAIL-NH Scale.
Non UofA Access
Kaehr E, Visvanathan R, Malmstrom TK, Morley JE.
Journal of the American Medical Directors Association 2014 Dec 31.

We have developed the FRAIL-NH as a relatively simple tool to identify frail persons in the nursing home who have reversible conditions that with appropriate treatment are likely to result in improved outcomes. We have arbitrarily set a score of higher than 7 as indicating frailty in a nursing home resident.

Expectations about future use of long-term services and supports vary by current living arrangement.
Non UofA Access
Henning-Smith CE, Shippee TP.
Health affairs (Project Hope) 2015 Jan 1;34(1):39-47

Most Americans know little about options for long-term services and supports and underestimate their likely future needs for such assistance. Using data from the 2012 National Health Interview Survey, we examined expectations about future use of long-term services and supports among adults ages 40-65 and how these expectations varied by current living arrangement. We found differences by living arrangement in expectations about both future need for long-term services and supports and who would provide such care if needed. Respondents living with minor children were the least likely to expect to need long-term services and supports and to require paid care if the need arose. In contrast, respondents living alone were the most likely to expect that it was “very likely” that they would need long-term services and supports and to rely on paid care. Overall, we found a disconnect between expectations of use and likely future reality: 60 percent of respondents believed that they were unlikely to need long-term services and supports in the future, whereas the evidence suggests that nearly 70 percent of older adults will need them at some point. These findings both underscore the need for programs that encourage people to plan for long-term services and supports and indicate that information about living arrangements can be useful in developing and targeting such programs.

Case management approaches to home support for people with dementia.
Non UofA Access
Reilly S, Miranda-Castillo C, Malouf R, Hoe J, Toot S, Challis D, et al.
The Cochrane database of systematic reviews 2015 Jan 5;1:CD008345

