HAPPY HOLIDAYS! See you in 2017!
New TREC article by Dr. Carole Estabrooks and Dr. Jennifer Knopp-Sihota
Interventions for the Treatment of Pain in Nursing Home Residents: A Systematic Review and Meta-Analysis
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Abstract: Background More than one-half of nursing home residents experience a complex mix of pain. Despite this, assessment and treatment of pain remain inadequate. Methods Using techniques of the Cochrane Collaboration and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we assessed efficacy of interventions aimed at reducing chronic pain in nursing home residents >65 years of age. We searched for controlled trials comparing and measuring pain interventions using standardized pain scales. Two reviewers independently selected included studies, abstracted data, and assessed risk of bias. We performed meta-analyses calculating standardized mean differences (SMDs) using random effect models. Results Fourteen trials (n = 2293) were included in the meta-analysis: 7 reported nonanalgesic treatments, 4 reported analgesic treatments, 5 reported system modifications, and 2 reported educational interventions. A variety of pain scales were used, reporting outcome measures from 1 week to 1 year. Pooled results at trial completion revealed a statistically significant small treatment effect [SMD −0.33, 95% confidence interval (CI) −0.51, −0.14]. Further subgroup analysis revealed that residents receiving analgesic interventions benefited most (SMD −0.65, 95% CI −1.07, −0.23), followed by those receiving educational interventions (SMD −0.40, 95% CI −0.59, −0.21), and those receiving system modification interventions (SMD −0.26, 95% CI −0.51, −0.02). Conclusions Nonanalgesic treatment and control groups showed no statistical differences. Our findings suggest that analgesics are the most effective pain intervention and should be considered first-line therapy. Caution should be used in interpreting findings as few trials were included, risk of bias was variable, sample sizes were small, and pooled treatment effects were small to moderate.
New article by Dr. Anne-Marie Bostrom and Dr. Lars Wallin
New Graduate Nurses’ Developmental Trajectories for Capability Beliefs Concerning Core Competencies for Healthcare Professionals: A National Cohort Study on Patient-Centered Care, Teamwork, and Evidence-based Practice
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BACKGROUND: This study aimed to describe the developmental trajectories of registered nurses’ capability beliefs during their first 3 years of practice. The focus was on three core competencies for health professionals-patient-centered care, teamwork, and evidence-based practice. METHODS: A national cohort of registered nurses (n = 1,205) was recruited during their nursing education and subsequently surveyed yearly during the first 3 years of working life. The survey included 16 items on capability beliefs divided into three subscales for the assessment of patient-centered care, teamwork, and evidence-based practice, and the data were analyzed with linear latent growth modeling. RESULTS: The nurses’ capability beliefs for patient-centered care increased over the three first years of working life, their capability beliefs for evidence-based practice were stable over the 3 years, and their capability beliefs for teamwork showed a downward trend. LINKING EVIDENCE TO ACTION: Through collaboration between nursing education and clinical practice, the transition to work life could be supported and competence development in newly graduated nurses could be enhanced to help them master the core competencies. Future research should focus on determining which factors impact the development of capability beliefs in new nurses and how these factors can be developed by testing interventions.
Calls for Abstracts
CALL FOR ABSTRACTS: Through the Looking Glass: Reflecting on the Scholarship of Teaching and Learning, March 24, 2017 University of Alberta
The 9th Annual Dr. Olive Yonge Teaching and Learning Scholarship Day
The 9th Annual Dr. Olive Yonge Teaching and Learning Scholarship Day is offered by the Nursing Pedagogy, Philosophy and History Area of Excellence in collaboration with the Centre for Teaching and Learning and supported by the Faculty of Education. Subtitled Through the Looking Glass: Reflecting on the Scholarship of Teaching Learning, The Dr. Olive Yonge Teaching and Learning Scholarship Day is in honour of an exceptional teacher and scholar at the Faculty of Nursing and is in recognition of her outstanding contribution to the discipline and profession of nursing.
Grants & Awards
The Weston Brain Institute is delighted to launch our Transformational Research 2017 program to fund high-potential translational research projects with excellent preliminary data. The Weston Brain Institute will be holding a second online Program Information Session for this funding opportunity on Thursday, January 19th at 1:00 pm EST. This session is intended to provide you with comprehensive information on the application process and to provide an opportunity for open questions.
Maximum of eight awards at $3,500 each and a plaque. These professorships are accessible to relatively new and junior staff members, as well as faculty who are more established academics. Although the process is one of self-nomination, your Faculty Evaluation Committee may want to consider encouraging a diversity of faculty members to apply.
Two awards at $5,000 each and plaque of recognition. The purpose of the award is to recognize and honour faculty members: a) whose research contributions, both fundamental and applied, add significantly to our knowledge base, b) who are recognized nationally and internationally for what they have accomplished as scholars, and c) who set a standard of excellence for other University of Alberta faculty, graduate and undergraduate students, and for the community-at-large.
The aim of this funding opportunity is to support and create new knowledge about the effectiveness of integrating gender considerations into knowledge translation interventions involving human participants.
Abstract Aim To measure the psychometric properties, reliability and validity of a tool that explores factors influencing the adoption of principles of evidence-based in nursing practice in Jordan. Background The use of principles of evidenced-based practice in nursing practice has been widely endorsed in many countries around the world; these principles have not yet been implemented in Jordan. Factors influencing the adoption of evidence-based practice in Jordanian nursing context were not identified to date. Methods A descriptive, cross-sectional research design approached experienced nurses from different specialties across Jordan (3 military, 3 governmental and 5 private hospitals). Results The psychometric properties indicated a valid and reliable tool. It consisted of three factors: personal characteristics; source of professional knowledge; and organizational environment. Conclusions: Findings provided evidence on the impact of the identified factors on nurses’ adoption of evidence-based practice. Although tests in this report showed the validity of this new tool, it still requires further testing to ensure its stability over time.
AIM: To explore the perceptions of nurses in an acute care setting on factors influencing the effectiveness of audit and feedback. BACKGROUND: Audit and feedback is widely used and recommended in nursing to promote evidence-based practice and to improve care quality. Yet the literature has shown a limited to modest effect at most. Audit and feedback will continue to be unreliable until we learn what influences its effectiveness. METHOD: A qualitative study was conducted using individual, semi-structured interviews with 14 registered nurses in an acute care teaching hospital in Montreal, Canada. RESULTS: Three themes were identified: the relevance of audit and feedback, particularly understanding the purpose of audit and feedback and the prioritisation of audit criteria; the audit and feedback process, including its timing and feedback characteristics; and individual factors, such as personality and perceived accountability. CONCLUSION: According to participants, they were likely to have a better response to audit and feedback when they perceived that it was relevant and that the process fitted their preferences. IMPLICATIONS FOR NURSING MANAGEMENT: This study benefits nursing leaders and managers involved in quality improvement by providing a better understanding of nurses’ perceptions on how best to use audit and feedback as a strategy to promote evidence-based practice.
Psychometric properties of implementation measures for public health and community settings and mapping of constructs against the Consolidated Framework for Implementation Research: a systematic review
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BACKGROUND: Recent reviews have synthesised the psychometric properties of measures developed to examine implementation science constructs in healthcare and mental health settings. However, no reviews have focussed primarily on the properties of measures developed to assess innovations in public health and community settings. This review identified quantitative measures developed in public health and community settings, examined their psychometric properties, and described how the domains of each measure align with the five domains and 37 constructs of the Consolidated Framework for Implementation Research (CFIR). METHODS: MEDLINE, PsycINFO, EMBASE, and CINAHL were searched to identify publications describing the development of measures to assess implementation science constructs in public health and community settings. The psychometric properties of each measure were assessed against recommended criteria for validity (face/content, construct, criterion), reliability (internal consistency, test-retest), responsiveness, acceptability, feasibility, and revalidation and cross-cultural adaptation. Relevant domains were mapped against implementation constructs defined by the CFIR. RESULTS: Fifty-one measures met the inclusion criteria. The majority of these were developed in schools, universities, or colleges and other workplaces or organisations. Overall, most measures did not adequately assess or report psychometric properties. Forty-six percent of measures using exploratory factor analysis reported >50 % of variance was explained by the final model; none of the measures assessed using confirmatory factor analysis reported root mean square error of approximation (0.95). Fifty percent of measures reported Cronbach’s alpha of 0.40). Twenty-five percent of measures reported revalidation or cross-cultural validation. The CFIR constructs most frequently assessed by the included measures were relative advantage, available resources, knowledge and beliefs, complexity, implementation climate, and other personal resources (assessed by more than ten measures). Five CFIR constructs were not addressed by any measure. CONCLUSIONS: This review highlights gaps in the range of implementation constructs that are assessed by existing measures developed for use in public health and community settings. Moreover, measures with robust psychometric properties are lacking. Without rigorous tools, the factors associated with the successful implementation of innovations in these settings will remain unknown.
