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Iaconi A, Hoben M, Berta, PhD W, Duan Y, Norton PG, Song Y, Chamberlain SA, Beeber A, Anderson RA, Lanham HJ, Perez J, Wang J, Choroschun K, Shrestha S, Cummings G, Estabrooks CA. The Association of Nursing Homes' Organizational Context With Care Aide Empowerment: A Cross-Sectional Study. THE GERONTOLOGIST 2024; 64:gnae033. [PMID: 38695153 PMCID: PMC11129593 DOI: 10.1093/geront/gnae033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Indexed: 05/28/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Organizational context is thought to influence whether care aides feel empowered, but we lack empirical evidence in the nursing home sector. Our objective was to examine the association of features of nursing homes' unit organizational context with care aides' psychological empowerment. RESEARCH DESIGN AND METHODS This cross-sectional study analyzed survey data from 3765 care aides in 91 Western Canadian nursing homes. Random-intercept mixed-effects regressions were used to examine the associations between nursing home unit organizational context and care aides' psychological empowerment, controlling for care aide, care unit, and nursing home covariates. RESULTS Organizational (IVs) culture, social capital, and care aides' perceptions of sufficient time to do their work were positively associated with all four components of psychological empowerment (DVs): competence (0.17 [0.13, 0.21] for culture, 0.18 [0.14, 0.21] for social capital, 0.03 [0.01, 0.05] for time), meaning (0.21 [0.18, 0.25] for culture, 0.19 [0.16, 0.23] for social capital, 0.03 [0.01, 0.05 for time), self-determination (0.38 [0.33, 0.44] for culture, 0.17 [0.12, 0.21] for social capital, 0.08 [0.05, 0.11] for time), and impact (0.26 [0.21, 0.31] for culture, 0.23 [0.19, 0.28] for social capital, 0.04 [0.01, 0.07] for time). DISCUSSION AND IMPLICATIONS In this study, modifiable elements of organizational context (i.e., culture, social capital, and time) were positively associated with care aides' psychological empowerment. Future interventions might usefully target these modifiable elements of unit level context in the interest of assessing their effects on staff work attitudes and outcomes, including the quality of resident care.
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Affiliation(s)
- Alba Iaconi
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Matthias Hoben
- Faculty of Health, School of Health Policy and Management, York University, Toronto, Ontario, Canada
| | - Whitney Berta, PhD
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Yinfei Duan
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Peter G Norton
- Family Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Yuting Song
- Faculty of Nursing, Qingdao University, Qingdao, Shandong, China
| | - Stephanie A Chamberlain
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Anna Beeber
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | - Ruth A Anderson
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Holly J Lanham
- Joe R. & Teresa Lozano Long School of Medicine, The University of Texas Health San Antonio, San Antonio, Texas, USA
| | - Janelle Perez
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jing Wang
- Nursing Department, College of Health and Human Services, University of New Hampshire, Durham, New Hampshire, USA
| | | | - Shovana Shrestha
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Greta Cummings
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Carole A Estabrooks
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
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McGough EL, Thompson HJ. Implementation of Evidence-Based Practice in Long-Term Care: A Scoping Review. J Am Med Dir Assoc 2024; 25:105026. [PMID: 38782040 DOI: 10.1016/j.jamda.2024.105026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 04/04/2024] [Accepted: 04/07/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVES To systematically examine implementation strategies within long-term care (LTC) settings. The goal was to identify elements that contribute to adoption and sustainability of evidence-based practices by facilities and frontline health care staff. DESIGN Scoping review. SETTING AND PARTICIPANTS LTC settings, frontline health care staff and facility administration. METHODS A scoping review of the literature across 3 databases was performed. Two researchers independently assessed literature for inclusion against criteria. The researchers independently extracted data for study characteristics following the Action, Actor, Context, Target, Time (AACTT) framework. The quality of included studies was assessed using the Melnyk and Fineout-Overholt Categorization. RESULTS Eleven studies examining implementation of a new evidence-based intervention into LTC settings met inclusion requirements. The types of new interventions shared a common classification within the Effective Practice and Organization of Care (EPOC) taxonomy, with all belonging to the Coordination of Care and Management of Care Processes category. All studies had frontline health care staff as the target of implementation strategies. Barriers to implementation included intervention timing in relation to workflow and workload, lack of interest in or skepticism regarding the new intervention, as well as perceptions that the intervention was not within scope or training. Face-to-face communication and asynchronous training were viewed positively, as was having a peer champion available for support. CONCLUSIONS AND IMPLICATIONS The results from this review highlight the importance of including communication strategies that use face-to-face delivery and peer champion approaches for successful implementation of new evidence-based interventions. Key implementation strategies also included education tailored to an individual's training and experience level.