Over 35 million people are estimated to be living with dementia in the world and the societal costs are very high. Case management is a widely used and strongly promoted complex intervention for organising and co-ordinating care at the level of the individual, with the aim of providing long-term care for people with dementia in the community as an alternative to early admission to a care home or hospital. OBJECTIVES: To evaluate the effectiveness of case management approaches to home support for people with dementia, from the perspective of the different people involved (patients, carers, and staff) compared with other forms of treatment, including ‘treatment as usual’, standard community treatment and other non-case management interventions. SEARCH METHODS: We searched the following databases up to 31 December 2013: ALOIS, the Specialised Register of the Cochrane Dementia and Cognitive Improvement Group,The Cochrane Library, MEDLINE, EMBASE, PsycINFO, CINAHL, LILACS, Web of Science (including Science Citation Index Expanded (SCI-EXPANDED) and Social Science Citation Index), Campbell Collaboration/SORO database and the Specialised Register of the Cochrane Effective Practice and Organisation of Care Group. We updated this search in March 2014 but results have not yet been incorporated. SELECTION CRITERIA: We include randomised controlled trials (RCTs) of case management interventions for people with dementia living in the community and their carers. We screened interventions to ensure that they focused on planning and co-ordination of care. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures as required by The Cochrane Collaboration. Two review authors independently extracted data and made ‘Risk of bias’ assessments using Cochrane criteria. For continuous outcomes, we used the mean difference (MD) or standardised mean difference (SMD) between groups along with its confidence interval (95% CI). We applied a fixed- or random-effects model as appropriate. For binary or dichotomous data, we generated the corresponding odds ratio (OR) with 95% CI. We assessed heterogeneity by the I² statistic. MAIN RESULTS: We include 13 RCTs involving 9615 participants with dementia in the review. Case management interventions in studies varied. We found low to moderate overall risk of bias; 69% of studies were at high risk for performance bias.The case management group were significantly less likely to be institutionalised (admissions to residential or nursing homes) at six months (OR 0.82, 95% CI 0.69 to 0.98, n = 5741, 6 RCTs, I² = 0%, P = 0.02) and at 18 months (OR 0.25, 95% CI 0.10 to 0.61, n = 363, 4 RCTs, I² = 0%, P = 0.003). However, the effects at 10 – 12 months (OR 0.95, 95% CI 0.83 to 1.08, n = 5990, 9 RCTs, I² = 48%, P = 0.39) and 24 months (OR 1.03, 95% CI 0.52 to 2.03, n = 201, 2 RCTs, I² = 0%, P = 0.94) were uncertain. There was evidence from one trial of a reduction in the number of days per month in a residential home or hospital unit in the case management group at six months (MD -5.80, 95% CI -7.93 to -3.67, n = 88, 1 RCT, P < 0.0001) and at 12 months (MD -7.70, 95% CI -9.38 to -6.02, n = 88, 1 RCT, P < 0.0001). One trial reported the length of time until participants were institutionalised at 12 months and the effects were uncertain (hazard ratio (HR): 0.66, 95% CI 0.38 to 1.14, P = 0.14). There was no difference in the number of people admitted to hospital at six (4 RCTs, 439 participants), 12 (5 RCTs, 585 participants) and 18 months (5 RCTs, 613 participants). For mortality at 4 – 6, 12, 18 – 24 and 36 months, and for participants’ or carers’ quality of life at 4, 6, 12 and 18 months, there were no significant effects. There was some evidence of benefits in carer burden at six months (SMD -0.07, 95% CI -0.12 to -0.01, n = 4601, 4 RCTs, I² = 26%, P = 0.03) but the effects at 12 or 18 months were uncertain. Additionally, some evidence indicated case management was more effective at reducing behaviour disturbance at 18 months (SMD -0.35, 95% CI -0.63 to -0.07, n = 206, 2 RCTs I² = 0%, P = 0.01) but effects were uncertain at four (2 RCTs), six (4 RCTs) or 12 months (5 RCTs).The case management group showed a small significant improvement in carer depression at 18 months (SMD -0.08, 95% CI -0.16 to -0.01, n = 2888, 3 RCTs, I² = 0%, P = 0.03). Conversely, the case management group showed greater improvement in carer well-being in a single study at six months (MD -2.20 CI CI -4.14 to -0.26, n = 65, 1 RCT, P = 0.03) but the effects were uncertain at 12 or 18 months. There was some evidence that case management reduced the total cost of services at 12 months (SMD -0.07, 95% CI -0.12 to -0.02, n = 5276, 2 RCTs, P = 0.01) and incurred lower dollar expenditure for the total three years (MD= -705.00, 95% CI -1170.31 to -239.69, n = 5170, 1 RCT, P = 0.003). Data on a number of outcomes consistently indicated that the intervention group received significantly more community services. AUTHORS’ CONCLUSIONS: There is some evidence that case management is beneficial at improving some outcomes at certain time points, both in the person with dementia and in their carer. However, there was considerable heterogeneity between the interventions, outcomes measured and time points across the 13 included RCTs. There was some evidence from good-quality studies to suggest that admissions to care homes and overall healthcare costs are reduced in the medium term; however, the results at longer points of follow-up were uncertain. There was not enough evidence to clearly assess whether case management could delay institutionalisation in care homes. There were uncertain results in patient depression, functional abilities and cognition. Further work should be undertaken to investigate what components of case management are associated with improvement in outcomes. Increased consistency in measures of outcome would support future meta-analysis.

The organizational culture of emergency departments and the effect on care of older adults: A modified scoping study. Canada-flat-icon
Non UofA Access
Skar P, Bruce A, Sheets D.
International emergency nursing 2014 Nov 10

How does the organizational micro culture in emergency departments (EDs) impact the care of older adults presenting with a complaint or condition perceived as non-acute? This scoping study reviews the literature and maps three levels of ED culture (artifacts, values and beliefs, and assumptions). Findings on the artifact level indicate that EDs are poorly designed for the needs of older adults. Findings on the ED value and belief level indicate that EDs are for urgent cases (not geriatric care), that older adults do not receive the care and respect they should be given, that older adults require too much time, and that the basic nursing needs of older adults are not a priority for ED nurses. Finally, finding on the assumptions level underpinning ED behaviors suggest that older adults do not belong in the ED, most older adults in the ED are not critically ill and therefore can wait, and staff need to be available for acute cases at all times. A systematic review on the effect of ED micro culture on the quality of geriatric care is warranted. Copyright © 2014. Published by Elsevier Ltd.