The success of integrated care interventions is highly dependent on the internal and collective capabilities of the organizations in which they are implemented. Yet, organizational capabilities are rarely described, understood, or measured with sufficient depth and breadth in empirical studies or in practice. Assessing these capabilities can contribute to understanding why some integrated care interventions are more effective than others. We identified, organized, and assessed survey instruments that measure the internal and collective organizational capabilities required for integrated care delivery. We conducted an expert consultation and searched Medline and Google Scholar databases for survey instruments measuring factors outlined in the Context and Capabilities for Integrating Care Framework. A total of 58 instruments were included in the review and assessed based on their psychometric properties, practical considerations, and applicability to integrated care efforts. This study provides a bank of psychometrically sound instruments for describing and comparing organizational capabilities. Greater use of these instruments across integrated care interventions and studies can enhance standardized comparative analyses and inform change management. Further research is needed to build an evidence base for these instruments and to explore the associations between organizational capabilities and integrated care processes and outcomes.
BACKGROUND: In order to better understand how to improve evidence-based decision making (EBDM) in state health departments, measurement tools are needed to evaluate changes in EBDM. The purpose of this study was to test the psychometric properties of a new measurement tool to assess EBDM in public health practice settings. METHODS: A questionnaire was developed, pilot-tested and refined in an iterative process with the input of public health practitioners with the aim of identifying a set of specific measures representing different components of EBDM. Data were collected in a national survey of state health department chronic disease practitioners. The final dataset (n=879) for psychometric testing was comprised of 19 EBDM items that were first examined using exploratory factor analysis, and then confirmatory factor analysis. RESULTS: The final model from confirmatory factor analysis includes five latent factors representing components of EBDM: capacity for evaluation, expectations and incentives for EBDM, access to evidence and resources for EBDM, participatory decision making, and leadership support and commitment. CONCLUSIONS: This study addresses the need for empirically tested and theory-aligned measures that may be used to assess the extent to which EBDM is currently implemented, and further, to gauge the success of strategies to improve EBDM, in public health settings. This EBDM measurement tool may help identify needed supports for enhanced capacity and implementation of effective strategies.
BACKGROUND: There is a significant potential for e-health to deliver cost-effective, quality health care, and spending on e-health systems by governments and healthcare systems is increasing worldwide. However, there remains a tension between the use of e-health in this way and implementation. Furthermore, the large body of reviews in the e-health implementation field, often based on one particular technology, setting or health condition make it difficult to access a comprehensive and comprehensible summary of available evidence to help plan and undertake implementation. This review provides an update and re-analysis of a systematic review of the e-health implementation literature culminating in a set of accessible and usable recommendations for anyone involved or interested in the implementation of e-health. METHODS: MEDLINE, EMBASE, CINAHL, PsycINFO and The Cochrane Library were searched for studies published between 2009 and 2014. Studies were included if they were systematic reviews of the implementation of e-health. Data from included studies were synthesised using the principles of meta-ethnography, and categorisation of the data was informed by the Consolidated Framework for Implementation Research (CFIR). RESULTS: Forty-four reviews mainly from North America and Europe were included. A range of e-health technologies including electronic medical records and clinical decision support systems were represented. Healthcare settings included primary care, secondary care and home care. Factors important for implementation were identified at the levels of the following: the individual e-health technology, the outer setting, the inner setting and the individual health professionals as well as the process of implementation. CONCLUSION: This systematic review of reviews provides a synthesis of the literature that both acknowledges the multi-level complexity of e-health implementation and provides an accessible and useful guide for those planning implementation. New interpretations of a large amount of data across e-health systems and healthcare settings have been generated and synthesised into a set of useable recommendations for practice. This review provides a further empirical test of the CFIR and identifies areas where additional research is necessary.
BACKGROUND: The translation of healthcare research into practice is typically challenging and limited in effectiveness. The Theoretical Domains Framework (TDF) identifies 12 domains of behaviour determinants which can be used to understand the principles of behavioural change, a key factor influencing implementation. The Accelerated Chest pain Risk Evaluation (ACRE) project has successfully translated research into practice, by implementing an intervention to improve the assessment of low to intermediate risk patients presenting to emergency departments (EDs) with chest pain. The aims of this paper are to describe use of the TDF to determine which factors successfully influenced implementation and to describe use of the TDF as a tool to evaluate implementation efforts and which domains are most relevant to successful implementation. METHODS: A 30-item questionnaire targeting clinicians was developed using the TDF as a guide. Questions encompassed ten of the domains of the TDF: Knowledge; Skills; Social/professional role and identity; Beliefs about capabilities; Optimism; Beliefs about consequences; Intentions; Memory, attention and decision processes; Environmental context and resources; and Social influences. RESULTS: Sixty-three of 176 stakeholders (36 %) responded to the questionnaire. Responses for all scales showed that respondents were highly favourable to all aspects of the implementation. Scales with the highest mean responses were Intentions, Knowledge, and Optimism, suggesting that initial education and awareness strategies around the ACRE project were effective. Scales with the lowest mean responses were Environmental context and resources, and Social influences, perhaps highlighting that implementation planning could have benefitted from further consideration of the factors underlying these scales. CONCLUSIONS: The ACRE project was successful, and therefore, a perfect case study for understanding factors which drive implementation success. The overwhelmingly positive response suggests that it was a successful programme and likely that each of these domains was important for the implementation. However, a lack of variance in the responses hampered us from concluding which factors were most influential in driving the success of the implementation. The TDF offers a useful framework to conceptualise and evaluate factors impacting on implementation success. However, its broad scope makes it necessary to tailor the framework to allow evaluation of specific projects.
BACKGROUND: To improve knowledge utilization in policymaking, alignment between researchers and policymakers during knowledge production is essential, but difficult to maintain. In three previously reported case studies, we extensively evaluated complex research projects commissioned by policymakers to investigate how alignment is achieved in a research process and to discover ways to enhance knowledge contributions to health policy. In the present study, we investigated how the findings of these three research projects could be integrated into a practical tool for researchers to enhance their contribution to evidence-based policy. METHODS: A cross-case analysis was conducted to integrate the findings of the evaluation of the three research projects and to identify important alignment areas in these projects. By means of an iterative process, we prepared a tool that includes reflection questions for researchers. The “Research for Policy” tool was tested with input from the project managers of three new research projects. Based on the findings, the final version of the Research for Policy tool was prepared. RESULTS: By cross-case analysis of the three case studies, the following important alignment areas were identified: the goal, quality, relevance, timing, and presentation of research, the tasks and authorities of actors, the consultative structure and vertical alignment within organizations, and the organizational environment. The project managers regarded the Research for Policy tool as a useful checklist for addressing the important alignment areas in a research project. Based on their feedback, the illustrative examples from the case studies were added to the reflection questions. The project managers suggested making the tool accessible not only to researchers but also to policymakers. The format of the Research for Policy tool was further adjusted to users’ needs by adding clickable links. CONCLUSIONS: Alignment between research and policymaking requires continuous efforts and a clear understanding of process issues in the research project. The Research for Policy tool offers practical alignment guidance and facilitates reflection on process issues, which supports researchers in aligning with policymakers and in acting in a context-sensitive way.
