Congratulations to Dr. Greta Cummings, the next Dean of the Faculty of Nursing!!!
The next Dean of the Faculty of Nursing
Dr. Greta Cummings has been appointed the next Dean of the Faculty of Nursing, effective July 1, 2017!!! On Friday, March 17, the Board of Governors approved the appointment of Dr. Cummings for a five year term. Dr. Cummings joined the Faculty of Nursing at the University of Alberta 13 years ago, becoming a full professor in 2010. She currently holds a Centennial Professorship (2013-2020), one of our university’s highest honours. Dr. Cummings is a nationally and internationally recognized researcher in nursing leadership to improve outcomes for healthcare staff and patients. She holds a BNSc from Queen’s University, in addition to her MEd (Admin) from the Faculty of Education and PhD in the Faculty of Nursing, both from the University of Alberta. She was named to the International Nurse Researcher Hall of Fame by the Sigma Theta Tau International Honour Society of Nursing in 2015 and is a fellow of both the American Academy of Nursing and the Canadian Academy of Health Sciences.
PURPOSE: Our study examined care aide characteristics, organizational context, and frequency of dementia-related resident responsive behaviours associated with burnout. Burnout is the experience of emotional exhaustion, cynicism, and professional inefficacy. Care aide burnout has implications for turnover, staff health, and quality of care. DESIGN AND METHODS: We used surveys collected from 1194 care aides from 30 urban nursing homes in three Western Canadian provinces. We used a mixed-effects regression analysis to assess care aide characteristics, dementia-related responsive behaviours, unit and facility characteristics, and organizational context predictors of care aide burnout. We measured burnout using the Maslach Burnout Inventory, Short Form. RESULTS: We found that care aides were at high risk for emotional exhaustion and cynicism, but report high professional efficacy. Statistically significant predictors of emotional exhaustion included English as a second language, medium facility size, organizational slack-staff, organizational slack-space, health (mental and physical) and dementia-related responsive behaviours. Statistically significant predictors of cynicism were care aide age, English as a second language, unit culture, evaluation (feedback of data), formal interactions, health (mental and physical) and dementia-related responsive behaviours. Statistically significant predictors of professional efficacy were unit culture and structural resources. Greater care aide job satisfaction was significantly associated with increased professional efficacy. IMPLICATIONS: This study suggests that individual care aide and organization features are both predictive of care aide burnout. Unlike care aide or structural characteristics of the facility elements of the organizational context are potentially modifiable, and therefore amenable to intervention.
Calls for Abstracts
CALL FOR ABSTRACTS: Health Affairs
Health Affairs ‘Aging and Health’ Series
Health Affairs is continuing its series on Aging and Health through 2016 and 2017. The publication is encouraging submissions from authors on topics surrounding the care of older adults, including new models of care and the management of multiple chronic conditions among this population. They are interested in work that spans the full range of care settings, including primary care and specialty practices, hospitals, nursing homes and other long-term care settings. Likewise, in addition to exploring topics that are directly related to the provision of care, we also welcome papers on a broad array of related dimensions that affect care, access, and affordability, such as financing models, coverage, and size and composition of the workforce. The series is sponsored by The John A. Hartford Foundation, which provides support for ongoing coverage of these topics.
Grants & Awards
As part of MSFHR’s commitment to facilitate the uptake and implementation of health research knowledge, we are excited to present the Reach Awards. New for 2017, these awards will provide funding to support the dissemination and uptake of research evidence to inform and improve further research, practice and policy-making. Each award will consist of up to $10,000 to help teams of health researchers and research users collaboratively plan and implement dissemination activities, adapting messages and mode of delivery in order to reach audiences who can directly use the information. Applications are due to open in the first week of April, 2017.
The Research Demonstration and Dissemination Grant (R18) is an award made by AHRQ to an institution/organization to support a discrete, specified health services research project. The project will be performed by the named investigator and study team. The R18 research plan proposed by the applicant institution/organization must be related to the mission and priority research interests of AHRQ.
This FOA will fund investigative research demonstration projects that examine the effective implementation of processes, policies, and behaviors that support safe use of medication as well as its sustainment and dissemination.
This Funding Opportunity Announcement (FOA) invites R18 grant applications for research projects to scale and spread existing clinical decision support (CDS) to facilitate the dissemination and implementation of findings from Patient-Centered Outcomes Research (PCOR) into clinical practice. The purposes of this FOA are to extend the implementation (“scale”) and evaluation of well-established and effective CDS beyond the initial clinical setting or institution in which the CDS was originally developed and implemented, thereby extending the impact on clinical practice.
This Funding Opportunity Announcement (FOA) invites R18 grant applications for developing new clinical decision support (CDS) to facilitate the dissemination and implementation of patient-centered outcomes research (PCOR) findings. The purposes of this FOA are to develop new, reliable, valid, and usable CDS from PCOR findings and then demonstrate its effectiveness to improve care in clinical practice.
This Funding Opportunity Announcement (FOA) encourages investigators to submit research grant applications that will identify, develop, test, evaluate and/or refine strategies to disseminate and implement evidence-based practices (e.g. behavioral interventions; prevention, early detection, diagnostic, treatment and disease management interventions; quality improvement programs) into public health, clinical practice, and community settings. In addition, studies to advance dissemination and implementation research methods and measures are encouraged.
This Funding Opportunity Announcement (FOA) encourages investigators to submit research grant applications that will identify, develop, evaluate and refine effective and efficient methods, systems, infrastructures, and strategies to disseminate and implement evidence-based health behavior change interventions, evidence-based prevention, early detection, diagnostic, treatment and management, and quality of life improvement services into public health, clinical practice, and community settings.