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Affiliation(s)
- Ellen L McGough
- Physical Therapy Department, University of Rhode Island, RI, USA.
| | - Hilaire J Thompson
- Biobehavioral Nursing & Health Informatics, University of Washington, Seattle, WA, USA; Harborview Injury Prevention and Research Center, Seattle, WA, USA; Biomedical Informatics and Medical Education, School of Medicine, Seattle, WA, USA
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Lyng HB, Ree E, Strømme T, Johannessen T, Aase I, Ullebust B, Thomsen LH, Holen-Rabbersvik E, Schibevaag L, Bates DW, Wiig S. Barriers and enablers for externally and internally driven implementation processes in healthcare: a qualitative cross-case study. BMC Health Serv Res 2024; 24:528. [PMID: 38664668 PMCID: PMC11046894 DOI: 10.1186/s12913-024-10985-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Quality in healthcare is a subject in need of continuous attention. Quality improvement (QI) programmes with the purpose of increasing service quality are therefore of priority for healthcare leaders and governments. This study explores the implementation process of two different QI programmes, one externally driven implementation and one internally driven, in Norwegian nursing homes and home care services. The aim for the study was to identify enablers and barriers for externally and internally driven implementation processes in nursing homes and homecare services, and furthermore to explore if identified enablers and barriers are different or similar across the different implementation processes. METHODS This study is based on an exploratory qualitative methodology. The empirical data was collected through the 'Improving Quality and Safety in Primary Care - Implementing a Leadership Intervention in Nursing Homes and Homecare' (SAFE-LEAD) project. The SAFE-LEAD project is a multiple case study of two different QI programmes in primary care in Norway. A large externally driven implementation process was supplemented with a tracer project involving an internally driven implementation process to identify differences and similarities. The empirical data was inductively analysed in accordance with grounded theory. RESULTS Enablers for both external and internal implementation processes were found to be technology and tools, dedication, and ownership. Other more implementation process specific enablers entailed continuous learning, simulation training, knowledge sharing, perceived relevance, dedication, ownership, technology and tools, a systematic approach and coordination. Only workload was identified as coincident barriers across both externally and internally implementation processes. Implementation process specific barriers included turnover, coping with given responsibilities, staff variety, challenges in coordination, technology and tools, standardizations not aligned with work, extensive documentation, lack of knowledge sharing. CONCLUSION This study provides understanding that some enablers and barriers are present in both externally and internally driven implementation processes, while other are more implementation process specific. Dedication, engagement, technology and tools are coinciding enablers which can be drawn upon in different implementation processes, while workload acted as the main barrier in both externally and internally driven implementation processes. This means that some enablers and barriers can be expected in implementation of QI programmes in nursing homes and home care services, while others require contextual understanding of their setting and work.
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Affiliation(s)
- Hilda Bø Lyng
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, N-4036, Norway.
| | - Eline Ree
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, N-4036, Norway
| | - Torunn Strømme
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, N-4036, Norway
| | - Terese Johannessen
- Department of Health and Nursing Sciences, Faculty of Health and Sports Science, University of Agder, Kristiansand, N-4604, Norway
| | - Ingunn Aase
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, N-4036, Norway
| | | | - Line Hurup Thomsen
- Helse Campus Stavanger, University of Stavanger, Stavanger, N-4036, Norway
| | - Elisabeth Holen-Rabbersvik
- Department of Health and Nursing Sciences, Faculty of Health and Sports Science, University of Agder, Kristiansand, N-4604, Norway
- Kristiansand municipality, Kristiansand, N-4604, Norway
| | - Lene Schibevaag
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, N-4036, Norway
| | - David W Bates
- Division of General Internal Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Siri Wiig
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, N-4036, Norway
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Duan Y, Hoben M, Song Y, Chamberlain SA, Iaconi A, Choroschun K, Shrestha S, Cummings GG, Norton PG, Estabrooks CA. Organizational Context and Quality Indicators in Nursing Homes: A Microsystem Look. J Appl Gerontol 2024; 43:13-25. [PMID: 37669619 PMCID: PMC10693724 DOI: 10.1177/07334648231200110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 08/14/2023] [Accepted: 08/18/2023] [Indexed: 09/07/2023] Open
Abstract
The association of organizational context with quality of care in nursing homes is not well understood at the clinical microsystem (care unit) level. This cross-sectional study examined the associations of unit-level context with 10 unit-level quality indicators derived from the Minimum Data Set 2.0. Study settings comprised 262 care units within 91 Canadian nursing homes. We assessed context using unit-aggregated care-aide-reported scores on the 10 scales of the Alberta Context Tool. Mixed-effects regression analysis showed that structural resources were negatively associated with antipsychotics use (B = -.06; p = .001) and worsened late-loss activities of daily living (B = -.03, p = .04). Organizational slack in time was negatively associated with worsened pain (B = -.04, p = .01). Social capital was positively associated with delirium symptoms (B = .12, p = .02) and worsened depressive symptoms (B = .10, p = .01). The findings suggested that targeting interventions to modifiable contextual elements and unit-level quality improvement will be promising.