A theory-based process evaluation alongside a randomised controlled trial of printed educational messages to increase primary care physicians’ prescription of thiazide diuretics for hypertension
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BACKGROUND: Pragmatic trials of implementation interventions focus on evaluating whether an intervention changes professional behaviour under real-world conditions rather than investigating the mechanism through which change occurs. Theory-based process evaluations conducted alongside pragmatic randomised trials address this by assessing whether the intervention changes theoretical constructs proposed to mediate change. The Ontario Printed Educational Materials (PEM) cluster trial was designed to increase family physicians’ guideline-recommended prescription of thiazide diuretics. The trial found no intervention effect. Using the theory of planned behaviour (TPB), we hypothesised that changes in thiazide prescribing would be reflected in changes in intention, consistent with changes in attitude and subjective norm, with no change to their perceived behavioural control (PBC), and tested this alongside the RCT. METHODS: We developed and sent TPB postal questionnaires to a random sub-sample of family physicians in each trial arm 2 months before and 6 months after dissemination of the PEMs. We used analysis of covariance to test for group differences using a 2 x 3 factorial design. We content-analysed an open-ended question about perceived barriers to thiazide prescription. Using control group data, we tested whether baseline measures of TPB constructs predicted self-reported thiazide prescribing at follow-up. RESULTS: Four hundred twenty-six physicians completed pre- and post-intervention questionnaires. Baseline scores on measures of TPB constructs were high: intention mean = 5.9 out of 7 (SD = 1.4), attitude mean = 5.8 (SD = 1.1), subjective norm mean = 5.8 (SD = 1.1) and PBC mean = 6.2 (SD = 1.0). The arms did not significantly differ post-intervention on any of the theory-based constructs, suggesting a possible ceiling effect. Content analysis of perceived barriers suggested post-intentional barriers to prescribing thiazides most often focused on specific patient clinical characteristics and potential side effects. Baseline intention (beta = 0.63, p < 0.01) but not PBC (beta = 0.04, p = 0.78) predicted 42.6 % of the variance in self-reported behaviour at follow-up in the control group. CONCLUSIONS: Congruent with the Ontario Printed Educational Messages trial results and aligned with the TPB, we saw no impact of the intervention on any TPB constructs. The theoretical basis of this evaluation suggests possible explanations for the failure of the PEM intervention to change professional behaviour, which can directly inform the design and content of future theory-based PEM interventions to change professional behaviour.
BACKGROUND: Suboptimal prescribing and medications use is a problem for health systems globally. Systematic reviews are a comprehensive resource that can help guide evidence-informed decision-making and implementation of interventions addressing such issues; however, a barrier to the use of systematic reviews is their inaccessibility (due to both dispersion across journals and inaccessibility of content). Publicly available databases, such as Rx for Change, provide quick access to summaries of appraised systematic reviews of professional and consumer-oriented interventions to improve prescribing behaviour and appropriate medication use, and may help maximise the use of evidence to inform decisions. The present study aims to evaluate a training program to improve attitudes towards, confidence in skills, intentions to use, and use of systematic review evidence contained within Rx for Change. METHODS: Guided by the Knowledge to Action framework, a training program with content customised to local provider and consumer contexts was developed with knowledge user input. The training program consisted of a 6 minute information video, a 1 hour workshop with hands-on, interactive and didactic components, and two post-training reminders. Forty-nine people from five medicines-focused organisations in Canada and Australia attended one of six workshops. Participants were surveyed immediately pre and post and 3 months after training to evaluate their attitudes towards, confidence in skills, intentions to use, and use of Rx for Change, and attitudes towards and confidence in skills for using evidence for decision-making. Analyses for differences for each of the outcomes at three time points (pre, post and 3 months after training) was performed using a random effects model. RESULTS: Immediately post-training, there were higher respondent attitudes towards Rx for Change (mean increase = 0.54 out of 5, 95% CI, 0.18-0.83, P < 0.005); intention to use Rx for Change (0.53, 95% CI, 0.21-0.86, P < 0.005); confidence in skills for using Rx for Change (2.08, 95% CI, 1.74-2.42, P < 0.005); and confidence in skills for using evidence in policy decision-making (0.50, 95% CI, 0.22-0.77, P < .005) compared to pre-training. Confidence in skills for using both Rx for Change and evidence were maintained 3 months after training (both P < 0.005). CONCLUSIONS: Participants of this training program reported sustained improvements in their confidence in skills for using evidence in policy decision-making. This may have important implications for uptake of systematic review evidence promoting improved prescribing and medication use.
BACKGROUND AND OBJECTIVES: Inadequate pain treatment leaves hospitalized children vulnerable to immediate and long-term sequelae. A multidimensional knowledge translation intervention (ie, the Evidence-based Practice for Improving Quality [EPIQ]) improved pain assessment, management, and intensity outcomes in 16 units at 8 Canadian pediatric hospitals. The sustained effectiveness of EPIQ over time is unknown, however. The goals of this study were to determine the following: (1) sustainability of the impact of EPIQ on pain assessment, management, and intensity outcomes 12, 24, and 36 months after EPIQ; (2) effectiveness of a pain practice change booster (Booster) intervention to sustain EPIQ outcomes over time; and (3) influence of context on sustainability. METHODS: A prospective, repeated measures, cluster randomized controlled trial was undertaken in the 16 EPIQ units, 12 months after EPIQ completion, to determine the effectiveness of a practice change booster (Booster) to sustain EPIQ outcomes. Generalized estimating equation models examined outcomes controlling for child and unit contextual factors. RESULTS: Outcomes achieved during EPIQ were sustained in the use of any pain assessment measure (P = .01) and a validated pain assessment measure in the EPIQ units (P = .02) up to 36 months after EPIQ. Statistically significant improvements in pain management practices persisted in EPIQ units; results varied across time. There were no significant differences in outcomes after implementation of the Booster between the Booster and Nonbooster groups. CONCLUSIONS: Improved pain assessment and management practices were sustained after EPIQ; however, the Booster did not seem to provide additional impact.
No abstract available.
BACKGROUND: Much of the research and theorising in the knowledge translation (KT) field has focused on clinical settings, providing little guidance to those working in community settings. In this study, we build on previous research in community-based KT by detailing the theory driven and empirically-informed CollaboraKTion framework. METHODS: A case study design and ethnographic methods were utilised to gain an in-depth understanding of the processes for conducting a community-based KT study as a means to distilling the CollaboraKTion framework. Drawing on extensive field notes describing fieldwork observations and interactions as well as evidence from the participatory research and KT literature, we detail the processes and steps undertaken in this community-based KT study as well as their rationale and the challenges encountered. In an effort to build upon existing knowledge, Kitson and colleagues’ co-KT framework, which provides guidance for conducting KT aimed at addressing population-level health, was applied as a coding structure to inform the current analysis. This approach was selected because it (1) supported the application of an existing community-based KT framework to empirical data and (2) provided an opportunity to contribute to the theory and practice gaps in the community-based KT literature through an inductively derived empirical example. RESULTS: Analysis revealed that community-based KT is an iterative process that can be viewed as comprising five overarching processes: (1) contacting and connecting; (2) deepening understandings; (3) adapting and applying the knowledge base; (4) supporting and evaluating continued action; and (5) transitioning and embedding as well as several key elements within each of these processes (e.g. building on existing knowledge, establishing partnerships). These empirically informed theory advancements in KT and participatory research traditions are summarised in the CollaboraKTion framework. We suggest that community-based KT researchers place less emphasis on enhancing uptake of specific interventions and focus on collaboratively identifying and creating changes to the contextual factors that influence health outcomes. CONCLUSIONS: The CollaboraKTion framework can be used to guide the development, implementation and evaluation of contextually relevant, evidence-informed initiatives aimed at improving population health, amid providing a foundation to leverage future research and practice in this emergent KT area.
