October 11


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New article by Dr. Shannon Scott
The potential for nurses to contribute to and lead improvement science in healthcare
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R. Flynn, S.D. Scott, T. Rotter and D. Hartfield.
J Adv Nurs 2016:n/a-n/a

Aim A discussion of how nurses can contribute to and lead improvement science activities in healthcare. Background Quality failures in healthcare have led to the urgent need for healthcare quality improvement. However, too often quality improvement interventions proceed to practice implementation without rigorous methods or sufficient empirical evidence. This lack of evidence for quality improvement has led to the development of improvement science, which embodies quality improvement research and quality improvement practice. This paper discusses how the discipline of nursing and the nursing profession possesses many strengths that enable nurses to lead and to play an integral role in improvement science activities. However, we also discuss that there are insufficiencies in nursing education that require attention for nurses to truly contribute to and lead improvement science in healthcare. Design Discussion paper Data Sources This paper builds on a collection of our previous work, a 12-month scoping review (March 2013-March 2014), baseline study on a quality improvement management system (Lean), interviews with nurses on quality improvement implementation and supporting literature. Implications for Nursing This paper highlights how nurses have the philosophical, theoretical, political and ethical positioning to contribute to and lead improvement science activities. However up to now, the potential for nurses to lead improvement science activities has not been fully used. Conclusion We suggest that one starting point is to include improvement science in nursing education curricula. Specifically, there needs to be increased focus on the nursing roles and skills needed to contribute to and lead healthcare improvement science activities.

New article by Dr. Greta Cummings
Nurse Leaders’ Perceptions of Influence of Organizational Restructuring on Evidence-Informed Decision-Making
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J. A. Spiers, E. Lo, A. Hofmeyer and G. G. Cummings.
Nurs Leadersh (Tor Ont) 2016;29(2):64-81

AIM: To describe how organizational context and restructuring influenced nurse leaders’ use of evidence in decision-making in their management practice. METHOD: Qualitative descriptive study. Fifteen leaders at executive and front-line manager levels in one organization were interviewed using a semi-structured format. FINDINGS: Inductive content analysis generated five main themes: leaders strove to keep relationships that preserve best decision-making ability; and sought the best knowledge to inform their decisions. However, a context of constant change; more scope; less autonomy; and decisional inertia in a sea of change had profound effects on their ability to employ evidence in decision-making. IMPLICATIONS: Evidence-informed decision-making is a dynamic social process highly influenced by political instability in work environments. Organizational restructuring creates threats to common decision-making strategies, including information flow, relationships and priority setting. Healthcare restructuring is now a global constant, and there is a need for hospital leaders to understand and mitigate the effect restructuring has on the ability of leaders to engage in evidence-informed decision-making. Strategies are proposed to manage uncertainty and support nurse leaders in their evidence-informed decision-making to deliver quality health services. This research provides an in-depth examination of how evidence-informed decision-making is influenced in the context of instability and uncertainty due to ever-present organizational restructuring.

The Latest World Alzheimer Report is Available
World Alzheimer Report 2016

Alzheimer’s Disease International

The World Alzheimer Report 2016, Improving healthcare for people living with dementia: Coverage, quality and costs now and in the future, reviews research evidence on the elements of healthcare for people with dementia, and, using economic modelling, suggests how it should be improved and made more efficient.

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Publications

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

KT

Flooded with evidence: using a ‘spillway’ model to improve research implementation in nursing practice
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C. Moloney, M. Taylor and N. Ralph.
Aus J Adv Nurs 2016;34(1):23-31

Objective To identify barriers to implementing evidence-based practice initiatives in small to medium sub-acute facilities in Queensland. Design The study uses a qualitative methodology in which field observations and convergent interviews were employed to generate data. Setting Four south-east Queensland sub-acute care facilities participated in the study. Observational and interview data were collected. Subjects Field observations were recorded across the sites. Five research fellows collected observational data on evidence-based practice implementation across a period of six months. Nine clinicians participated in in-depth, convergent interviews at the end of the period of observation. Main outcome measures The authors analysed observational and interview data using qualitative thematic analysis. Results Three themes emerged which described the needs of clinicians when evidence-based practice initiatives were being implemented: (1) valuing evidence; (2) risk prioritisation; and (3) controlling the flow of evidence. A ‘Spillway Model’ is proposed as a mechanism for targeting clinical priorities using integrated risk management. Conclusion This study supports the use of integrated risk management as part of a Spillway Model to guide the introduction of evidence-based practice initiatives in the clinical setting.

Patient and public involvement and the implementation of research into practice
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S. Gillard, R. Foster and C. Papoulias.
J Ment Health Train Educ Pract 2016;11(4):256-267

Purpose: Patient and public involvement (PPI) is increasingly central to the delivery of health services research. However, it has proved challenging to evaluate the impact of PPI on the implementation of research into clinical practice and health service delivery. The purpose of this paper is to develop and test a conceptual model explaining how PPI in the research process might impact on implementation. Design/methodology/approach: A scoping review of knowledge translation and implementation science literature was performed to develop a conceptual model of the impact of PPI in research on implementation. A retrospective case study of a research project was used to illustrate the model. Findings: The authors identified five domains in which PPI can impact on the implementation of research into practice. The review demonstrated that successful implementation depends on developing relational models of knowledge production, valuing experiential knowledge, engaging in collaborative practice, making use of knowledge brokers or tools for knowledge facilitation and embedding these factors into the implementation context. In the case study the authors were able to find examples that illustrated each of the five domains of the model. Originality/value: The paper builds on existing endeavour to evaluate the impact of PPI in research, demonstrating that it is possible to model, conceptually, the processes whereby PPI in research might impact on practice and service delivery. By illustrating those processes through the exemplar case the authors also demonstrate the potential for the model to be “operationalised”, allowing the impacts, on practice, of PPI in research to be systematically and directly evidenced.