Effects of small-scale, home-like facilities in dementia care on residents’ behavior, and use of physical restraints and psychotropic drugs: a quasi-experimental study.
Non UofA Access
Verbeek H, Zwakhalen SM, van Rossum E, Ambergen T, Kempen GI, Hamers JP.
International psychogeriatrics / IPA 2014 Apr;26(4):657-668

Small-scale, home-like care environments are increasingly implemented in institutional nursing care as a model to promote resident-directed care, although evidence on its effects is sparse. This study focuses on the effects of small-scale living facilities on the behavior of residents with dementia and use of physical restraints and psychotropic drugs. METHODS: A quasi-experimental study was conducted comparing residents in two types of long-term institutional nursing care (i.e., small-scale living facilities and traditional psychogeriatric wards) on three time points: at baseline and follow-ups after six and 12 months. Residents were matched at baseline on cognitive and functional status to increase comparability of groups at baseline. Nurses assessed neuropsychiatric and depressive symptoms, agitation, social engagement, and use of physical restraints using questionnaires. Psychotropic drug use was derived from residents’ medical records. RESULTS: In total, 259 residents were included: 124 in small-scale living facilities and 135 controls. Significantly fewer physical restraints and psychotropic drugs were used in small-scale living facilities compared with traditional wards. Residents in small-scale living facilities were significantly more socially engaged, at baseline and after six months follow-up, and displayed more physically non-aggressive behavior after 12 months than residents in traditional wards. No other differences were found. CONCLUSIONS: This study suggests positive effects of small-scale living facilities on the use of physical restraints and psychotropic drugs. However, the results for behavior were mixed. More research is needed to gain an insight on the relationship between dementia care environment and other residents’ outcomes.

Activities of daily living and quality of life across different stages of dementia: a UK study.
Non UofA Access
Giebel CM, Sutcliffe C, Challis D.
Aging & mental health 2015 Jan;19(1):63-71

People with dementia (PwD) require an increasing degree of assistance with activities of daily living (ADLs), and dependency may negatively impact on their well-being. However, it remains unclear which activities are impaired at each stage of dementia and to what extent this is associated with variations in quality of life (QoL) across the different stages, which were the two objectives of this study. METHODS: The sample comprised 122 PwD, and their carers, either living at home or recently admitted to long-term care. Measures of cognition and QoL were completed by the PwD and proxy measures of psychopathology, depression, ADLs and QoL were recorded. Using frequency, correlation and multiple regression analysis, data were analysed for the number of ADL impairments across mild, moderate and severe dementia and for the factors impacting on QoL. RESULTS: ADL performance deteriorates differently for individual activities, with some ADLs showing impairment in mild dementia, including dressing, whereas others only deteriorate later on, including feeding. This decline may be seen in the degree to which carers perceive ADLs to explain the QoL of the PwD, with more ADLs associated with QoL in severe dementia. RESULTS of the regression analysis showed that total ADL performance however was only impacting on QoL in moderate dementia. CONCLUSION: Knowledge about performance deterioration in different ADLs has implications for designing interventions to address specific activities at different stages of the disease. Furthermore, findings suggest that different factors are important to consider when trying to improve or maintain QoL at different stages.

Caring for Caregivers of High-Needs Older Persons
Warrick N, Peckham A, Watkins J, Padjen M, Williams AP.
Healthcare Quarterly 2014 10/29;17(3):24-29

The Caregiver Framework for Seniors Project (CFSP) is led by the Alzheimer Society of Toronto in partnership with the Toronto Central Community Care Access Centre and six community support service agencies. This ground-breaking initiative aims to increase caregiver resiliency and capacity to continue to provide care through a platform of supports. In the CFSP, care coordinators negotiate flexible support packages in consultation with caregivers to meet their self-reported needs and the needs of care recipients. This paper presents the findings from a multi-stage, mixed-methods formative evaluation of the CFSP.