This Funding Opportunity Announcement (FOA) encourages investigators to submit research grant applications that will identify, develop, test, evaluate and/or refine strategies to disseminate and implement evidence-based practices (e.g. behavioral interventions; prevention, early detection, diagnostic, treatment and disease management interventions; quality improvement programs) into public health, clinical practice, and community settings. In addition, studies to advance dissemination and implementation research methods and measures are encouraged.
OBJECTIVE: To identify factors that influence the intentions of health professionals to improve their practice when confronted with clinical performance feedback, which is an essential first step in the audit and feedback mechanism. METHODS: We conducted a theory-driven laboratory experiment with 41 individual professionals, and a field study in 18 centres in the context of a cluster-randomised trial of electronic audit and feedback in cardiac rehabilitation. Feedback reports were provided through a web-based application, and included performance scores and benchmark comparisons (high, intermediate or low performance) for a set of process and outcome indicators. From each report participants selected indicators for improvement into their action plan. Our unit of observation was an indicator presented in a feedback report (selected yes/no); we considered selecting an indicator to reflect an intention to improve. RESULTS: We analysed 767 observations in the laboratory experiment and 614 in the field study, respectively. Each 10% decrease in performance score increased the probability of an indicator being selected by 54% (OR, 1.54; 95% CI 1.29% to 1.83%) in the laboratory experiment, and 25% (OR, 1.25; 95% CI 1.13% to 1.39%) in the field study. Also, performance being benchmarked as low and intermediate increased this probability in laboratory settings. Still, participants ignored the benchmarks in 34% (laboratory experiment) and 48% (field study) of their selections. CONCLUSIONS: When confronted with clinical performance feedback, performance scores and benchmark comparisons influenced health professionals’ intentions to improve practice. However, there was substantial variation in these intentions, because professionals disagreed with benchmarks, deemed improvement unfeasible or did not consider the indicator an essential aspect of care quality. These phenomena impede intentions to improve practice, and are thus likely to dilute the effects of audit and feedback interventions. TRIAL REGISTRATION NUMBER: NTR3251, pre-results.
BACKGROUND: Audit and feedback (A&F) is a common intervention used to change healthcare provider behaviour and, thus, improve healthcare quality. Although A&F can be effective its effectiveness varies, often due to the details of how A&F interventions are implemented. Some have suggested that a suitable conceptual framework is needed to organise the elements of A&F and also explain any observed differences in effectiveness. Through two examples from applied research studies, this article demonstrates how a suitable explanatory theory (in this case Kluger & DeNisi’s Feedback Intervention Theory (FIT)) can be systematically applied to design better feedback interventions in healthcare settings. METHODS: Case 1: this study’s objective was to reduce inappropriate diagnosis of catheter-associated urinary tract infections (CAUTI) in inpatient wards. Learning to identify the correct clinical course of action from the case details was central to this study; consequently, the feedback intervention featured feedback elements that FIT predicts would best activate learning processes (framing feedback in terms of group performance and providing of correct solution information). We designed a highly personalised, interactive, one-on-one intervention with healthcare providers to improve their capacity to distinguish between CAUTI and asymptomatic bacteruria (ASB) and treat ASB appropriately. Case 2: Simplicity and scalability drove this study’s intervention design, employing elements that FIT predicted positively impacted effectiveness yet still facilitated deployment and scalability (eg, delivered via computer, delivered in writing). We designed a web-based, report-style feedback intervention to help primary care physicians improve their care of patients with hypertension. RESULTS: Both studies exhibited significant improvements in their desired outcome and in both cases interventions were received positively by feedback recipients. SUMMARY: A&F has been a popular, yet inconsistently implemented and variably effective tool for changing healthcare provider behaviour and, improving healthcare quality. Through the systematic use of theory such as FIT, robust feedback interventions can be designed that yield greater effectiveness. Future work should look to comparative effectiveness of specific design elements and contextual factors that identify A&F as the optimal intervention to effectuate healthcare provider behaviour change. TRIAL REGISTRATION NUMBER: NCT01052545, NCT00302718; post-results.
BACKGROUND: Workforce development is an important aspect of evidence-informed decision making (EIDM) interventions. The social position of individuals in formal and informal social networks, and the relevance of formal roles in relation to EIDM are important factors identifying key EIDM players in public health organizations. We assessed the role of central actors in information sharing networks in promoting the adoption of EIDM by the staff of three public health units in Canada, over a two-year period during which an organization-wide intervention was implemented. METHODS: A multi-faceted and tailored intervention to train select staff applying research evidence in practice was implemented in three public health units in Canada from 2011 to 2013. Staff (n = 572) were asked to identify those in the health unit whom they turned to get help using research in practice, whom they considered as experts in EIDM, and friends. We developed multi-level linear regression models to predict the change in EIDM behavior scores predicted by being connected to peers who were central in networks and were engaged in the intervention. RESULTS: Only the group of highly engaged central actors who were connected to each other, and the staff who were not engaged in the intervention but were connected to highly engaged central actors significantly improved their EIDM behavior scores. Among the latter group, the staff who were also friends with their information sources showed a larger improvement in EIDM behavior. CONCLUSIONS: If engaged, central network actors use their formal and informal connections to promote EIDM. Central actors themselves are more likely to adopt EIDM if they communicate with each other. These social communications should be reinforced and supported through the implementation of training interventions as a means to promoting EIDM.