Dissemination and implementation science in program evaluation: A telemental health clinical consultation case example
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P. G. Arora, E. H. Connors, A. Blizzard, K. Coble, N. Gloff and D. Pruitt.
Eval Program Plann 2016 Sep 20;60:56-63

Increased attention has been placed on evaluating the extent to which clinical programs that support the behavioral health needs of youth have effective processes and result in improved patient outcomes. Several theoretical frameworks from dissemination and implementation (D&I) science have been put forth to guide the evaluation of behavioral health program implemented in the context of real-world settings. Although a strong rationale for the integration of D&I science in program evaluation exists, few examples exist available to guide the evaluator in integrating D&I science in the planning and execution of evaluation activities. This paper seeks to inform program evaluation efforts by outlining two D&I frameworks and describing their integration in program evaluation design. Specifically, this paper seeks to support evaluation efforts by illustrating the use of these frameworks via a case example of a telemental health consultation program in pediatric primary care designed to improve access to behavioral health care for children and adolescents in rural settings. Lessons learned from this effort, as well as recommendations regarding the future evaluation of programs using D&I science to support behavioral health care in community-based settings are discussed.

Enhancing implementation science by applying best principles of systems science
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M.E. Northridge and S.S. Metcalf.
Health Research Policy and Systems 2016;14(1):1-8

Implementation science holds promise for better ensuring that research is translated into evidence-based policy and practice, but interventions often fail or even worsen the problems they are intended to solve due to a lack of understanding of real world structures and dynamic complexity. While systems science alone cannot possibly solve the major challenges in public health, systems-based approaches may contribute to changing the language and methods for conceptualising and acting within complex systems. The overarching goal of this paper is to improve the modelling used in dissemination and implementation research by applying best principles of systems science.

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Health Care Administration and Organization

An exploration of nursing assistants’ perceptions about job satisfaction
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D. M. Brady.
Crit Care Nurs Q 2016 Oct-Dec;39(4):371-386

High levels of staff turnover of certified nursing assistants (CNAs) are costly and disruptive to patient care. A variety of factors contribute to a 36% turnover rate of CNAs nationwide (2015 Staffing Report, 2015). According to Stone and Wiener, high rates of turnover and staff vacancies have multilayered consequences; patient care suffers, cost of constantly replacing workers soars, and worker job dissatisfaction increases. This study examined the CNAs’ beliefs about job satisfaction as an approach to prevent job turnover and retain high achieving staff in one acute care hospital in a south eastern region. The goal was to determine how CNAs define job satisfaction, evaluate their understanding of and gauge interest in the career options presented at information sessions as well as listen to their ideas on how they believe are the best approaches to achieve job satisfaction for the CNAs at this facility. A qualitative key informant design was used to interview a purposive sample of 9 nursing assistants who were currently employed at the hospital for at least 6 months and who attended a brief information session. Individual 20-minute face-to-face interviews of consented participants were recorded, transcribed, and coded for themes using constant comparative analysis. Four major categories emerged from the interviews: CNA views of job satisfaction, clinical ladder option, support services option, and what CNAs want.

Impact of serious mental illness online training for certified nursing assistants in long term care
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V. Molinari, J.V. Hobday, R. Roker, et al.
Gerontol Geriatr Educ 2016 09/22:1-16

ABSTRACT Certified nurse assistants (CNAs) spend the most staff time with nursing home residents, yet they receive little training in addressing the mental health needs of residents with serious mental illness (SMI). Forty CNAs from four long-term-care facilities took the online interactive CARES-? Serious Mental Illness? training consisting of two modules guided by the Recovery Movement philosophy of care. Responses from pre-post testing, Likert-type items, and open-ended questions indicated that CNAs gained information, changed their perspectives, and had more confidence in dealing with SMI. Although there were minor concerns regarding length, clarity of content, and technical issues, CNAs found the online format acceptable and easy to use, and many said they would recommend the training. CARES Serious Mental Illness online training appears to be a viable way of helping CNAs address the mental health needs of long term care residents. Additional testing on CARES Serious Mental Illness is planned.; ABSTRACTCertified nurse assistants (CNAs) spend the most staff time with nursing home residents, yet they receive little training in addressing the mental health needs of residents with serious mental illness (SMI). Forty CNAs from four long-term-care facilities took the online interactive CARES-? Serious Mental Illness? training consisting of two modules guided by the Recovery Movement philosophy of care. Responses from pre-post testing, Likert-type items, and open-ended questions indicated that CNAs gained information, changed their perspectives, and had more confidence in dealing with SMI. Although there were minor concerns regarding length, clarity of content, and technical issues, CNAs found the online format acceptable and easy to use, and many said they would recommend the training. CARES Serious Mental Illness online training appears to be a viable way of helping CNAs address the mental health needs of long term care residents. Additional testing on CARES Serious Mental Illness is planned.