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Affiliation(s)
- Yinfei Duan
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Matthias Hoben
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
- Faculty of Health, York University, Toronto, ON, Canada
| | - Yuting Song
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
- School of Nursing, Qingdao University, Qingdao, China
| | | | - Alba Iaconi
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | | | | | | | - Peter G. Norton
- Department of Family Medicine, University of Calgary, Calgary, AB, Canada
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Song Y, Bolt S, Thorne T, Norton P, Poss J, Fu F, Squires J, Cummings G, Estabrooks CA. Nursing assistants' use of best practices and pain in older adults living in nursing homes. J Am Geriatr Soc 2023; 71:3413-3423. [PMID: 37565426 DOI: 10.1111/jgs.18527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 06/15/2023] [Accepted: 07/01/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Inadequate pain management persists in nursing homes. Nursing assistants provide the most direct care in nursing homes, and significantly improving the quality of care requires their adoption of best care practices informed by the best available evidence. We assessed the association between nursing assistants' use of best practices and residents' pain levels. METHODS We performed a cross-sectional analysis of data collected between September 2019 and February 2020 from a stratified random sample of 87 urban nursing homes in western Canada. We linked administrative data (the Resident Assessment Instrument-Minimum Data Set [RAI-MDS], 2.0) for 10,093 residents and survey data for 3547 nursing assistants (response rate: 74.2%) at the care unit level. Outcome of interest was residents' pain level, measured by the pain scale derived from RAI-MDS, 2.0. The exposure variable was nursing assistants' use of best practices, measured with validated self-report scales and aggregated to the unit level. Two-level random-intercept multinomial logistic regression accounted for the clustering effect of residents within care units. Covariates included resident demographics and clinical characteristics and characteristics of nursing assistants, unit, and nursing home. RESULTS Of the residents, 3305 (30.3%) were identified as having pain. On resident care units with higher levels of best practice use among nursing assistants, residents had 32% higher odds of having mild pain (odds ratio, 1.32; 95% confidence interval, 1.01-1.71; p = 0.040), compared with residents on care units with lower levels of best practice use among nursing assistants. The care units did not differ in reported moderate or severe pain among residents. CONCLUSIONS We observed that higher unit-level best practice use among nursing assistants was associated with mild resident pain. This association warrants further research to identify key individual and organizational factors that promote effective pain assessment and management.