BACKGROUND: Delirium and dementia (cognitive impairment; CI), are common in older hospital patients, and both are associated with serious adverse outcomes. Despite delirium often being preventable, it is frequently not recognized in hospital settings, which may be because hospital nurses have not received adequate education or training in recognizing or caring for those with CI. However, the most effective way of increasing nurses’ awareness about delirium and dementia, and initiating regular patient screening and monitoring to guide best practices for these patients in hospital settings is not known. Hence this current project, conducted in 2015-2017, aims to redress this situation by implementing a multi-component non-pharmacological evidence-based intervention for patients with CI, through educating and mentoring hospital nurses to change their practice. METHODS: The development of the practice change component is informed by recent findings from implementation science that focuses on facilitation as the active ingredient in knowledge uptake and utilization. This component focuses on educating and empowering experienced nurses to become Cognition Champions (CogChamps) across six wards in a large Australian tertiary referral hospital. The CogChamps will, in turn, educate other nursing team members to more effectively care for patients with CI. The hospital leadership team are supportive of the project and are directly involved in selecting the CogChamps. CogChamps will be provided with comprehensive education in evidence-based delirium assessment, prevention and management, and practice change management skills. They will receive continuing support from research and education staff about raising awareness, upskilling other staff in delirium assessment and in the adoption of best practices for preventing and managing delirium. Both qualitative and quantitative data are being collected at multiple time-points to evaluate process, impact and outcome, and to provide clarity regarding the most effective aspects of the intervention. DISCUSSION: This paper describes the study protocol for the implementation of multi-component evidence-based non-pharmacological practices designed to improve the care of older hospital patients with CI. Findings will inform subsequent initiatives directed towards enhancing the capacity of the nursing workforce to implement best practices for providing high quality care for this growing patient population throughout their acute care hospital stay.
Objective:: to culturally adapt The Barriers to Research Utilization Scale and to analyze the metric validity and reliability properties of its Brazilian Portuguese version. Method:: methodological research conducted by means of the cultural adaptation process (translation and back-translation), face and content validity, construct validity (dimensionality and known groups) and reliability analysis (internal consistency and test-retest). The sample consisted of 335 nurses, of whom 43 participated in the retest phase. Results:: the validity of the adapted version of the instrument was confirmed. The scale investigates the barriers for the use of the research results in clinical practice. Confirmatory factorial analysis demonstrated that the Brazilian Portuguese version of the instrument is adequately adjusted to the dimensional structure the scale authors originally proposed. Statistically significant differences were observed among the nurses holding a Master’s or Doctoral degree, with characteristics favorable to Evidence-Based Practice, and working at an institution with an organizational cultural that targets this approach. The reliability showed a strong correlation (r ranging between 0.77 and 0.84, p<0.001) and the internal consistency was adequate (Cronbach’s alpha ranging between 0.77 and 0.82). Conclusion:: the Brazilian Portuguese version of The Barriers Scale was valid and reliable in the group studied.
BACKGROUND: Traditional reporting of research outcomes and impacts, which tends to focus on research product publications and grant success, does not capture the value, some contributions, or the complexity of research projects. The purpose of this study was to understand the contributions of five systems-level research projects as they were unfolding at the Bruyere Centre for Learning, Research and Innovation (CLRI) in long-term care (LTC) in Ottawa, Ontario, Canada. The research questions were, (1) How are partnerships with research end-users (policymakers, administrators and other public/private organisations) characterised? (2) How have interactions with the CLRI Management Committee and Steering Committee influenced the development of research products? (3) In what way have other activities, processes, unlinked actors or organisations been influenced by the research project activities? METHODS: The study was guided by Kok and Schuit’s concept of research impacts, using a multiple case study design. Data were collected through focus groups and interviews with research teams, a management and a steering committee, research user partners, and unlinked actors. Documents were collected and analysed for contextual background. RESULTS: Cross-case analysis revealed four major themes: (1) Benefits and Perceived Tensions: Working with Partners; (2) Speaking with the LTC Community: Interactions with the CLRI Steering Committee; (3) The Knowledge Broker: Interactions with the Management Committee; and (4) All Forms of Research Contributions. CONCLUSIONS: Most contributions were focused on interactions with networks and stimulating important conversations in the province about LTC issues. These contributions were well-supported by the Steering and Management Committees’ research-to-action platform, which can be seen as a type of knowledge brokering model. It was also clear that researcher-user partnerships were beneficial and important.
No abstract available.
Health Care Administration and Organization
Certified nursing assistants (CNAs) provide the majority of hands-on care and become highly sensitive to residents’ communication behaviors. Yet, CNAs feel disempowered when communicating residents’ concerns to higher levels of authority. A grounded theory approach using focus group interviews with 23 CNAs was used to describe the communication environment in long-term care (LTC) and explore CNAs’ perceptions of the acceptability of communication plans, a recent Canadian intervention to facilitate resident-staff communication. Findings suggest the communication environment in LTC relates to three overlapping constructs: (a) CNA and resident communication style; (b) paradox of context; and (c) dedication to residents. Although CNAs frequently interact with residents, a division between “top and bottom staff” communication was apparent in the findings. The current study suggested that communication plans may improve the communication environment in LTC settings.