Abstract The roots of knowledge transfer (KT) can be traced back to the 1960s and the development of conceptual frameworks to improve the use of research from theory into practice. Its relevance to occupational safety and health (OSH) is clear in that often practitioners are aiming to transfer knowledge to employees to reduce health or safety risks in the working environment. This paper examines methodologies and tools that can be used for KT in the organizational context and identified those that were most relevant in OSH. The methodology development process is described within the paper which used the Diffusion of Innovations theory as a framework to describe the type of knowledge being transferred, the persuasion route used, the decision of whether new knowledge was adopted, how the KT was implemented and how success or failure of an intervention could be assessed. Using this framework structured interviews and shorter employee surveys were developed to evaluate KT in an organizational setting after an OSH intervention. In addition, further questions were developed using KT tools to describe the properties of the knowledge transferred, the level of media richness and its appropriateness in a given context and examination of the methods used within a sender receiver framework. The methodology development process allowed the production of a question set to enable the research team to interview and survey stakeholders involved in OSH interventions in the workplace.; AbstractThe roots of knowledge transfer (KT) can be traced back to the 1960s and the development of conceptual frameworks to improve the use of research from theory into practice. Its relevance to occupational safety and health (OSH) is clear in that often practitioners are aiming to transfer knowledge to employees to reduce health or safety risks in the working environment. This paper examines methodologies and tools that can be used for KT in the organizational context and identified those that were most relevant in OSH. The methodology development process is described within the paper which used the Diffusion of Innovations theory as a framework to describe the type of knowledge being transferred, the persuasion route used, the decision of whether new knowledge was adopted, how the KT was implemented and how success or failure of an intervention could be assessed. Using this framework structured interviews and shorter employee surveys were developed to evaluate KT in an organizational setting after an OSH intervention. In addition, further questions were developed using KT tools to describe the properties of the knowledge transferred, the level of media richness and its appropriateness in a given context and examination of the methods used within a sender receiver framework. The methodology development process allowed the production of a question set to enable the research team to interview and survey stakeholders involved in OSH interventions in the workplace.
OBJECTIVES: Funding bodies, policy makers, researchers and clinicians are seeking strategies to increase the translation of knowledge between research and practice. Participatory research encompasses a range of approaches for clinicians’ involvement in research in the hope of increasing the relevance and usability of research. Our aim was to explore how knowledge is translated and integrated in participants’ presentations and negotiations about knowledge. METHODS: Twelve collaboration meetings were observed, and discussions between researchers and clinicians were recorded. The material was examined using the following analytical terms: knowledge object, knowledge form, knowledge position and knowledge tasks. RESULTS: We identified a recurring rhetorical pattern in translational processes that we call ‘relevance testing’: a strategy by which the participants attempt to create coherence and identify relevance across different contexts. The limitation of this translational strategy was a tendency to reinforce a ‘two-communities’ logic: re-establishing the separated worlds and rationales between clinicians and researchers. The ‘translational work’ that unfolds during discussions remains implicit. It may be that participants are unable to explicitly address and identify the knowledge translation processes because they lack necessary conceptual tools. CONCLUSIONS: Our results contribute to increased awareness about translational processes and provide a language through which barriers to translation can be addressed.
Introduction: Data quality and fitness for analysis are crucial if outputs of analyses of electronic health record data or administrative claims data should be trusted by the public and the research community. Methods: We describe a data quality analysis tool (called Achilles Heel) developed by the Observational Health Data Sciences and Informatics Collaborative (OHDSI) and compare outputs from this tool as it was applied to 24 large healthcare datasets across seven different organizations. Results: We highlight 12 data quality rules that identified issues in at least 10 of the 24 datasets and provide a full set of 71 rules identified in at least one dataset. Achilles Heel is a freely available software that provides a useful starter set of data quality rules with the ability to add additional rules. We also present results of a structured email-based interview of all participating sites that collected qualitative comments about the value of Achilles Heel for data quality evaluation. Discussion: Our analysis represents the first comparison of outputs from a data quality tool that implements a fixed (but extensible) set of data quality rules. Thanks to a common data model, we were able to compare quickly multiple datasets originating from several countries in America, Europe and Asia.
Health Care Administration and Organization
The aim of this study was to explore Taiwanese nurses’ LTC competence and to examine its relationship with their LTC-related knowledge, care intention, and practical experience. The total sampling was selected from nurses who participated in a 2013 LTC course offered by the Ministry of Health and Welfare. Participants in this study (n = 122) voluntarily provided email addresses and responded to an online survey. A self-developed scale with acceptable reliability and validity was used for data collection. Findings from this study showed median high levels of LTC nursing competence, which was found to be positively correlated with LTC knowledge, care intention, practical experience, continuing education, and marital status. The study revealed that through on-the-job training, nurses’ LTC knowledge, care intention, practical experience and nursing competence can be improved, which will benefit the quality of care for LTC clients.
CONTEXT: Deficits in quality end-of-life care for nursing home (NH) residents are well known. Palliative care is promoted as an approach to improve quality. The Palliative Care Survey (PCS) is designed to measure NH staff palliative care knowledge and practice. OBJECTIVES: To comparing palliative care knowledge and practices across NH staff roles using the PCS, and to examine relationships between facility characteristics and PCS scores. METHODS: The PCS was administered to frontline NH staff-certified nursing assistants (CNAs), licensed practical nurses (LPNs), registered nurses (RNs), and social workers (SWs)-in 51 facilities in 2012. Descriptive statistics were calculated by job role. Linear mixed effects models were used to identify facility and individual factors associated with palliative care practice and knowledge. RESULTS: The analytic sample included 1200 surveys. CNAs had significantly lower practice and knowledge scores compared to LPNs, RNs, and SWs (P < 0.05). LPNs had significantly lower psychological, end-of-life, and total knowledge scores than RNs (P < 0.05 for all). Although knowledge about physical symptoms was uniformly high, end-of-life knowledge was notably low for all staff. A one-point higher facility star rating was significantly associated with a 0.06 increase in family communication score (P = 0.003; 95% CI: 0.02-0.09; SE = 0.02). Higher penetration of hospice in the NH was associated with higher end-of-life knowledge (P = 0.003; parameter estimate = 0.006; 95% CI: 0.002-0.010; SE = 0.002). Sixty-two percent of respondents stated that, with additional training, they would be interested in being leaders in palliative care. CONCLUSION: Given observed differences in palliative care practice and knowledge scores by staff training, it appears the PCS is a useful tool to assess NH staff. Low end-of-life knowledge scores represent an important target for quality improvement.
BACKGROUND: Although physicians are responsible for writing the antipsychotic prescriptions for patients with dementia, the initiative is often taken by nurses or nursing assistants. To reduce antipsychotics uses, one needs to understand the reasons for nurses and nursing assistants to request them. This study gives an overview of the influencing factors for this request based on the Theory of Planned Behavior in which attitude, beliefs, and behavioral control is thought to influence the intention to request, which in turn affects the behavior to request for a prescription. METHODS: Eighty-one nurses and nursing assistants of one Dutch nursing home organization completed an online survey. RESULTS: Nurses and nursing assistants frequently agreed on items related to the positive effects of antipsychotics for the resident and for the staff. Nurses and nursing assistants with a lower job satisfaction were more likely to call for antipsychotics. Having more positive beliefs about treatment effects and feel of being more in control toward asking for antipsychotics were positively associated with intention to call. All variables explained 59% of the variance of intention. The current position (nurse/nursing assistant) was associated with actual behavior to call. The explained variance was 25%. CONCLUSIONS: Policy-makers should focus on the nurses’ and nursing assistants’ belief in positive effects of antipsychotics for the resident, which is not in line with available evidence. Nurses and nursing assistants should be educated about the limited effectiveness of antipsychotics.
Between 75 and 89% of residents living in long-term care facilities have limited mobility. Nurses as well as other licensed and unlicensed personnel directly involved in resident care are in a key position to promote and maintain the mobility of care-dependent persons. This requires a certain level of competence. Kinaesthetics is a training concept used to increase nursing staff’s interaction and movement support skills for assisting care-dependent persons in their daily activities. This study aims to develop and test an observation instrument for assessing nursing staff’s competences in kinaesthetics.
The shortage of core direct care workers (DCWs, including nurses and nursing assistants) in the residential aged care (RAC) industry is a worldwide phenomenon. Despite burgeoning international literature on employment outcomes (i.e. turnover and intention to stay or leave) of DCWs, there is little research exploring multiple predictive models of employment outcomes with Australian samples, and limited Australian evidence regarding the perspectives of nursing assistants and overseas born DCWs. The current research fills these gaps by describing and exploring factors associated with employment outcomes of DCWs in Australian RAC facilities. Guided by the Job Demand-Control-Support (JDCS) model, the sequential mixed methods research design comprised three studies that explored different domains of the problem. Findings from earlier studies informed the development of methods for the later studies.