Assessing knowledge, motivation and perceptions about falls prevention among care staff in a residential aged care setting
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J. A. Hang, J. Francis-Coad, B. Burro, D. Nobre and A. M. Hill.
Geriatr Nurs 2016 Sep 23

Falls are a serious problem in residential aged care settings. The aims of the study were to determine the feasibility of surveying care staff regarding falls prevention, and describe care staff levels of knowledge and awareness of residents’ risk of falls, knowledge about falls prevention, motivation and confidence to implement falls prevention strategies. A custom designed questionnaire was administered to care staff at one site of a large residential aged care organization in Australia. The survey response was 58.8%. Feedback from staff was used to inform the administration of the survey to the wider organization. Seven (29.2%) care staff reported they were unsure or thought residents were at low risk of falls. Only five (20.8%) care staff were able to suggest more than three preventive strategies. These preliminary findings suggest that education to change care staff behavior regarding falls prevention should target improving care staff knowledge and awareness of falls.

Comparison Between Quality of Care Provided by Trained Feeding Assistants and Certified Nursing Assistants During Between-Meal Supplementation in Long-Term Care Settings
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E. K. Hollingsworth, E. A. Long and S. F. Simmons.
J Appl Gerontol 2016 Sep 22

The purpose of this study was to compare the quality of feeding assistance provided by trained non-nursing staff with care provided by certified nursing assistants (CNAs). Research staff provided an 8-hr training course that met federal and state requirements to non-nursing staff in five community long-term care facilities. Trained staff were assigned to between-meal supplement and/or snack delivery for 24 weeks. Using standardized observations, research staff measured feeding assistance care processes between meals across all study weeks. Trained staff, nurse aides, and upper level staff were interviewed at 24 weeks to assess staff perceptions of program impact. Trained staff performed significantly better than CNAs for 12 of 13 care process measures. Residents also consumed significantly more calories per snack offer from trained staff (M = 130 +/- 126 [SD] kcal) compared with CNAs (M = 77 +/- 94 [SD] kcal). The majority of staff reported a positive impact of the training program.

“The Red Dress or the Blue?”: How Do Staff Perceive That They Support Decision Making for People With Dementia Living in Residential Aged Care Facilities?
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D. Fetherstonhaugh, L. Tarzia, M. Bauer, R. Nay and E. Beattie.
J Appl Gerontol 2016 Feb;35(2):209-226

Respect for a person’s right to make choices and participate in decision making is generally seen as central to quality of life and well-being. When a person moves into a residential aged care facility (RACF), however, decision making becomes more complicated, particularly if the person has a diagnosis of dementia. Little is known about how staff in RACFs perceive that they support decision making for people with dementia within their everyday practice, and this article seeks to address this knowledge gap. The article reports on the findings of a qualitative study conducted in the states of Victoria and Queensland, Australia with 80 direct care staff members. Findings revealed that the participants utilized a number of strategies in their intention to support decision making for people with dementia, and had an overall perception that “a little effort goes a long way.”.

Priorities for the professional development of registered nurses in nursing homes: a Delphi study
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E. Cooper, K. Spilsbury, D. McCaughan, C. Thompson, T. Butterworth and B. Hanratty.
Age Ageing 2016 Sep 8

OBJECTIVE: to establish a consensus on the care and professional development needs of registered nurses (RNs) employed by UK care homes. DESIGN: two-stage, online modified Delphi study. SETTING AND PARTICIPANTS: a panel (n = 352) of individuals with experience, expertise or interest in care home nursing: (i) care home nurses and managers; (ii) community healthcare professionals (including general practitioners, geriatricians, specialist and district nurses); and (iii) nurse educators in higher education. RESULTS: RNs employed by nursing homes require particular skills, knowledge, competence and experience to provide high-quality care for older residents. The most important responsibilities for the nursing home nurse were: promoting dignity, personhood and wellbeing, ensuring resident safety and enhancing quality of life. Continuing professional development priorities included personal care, dementia care and managing long-term conditions. The main barrier to professional development was staff shortages. Nursing degree programmes were perceived as inadequately preparing nurses for a nursing home role. Nursing homes could improve by providing supportive learning opportunities for students and fostering challenging and rewarding careers for newly RNs. CONCLUSION: if nurses employed by nursing homes are not fit for purpose, the consequences for the wider health and social-care system are significant. Nursing homes, the NHS, educational and local authorities need to work together to provide challenging and rewarding career paths for RNs and evaluate them. Without well-trained, motivated staff, a high-quality care sector will remain merely an aspiration.

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Health Care Innovation and Quality Assurance

Culture change in care homes: development and facilitation
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D. Wild and A. Kydd.
Nurs Older People 2016 Sep 29;28(8):31-37

This article is the second of a two-part series that explores a programme of culture change in care homes. In this article, the authors describe their independent development and facilitation of a flexible learning programme for care homes, designed to meet a quality improvement request made by a care home company. The two selected care homes’ staff conducted a review of their care culture, as a precursor to their creation of a new care philosophy. These activities provided a firm foundation from which the homes could, in theory, become a Remedial Enterprise Active Learning care home. Although the learning programme was not completed due to unavoidable circumstances, the staff’s experiences highlight some of the challenges and successes that may be experienced when seeking to improve care homes’ learning culture and practice.