PURPOSE OF THE STUDY: This study examines how certified nursing assistants (CNAs) balancing family caregiving roles-child care (double-duty child caregivers), elder care (double-duty elder caregivers), and both child and elder care (triple-duty caregivers)-utilize health care services relative to nonfamily caregiving counterparts (formal-only caregivers). DESIGN AND METHODS: A sample of 884 CNAs from the Work, Family and Health Study was drawn on to assess the number of acute care (i.e., emergency room or urgent care facility) and other health care (i.e., outpatient treatment or counseling) visits made during the past 6 months. RESULTS: Double-duty elder and triple-duty caregivers had higher acute care utilization rates than formal-only caregivers. CNAs with and without family caregiving roles had similar rates of other health care visits. IMPLICATIONS: CNAs providing informal care for older adults have higher acute care visit rates. Given the increasing need for family caregivers and the vital importance of the health of the nursing workforce for the health of others, future research on how double- and triple-duty caregivers maintain their health amidst constant caregiving should be a priority.
Objective: The objective of the study was to determine whether health care aides (HCAs) could safely assist in medication administration in long-term care (LTC). Method: We obtained medication error reports from LTC facilities that involve HCAs in oral medication assistance and we analyzed Resident Assessment Instrument (RAI) data from these facilities. Standard ratings of error severity were “no apparent harm,” “minimum harm,” and “moderate harm.” Results: We retrieved error reports from two LTC facilities with 220 errors reported by all health care providers including HCAs. HCAs were involved in 137 (63%) errors, licensed practical nurses (LPNs)/registered nurses (RNs) in 77 (35%), and pharmacy in four (2%). The analysis of error severity showed that HCAs were significantly less likely to cause errors of moderate severity than other nursing staff (2% vs. 7%, chi-square = 5.1, p value = .04). Conclusion: HCAs’ assistance in oral medications in LTC facilities appears to be safe when provided under the medication assistance guidelines.
Developing culturally appropriate end-of-life care for Chinese elderly and families is not an endemic challenge for Hong Kong, but that of the Western countries with a noticeable trend of rising Chinese population. The particular development of Hong Kong healthcare system, which is currently the major provider of end-of-life care, makes Hong Kong a fruitful case for understanding the confluence of the West and the East cultures in end-of-life care practices. This study therefore aims at building our best practice to enhance the capacity of residential care homes in providing culturally appropriate end-of-life care. We conducted two phases of research, a questionnaire survey and a qualitative study, which respectively aims at (1) understanding the EoL care service demand and provision in RCHEs, including death facts and perceived barriers and challenges in providing quality end-of-life care in care homes, and (2) identifying the necessary organizational capacities for the ‘relational personhood’ to be sustained in the process of ageing and dying in residential care homes. Findings shed light on how to empower residential care homes with necessary environmental, structural and cultural-resource-related capacity for providing quality end-of-life care for Chinese elders and their families.
Health Care Innovation and Quality Assurance
BACKGROUND AND AIM: There has recently been a growing interest towards patients’ affective and emotional needs, especially in relational therapies, which are considered vital as to increase the understanding of those needs and patients’ well-being. In particular, we paid attention to those patients who are forced to spend the last phase of their existence in residential facilities, namely elderly people in nursing homes, who often feel marginalized, useless, depressed, unstimulated or unable to communicate. The aim of this study is to verify the effectiveness of pet therapy in improving well-being in the elderly living in a nursing home. METHODS: This is a longitudinal study with before and after intervention variables measurement in two groups of patients of a nursing home for elderly people. One group followed an AAI intervention (experimental group) the other one did not (control group). As to perform an assessment of well-being we measured the following dimensions in patients: anxiety (HAM-A), depression (GDS), apathy (AES), loneliness (UCLA), and quality of life (QUALID). Both groups filled the questionnaires as to measure the target variables (time 0). Once finished the scheduled meetings (time 1), all the participants, including the control group, filled the same questionnaires. RESULTS: In accordance with scientific evidence the results confirmed a significant reduction of the measured variables. Especially for the quality of life, which showed a greater reduction than the other. CONCLUSIONS: The implementation and success of the Pet Therapy could have a great emotional and social impact, bringing relief to patients and their family members, but also to health professionals.
BACKGROUND: The 2014 Institute of Medicine report recommended that healthcare providers caring for individuals with advanced illness have basic palliative care competencies in communication, inter-professional collaboration, and symptom management. Nursing homes, where one in three American decedents live and die, have fallen short of these competency goals. We implemented an intervention study to examine the efficacy of nursing home-based integrated palliative care teams in improving the quality of care processes and outcomes for residents at the end of life. METHODS/DESIGN: This paper describes the design, rationale, and challenges of a two-arm randomized controlled trial of nursing home-based palliative care teams in 31 facilities. The impact of the intervention on residents’ outcomes is measured with four risk-adjusted quality indicators: place of death (nursing home or hospital), number of hospitalizations, and self-reported pain and depression in the last 90-days of life. The effect of the intervention is also evaluated with regard to staff satisfaction and impact on care processes (e.g. palliative care competency, communication, coordination). Both secondary (e.g. the Minimum Data Set) and primary (e.g. staff surveys) data are employed to examine the effect of the intervention. DISCUSSION: Several challenges in conducting a complex, nursing home-based intervention have been identified. While sustainability of the intervention without research funding is not clear, we surmise that without changes to the payment model that put palliative care services in this care setting on par with the more “skilled” care, it will not be reasonable to expect any widespread efforts to implement facility-based palliative care services.