OBJECTIVES: Healthcare workers have high rates of low back pain (LBP) related to handling patients. A large chain of nursing homes experienced reduced biomechanical load, compensation claims and costs following implementation of a safe resident handling programme (SRHP). The aim of this study was to examine whether LBP similarly declined and whether it was associated with relevant self-reported occupational exposures or personal health factors. METHODS: Worker surveys were conducted on multiple occasions beginning with the week of first SRHP introduction (baseline). In each survey, the outcome was LBP during the prior 3 months with at least mild severity during the past week. Robust Poisson multivariable regression models were constructed to examine correlates of LBP cross-sectionally at 2 years (F3) and longitudinally at 5-6 years (F5) post-SRHP implementation among workers also in at least one prior survey. RESULTS: LBP prevalence declined minimally between baseline and F3. The prevalence was 37% at F3 and cumulative incidence to F5 was 22%. LBP prevalence at F3 was positively associated with combined physical exposures, psychological job demands and prior back injury, while frequent lift device usage and ‘intense’ aerobic exercise frequency were protective. At F5, the multivariable model included frequent lift usage at F3 (relative risk (RR) 0.39 (0.18 to 0.84)) and F5 work-family imbalance (RR=1.82 (1.12 to 2.98)). CONCLUSIONS: In this observational study, resident lifting device usage predicted reduced LBP in nursing home workers. Other physical and psychosocial demands of nursing home work also contributed, while frequent intense aerobic exercise appeared to reduce LBP risk.
BACKGROUND AND OBJECTIVE: Ongoing shortages of care workers, together with an ageing population, make it of utmost importance to increase the quality of working life in nursing homes. Since the 1970s, normalised and small-scale nursing homes have been increasingly introduced to provide care in a family and homelike environment, potentially providing a richer work life for care workers as well as improved living conditions for residents. ‘Normalised’ refers to the opportunities given to residents to live in a manner as close as possible to the everyday life of persons not needing care. The study purpose is to provide a synthesis and overview of empirical research comparing the quality of working life – together with related work and health outcomes – of professional care workers in normalised small-scale nursing homes as compared to conventional large-scale ones. DESIGN: A systematic review of qualitative and quantitative studies. DATA SOURCES: A systematic literature search (April 2015) was performed using the electronic databases Pubmed, Embase, PsycInfo, CINAHL and Web of Science. References and citations were tracked to identify additional, relevant studies. REVIEW METHODS: We identified 825 studies in the selected databases. After checking the inclusion and exclusion criteria, nine studies were selected for review. Two additional studies were selected after reference and citation tracking. Three studies were excluded after requesting more information on the research setting. RESULTS: The findings from the individual studies suggest that levels of job control and job demands (all but “time pressure”) are higher in normalised small-scale homes than in conventional large-scale nursing homes. Additionally, some studies suggested that social support and work motivation are higher, while risks of burnout and mental strain are lower, in normalised small-scale nursing homes. Other studies found no differences or even opposing findings. The studies reviewed showed that these inconclusive findings can be attributed to care workers in some normalised small-scale homes experiencing isolation and too high job demands in their work roles. CONCLUSION: This systematic review suggests that normalised small-scale homes are a good starting point for creating a higher quality of working life in the nursing home sector. Higher job control enables care workers to manage higher job demands in normalised small-scale homes. However, some jobs would benefit from interventions to address care workers’ perceptions of too low social support and of too high job demands. More research is needed to examine strategies to enhance these working life issues in normalised small-scale settings.
Health Care Innovation and Quality Assurance
BACKGROUND: Effective communication between residents with dementia and care providers in long-term care homes (LTCHs) is essential to resident-centered care. PURPOSE: To determine the effects of a communication intervention on residents’ quality of life (QOL) and care, as well as care providers’ perceived knowledge, mood, and burden. METHOD: The intervention included (1) individualized communication plans, (2) a dementia care workshop, and (3) a care provider support system. Pre- and postintervention scores were compared to evaluate the effects of the intervention. A total of 12 residents and 20 care providers in an LTCH participated in the feasibility study. RESULTS: The rate of care providers’ adherence to the communication plans was 91%. Postintervention, residents experienced a significant increase in overall QOL. Care providers had significant improvement in mood and perceived reduced burden. CONCLUSION: The results suggest that the communication intervention demonstrates preliminary evidence of positive effects on residents’ QOL and care providers’ mood and burden.
In health care, executive walk rounds are used to help senior leadership engage in discussions about safety issues with frontline staff. Although prior research has demonstrated a positive impact of walk rounds on safety culture in the hospital setting, less is known about their value in other types of care settings. In this mixed methods analysis, executive walk rounds were implemented across six long-term care institutions. Leaders reported that participating in walk rounds increased their awareness around safety issues and enhanced their engagement with frontline staff. An accompanying editorial discusses the utility of walk rounds in improving the safety culture in nursing homes.
BACKGROUND: Care planning nowadays is a key activity in the provision of services to nursing home residents. A care plan describes the residents’ needs and the actions to address them, providing both individualized and standardized interventions and should be updated as changes in the residents’ conditions occur. OBJECTIVE: The aim of this review was to identify the core elements of the implementation of changes in nursing homes’ care plans, by providing an overview of the type of stakeholders involved, describing the implementation strategies used, and exploring how care plans changed. METHODS: An integrative literature review was used to evaluate intervention studies taking place in nursing homes. Data were collected from PubMed, CINHAL-EBSCO, and PsycINFO. English language articles published between 1995 and April 2015 were included. Data analysis followed the strategy of Knafl and Whittemore. RESULTS: Twenty-six articles were included. The stakeholders involved were professionals, family caregivers, and patients. Only a few studies directly involved residents and family caregivers in the quality improvement process. The implementation strategies used were technology implementation, audit, training, feedback, and supervision. The majority of interventions changed the residents’ care plans in terms of developing a more standardized care documentation that primarily focuses on its quality. Only some interventions developed more tailored care plans that focus on individualized needs. CONCLUSION: Care plans generally failed in providing both standardized and personalized interventions. Efforts should be made to directly involve residents in care planning and provide professionals with efficient tools to report care goals and actions in care plans.
Research Practice and Methodology
Since its very beginning, modern science has put images at the center of its communicative processes: drawings, diagrams, and schemes, and later photographs, satellite images, and film. In the age of digital communication, specialists and publics live constantly immersed in a visually dense environment, particularly when it comes to science and technology content. Do we have the competence to decipher all these images, often complex and elaborate? If the so-called science literacy has become a standard dimension of public understanding of science at the international level, much less studied so far is visual science literacy. We tested empirical indicators of visual science literacy in the context of three surveys (2014, 2015, and 2016) of public perception in Italy on a representative sample of the population. The results show that respondents fare generally better in recognizing images related to science than in responding to textual questions. Images could offer relevant opportunities for greater public engagement with scientific results.
BACKGROUND: Rapid reviews have the potential to overcome a key barrier to the use of research evidence in decision making, namely that of the lack of timely and relevant research. This rapid review of systematic reviews and primary studies sought to answer the question: What are the best methodologies to enable a rapid review of research evidence for evidence-informed decision making in health policy and practice? METHODS: This rapid review utilised systematic review methods and was conducted according to a pre-defined protocol including clear inclusion criteria (PROSPERO registration: CRD42015015998). A comprehensive search strategy was used, including published and grey literature, written in English, French, Portuguese or Spanish, from 2004 onwards. Eleven databases and two websites were searched. Two review authors independently applied the eligibility criteria. Data extraction was done by one reviewer and checked by a second. The methodological quality of included studies was assessed independently by two reviewers. A narrative summary of the results is presented. RESULTS: Five systematic reviews and one randomised controlled trial (RCT) that investigated methodologies for rapid reviews met the inclusion criteria. None of the systematic reviews were of sufficient quality to allow firm conclusions to be made. Thus, the findings need to be treated with caution. There is no agreed definition of rapid reviews in the literature and no agreed methodology for conducting rapid reviews. While a wide range of ‘shortcuts’ are used to make rapid reviews faster than a full systematic review, the included studies found little empirical evidence of their impact on the conclusions of either rapid or systematic reviews. There is some evidence from the included RCT (that had a low risk of bias) that rapid reviews may improve clarity and accessibility of research evidence for decision makers. CONCLUSIONS: Greater care needs to be taken in improving the transparency of the methods used in rapid review products. There is no evidence available to suggest that rapid reviews should not be done or that they are misleading in any way. We offer an improved definition of rapid reviews to guide future research as well as clearer guidance for policy and practice.