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Affiliation(s)
- Yuting Song
- School of Nursing, Qingdao University, Qingdao, China
- Faculty of Nursing, University of Alberta, Edmonton, Canada
| | - Sascha Bolt
- School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands
| | - Trina Thorne
- Faculty of Nursing, University of Alberta, Edmonton, Canada
| | - Peter Norton
- Department of Family Medicine, University of Calgary, Calgary, Canada
| | - Jeff Poss
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | - Fangfang Fu
- Faculty of Nursing, University of Alberta, Edmonton, Canada
| | - Janet Squires
- School of Nursing, University of Ottawa, Ottawa, Canada
| | - Greta Cummings
- College of Health Sciences, University of Alberta, Edmonton, Canada
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Darwich AS, Boström AM, Guidetti S, Raghothama J, Meijer S. Investigating the Connections Between Delivery of Care, Reablement, Workload, and Organizational Factors in Home Care Services: Mixed Methods Study. JMIR Hum Factors 2023; 10:e42283. [PMID: 37389904 PMCID: PMC10365606 DOI: 10.2196/42283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 04/27/2023] [Accepted: 04/29/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Home care is facing increasing demand due to an aging population. Several challenges have been identified in the provision of home care, such as the need for support and tailoring support to individual needs. Goal-oriented interventions, such as reablement, may provide a solution to some of these challenges. The reablement approach targets adaptation to disease and relearning of everyday life skills and has been found to improve health-related quality of life while reducing service use. OBJECTIVE The objective of this study is to characterize home care system variables (elements) and their relationships (connections) relevant to home care staff workload, home care user needs and satisfaction, and the reablement approach. This is to examine the effects of improvement and interventions, such as the person-centered reablement approach, on the delivery of home care services, workload, work-related stress, home care user experience, and other organizational factors. The main focus was on Swedish home care and tax-funded universal welfare systems. METHODS The study used a mixed methods approach where a causal loop diagram was developed grounded in participatory methods with academic health care science research experts in nursing, occupational therapy, aging, and the reablement approach. The approach was supplemented with theoretical models and the scientific literature. The developed model was verified by the same group of experts and empirical evidence. Finally, the model was analyzed qualitatively and through simulation methods. RESULTS The final causal loop diagram included elements and connections across the categories: stress, home care staff, home care user, organization, social support network of the home care user, and societal level. The model was able to qualitatively describe observed intervention outcomes from the literature. The analysis suggested elements to target for improvement and the potential impact of relevant studied interventions. For example, the elements "workload" and "distress" were important determinants of home care staff health, provision, and quality of care. CONCLUSIONS The developed model may be of value for informing hypothesis formulation, study design, and discourse within the context of improvement in home care. Further work will include a broader group of stakeholders to reduce the risk of bias. Translation into a quantitative model will be explored.
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Affiliation(s)
- Adam S Darwich
- Division of Health Informatics and Logistics, Department of Biomedical Engineering and Health Systems, KTH Royal Institute of Technology, Huddinge, Stockholm, Sweden
| | - Anne-Marie Boström
- Division of Nursing, Department of Neurobiology, Care Science and Society, Karolinska Institutet, Huddinge, Sweden
- Theme Inflammation and Aging, Karolinska University Hospital, Huddinge, Sweden
- Research and Development Unit, Stockholms Sjukhem, Stockholm, Sweden
| | - Susanne Guidetti
- Division of Occupational Health, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Theme Women's Health and Allied Professionals, Medical Unit Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | - Jayanth Raghothama
- Division of Health Informatics and Logistics, Department of Biomedical Engineering and Health Systems, KTH Royal Institute of Technology, Huddinge, Stockholm, Sweden
| | - Sebastiaan Meijer
- Division of Health Informatics and Logistics, Department of Biomedical Engineering and Health Systems, KTH Royal Institute of Technology, Huddinge, Stockholm, Sweden
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Fares MOA, Perracini MR, Rosa MABMV, Cunha AIL, de Souza MA, Ricci NA. Research utilisation in older people care: Translation, cross-cultural adaptation and validation of instruments into Brazilian Portuguese. Int J Older People Nurs 2023; 18:e12494. [PMID: 35842923 DOI: 10.1111/opn.12494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 06/17/2022] [Accepted: 06/24/2022] [Indexed: 01/13/2023]
Abstract
AIMS To translate and culturally validate the Estabrooks' Kinds of Research Utilization (RU) and the Conceptual Research Utilization Scale (CRU) into Brazilian Portuguese; and to describe the research use by health professionals working on Long Term Care Institutions (LTCI) for older people. BACKGROUND Research utilisation ensures greater quality and effectiveness in the care provided by health professionals. However, there are no instruments to evaluate research utilisation in Latin America countries, like Brazil. MATERIALS & METHODS A methodological cross-sectional questionnaire validity and descriptive study. The translation and adaptation of the instruments was performed in seven steps following psychometric guidelines. The instruments evaluate research utilisation by health professionals in clinical practice. The RU is composed of single-items of instrumental, persuasive, conceptual and overall forms; and the CRU the conceptual form through a 5-item scale. Professionals of technical level and graduated working in nine LTCI were evaluated from August to December 2018. Descriptive and inferential (reliability, correlation, internal consistency and structure of CRU) analyses were conducted. RESULTS Sample composed of 117 professionals, 67.5% of healthcare aides and 32.5% of graduated health professionals. All forms of research utilisation showed high implementation in practice (about 75% of the time, or frequently). CRU internal consistency (α = 0.885) and structure were adequate. There were significant correlations between RU and CRU (from very low r = 0.187 to high r = 0.712). Intra-rater, inter-rater and alternate forms reliability ranged from moderate to substantial. CONCLUSIONS The Brazilian versions of the RU and the CRU are valid, reliable and acceptable for evaluating research utilisation by professionals working on LTCI. It is of great relevance to introduce these instruments in low- and middle-income countries to have future data on how much older people care is influenced by the best evidence available. These instruments can be adapted to different healthcare settings and populations.