OBJECTIVES: Hospitalizations among nursing facility residents are frequent and often potentially avoidable. A number of initiatives and interventions have been developed to reduce excessive hospitalizations; however, little is known about the specific approaches nursing facilities use to address this issue. The objective of this study is to better understand which types of interventions nursing facilities have introduced to reduce potentially avoidable hospitalizations of long-stay nursing facility residents. DESIGN: Cross-sectional survey. SETTING: 236 nursing facilities from 7 states. PARTICIPANTS: Nursing facility administrators. MEASUREMENTS: Web-based survey to measure whether facilities introduced any policies or procedures designed specifically to reduce potentially avoidable hospitalizations of long-stay nursing facility residents between 2011 and 2015. We surveyed facilities about seven types of interventions and quality improvement activities related to reducing avoidable hospitalizations, including use of Interventions to Reduce Acute Care Transfers (INTERACT) and American Medical Directors Association tools. RESULTS: Ninety-five percent of responding nursing facilities reported having introduced at least one new policy or procedure to reduce nursing facility resident hospitalizations since January 2011. The most common practice reported was hospitalization rate tracking or review, followed by standardized communication tools, such as Situation, Background, Assessment, Recommendation (SBAR). We found some variation in the extent and types of these reported interventions. CONCLUSIONS: Nearly all facilities surveyed reported having introduced a variety of initiatives to reduce potentially avoidable hospitalizations, likely driven by federal, state, and corporate initiatives to decrease hospital admissions and readmissions.
The current quality improvement initiative evaluated the medication reconciliation process within select nursing homes in Washington, DC. The identification of common types of medication discrepancies through monthly retrospective chart reviews of newly admitted patients in two different nursing homes were described. The use of high-risk medications, namely antidiabetic, anticoagulant, and opioid agents, was also recorded. A standardized spreadsheet tool based on multiple medication reconciliation implementation tool kits was created to record the information. The five most common medication discrepancies were incorrect indication (21%), no monitoring parameters (17%), medication name omitted (11%), incorrect dose (10%), and incorrect frequency (8%). Antidiabetic agents in both sites were the most used high-risk medication. This initiative highlights that medication discrepancies on admission are common in nursing homes and may be clinically impactful. More attention needs to be given to work flow processes to improve medication reconciliation considering the increased risk for adverse drug events and hospitalizations.
Unintentional weight loss is a health risk for residents of aged care facilities, a concern for families and places demands on nursing staff. An existing weight loss framework to assess and manage residents’ weight developed by a multidisciplinary team was implemented and evaluated with nurses and residents in aged care facilities within an area health service of Sydney, Australia. Thematic analysis generated seven binary concepts relating to relational, procedural, behavioural, physical, psychological, environmental and temporal aspects of feeding assistance provided by nurses to residents. Theoretical sampling was applied to the literature confirming those concepts which were organized as a model of feeding assistance labelled the Focus on Feeding! Decision Model. Nurses can play a pivotal role in the assessment of feeding difficulty and implementation of innovative mealtime programs. The Model aims to promote nurses’ critical thinking and decision-making to improve nutritional intake of residents and avoid preventable weight loss.
Research Practice and Methodology
BACKGROUND: Substantial amounts of public funds are invested in health research worldwide. Publicly funded randomised controlled trials (RCTs) often recruit participants at a slower than anticipated rate. Many trials fail to reach their planned sample size within the envisaged trial timescale and trial funding envelope. OBJECTIVES: To review the consent, recruitment and retention rates for single and multicentre randomised control trials funded and published by the UK’s National Institute for Health Research (NIHR) Health Technology Assessment (HTA) Programme. DATA SOURCES AND STUDY SELECTION: HTA reports of individually randomised single or multicentre RCTs published from the start of 2004 to the end of April 2016 were reviewed. DATA EXTRACTION: Information was extracted, relating to the trial characteristics, sample size, recruitment and retention by two independent reviewers. MAIN OUTCOME MEASURES: Target sample size and whether it was achieved; recruitment rates (number of participants recruited per centre per month) and retention rates (randomised participants retained and assessed with valid primary outcome data). RESULTS: This review identified 151 individually RCTs from 787 NIHR HTA reports. The final recruitment target sample size was achieved in 56% (85/151) of the RCTs and more than 80% of the final target sample size was achieved for 79% of the RCTs (119/151). The median recruitment rate (participants per centre per month) was found to be 0.92 (IQR 0.43-2.79) and the median retention rate (proportion of participants with valid primary outcome data at follow-up) was estimated at 89% (IQR 79-97%). CONCLUSIONS: There is considerable variation in the consent, recruitment and retention rates in publicly funded RCTs. Investigators should bear this in mind at the planning stage of their study and not be overly optimistic about their recruitment projections.
Objective: This study was conducted to describe care arrangements for persons with dementia (PwDs) who are living at home with the support of a dementia care network (DCN). Method: Data on the utilization of formal and informal support were collected in face-to-face interviews at baseline and 1-year follow-up with PwDs and caregivers receiving support from 1 of 13 DCNs. Results: Men with dementia were supported by twice as many informal caregivers as women (2 vs. 1, respectively, p < .001). Regional differences were found in home-care nursing services, social care groups, companion home services, and day care. The care situations were considered stable by most caregivers. Discussion: DCNs appear to contribute to a high degree of perceived stability in care situations. Future research should investigate possible gender differences in informal support networks. DCNs should continue their efforts in making low-threshold services in rural areas available and accessible.
INTRODUCTION: Knowledge regarding the longitudinal course, impact, or treatment implications of pain in people with dementia living in care homes is very limited. METHODS: We investigated the people with dementia living in 67 care homes in London and Buckinghamshire, United Kingdom. Pain, dementia severity, neuropsychiatric symptoms, depression, agitation, and quality-of-life were measured using appropriate instruments at baseline (N = 967) and after 9 months (n = 629). RESULTS: Baseline prevalence of pain was 35.3% (95% CI 32.3-38.3). Pain severity was significantly correlated with dementia severity, neuropsychiatric symptoms, depression, agitation, and quality of life at both time points. Regular treatment with analgesics significantly reduced pain severity. Pain was significantly associated with more antipsychotic prescriptions. Pain was significantly associated (OR 1.48; 95% CI 1.18-1.85) with all-cause mortality during follow-up. CONCLUSIONS: Pain is an important determinant of neuropsychiatric symptoms, mortality, quality-of-life, and antipsychotic prescriptions. Improved identification, monitoring, and treatment of pain are urgent priorities to improve the health and quality-of-life for people with dementia.