Better integration of care within the health sector and between health and social care is seen in many countries as an essential way of addressing the enduring problems of dwindling resources, changing demographics and unacceptable variation in quality of care. Current research evidence about the effectiveness of integration efforts supports neither the enthusiasm of those promoting and designing integrated care programmes nor the growing efforts of practitioners attempting to integrate care on the ground. In this paper we present a methodological approach, based on the principles of participatory research, that attempts to address this challenge. Participatory approaches are characterised by a desire to use social science methods to solve practical problems and a commitment on the part of researchers to substantive and sustained collaboration with relevant stakeholders. We describe how we applied an emerging practical model of participatory research, the researcher-in-residence model, to evaluate a large-scale integrated care programme in the UK. We propose that the approach added value to the programme in a number of ways: by engaging stakeholders in using established evidence and with the benefits of rigorously evaluating their work, by providing insights for local stakeholders that they were either not familiar with or had not fully considered in relation to the development and implementation of the programme and by challenging established mindsets and norms. While there is still much to learn about the benefits and challenges of applying participatory approaches in the health sector, we demonstrate how using such approaches have the potential to help practitioners integrate care more effectively in their daily practice and help progress the academic study of integrated care.
Abstract: Background With the growing demand for long-term care (LTC) services, it is increasingly important to explore experience with care. This study examined care satisfaction in a nursing home and at home among low-income elders in South Korea. Methods This cross-sectional study was conducted with 246 elderly recipients of welfare benefits using a proportional stratified sampling method. Two self-reported versions of a questionnaire developed for users of nursing home care and homecare were used. Results Those at home reported higher care satisfaction than those in nursing homes did. Both users of nursing home care and homecare were less satisfied with the food served. Users of nursing homes had comparatively less satisfaction regarding the daily activities available to them and less autonomy concerning their care decisions. Factors that influenced satisfaction with nursing home care and homecare were the quality of caregivers, care facilities, and physical wellbeing. Conclusions An approach focused on improving the quality of the care facilities and caregivers could help enhance care satisfaction among low-income Korean elders receiving LTC.
OBJECTIVE: Death wishes in older people are common and may progress to suicidal ideation and attempts. This study used routinely collected data from the interRAI Home Care assessment to examine the prevalence and clinical predictors of death wishes in older New Zealanders assessed for home support and long-term aged residential care. METHODS: Data were collected from 35 734 people aged over 65 during 2012-2014. Chi-squared analyses were used to determine significant relationships between the presence of death wishes and demographic factors, health and functional status, and emotional and psychosocial well-being. A three-step hierarchical logistic regression model was used to determine the predictive variables of death wishes, and odds ratios were calculated. RESULTS: Death wishes were present in 9.5% of the sample. The following factors were significantly associated with death wishes: physical health (poor self-reported health, recurrent falls, severe fatigue and inadequate pain control), psychological factors (depression, major stressors and anxiety), social factors (loneliness and decline in social activities) and impaired cognition. Depression (odds ratio = 2.54, 95% confidence interval = 2.29-2.81), loneliness (odds ratio = 2.40, 95% confidence interval = 2.20-2.63) and poor self-reported health (odds ratio = 2.34, 95% confidence interval = 1.78-3.07) had the greatest odds ratios in the full model. CONCLUSIONS: Clinically significant depression alone cannot fully account for the development of death wishes in the elderly, and several factors are independently associated with death wishes. This knowledge can help clinicians caring for older persons to identify people who are most at risk of developing death wishes.
The physical environment is of particular importance for supporting activities and interactions among older people living in residential care facilities (RCFs) who spend most of their time inside the facility. More knowledge is needed regarding the complex relationships between older people and environmental aspects in long-term care. The present study aimed to explore how the physical environment influences resident activities and interactions at two RCFs by using a mixed-method approach. Environmental assessments were conducted via the Swedish version of the Sheffield Care Environment Assessment Matrix (S-SCEAM), and resident activities, interactions and locations were assessed through an adapted version of the Dementia Care Mapping (DCM). The Observed Emotion Rating Scale (OERS) was used to assess residents’ affective states. Field notes and walk-along interviews were also used. Findings indicate that the design of the physical environment influenced the residents’ activities and interactions. Private apartments and dining areas showed high environmental quality at both RCFs, whereas the overall layout had lower quality. Safety was highly supported. Despite high environmental quality in general, several factors restricted resident activities. To optimise care for older people, the design process must clearly focus on accessible environments that provide options for residents to use the facility independently.
Institutionalized older adults are known to be at high risk of malnutrition, but few nutritional interventions have been used for older adults in long-term care (LTC) settings. The purpose of the current study was to investigate the effects of implementing a nutritional intervention involving nursing staff education, facilitation, and a shared algorithm (NIEFA) for institutionalized older adults in Korea. A quasi-experimental pre- and posttest design was used. Patients in two LTC facilities were assigned to an intervention (n = 23) or control (n = 22) group. After completion of the 4-week NIEFA program, significant improvements were found in the intervention group’s daily energy intake (t = 3.832, p < 0.001), total lymphocytes (t = 3.87, p < 0.001), hemoglobin levels (t = 4.991, p < 0.001), hematocrit levels (t = 4.305, p < 0.001), and Mini Nutritional Assessment scores (t = 10.223, p < 0.001). Implementation of NIEFA in a LTC facility may be effective in improving the nutritional status of older adults with or at risk of malnutrition.
OBJECTIVES: To describe the prevalence and epidemiology of antimicrobial use (AU) in nursing home residents. DESIGN: One-day point prevalence survey. SETTING AND PARTICIPANTS: Nine nursing homes in four states; 1,272 eligible residents. MEASUREMENT: Frequency of antimicrobials prescribed, drug name, start date, duration, route, rationale, and treatment site. AU prevalence per 100 residents overall and by resident characteristic. RESULTS: AU prevalence was 11.1% (95% confidence interval, 9.4%-12.9%) and varied by resident characteristics. Most (32%) antimicrobials were given for urinary tract infection. For 38% of AU, key prescribing information was not documented. CONCLUSION: Opportunities to improve AU documentation and prescribing exist in nursing homes.
BACKGROUND: Aging is often associated with various underlying comorbidities that warrant the use of multiple medications. Various interventions, including medication reviews, to optimize pharmacotherapy in older people residing in aged care facilities have been described and evaluated. Previous systematic reviews support the positive impact of various medication-related interventions but are not conclusive because of several factors. OBJECTIVES: The current study aimed to assess the impact of medication reviews in aged care facilities, with additional focus on the types of medication reviews, using randomized controlled trials (RCTs) and observational studies. METHODS: A systematic searching of English articles that examined the medication reviews conducted in aged care facilities was performed using the following databases: PubMed, CINAHL, IPA, TRiP, and the Cochrane Library, with the last update in December 2015. Extraction of articles and quality assessment of included articles were performed independently by 2 authors. Data on interventions and outcomes were extracted from the included studies. The SIGN checklist for observational studies and the Cochrane Collaboration’s tool for assessing risk of bias in RCTs were applied. Outcomes assessed were related to medications, reviews, and adverse events. RESULTS: Because of the heterogeneity of the measurements, it was deemed inappropriate to conduct a meta-analysis and thus a narrative approach was employed. Twenty-two studies (10 observational studies and 12 controlled trials) were included from 1141 evaluated references. Of the 12 trials, 8 studies reported findings of pharmacist-led medication reviews and 4 reported findings of multidisciplinary team-based reviews. The medication reviews performed in the included trials were prescription reviews (n = 8) and clinical medication reviews (n = 4). In the case of the observational studies, the majority of the studies (8/12 studies) reported findings of pharmacist-led medication reviews, and only 2 studies reported findings of multidisciplinary team-based reviews. Similarly, 6 studies employed prescription reviews, whereas 4 studies employed clinical medication reviews. The majority of the recommendations put forward by the pharmacist or a multidisciplinary team were accepted by physicians. The number of prescribed medications, inappropriate medications, and adverse outcomes (eg, number of deaths, frequency of hospitalizations) were reduced in the intervention group. CONCLUSION: Medication reviews conducted by pharmacists, either working independently or with other health care professionals, appear to improve the quality of medication use in aged care settings. However, robust conclusions cannot be drawn because of significant heterogeneity in measurements and potential risk for biases.