An Interim Analysis of an Advance Care Planning Intervention in the Nursing Home Setting
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S. E. Hickman, K. T. Unroe, M. T. Ersek, B. Buente, A. Nazir and G. A. Sachs.
J Am Geriatr Soc 2016 Sep 27

OBJECTIVES: To describe processes and preliminary outcomes from the implementation of a systematic advance care planning (ACP) intervention in the nursing home setting. DESIGN: Specially trained project nurses were embedded in 19 nursing homes and engaged in ACP as part of larger demonstration project to reduce potentially avoidable hospitalizations. SETTING: Nursing homes. PARTICIPANTS: Residents enrolled in the demonstration project for a minimum of 30 days between August 2013 and December 2014 (n = 2,709) and residents currently enrolled in March 2015 (n = 1,591). MEASUREMENTS: ACP conversations were conducted with residents, families, and the legal representatives of incapacitated residents using a structured ACP interview guide with the goal of offering ACP to all residents. Project nurses reviewed their roster of currently enrolled residents in March 2015 to capture barriers to engaging in ACP. RESULTS: During the initial implementation phase, 27% (731/2,709) of residents had participated in one or more ACP conversations with a project nurse, resulting in a change in documented treatment preferences for 69% (504/731). The most common change (87%) was the generation of a Physician Orders for Scope of Treatment form. The most frequently reported barrier to ACP was lack of time. CONCLUSION: The time- and resource-intensive nature of robust ACP must be anticipated when systematically implementing ACP in the nursing home setting. The fact that these conversations resulted in changes over 2/3 of the time reinforces the importance of deliberate, systematic ACP to ensure that current treatment preferences are known and documented so that these preferences can be honored.

Exploring the Effect of Educating Certified Nursing Assistants on Pressure Ulcer Knowledge and Incidence in a Nursing Home Setting.
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C. L. Wogamon.
Ostomy Wound Manage 2016 Sep;62(9):42-50

The certified nursing assistant (CNA) is the caregiver who frequently identifies the first signs and symptoms of pressure ulcers (PUs) in the long-term care setting. A quality improvement effort was implemented to explore the effect of a 1-hour CNA education program about early identification, treatment, and prevention of PUs on PU knowledge, PU incidence, and PU prevention interventions, including skin checks. All 33 CNAs employed in a care facility for residents 55+ years old were invited to participate. CNA demographic and PU education variables were obtained. PU knowledge was assessed using the Pressure Ulcer Toolkit questionnaire before, immediately after, and 3 months following the educational intervention about PU prevention. PU incidence data were abstracted from monthly quality assurance reports for the 3 months pre-intervention and 3 months post intervention. Patient medical records were mined for data on turning/repositioning, skin checks, and informing care staff of suspicious areas of skin for the 3 months pre- and post educational intervention. Data for percent of short-stay residents (< 90 days) with PUs were collected via the quarterly Medicare Nursing Home Compare Quality Measures report for this facility before and 3 months after the educational intervention. Pre-intervention and post-intervention PU incidence was statistically analyzed using the t-test. The CNA demographic survey was administered using an anonymous pencil-and-paper format and hand-tabulated by the primary investigator. Of the 31 CNAs surveyed (mean age 32 years [range 18-65], mean years of experience 7.7 years [SD = 8.1, range 0.5-40], 26 (84%) reported they received training regarding PU prevention in the classroom during their initial CNA training, and 81% received on-the-job training at some point in their careers regarding PU prevention. The Quality Indicator report showed a reduction from 5 PUs to 0 (12.3%) in the 3 months pre-intervention to 0% in the 3 months post-intervention. CNA reporting of skin breakdown increased by 68% from 8 reports to 17. CNA training regarding PU identification and prevention measures did not significantly improve knowledge scores, but the rate of PU development was significantly lower and the number of documented skin assessments and PU interventions higher after the education program. Additional studies to evaluate the effect of CNA education on the rate of PU development in nursing homes are warranted.

Development and validation of a survey to measure features of clinical networks
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B.B. Brown, M. Haines, S. Middleton, et al.
BMC Health Services Research 2016;16(1):1-11

Networks of clinical experts are increasingly being implemented as a strategy to improve health care processes and outcomes and achieve change in the health system. Few are ever formally evaluated and, when this is done, not all networks are equally successful in their efforts. There is a need to formatively assess the strategic and operational management and leadership of networks to identify where functioning could be improved to maximise impact. This paper outlines the development and psychometric evaluation of an Internet survey to measure features of clinical networks and provides descriptive results from a sample of members of 19 diverse clinical networks responsible for evidence-based quality improvement across a large geographical region.

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Research Practice and Methodology

Code Saturation Versus Meaning Saturation: How Many Interviews Are Enough?
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M.M. Hennink, B.N. Kaiser and V.C. Marconi.
Qualitative Health Research 2016 September 25

Saturation is a core guiding principle to determine sample sizes in qualitative research, yet little methodological research exists on parameters that influence saturation. Our study compared two approaches to assessing saturation: code saturation and meaning saturation. We examined sample sizes needed to reach saturation in each approach, what saturation meant, and how to assess saturation. Examining 25 in-depth interviews, we found that code saturation was reached at nine interviews, whereby the range of thematic issues was identified. However, 16 to 24 interviews were needed to reach meaning saturation where we developed a richly textured understanding of issues. Thus, code saturation may indicate when researchers have “heard it all,” but meaning saturation is needed to “understand it all.” We used our results to develop parameters that influence saturation, which may be used to estimate sample sizes for qualitative research proposals or to document in publications the grounds on which saturation was achieved.