Background and Objectives: Poor food intake is common in long-term care (LTC). The mealtime experience has been identified as influential, yet, research has been limited by lack of quality, standardized measures. The purpose of this study was to develop and test for inter-rater reliability the Mealtime Scan (MTS), an observational measure. Research Design and Methods: MTS was derived from the literature on ambiance, mealtime experience, social interactions at mealtimes, and social models of care. Three scales on person-centered care and physical and social environments are used to summarize key aspects observed with MTS. Two raters assessed MTS for reliability at 30 different meals conducted in 10 dining rooms, within three LTC residences. Intraclass correlation coefficient (ICC) was used to assess reliability. Results: MTS demonstrated good to excellent reliability on the three summative scales (physical ICC = 0.73, social ICC = 0.81, person-centered care ICC = 0.83) and other scalable items had good to excellent reliability (e.g., background noise ICC = 0.65, Mealtime Relational Care checklist: negative interactions ICC = 0.85). Discussion and Implications: MTS is reliable and face valid for assessing mealtime experience. Future work will explore construct validity of this measure. MTS can be used to support improving the mealtime experience for residents living in LTC.
PURPOSE: To present findings of a study of institutional factors related to pressure ulcer (PrU) prevention in Veterans Health Administration nursing homes. TARGET AUDIENCE: This continuing education activity is intended for physicians and nurses with an interest in skin and wound care. OBJECTIVES: After participating in this educational activity, the participant should be better able to:1. Identify the study’s design, process, and purpose.2. List the factors pertaining to sites with improving performance. OBJECTIVES: Important gaps exist in the knowledge of how to achieve successful, sustained prevention of pressure ulcers (PrUs) in nursing homes. This study aimed to address those gaps by comparing nursing leadership and indirect care staff members’ impressions about the context of PrU prevention in facilities with improving and declining PrU rates. SETTING: The study was conducted in a sample of 6 Veterans Health Administration nursing homes (known as community living centers) purposively selected to represent a range of PrU care performance. DESIGN AND PARTICIPANTS: One-time 30-minute semistructured interviews with 23 community living center staff were conducted. Qualitative interview data were analyzed using an analytic framework containing (a) a priori analytic constructs based on the study’s conceptual framework and (b) sections for emerging constructs. MAIN RESULTS: Analysis revealed 6 key concepts differentiating sites with improving and declining PrU care performance. These concepts were (1) structures through which the change effort is initiated; (2) organizational prioritization, alignment, and support; (3) improvement culture; (4) clarity of roles and responsibilities; (5) communication strategies; and (6) staffing and clinical practices. Results also pointed to potential contextual facilitators of and barriers to successful PrU prevention. CONCLUSIONS: Leadership’s visible prioritization of and support for PrU prevention and the initiation of PrU prevention activities through formal structures were the most striking components represented at sites with improving performance, but not at ones where performance declined. Sites with improving performance were more likely to align frontline staff and leadership goals for PrU prevention.
BACKGROUND: Unexplained absence of nursing home (NH) residents is one of the most challenging issues related to the care of older people. The aim of this review was to examine the death and injury outcomes of unexplained absence of NH residents. METHOD: We searched MEDLINE, CINAHL, EMBASE, PsycINFO, AgeLine, and Cochrane Library to identify qualitative and quantitative studies published in the English language. Data on death and injury were collated, and aggregate proportions were calculated where possible. RESULTS: Nine studies were identified; most (n = 6) were conducted in the United States. Persons with dementia formed the study population in all studies. There were 1440 individual unexplained absences reported across the 9 studies. We calculated a rate of 82 deaths and 61 injuries per 1000 incidents of unexplained absence. Extreme temperatures were the most common cause of death. Most individuals left by foot, and were found within a 1-mile radius of place last seen in green vegetation and waterways. CONCLUSION: This review provides valuable insight into death and injury outcomes. Further studies are recommended to improve understanding and prevent adverse outcomes.
OBJECTIVES: The aim of this study is to comprehensively describe nutritional care in German nursing homes (NHs) and to examine if nutritional care differs between small, medium and large NHs. DESIGN: Nationwide cross-sectional postal survey. SETTING: Nursing homes. PARTICIPANTS: 541 NHs across Germany. MEASUREMENTS: Information on structural NH characteristics and nutritional care (food provision and menu planning, nursing care, and management and quality assurance) was collected by means of a questionnaire addressed to the management of a random sample of German NHs. NHs were grouped by size as small ( 100 beds) institutions. Frequencies were used to describe nutritional care, and Chi2-test to identify differences in nutritional care by NH size. RESULTS: Aspects in the domain of food provision and menu planning regarding food variety and choice were widely implemented in German NHs (77 – 100 %). Best results were achieved in the domain of nursing care, where all aspects were implemented in at least 68 % of the NHs. Aspects regarding management and quality assurance, especially those concerning staffing, i.e. the availability of an interface manager (14 %), an interdisciplinary nutrition team (12 %) and a dietician (42 %), were only rarely implemented. Differences by NH size were found between small and medium or large NHs. On the one hand, small NHs stated more often to consider individual capabilities of the residents with texture-modified food (81 % vs. 60 %, p<0.05) and produce more often hot meals at ward level on a regular base (46 % vs. 32 %, p<0.05) than large NHs. On the other hand, several aspects regarding food provision and menu planning, and management and quality assurance were significantly more often implemented in larger than smaller NHs. CONCLUSION: Whereas kitchen and nursing-related aspects of nutritional care seem to be widely implemented in German NHs, management and quality assurance demands are often not met. The differences found by NH size support the hypothesis that the number of residents living in a NH has an impact on how nutritional care is performed.