BACKGROUND: High dietary sugar intake may compromise protein and micronutrient intakes in people with low energy intakes. The results of micronutrient dilution studies in older people have been few and conflicting. We examined the nutritional status and nutrient intakes associated with nonmilk extrinsic sugars (NMES) intakes in older people representing a broad spectrum of both healthy and vulnerable older populations. DESIGN AND PARTICIPANTS: This cross-sectional study combined five Finnish data sets covering home-dwelling (n = 526) and institutionalized (n = 374) older people. Their nutritional status was assessed using Mini Nutritional Assessment (MNA) and nutrient intakes retrieved from 1- to 3-day food records. The participants were divided into quartiles corresponding to the proportions of energy received from NMES. Energy, nutrient, and fiber intakes were classified according to the NMES quartiles, and the participants were divided according to their places of residence (home, institution). RESULTS: High NMES intakes were associated with older age, female sex, poor cognition, low MNA scores, immobility, and institutionalization. In all, 90% of the participants in the highest NMES quartile (Q4) were institutionalized. In the institutionalized individuals, low protein and micronutrient intakes were observed in both those with low energy intake (Q1) and in those with very high NMES intakes (Q4). In home-dwelling individuals, the nutrient intakes tended to decline linearly with increasing NMES intakes in protein and most micronutrients. CONCLUSIONS: Institutionalized older people consumed diets high in NMES, compared with those living at home, and their low energy and high NMES intakes were associated with low protein and micronutrient intakes.
BACKGROUND: A need exits to develop a protocol for preventing pressure ulcers (PUs) in private for-profit nursing homes in Hong Kong, where the incidence of PUs is relatively high and which have high proportion of non-professional care staff. The implementation of such protocol would involve changes in the practice of care, likely evoking feelings of fear and uncertainty that may become a barrier to staff adherence. We thus adopted the Systems Model of Action Research in this study to manage the process of change for improving PU prevention care and to develop a pressure ulcer prevention protocol for private for-profit nursing homes. METHODS: A total of 474 residents and care staff who were health workers, personal care workers, and/or nurses from four private, for-profit nursing homes in Hong Kong participated in this study. Three cyclic stages and steps, namely, unfreezing (planning), changing (action), and refreezing (results) were carried out. During each cycle, focus group interviews, field observations of the care staff’s practices and inspections of the skin of the residents for pressure ulcers were conducted to evaluate the implementation of the protocol. Qualitative content analysis was adopted to analyse the data. The data and methodological triangulation used in this study increased the credibility and validity of the results. RESULTS: The following nine themes emerged from this study: prevention practices after the occurrence of PUs, the improper use of pressure ulcer prevention materials, non-compliance with several prevention practices, improper prevention practices, the perception that the preventive care was being performed correctly, inadequate readiness to use the risk assessment tool, an undesirable environment, the supplying of unfavorable resources, and various management styles in the homes with or without nurses. At the end of the third cycle, the changes that were identified included improved compliance with the revised risk assessment method, the timely and appropriate use of PU prevention materials, the empowering of staff to improve the quality of PU care, and improved home management. CONCLUSION: Through the action research approach, the care staff were empowered and their PU prevention care practices had improved, which contributed to the decreased incidence of pressure ulcers. A PU prevention protocol that was accepted by the staff was finally developed as the standard of care for such homes.
In health care policies, the right to complain is presented as a key patient right. Complaints are also seen as a potential vehicle for quality improvement. However, in long-term care facilities for older persons in the Netherlands, relatively few complaints are registered. An explorative qualitative study was performed at three long-term care facilities to examine the ways in which different relevant actors define and relate to complaints. We conducted observations and semi-structured interviews with 76 persons: residents, their family members, nurses, volunteers, middle (facility) and upper (institutional) managers and complaint handling personnel. Long-term care facilities are social contexts obeying complex social and cultural norms. There are great differences in how complaining and complaints are perceived. For most residents, ‘complaining’ had strong negative connotations: they expected it would lead to undesirable social consequences that could not outweigh possible advantages. To nurses it was important to hear of residents’ dissatisfactions but communicative aspects were challenging. Institutional managers saw complaints as ‘free advice’ they wished to use to enhance the quality of the care provision. Complaint managers underlined the procedural aspects to complaints. A more appropriate and productive policy on complaints in this health care sector should take these differences into account.
Nutritional care is a basic human right for all people. Nevertheless, undernourishment is known to be a frequent and serious health care problem among elderly hospitalized patients in Western Europe. Nutritional documentation contributes to ensuring proper nutritional treatment and care. Only a few studies have explored how nurses document nutritional care in hospitals, and between hospitals and nursing homes. Available research suggests that documentation practices are unsatisfactory. The aim of this study was to explore how nurses document nutritional treatment and care for elderly patients in hospitals and how nurses and undergraduate nurses communicate information about patientsâ€™ nutritional status when elderly patients are transferred between hospital and nursing homes.
People with advanced dementia living in care homes can experience social death before their physical death. Social death occurs when a person is no longer recognised as being an active agent within their relationships. A shift is required in how we perceive people with advanced dementia so that the ways they continue to be active in their relationships are noticed. Paying attention to embodied and interembodied selfhood broadens the scope and opportunities for relationships with people with advanced dementia, acting as a counter to social death. This has the potential to improve the quality of care, including end of life care, of people with advanced dementia in care homes. This study examined the role of embodied and interembodied selfhood within care-giving/care-receiving relationships in a specialist dementia care home. Empirical findings and their implications for the development of relationship-centred care and the Senses Framework in care homes are discussed.
Medication errors (MEs) result in preventable harm to nursing home (NH) residents and pose a significant financial burden. Institutionalized older people are particularly vulnerable because of various organizational and individual factors. This systematic review reports the prevalence of MEs leading to hospitalization and death in NH residents and the factors associated with risk of death and hospitalization. A systematic search was conducted of the relevant peer-reviewed research published between January 1, 2000, and October 1, 2015, in English, French, German, or Spanish examining serious outcomes of MEs in NHs residents. Eleven studies met the inclusion criteria and examined three types of MEs: all MEs (n = 5), transfer-related MEs (n = 5), and potentially inappropriate medications (PIMs) (n = 1). MEs were common, involving 16-27% of residents in studies examining all types of MEs and 13-31% of residents in studies examining transfer-related MEs, and 75% of residents were prescribed at least one PIM. That said, serious effects of MEs were surprisingly low and were reported in only a small proportion of errors (0-1% of MEs), with death being rare. Whether MEs resulting in serious outcomes are truly infrequent, or are underreported because of the difficulty in ascertaining them, remains to be elucidated to assist in designing safer systems.