Reflections and Recommendations for Conducting In-Depth Interviews With People With Dementia
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E. K. Cridland, L. Phillipson, C. Brennan-Horley and K. Swaffer.
Qual Health Res 2016 Apr 6

Despite the importance and advantages of including people with dementia in research, there are various challenges for researchers and participants to their involvement. This article draws on the literature and experiences of a diverse group of authors, including a person with dementia, to provide recommendations about conducting research with people with dementia. Particular attention is given to in-depth interviews as a qualitative technique. More specifically, topics discussed include interview guide preparation, recruitment, obtaining consent/assent, conducting effective interviews, analysis and interpretation of data, effective communication of research findings, and reflections and recommendations for maintaining researcher and participant health. Given the current obstacles to participation in research of people with dementia, this is a timely article providing useful insights to promote improved outcomes using in-depth interviews.

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Aging

Urinary incontinence and mortality among older adults residing in care homes
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J. Damian, R. Pastor-Barriuso, F. J. Garcia Lopez and J. De Pedro-Cuesta.
J Adv Nurs 2016 Sep 28

AIM: To assess the association between baseline urinary incontinence and long-term, all-cause mortality. BACKGROUND: Urinary incontinence is a common disorder among older institutionalised adults, with important consequences for morbidity and quality of life. Moreover, while it is a consistent mortality marker, the extent to which this association might be causal remains controversial. DESIGN: A cohort study. METHODS: We conducted a mortality follow-up study on a cohort of 675 nursing-home residents in the city of Madrid (Spain), from their 1998-1999 baseline interviews to September 2013. Study subjects or their caregivers were asked whether the resident had experienced any involuntary leakage of urine in the preceding 14 days, with subjects being subsequently defined as continent, mildly incontinent or severely incontinent. Hazard ratios for all-cause mortality were estimated using Cox proportional hazards models. RESULTS: After a 4061 person-year follow-up (median/maximum of 4.6/15.2 years), 576 participants had died. In fully-adjusted models, urinary incontinence was associated with a twenty-four percent increased risk of all-cause mortality. There was a graded relationship across severity levels, with hazard ratios seven percent higher for mild and forty-four percent higher for severe incontinence as compared with the continent group. The adjusted mortality fraction attributable to urinary incontinence was eleven percent. CONCLUSION: It would appear that urinary incontinence is not only a marker but also a real determinant of survival in the institutionalised population. This finding, which seems plausible in a population of frail older adults, warrants further research into mechanisms that could help to elucidate this hypothesis.

Indicators of health and safety among institutionalized older adults
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M. L. Cavalcante, C. L. Borges, A. M. Moura and R. E. Carvalho.
Rev Esc Enferm USP 2016 Jul-Aug;50(4):602-609

OBJECTIVE: To identify the incidence of mortality, diarrheal diseases, scabies and falls; and the prevalence of pressure ulcers – all of which are related to the safety of institutionalized older adults. METHOD: This was a documentary retrospective study developed in a long-term residential car einstitution for older adults in the Northeast region of Brazil. The data were gathered from records of health assessment indicators filed between January 2008 and December 2015. Analysis included absolute case frequency; the sum of monthly prevalence and incidence rates; mean values of cases; and mean annual incidence and prevalence rates. RESULTS: The incidence of mortality over these nine years ranged from 9% to 13%; of acute diarrheic disease from 13% to 45%; and scabies from 21% to 63%. The prevalence of pressure ulcers ranged from 8% to 23%. Between 2012 and 2015, the incidence rate of falls without injury varied from 38% to 83%, and with injury from12% to 20%. CONCLUSION: Analysis of the health indicators revealed a high incidence of scabies and falls and a high prevalence of pressure ulcers. The identification of less than optimal rates for performance indicators can help improve the quality of nursing care.

Resident-Centered Care in 10 U.S. Nursing Homes: Residents’ Perspectives
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J. Harrison and S. Frampton.
J Nurs Scholarsh 2016 Sep 27

PURPOSE: With increased focus on resident-centered care (RCC) as an organizational imperative and a guiding principle of culture change for long-term care communities, evaluation of its success has centered primarily on the organizational perspective. METHODS: For this case report, we examine resident perspectives of RCC in 10 nursing homes across the United States that had adopted RCC as a philosophy and model of care for at least 12 months with a maximum engagement of 3 years using a phenomenological approach. FINDINGS: Qualitative findings from 20 focus groups with residents in 10 nursing homes suggest that RCC has meaning in ways that are consistent with intentions at the national and state levels to advance culture change in nursing homes, including efforts to create a more homelike environment, increase resident decision making and direction of his or her lifestyle, and put residents first. CLINICAL RELEVANCE: Residents attribute increased choice in wake and bed times, being heard by organizational leaders, and consistent staff assignment as positive changes since RCC began. However, according to residents, aspects of institutional life in nursing homes, inconsistent with RCC, remain. Residents identified three areas of improvement that would make nursing homes more resident centered. The three areas are response time, access to nature, and transparency about illness and death in the community.