BACKGROUND: Nursing home residents with dementia experience increased risk for compromised eating performance due to intrapersonal, interpersonal, and environmental factors. Environmental stimulation is physical, social, and/or sensory stimulation present in the environment that can potentially trigger individuals’ emotion or motivate physical reactions. Beyond the personal factors, there is a lack of evidence on how environmental stimulation influences individuals’ eating performance at mealtimes. OBJECTIVES: This study examined the association between environmental stimulation and eating performance among nursing home residents with dementia. DESIGN: This study was a secondary analysis using baseline videos selected from a communication intervention study, where videos were recorded to capture staff-resident interactions during care activities for nursing home residents with dementia. Videos were included in this study only if residents demonstrated eating activities at mealtimes. SAMPLE AND SETTING: A total of 36 videos were selected (mean length=4min). The sample included 15 residents with dementia (mean age=86), and 19 certified nursing assistants (mean age=36) in 8 nursing homes. METHODS: The dependent variable was eating performance as measured by the Level of Eating Independence scale (range: 15-36, with higher scores indicating better eating performance). The independent variables were characteristics of environmental stimulation measured by the Person-Environment Apathy Rating-Environment subscale (stimulation clarity, stimulation strength, stimulation specificity, interaction involvement, physical accessibility, and environmental feedback). Each characteristic was rated on a 1-4 scale with higher scores indicating more desirable environmental stimulation. Multilevel models were used to examine the association between eating performance and environmental stimulation, adjusting for resident characteristics (i.e., age, gender, dementia stage, function, comorbidity, psychoactive medication use) and nesting effects of residents and staff. RESULTS: Resident participants demonstrated moderate levels of eating performance (M=27.08, SD=5.16). Eating performance was significantly lower among older residents, those with more advanced dementia, and higher comorbidity. After controlling for resident characteristics, eating performance was significantly associated with stimulation specificity (how the stimulation is delivered and tailored to the resident), and was not associated with other environmental stimulation characteristics. For each 1 point increase in stimulation specificity, eating performance increased by 8.78 points (95% CI=0.59, 16.97). CONCLUSIONS: Environmental stimulation that is personally tailored to a resident’ needs and preferences and directly offered to a resident contributed to better eating performance among residents with dementia. The findings will direct future development and implementation of person-directed mealtime care programs and dining environment arrangements for residents with dementia in nursing homes.
The 2017 Campus Alberta’s annual Provincial Forum on Health Outcomes and Public Health will take place on May 16, from 10 a.m. until 4 p.m. at Telus International Centre on the University of Alberta campus in Edmonton. The School of Public Health and the Faculty of Medicine and Dentistry at the University of Alberta, along with partners at the University of Calgary, University of Lethbridge and Alberta Health Services, will present the full-day forum on the theme of Precision Public Health. Presentations and panel discussions will focus on emerging methods and innovations to achieve better health outcomes and public health. Register by April 28.
Join us for Summer Institute 2017 where researchers, patients, clinicians, students, policy makers and more gather to share insights, connect with colleagues, and promote patient-oriented research. We’re working together to shine a spotlight on patient-oriented research. Join us for an outstanding line-up of engaging speakers, workshops on patient-oriented research topics, networking opportunities with colleagues, and capacity building opportunities for patient-oriented research.
The Canadian Open Data Summit (CODS) is an annual event where the most pressing challenges facing the open data and open government communities are addressed on a national scale.
The Society for Implementation Research Collaboration (SIRC) biennial conferences are dedicated to facilitating communication and collaboration between implementation research teams, researchers, and community providers.
Knowledge Translation Canada is a network of Canadian experts in knowledge translation joining forces to tackle the greatest challenge in health care today: the fact that although there is a great deal of health research being conducted, there is a gap in applying the results at the patient’s bedside and in every day health decisions. We invite you to join the discussion on KT IN PRIMARY CARE through attendance at the KT Canada Annual Scientific Meeting.
The James M. Anderson Center for Health Systems Excellence and the Academy for Healthcare Improvement community invite researchers, clinicians, patients/families and others working at the front lines of improving health to an inter-professional research and methodology conference focused on co-production of healthcare services.
Registration is now open for AcademyHealth’s 2017 Annual Research Meeting! AcademyHealth’s Annual Research Meeting shares important findings and showcases the latest evidence to move research into action and improve health and health care.
Early registration is now open for the Global Evidence Summit 2017! The summit aims to advance the use of reliable research evidence in addressing serious health and social challenges. Individuals with systematic reviews, research synthesis, and evidence-informed health care are encouraged to attend.
Attend the symposium and: hear from experts leading the field of systematic review methods and knowledge translation; learn to apply the latest research, tools and techniques to produce high-quality, relevant and up-to-date systematic reviews and other synthesized research evidence; develop an understanding of the latest strategies and innovations to ensure evidence can be used by people making healthcare decisions; and, engage in meaningful conversations on how to improve the impact of evidence on healthcare decision making.