European Commission: The 2015 Ageing Report: Understanding Assumptions and Projection Methodologies
2014

This report provides a description of underlying macroeconomic assumptions and methodologies of the age-related expenditure projections for all Member States such as pensions, health care, long-term care, education, and unemployment benefits. These projections identify policy challenges, in the annual assessment of the sustainability of public finances and in the analysis on the impact of ageing populations on the labour market and potential economic growth. Report includes chapter on long term care.

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Events

UofA

Influenza immunization resistance by healthcare professionalsN
12:00 Friday 6 February Dvorkin Centre (2G2.07 WMC)

In this presentation, Dr Diane Kunyk will discuss the ethics around health professionals refusal to immunize themselves against influenza.

IIQM- International Institute for Qualitative Methodology TQ2U: United Kingdom-Ireland
Glasgow 16-17 March
Dublin 18-19 March
Manchester 23-24 March

Over two days in each city, between 6 and 10 different TQ2U workshops will be facilitated by internationally-known experts in qualitative research.
-Develop Key Qualitative Research Skills
-Learn from Leading International Workshop Facilitators
-Network within the Qualitative Research Community

Non UofA

CADTH: Rapid Review Summit: Then, Now, and in the Future
3-4 February Vancouver BC

The summit objectives are:
-to provide a forum for rapid review producers, health care decision-makers, and providers and representatives from organizations interested in rapid reviews, to share knowledge, information, and experiences
-to facilitate discussions on specific topic areas concerning the production and applications of rapid reviews
-to develop a research priority agenda to continue to advance the science of rapid reviews.

Researching Complex Interventions in Health: The State of the Art
14-15 October Exeter UK £150

This conference will bring together leading international contributors from the field of complex interventions for two days of presentations, workshops and discussion on the latest thinking in applied clinical health services research. The conference is jointly convened by: David Richards, University of Exeter Medical School, UK and Ingalill Rahm-Hallberg, Lund University, Sweden

Improvement Science…definitions and deliberations
Friday 13 March London UK

Help King’s Improvement Science [KIS] take stock of its activities and plan for the future…find out what King’s Improvement Science has achieved since it launched at the beginning of 2013 and join a debate about the nature of improvement science, the definitions used within the discipline and the differences between improvement and implementation.

Online

CFHI Webinar: Analyzing Data Over Time for Quality Improvement: A Focus on Control Charts
Wednesday 28 January 10:00-11:00 MT $100

Participants will build off of fundamental measurement for quality improvement principles reviewed during the Making Data Matter: Measurement Basics for Quality Improvement webinar and learn about:
-The differences between a run chart and control chart
-How to create and analyze control charts
-Linking data from quality improvement activities with organizational performance data

KT Canada Webinar OR4KT: Development of an instrument to assess organizational readiness for knowledge translation in healthcare
Online OR ECHA 4-009 Thursday 12 February 10:00-11:00 MT

Learning Objectives:
-Understand the different steps involved in the development and validation of the OR4KT instrument;
-Identify key dimensions for assessing organizational-level factors that influence KT in healthcare;
-Explore how the OR4KT instrument could be used in one’s context.

Acknowledging Staff Grief When Working with Dementia: It is Vital
Tuesday 10 February 10:00-11:00 MT

This presentation will help us understand how staff grief and loss impacts on their work with people with dementia in a variety of settings (both LTC and community settings). We will hear about examples of organizations and peer-led strategies to support staff when a person with dementia dies. We will highlight a study that looked at peer led debriefs in response to staff grief in a LTC home environment and will examine key ingredients for a successful peer debrief, facilitation strategies and the review of key models that may prove beneficial to staff. We will also outline self-care techniques and introduce the new Alzheimer Canada resource: Dementia and Staff Grief: A resource for healthcare providers.

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Courses

Workshop on finding and using research evidence
17-21 February McMaster University, Hamilton ON

This five-day training workshop will teach policymakers, stakeholders and researchers how to find and make use of research evidence in their work to reform, renew or strengthen health systems, and to get cost-effective programs, services and drugs to those who need them.