Public reporting and the quality of care of German nursing homes
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A. Herr, T. V. Nguyen and H. Schmitz.
Health Policy 2016 Sep 13

OBJECTIVES: Since 2009, German nursing homes have been evaluated regularly by an external institution with quality report cards published online. We follow recent debates and argue that most of the information in the report cards does not reliably measure quality of care. However, a subset of up to seven measures does. Do these measures that reflect “risk factors” improve over time? METHOD: Using a sample of more than 3000 German nursing homes with information on two waves, we assume that the introduction of public reporting is an exogenous institutional change and apply before-after-estimations to obtain estimates for the relation between public reporting and quality. RESULTS: We find a significant improvement of the identified risk factors. Also, the two employed outcome quality indicators improve significantly. The improvements are driven by nursing homes with low quality in the first evaluation. CONCLUSION: To the extent that this can be interpreted as evidence that public reporting positively affects the (reported) quality in nursing homes, policy makers should carefully choose indicators reflecting care-sensitive quality.

Characteristics Associated with Quality of Life in Long-Term Care Residents with Dementia: A Cross-Sectional Study
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M. S. Klapwijk, M. A. Caljouw, M. J. Pieper, J. T. van der Steen and W. P. Achterberg.
Dement Geriatr Cogn Disord 2016 Sep 27;42(3-4):186-197

BACKGROUND: To determine which characteristics are associated with quality of life (QOL) in residents with moderate to very severe dementia in long-term care facilities (LTCFs). MATERIAL AND METHODS: This was a cross-sectional analysis of a cluster randomized controlled study in 12 Dutch LTCFs that enrolled 288 residents, with moderate to severe dementia assessed with the Reisberg Global Deterioration Scale (Reisberg GDS) and QOL with the QUALIDEM. Characteristics that were hypothesized to be associated with the six domains of QOL (applicable to very severe dementia) included demographic variables, activities of daily living (Katz ADL), cognitive performance (Cognitive Performance Scale; CPS), pain (Pain Assessment Checklist for Seniors with Limited Ability to Communicate; PACSLAC-D), neuropsychiatric symptoms (Neuropsychiatric Inventory-Nursing Home Version; NPI-NH) and comorbidities. RESULTS: Multivariate logistic regression modelling showed associations with age in the domain Social isolation [odds ratio, OR, 0.95 (95% confidence interval, CI, 0.91-0.99)], ADL level in the domain Positive affect [OR 0.89 (95% CI 0.83-0.95)] and the domain Social relations [OR 0.87 (95% CI 0.81-0.93)], severity of dementia in the domain Social relations [OR 0.28 (95% CI 0.12-0.62)] and in the domain Social isolation [OR 2.10 (95% CI 1.17-3.78)], psychiatric disorders in the domain Positive affect [OR 0.39 (95% CI 0.17-0.87)] and pulmonary diseases in the domain Negative affect [OR 0.14 (95% CI 0.03-0.61)] of the QUALIDEM. Neuropsychiatric symptoms were independently associated with all six domains of the QUALIDEM [OR 0.93 (95% CI 0.90-0.96) to OR 0.97 (95% CI 0.95-0.99)]. Pain was associated with the domains Care relationship [OR 0.92 (95% CI 0.84-1.00)] and Negative affect [OR 0.92 (95% CI 0.85-1.00)]. CONCLUSION: QOL in dementia is independently associated with age, ADL, dementia severity, pain, psychiatric disorders, pulmonary diseases and neuropsychiatric symptoms. It is possible to detect persons with dementia at risk for a lower QOL. This information is important for developing personalized interventions to improve QOL in persons with dementia in LTCFs.

The acceptability and feasibility of using the Adult Social Care Outcomes Toolkit (ASCOT) to inform practice in care homes
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A. Towers, N. Smith, S. Palmer, E. Welch and A. Netten.
BMC Health Services Research 2016;16(1):1-14

The Adult Social Care Outcomes Toolkit (ASCOT) measures social care related quality of life (SCRQoL) and can be used to measure outcomes and demonstrate impact across different social care settings. This exploratory study built on previous work by collecting new inter-rater reliability data on the mixed-methods version of the toolkit and exploring how it might be used to inform practice in four case study homes.

A three perspective study of the sense of home of nursing home residents: the views of residents, care professionals and relatives
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J. van Hoof, H. Verbeek, B. M. Janssen, et al.
BMC Geriatrics 2016;16(1):1-15

The sense of home of nursing home residents is a multifactorial phenomenon which is important for the quality of living. This purpose of this study is to investigate the factors influencing the sense of home of older adults residing in the nursing home from the perspective of residents, relatives and care professionals.

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Events

UofA

Integrated Knowledge Translation

23 November, 9:00 am-12:00 pm MT

In this workshop, participants will be provided with a general primer on KT, where iKT fits within KT science, and the main iKT principles. Participants will have opportunity to watch a documentary film called “Bureaucrazy”. The film was an integrated knowledge translation tool with the objective of informing policy- and decision-makers, service providers, students and other interested in improving the provision of health and social sciences in Alberta. Through discussion about the methodological, organizational, and ethical aspects of the film production and distribution, participants will examine the complexities of implementing iKT in the context of a multiple stakeholder research collaboration.