The Alberta SPOR SUPPORT Unit (AbSPORU) Knowledge Translation Platform is hosting a FREE event April 27th at 28th. This event aims to inform researchers about the services AbSPORU offers and how to access the services, provide presentations/workshops with a knowledge synthesis and knowledge translation focus, and offer individual research consultations for people with specific questions.
The Training Program is open to anyone who is collaborating, or planning to collaborate, in POR. It is intended for graduate students, trainees, community and academic researchers, patients and family members, health care professionals, decision-makers, and industry and community stakeholders who are interested in learning about, or contributing to, POR in Alberta.
Evidence to practice: Designing gender-sensitive health promotion approaches for men
Please join us for the Knowledge Translation Canada National Seminar Series session on Thursday, April 13th from 12:00-13:00 ET, with Dr. Joan Bottorff. Dr. Joan L. Bottorff is a Professor in the School of Nursing and Director of the Institute for Healthy Living and Chronic Disease Prevention at the University of British Columbia’s Okanagan campus in Kelowna, Canada. She is an Affiliate Scientist at the BC Cancer Agency, a Fellow of the Canadian Academy of Health Sciences, and a Fellow of the American Academy of Nursing. Her research program focuses on developing more inclusive understandings of health behaviours, and the development of gender-sensitive and gender-specific health promotion interventions for women and men. This session is offered by WebEx from St. Michael’s Hospital in Toronto. All registration requests should be sent to Meghan Storey: email@example.com by Wednesday, April 12th at 12:00 PM ET.
Do you plan program implementation? Are you interested in an overview of the key concepts regarding the implementation of evidence-based practices?
Lunch & Learn: Introduction to Knowledge Translation presented by Dr. Gabrielle Zimmermann. Dr. Gabrielle Zimmerman has a strong background in research and has coordinated complex research activities and analysis specific to knowledge translation and implementation science. Please join Gabrielle for her online presentation introducing the concept and importance of knowledge translation.
Lunch & Learn: Introduction to Knowledge Synthesis and Systematic Reviews presented by Dr. Meghan Sebastianski. Dr. Sebastianski brings a wealth of experience in clinical epidemiology, research methodology, and evidence-based decision making to her role as the SPOR Project Coordinator for Knowledge Synthesis. Please join Dr. Sebastianski for her online presentation, where she will introduce you to knowledge synthesis and systematic review basics.
KT Approaches in Patient-Oriented Research in Saskatchewan and Alberta co-presented by Dr. Shannon Scott (University of Alberta), Dr. Donna Goodridge (University of Saskatchewan), and Dr. Thomas Rotter (University of Saskatchewan). This webinar is co-hosted with the Saskatchewan SPOR KT Platform.
The sisters caring for cognitively impaired elderly nuns in a Midwestern convent spoke to their care recipients in a way that sounded strikingly different to linguistic anthropologist Anna Corwin. The nuns rarely used “elderspeak” — a loud, slow, simple, patronizing and common form of baby talk for seniors. Instead, Corwin reports, they told jokes, stories and blessed the sick nuns, all the while speaking to them like they were completely capable, even though their ability to communicate was significantly diminished.
Objectives — To determine the prevalence of and resident characteristics associated with the prescription of medications of questionable benefit (MQBs) near the end of life in older adults with advanced dementia in nursing homes. Design — Population-based, cross-sectional study using Resident Assessment Instrument Minimum Data Set 2.0 linked to health administrative data. Setting — Ontario, Canada. Participants — All 9,298 nursing home residents with advanced dementia who died between June 1, 2010, and March 31, 2013; were aged 66 and older at time of death;and received at least one MQB in their last year of life. Measurements — Prevalence of eight classes of MQBs (e.g., lipid-lowering agents, antidementia drugs) used in the last 120 days and last week of life. Results — Of older nursing home residents with advanced dementia who received at least one MQB in the last year of life, 8,027 (86.3%) received them in the last 120 days and 4,180 (45.0%) in the last week of life. The most commonly prescribed MQB were antidementia (63.6%) and lipid-lowering agents (47.8%). Severe cognitive impairment (adjusted odds ratio (aOR) = 1.19, 95% confidence interval (CI) = 1.07–1.33, P = .002) and fewer signs and symptoms of health instability (aOR = 1.58, 95% CI = 1.44–1.74, P < .001) were associated with MQB use into the last week of life. Seeing a neurologist or psychiatrist was associated with less likelihood of MQB use in the last week of life. Conclusion — Many nursing home residents with advanced dementia are dispensed MQBs in the last week of life. Given that MQBs may cause more harm than benefit in this vulnerable population, it is important for physicians to actively reassess the role of all medications toward the end of life.
Care home residents in Rushcliffe Nottinghamshire who received an ‘enhanced’ care package through Principia, an NHS multi-specialty community provider, attended A&E 29% less frequently than similar care home residents in other parts of the country. They were also admitted to hospital as an emergency 23% less often. These are the main findings of the first statistical analysis by the Improvement Analytics Unit – a joint initiative between the Health Foundation, an independent charity, and NHS England. In its report published, the Health Foundation says the positive results in Rushcliffe are likely to be the result of higher quality care being provided to the care home residents by Principia, one of 50 NHS vanguard sites in England.
CHOICE+ is an innovative program that aims to improve the mealtime experience for residents in long-term care by focusing on relationship-centred practices and enhancing the dining environment. The website includes Mealtime Practices Checklist and Dining Room Checklist.
The University of Alabama College of Education is looking for an associate or full professor of implementation science. The position is in the special education department (SPEMA), but the person is expected to work across disciplines.