Online

MOOC Pragmatic Randomized Controlled Trials in Health Care
Class begins 17 February

In this MOOC, we are going to study the mismatch between the real world and research, and see what its effect is on modern medical care. One example of the studies we will discuss is the VIGOR trial. This influential drug trial resulted in the widespread global overuse of this drug, at a cost of wasted billions of dollars. Ironically, this drug, intended to reduce a problem in individuals, ended up causing more of the same problem in the population! After we understand the consequences of designing the wrong kinds of trials, we will also look at how best to design pragmatic randomized trials, which answer the important questions that ordinary patients and decision makers in the real world most often ask. We will also explore how these can be combined with economic evaluations and qualitative research – to answer important questions about how much these interventions cost, and how they are experienced by the recipients.

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News

Writerly, readerly and strategic – practices for getting published

Here are some top tips for early academic career publishing.

How to Correct the Media When They Misreport Your Research

A study published in BMJ 2014;349 reports that mass-media misrepresentations and inaccuracies concerning research findings are often the products of university communication offices’ self-promotion efforts, the result of increasing competition among high education institutions to claim points of pride.

Social Media And Its Impact on Medical Research

This is an interesting comment on recent research showing that social media does not have an impact on research pick up.

RAI is being used to help wean seniors off antipsychotic medications in Manitoba and Alberta Canada-flat-icon

The Winnipeg Health Region, with support from the Canadian Foundation for Healthcare Improvement (CFHI), used RAI data as a measurement and assessment tool to help monitor and reduce antipsychotic medication use in long-term care. Now, Alberta is also using RAI data as a key measurement and assessment tool for the provincial Appropriate Use of Antipsychotics in Long Term Care (AUA in LTC) project.

Nova Scotia keeps focus on in-home care for elderly Canada-flat-icon

If the Nova Scotia health-care system is to manage the growing demand for elder care and not bankrupt the province, there needs to be a shift in how we care for seniors, says Health Minister Leo Glavine.

From early career researcher to Editor-in-Chief in 5 steps

How your contributions as an author and reviewer are important milestones on your path to success.

Launch of the Revised Version of the 2nd Edition of the Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans Canada-flat-icon

Changes include increased emphasis on the participant’s decision-making capacity, more detailed guidance about alterations to consent requirements, and the full integration of CIHR’s Guidelines for Human Pluripotent Stem Cell Research. The inclusion of the Guidelines addresses the Agencies’ goal of making TCPS 2 the single Agency policy for the ethics of research involving humans.

When a stagnant health system meets an aging population, disaster awaits Canada-flat-icon

Since we are all going to get old and die one day, we have a stake in how well Canada’s health-care system looks after senior citizens. The problem is, not many of us are confident that it’s going well.

Long-term care work more demanding Canada-flat-icon

Staffing issues in long-term care do exist, both in Saskatchewan and across the continent. To understand the issue from the inside, Steven Lopez, a sociologist at Ohio State University, took a job as a care assistant. Despite his best intentions, Lopez found himself breaking rules in order to complete his work on time.

BC Ministry of Health releases Fire Safety Assessment Report for Licensed Residential Care Facilities and Registered Assisted Living Residences Canada-flat-icon

The Report summarizes key findings of assessments conducted during site visits to seniors’ residential care facilities and registered seniors’ assisted living residences that did not have full sprinkler systems.

Government of Canada and Alberta Caregivers Association partner on project to support women caregivers in Edmonton Canada-flat-icon

The Alberta Caregivers Association will receive $172,371 for a two-year project that will work to increase economic opportunities for women who are providing care for family members who are either ill, aging, or have a disability in Edmonton, Alberta. Through the project, tools, training or policies will be developed and piloted with employers to assist them in adopting supportive and inclusive work environments for women caregivers.

Japan’s national government plans new continuing care retirement communities to lure seniors out of shorthanded big cities

The national government noted that across the country, large cities are finding themselves facing an increasing shortage of nursing care homes, particularly facilities for elderly people with severe disabilities. In the countryside, meanwhile, the government is expecting the number of seniors to stop growing, causing jobs to decline at nursing care facilities.