End-of-grant Knowledge Translation

23 November, 1:00-4:00 pm MT

This workshop will provide a framework for researchers interested in developing an End of Grant Knowledge Translation (KT) plan for their grant or research project. A general approach to end of grant KT will be presented with time for participants to develop their own plan. Participants are expected to bring a research project or grant to work on.

Non UofA

KT Platform of Alberta SPOR SUPPORT Unit: Workshops in Knowledge Synthesis and Knowledge Translation

$80-$90/course, 23-25 November, Lister Centre University of Alberta

The Knowledge Translation Platform of the Alberta SPOR SUPPORT Unit is presenting a series of half-day workshops in knowledge synthesis and knowledge translation. Topics include: integrated KT, end-of-grant KT, meta-analysis, clearer communication and plain language writing, using social media for KT, GRADE, community engagement lessons for KT, searching strategies for conducting systematic reviews, and research impact assessment. You may sign up for one or several of our offerings.

workshops

Cochrane Standard Author Training Workshop

$350, 23-25 November, University of Alberta

Are you thinking of undertaking a Cochrane review? Have you recently registered a review title with a Cochrane group? If so, please join us at the University of Alberta for Cochrane’s standard author training course in November 2016. Take this 2.5-day session to learn the basic skills of conducting a Cochrane review. Topics include protocols, setting your question, literature searching, study selection, assessing bias, data and analysis, formulating conclusions, and a hands-on session with the Review Manager software.

End of Grant KT Workshop

$300, 15 November, Toronto

We are pleased to offer our End of Grant Knowledge Translation (KT) Course on November 15th, 2016 (9am – 4:00pm) at the Li Ka Shing Knowledge Institute of St. Michael’s Hospital in Toronto. This course is designed to provide grant writers with the needed tools to write the KT portion of their grant applications. Course attendees will use their own grants to develop an end of grant KT plan.

21st IAGG World Congress

23-27 July 2017, San Francisco

Keynote sessions announced: Palliative Care in the Mainstream: Stepping up to the Plate the Case for Integrated Geriatric and Palliative Care Strategies, Beyond Rhetoric: Taking Global Action on Ageing, Longitudinal Studies on Aging: From Science to Policy , etc.

Online

Blending iKT and Community-Based Research in the Mental Health Arena

12 October, 2:00 pm MT

In this webinar, Dr. Erin Michalak, the founder and leader of the Collaborative RESearch Team to study psychosocial issues in Bipolar Disorder (CREST.BD) network, will share some of the lessons learned in the first decade of the network’s existence. She’ll describe what’s worked, and what hasn’t worked so well, during CREST.BD’s collective effort to meaningfully and authentically engage people with bipolar disorder and their supporters in the cycle of research and knowledge exchange.

Considering Researchers as Knowledge Translation Stakeholders: Exploring Health Researchers’ Understanding of and Experiences with KT

13 October, 10:00 am MT

Learning Objectives: Understand how the perspectives of researchers as stakeholders in the knowledge-to-action process have been examined in KT and implementation science to date; Consider the implications of new research exploring how researchers across health research pillars conceptualize and practice KT; Identify opportunities to support researcher stakeholders in engaging in integrated, theory-based, and evidence-informed knowledge-to-action processes. All registration requests must be sent to Gail Klein: KleinG@smh.ca by Wednesday, October 12 at 12:00 PM ET.

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News

New KT Blog in Manitoba Canada-flat-icon

KnowledgeNudge.com is an education and networking initiative of the Knowledge Translation Platform at Manitoba’s George & Fay Yee Centre for Healthcare Innovation. Launched in earnest in August 2016, the blog features weekly posts about all things KT, including synthesis, exchange, application & dissemination. Topics range from patient engagement, to the science of KT, to media & dissemination. Popular posts include “The Levels of Patient and Public Involvement”, “How KT Can Help Reduce Research Waste”, and “10 Tips for Researchers to Write a Good OpEd.”

New report decries “patchwork” approach to seniors care in Canada Canada-flat-icon

A new report launched by the Canadian Medical Association (CMA) shows that many seniors are falling through cracks in terms of accessing care and services due to a lack of a national approach and strategy. The report, The State of Seniors Health Care in Canada, demonstrates the need for a pan-Canadian strategy to address the health needs of Canada’s growing senior population.

Nursing homes ‘closing each week’ (UK)

Nursing homes are closing at the rate of at least one per week in England, due mainly to a shortage of nurses, official figures suggest. It means the number of nursing homes and nursing beds has fallen for the first time in five years. A total of 73 homes cancelled their registration in the first six months of 2016, the Care Quality Commission said, partly due to recruiting problems.

U.S. Just Made It a Lot Less Difficult to Sue Nursing Homes

The federal agency that controls more than $1 trillion in Medicare and Medicaid funding has moved to prevent nursing homes from forcing claims of elder abuse, sexual harassment and even wrongful death into the private system of justice known as arbitration. An agency within the Health and Human Services Department on Wednesday issued a rule that bars any nursing home that receives federal funding from requiring that its residents resolve any disputes in arbitration, instead of court.

Action through policy: Legislation supporting family caregivers Canada-flat-icon

Over the last few years, governments around the world have started taking action to improve legislative and policy supports for caregivers. As part of our research and discovery work, The Change Foundation took a closer look at some of the recent changes in legislation and policy worldwide. Although we found promising policy developments in many jurisdictions, there were three recent changes gaining momentum in the U.S., Canada, and Scotland which were the most relevant for our work.