PURPOSE OF THE STUDY: A structured interview was conducted with Medicare patients readmitted to a private, tertiary teaching hospital from skilled nursing facilities (SNFs) to assess their perspectives of readmission preventability and their role in the readmission. DESIGN AND METHODS: Data were collected at Vanderbilt University Medical Center using a 6-item interview administered at the bedside to Medicare beneficiaries with unplanned hospital readmissions from 23 SNFs within 60 days of a previous hospital discharge. Mixed analytical methods were applied, including a content analysis that evaluated factors contributing to hospital readmission as perceived by consumers. RESULTS: Among 208 attempted interviews, 156 were completed, of which 53 (34%) respondents rated their readmission as preventable. 28.3% of the 53 consumers attributed the readmission to hospital factors, 52.8% attributed it to the SNF, and 18.9% believed both sites could have prevented the readmission. The primary driver of the readmission was a family member/caregiver in 31 cases and the patient in 24 of the 156 cases, amounting to 55 (35.3%) consumer-driven readmissions. Contributing factors included: premature hospital discharge (16.3%); poor discharge planning (16.3%); a clinical issue not resolved in the hospital (14.3%); inadequate treatment at the SNF (69.4%); improper medication management at the SNF (20.4%); and poor decision-making regarding the transfer (14.3%). CONCLUSIONS AND IMPLICATIONS: Interviewing readmitted patients provides information relevant to reducing readmissions that may otherwise be omitted from hospital and SNF records. Consumers identified quality issues at both the hospital and SNF and perceived themselves as initiating a significant number of readmissions.
Ken Spears is the Canadian Country Director and Regional Vice President of Boston Scientific. He began his medical device career in 1991 with Abbott Laboratories and joined Boston Scientific Canada in 2004 as Director of Cardiology. In 2005, Ken was promoted to Canadian Country Director of Boston Scientific. He currently serves on the MEDEC Board of Directors and recently joined the EXCITE Management Board of Directors. Ken is an active health system advocate focused on improving patient outcomes, health system value for money and the evidence-based adoption of innovative health technology.
Don’t miss your chance to attend this two-day workshop organized by the Alberta SPOR Support Unit in collaboration with the McMaster Health Forum.
Session 3: Tools & Resources to Improve Prescribing – Canadian and International Perspectives
The KT Basics workshop, offered by the KT Program at St. Michael’s Hospital in Toronto, Canada, is a 1.5-day workshop designed for health professionals and students aiming to gain knowledge about the foundations of KT, focusing on the implementation of research evidence. Through interactive group activities and lectures, workshop participants will learn the fundamentals of KT, including key definitions and frameworks, how to assess and prioritize needs, select high quality evidence, and define the practice change. The cost includes the 1.5-day in-person workshop and take-home resources. Travel and accommodation in Toronto for the 1.5-day in-person workshop is not included.
EXTRA is the only fully bilingual improvement fellowship of its kind in Canada. It is grounded in the complex reality of leading and managing change in today’s health and healthcare environments.
The inappropriate use of antipsychotic drugs for the 27,000 B.C. seniors living in nursing homes has decreased but the use of antidepressants among such seniors remains high in British Columbia compared to other provinces, says B.C. seniors advocate Isobel Mackenzie.
Hospitals have long been reluctant to share with patients their assessments of which nursing homes are best because of a Medicare requirement that patients’ choices can’t be restricted. For years, many hospitals simply have given patients a list of all the skilled nursing facilities near where they live and told them which ones have room for a new patient. Patients have rarely been told which homes have poor quality ratings from Medicare or a history of public health violations, according to researchers and patient advocates.
The Department of Health’s listening programme will include different ways of gathering people’s views and experiences, both in person and online. The first part of this work is an online survey for people who have been diagnosed with dementia in the past 2 years (since November 2014), and people who provide unpaid care for them. The survey, which is open until 31 January 2017, asks about people’s experiences of dementia diagnosis, support and awareness. It has been produced in consultation with people with dementia, their carers and our partner organisations.
The Alzheimer Society Research Portal connects researchers with Canadians looking to participate in studies. This initiative will help to advance Canadian studies on Alzheimer’s disease and other dementias.
Addressing the specific needs of Canada’s frail older adults would improve health outcomes and quality of life ― and reduce health costs.
The Care Quality Commission has published the full findings of its inspections of four nursing homes provided by the Morleigh Group in Cornwall. All four homes have been rated Inadequate and placed into special measures following the inspections. CQC is currently taking further action to protect the safety and welfare of all the people living at the homes.
Seniors advocacy groups are urging Ottawa to reject the sale of a retirement home chain to a Chinese company. British Columbia-based Retirement Concepts operates about two dozen supportive living facilities, including two in Calgary.
Inside the walls of a geriatric hospital in France, time stands still. Light falls across two stockinged feet on a bed. The fading floral pattern on a swath of wallpaper is interrupted by an unused corkboard. And between these scenes of stillness, residents approach a pair of locked doors with modest curiosity, expectation and even anger.
Here’s some good news for America’s seniors: Dementia rates have dropped dramatically over the last decade or so, according to a new study. An analysis of responses from a study of more than 10,000 people aged 65 and older found the prevalence of dementia dropped about 24 percent between 2000 and 2012. The reasons for the decline aren’t clear, researchers say. But two factors stand out: The participants in 2012 had more years of schooling than those in 2000; and chronic conditions such as high blood pressure and diabetes were being controlled more aggressively.
In a hopeful sign for the health of the nation’s brains, the percentage of American seniors with dementia is dropping, a new study finds. The downward trend has emerged despite something else the study shows: a rising tide of three factors that are thought to raise dementia risk by interfering with brain blood flow, namely diabetes, high blood pressure and obesity.
Discussions about research and policy have a tendency to be more reflective about policy-making in general, rather than focusing on the more practical aspects of how research filters through a variety of networks and into policy discussions. Sarah Foxen looks at eight specific ways research currently gets into Parliament and provides some helpful links on where to start to get more involved.
Recently, a group of French researchers took it upon themselves to test a widely voiced opinion that the peer review system is unsustainable — that the explosion of scientific papers has overwhelmed the community of scientists willing to review them.
The new owner of two prominent chains of Canadian medical journals is publishing fake research for cash, and pretending it is genuine. OMICS International, based in Hyderabad, India, had a reputation as a “predatory publisher” when it bought Pulsus Group and Andrew John Publishing, two Canadian publishers of medical journals, earlier this year. Predatory journals print fake or incompetent studies to help unqualified academics pad their CVs and advance their careers.
The Agency for Healthcare Research and Quality developed the Nursing Home Survey on Patient Safety Culture to assess safety culture in the nursing home setting. The 2016 user comparative database report summarizes survey data obtained from 12,395 staff and provider respondents working in 209 nursing homes. The report highlights two areas of safety culture in which nursing homes appear to do well: overall perceptions of resident safety and feedback and communication about incidents. Areas identified as needing improvement across most nursing homes included staffing issues and ensuring a nonpunitive response to mistakes. A previous PSNet perspective provided insights on safety culture.
Moving into a care home is likely to be a big change for your partner, relative or friend, so it’s important for them to see a familiar face. To help them feel at home, they should be able to welcome you in the same way they did before they started living there.
Updated data for a number of health system performance indicators is now available in the interactive Your Health System (YHS) web tool created by the Canadian Institute for Health Information (CIHI). This online tool allows users to access an array of health system data on hospitals, long-term care (LTC) facilities and the health of Canadians across the country.
The following report, put together by the British Psychological Society Dementia Advisory Group, presents a psychological perspective on the nature and experience of dementia, outlines the extensive contributions that psychologists have made in this field, and issues a number of recommendations on how to improve understanding and care for those experiencing dementia and their families.
The 2011 Census found that 6.5 million people in the UK were providing unpaid care. This represents 10.3% of the UK population, roughly the same proportion as reported in the 2001 Census although the absolute number has increased by around 625,000.
The purpose of this guide is to bring together in one place the facts about some of the key rights relating to dementia in the UK. It is hoped that the publication will empower people with dementia, their carers and their advocates to use their rights.
Published by the Canadian Centre for Policy Alternatives in November 2016, this book provides examples of promising practices for physical environments in long-term residential care. Based on over 500 interviews gathered during a research project funded by the Canadian Institutes for Health Research and the European Research Area on Aging Project, the book focuses on the complex relationship between the physical environment (location, space, features, etc.) and what goes on within it.
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. It aims to support all nurses to be responsive to the needs of people with dementia, continue to develop their skills and expertise, and achieve the best outcomes for people with dementia, their carers and families.
Researchers conduct qualitative research because they acknowledge the human condition and want to learn more, and think differently, about a research issue than what is usual from mostly numerical quantitative survey research data. Not surprisingly, the unique nature of qualitative inquiry is characterized by a distinctive set of attributes, all of which impact the design of qualitative research one way or the other.