First seniors’ advocate says similar roles needed across Canada Canada-flat-icon

Canada’s first seniors advocate says similar positions are necessary in every province to protect a vulnerable population that is too often neglected. “I think that seniors are a diverse group of people with diverse needs,” says Ms. Isobel Mackenzie, who was appointed British Columbia’s seniors advocate in March. “Having an office that can focus on those issues that affect significant numbers of seniors is important to ensure that they don’t get drowned out in all of the other competing agendas.”

Alberta Health Services launches Palliative and End of Life Care Alberta Provincial Framework 2014 Canada-flat-icon

The Palliative and End of Life Care (PEOLC) Provincial Framework was developed with the intention of improving patient care to all Albertans regardless of the type of illness or geographic location in which one resides. The Framework was built around Alberta Health Services (AHS) seven core values and the mission of providing a patient-focused, quality health system that is accessible and sustainable for all Albertans. The next steps for the Framework initiatives will be governed by an expert panel committee (Provincial Palliative and End of Life Care Innovations Steering Committee) which provides guidance and support along the development and implementation process.

Recommendation against national dementia screening (UK)

The UK National Screening Committee (UK NSC) has today upheld its recommendation against screening everyone aged 65 and over for dementia.

Federal Funding Bill Includes Alzheimer’s Accountability Act (US)

Congress recently signed a funding bill including the Alzheimer’s Accountability Act, enabling scientists at the National Institutes of Health to tell Congress the amount of funding they need on an annual basis to reach the national goal to prevent and effectively treat Alzheimer’s disease by 2025.

Complexity and the failure of quantitative social science

If you received a social science education in conventional statistics alone, your professors failed you. And, they failed you because they should have taught you five additional things.

NHS cannot cope with ageing population, warns top doctor (UK)

Prof Sir Bruce Keogh, medical director of NHS England, said without massive changes, service risks becoming unaffordable

5 tips for promoting your research through Facebook

Let’s face it; whether you love it or love to hate it, for now, Facebook is here to stay. With 71% of online adults using Facebook, the channel presents a real opportunity for authors and researchers like you, to promote their work, assuming you have the bandwidth to maintain it. However, before you jump headfirst into using Facebook as a marketing tool, we have some tips for maximizing the potential of the channel.

Coming Out as Academic Mothers

What happens when two highly driven women in academe decide to have children?

Use of Mobile Devices for Patient Care in Long Term Care Facilities

One nursing assistant at the Dover home commented on the mobile devices: “They were able to go room to room which made it less likely for us to forget something that needed (to be) charted.” 93% of participants felt the mobile devices reduced the amount of time required to complete documentation and 100% said they made their jobs easier. Administrators reported that the level of documentation increased with use of the mobile devices, as well as the timeliness and detail. According to Shann Teen Chance, Director of Nursing, “The documentation appeared to be more complete. Our staff was able to chart anywhere they were in the building.” From a facility viewpoint, faster and more accurate documentation translates to higher reimbursements and a better standard of patient care, as staff spends less time on charting and more time with their residents.

Older people in England are being left “high and dry” by councils cutting back on the care they provide, Age UK says.

“Hundreds of thousands of older people who need social care are being left high and dry. The lucky ones have sufficient funds to buy in some support, or can rely on the goodwill of family, neighbours and friends. But there are many who are being left to struggle on entirely alone.”

Mean Girls in the Retirement Home

In this provocative essay in the Sunday New York Times Sunday Magazine, novelist Jennifer Weiner writes about her 97-year-old grandmother’s experiences with mean girls in a retirement home.

Ageing population ‘one of top three challenges facing the UK’, poll finds

The country’s ageing population is seen to be one of the top three challenges facing UK society over the next 20 years, falling just behind healthcare and immigration¹ according to a new YouGov poll commissioned by Independent Age. Additionally, four fifths (79%) of adults think the ageing population will present a large challenge for the UK.

Attracting the best staff to residential care (Australia)

Candidates looking for work in aged care have more choice than ever and competition is fierce. Natasha Egan reports on what three aged care providers are doing to ensure they recruit the best people for the job.