Fail To Scale: Why Great Ideas In Health Care Don’t Thrive Everywhere (US)

Health policy advocates have sought for generations to propagate promising forms of health care organization across the country. Yet one finds repeatedly that some forms of organization that prosper in one part of the country fail to thrive in others. Is it possible that the concept of terroir also applies in health care?

What to Do When Alzheimer’s Threatens to Tear Your Family Apart (US)

Having a family member with Alzheimer’s disease is a stressful situation. According to the Alzheimer’s Association, “Dealing with Alzheimer’s can bring out many strong emotions. As the disease progresses caregiving issues can often ignite or magnify [existing] family conflicts.”

From Alzheimer’s to heart attacks, loneliness in seniors has serious health effects

The number of isolated seniors like Joe is growing as families move further apart, people live longer and the baby boomers age. Rates of loneliness and isolation follow a U-curve, peaking in early adulthood and old age, with reports suggesting that about 20% of older adults are somewhat isolated.

Dementia Nursing

The Department of Health has published Making a difference in dementia: nursing vision and strategy: refreshed edition. This strategy sets out how nurses can provide high quality compassionate care and support for people with dementia, so they can live well with dementia within all care settings, including a person’s own home.

Applying as an Assistant Professor

How should your job talk differ if you’re on the market again for a tenure-track job?

Why are academic papers rejected by journals?

Getting rejected from a journal can be emotionally traumatic, but it can also be infuriating when the reasons given appear spurious and even deliberately unhelpful. Having worked as an editor at the Royal Society of Chemistry prior to taking forensic science posts in the UK and New Zealand, Hilary Hamnett, now a lecturer in forensic toxicology at the University of Glasgow, knows the publishing process better than most.

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Resources

Free eBook: Why We Need More Canadian Health Policy in the Media Canada-flat-icon

By Noralou Roos, Kathleen O’Grady, Eileen Boriskewich, Mélanie Meloche-Holubowski, Carolyn Shimmin, Kristy Wittmeier and Nanci Armstrong

Why We Need More Canadian Health Policy in the Media is a compilation of the EvidenceNetwork.ca commentaries published in major newspapers in 2015, written by experts in the health policy field. These articles highlight the most recent evidence on a wide range of topics, including our aging population, healthcare costs and spending, mental health, pharmaceutical policy, the social determinants of health and distinctions between the Canadian and American healthcare systems among other topics.

The State of Seniors Health Care in Canada Canada-flat-icon

September 2016, Canadian Medical Association (CMA)

The purpose of this report is to assess efforts in Canada to: 1. develop and implement a pan-Canadian seniors’ strategy that would identify objectives and targets for improving seniors care; and 2. provide effective and timely care for seniors across the country.

How to reach the person inside the dementia Canada-flat-icon

CBC Radio

Feil is the creator of Validation, a method of communicating with elderly people who suffer from dementia. Its basis is a deep empathy with the person who has dementia – and the idea that patients are trying to resolve an issue from their past.

Documents on Dying with dementia (UK)

National Mental Health Dementia and Neurology Intelligence Network

Data to help policy makers and commissioners deliver high-quality end of life care to people with dementia.

Increase in the number of people dying with dementia (UK)

Public Health England

The proportion of people dying with a recorded dementia diagnosis has more than doubled since 2001.

Inequalities In Mental Health, Cognitive Impairment And Dementia Among Older People

This report, found on the UCL Institute of Health Equity website, focuses on inequalities in the experience and prevalence of poor mental health, cognitive impairment and dementia and the impact of social isolation, lack of mental stimulation and physical activity, before and after retirement, and in later old age.

Making a Difference in Dementia: Refreshed Nursing Vision and Strategy (UK)

Department of Health

The Department of Health has updated the Making a Difference in Dementia: Nursing Vision and Strategy (first published in 2013), which clarifies the role(s) and responsibilities of nurses when providing care and support for people with dementia. It explains how nurses can contribute to the provision of compassionate care and support for people with dementia, assisting them to live well with dementia in all care settings, and at home.

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Opportunities

Program Coordinator – Training and Professional Development Canada-flat-icon

Will remain open until filled

Under direction from the Assistant Director, Knowledge Translation (KT) Platform, Alberta SPOR SUPPORT unit, the Program Coordinator – Training and Professional Development will lead the Training and Professional Development program within the SPOR KT Platform, addressing the areas of knowledge synthesis, knowledge translation and implementation science. We are keen to fill this position with someone with a strong interest in and aptitude for planning and delivering innovative and high-quality training events and programs in the area of knowledge translation (including knowledge synthesis and implementation science). We are particularly interested in pursuing opportunities in online education so someone with experience in this area, or an interest in developing expertise in this area, would be ideal. Although this is a University of Alberta position we are open to applicants from across Alberta and willing to make arrangements for remote working for the right candidate.

REAL Impact Fellowship Canada-flat-icon

19 October, Nova Scotia Department of Health & Wellness in collaboration with the Nova Scotia Health Research Foundation

The REAL Impact Fellowship is a three-year, full-time paid position aimed at providing an alternate career path for Post-doctoral Fellows. The Fellow will be in a position to develop and use applied research and analytical skills with a particular focus on advanced analytics.

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