CIHR: Changes to the Institutes and Reforms of Open Programs and peer review Canada-flat-icon

It is important to note that there will be no change in the number or slate of Institutes and no reduction in the total amount of funding available to Canadian health researchers. Two key changes are: Restructuring the Institute Advisory Boards (IABs) and Creating a Common Research Fund.

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Resources

Data Purchase Program: Call for Requests from Researchers Canada-flat-icon
ONLY available for UofA folk.
DEADLINE 31 January

University of Alberta Libraries (UAL) invites faculty, post-doctoral fellows, and graduate students to express their interest in acquiring commercially available data sets through the Libraries’ Data Purchase Program. Access to numeric, spatial, and other forms of data produced by others can be essential for research. While Open Data is becoming more widely available, there are still many cases where data are only commercially available. To support data-dependent research better, the Libraries is piloting a demand-driven data purchase program.

National Consumer Voice for Quality Long-Term Care and the National Center on Elder Abuse releases brochure and fact sheet on resident to resident aggression (US)

Newly released from the National Consumer Voice for Quality Long-Term Care and the National Center on Elder Abuse, this brochure (and large print fact sheet) identifies mistreatment, shares information about an individual’s rights, and offers resources where they can go for help.

How to Correct the Media When They Misreport Your Research

Researchers should pay careful attention to both inaccuracies and omissions in popular new reporting of their research. At the very least, a letter to the editor or a comment on the news web site is in order.

Writing With a Heavy Teaching Load

Yes, you can ‘find time’ to write, but not without sacrifices.

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Opportunities

Post-Doctoral Fellowship TREC Canada-flat-icon
Faculty of Nursing, University of Alberta, Edmonton, AB
Open until filled

The TREC team invites applicants with an earned PhD or PhD-equivalent in Health Services Research, Epidemiology, Nursing, or a related field. Expertise in quantitative analysis and strong writing skills are essential requirements. Experience with large databases and experience and understanding of the residential long term care sector are strong assets. Experience with the MDS-RAI 2.0 database is an asset.

Editor: CIN Plus and ANI Connection
DEADLINE 28 February

The selected Editor will have primary responsibility for coordinating the CIN Plus and ANI Connection departments of CIN: Computers, Informatics, Nursing. The Editor will also be actively engaged in promoting CIN through social media channels, including Facebook and Twitter. This is an ideal opportunity for a nurse with an emerging interest in publishing and the editor role to have responsibility for journal and manuscript development while at the same time being mentored by an experienced Editor-in-Chief, Dr. Leslie Nicoll.

Win prizes for sharing your research with the world
DEADLINE 1 June

The 5-Minute Science Fair competition is an online global “science fair”. The competition invites international researchers, across numerous disciplines and fields, to participate by submitting short (5 minutes max.) narrated video presentations about their research. The 5-Minute Science Fair is not designed to trivialize or “dumb-down” research, but rather encourage researchers to consolidate their ideas, crystalize their research discoveries, and share those broadly with the world.

Call for Entries: Capstone International Nursing Book Award
DEADLINE 4 March

The Honor Society of Nursing, Sigma Theta Tau International (STTI) is pleased to announce that the call for entries for the 2015 Capstone International Nursing Book Award is open. The deadline for submitting an entry is 4 March, 2015. This award was created by STTI to recognize the single most outstanding nursing book published by or for nurses in the biennium. Any nursing book – textbook, professional, or consumer title – published between 2 February 2013 and 1 February 2015 is eligible (books must be in print by close of eligibility period). Publishers, editors, authors, or readers may nominate books for The Capstone International Nursing Book Award.

Tier II Canada Research Chair in Health Outcomes and Quality of Care Canada-flat-icon
Faculty of Nursing, University of Alberta, Edmonton AB

The Faculty of Nursing at the University of Alberta seeks to nominate a Tier II Canada Research Chair in Health Outcomes and Quality of Care. We are seeking a highly productive individual with a strong grounding in the quantitative sciences, e.g., epidemiology, quantitative sociology, biostatistics. Experience working with large databases or conducting intervention studies will be a definite asset.

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