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Affiliation(s)
- Mainá Osório Akel Fares
- Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo (UNICID), São Paulo, Brazil
| | - Monica Rodrigues Perracini
- Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo (UNICID), São Paulo, Brazil
| | | | - Ana Izabel Lopes Cunha
- Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo (UNICID), São Paulo, Brazil
| | - Mariana Abacherly de Souza
- Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo (UNICID), São Paulo, Brazil
| | - Natalia Aquaroni Ricci
- Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo (UNICID), São Paulo, Brazil
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van de Bovenkamp H, van Pijkeren N, Ree E, Aase I, Johannessen T, Vollaard H, Wallenburg I, Bal R, Wiig S. Creativity at the margins: A cross-country case study on how Dutch and Norwegian peripheries address challenges to quality work in care for older persons. Health Policy 2023; 127:66-73. [PMID: 36543693 DOI: 10.1016/j.healthpol.2022.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 11/15/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Peripheral areas are often overlooked in health-care research but they in fact deserve specific attention. Such areas struggle to maintain access to good quality health-care services due to their geographical context. At the same time, new interventions or promising innovations often emerge in places where creativity is urgently needed. In this paper, we explore this creativity at the margins in older persons care organizations in peripheral areas, which other healthcare providers and policymakers can learn from. METHODS This exploratory study is based on two large research projects on the quality of care for older persons in Norway and the Netherlands. We performed secondary analysis of interviews with quality managers and other quality workers and used additional document analysis and expert interviews to deepen our analysis. RESULTS The results show that older persons care organizations working in peripheral areas must deal with a number of challenges caused by their geographical context, e.g. geographical distances (between services and to the geographical center), workforce shortages, and landscape characteristics. We found that organizations use different strategies to tackle these challenges, such as scaling up, brightening up and opening up. These strategies, conceptualized as creativity at the margins, impact quality work in different ways, for example by enabling more person-centered care. CONCLUSION We conclude that both policymakers and research should overcome their peripheral blindness by learning from and supporting creativity at the margins in future policies and research.
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Affiliation(s)
- Hester van de Bovenkamp
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Postbus 1738, 3000 DR Rotterdam, The Netherlands.
| | - Nienke van Pijkeren
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Postbus 1738, 3000 DR Rotterdam, The Netherlands
| | - Eline Ree
- Faculty of Health Sciences, University of Stavanger, Norway
| | - Ingunn Aase
- Faculty of Health Sciences, University of Stavanger, Norway
| | | | - Hans Vollaard
- Utrecht School of Governance, Utrecht University, The Netherlands
| | - Iris Wallenburg
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Postbus 1738, 3000 DR Rotterdam, The Netherlands
| | - Roland Bal
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Postbus 1738, 3000 DR Rotterdam, The Netherlands
| | - Siri Wiig
- Faculty of Health Sciences, University of Stavanger, Norway
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Cranley LA, Lo TKT, Weeks LE, Hoben M, Ginsburg LR, Doupe M, Anderson RA, Wagg A, Boström AM, Estabrooks CA, Norton PG. Reporting unit context data to stakeholders in long-term care: a practical approach. Implement Sci Commun 2022; 3:120. [DOI: 10.1186/s43058-022-00369-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 11/04/2022] [Indexed: 11/24/2022] Open
Abstract
Abstract
Background
The importance of reporting research evidence to stakeholders in ways that balance complexity and usability is well-documented. However, guidance for how to accomplish this is less clear. We describe a method of developing and visualising dimension-specific scores for organisational context (context rank method). We explore perspectives of leaders in long-term care nursing homes (NHs) on two methods for reporting organisational context data: context rank method and our traditionally presented binary method—more/less favourable context.
Methods
We used a multimethod design. First, we used survey data from 4065 healthcare aides on 290 care units from 91 NHs to calculate quartiles for each of the 10 Alberta Context Tool (ACT) dimension scores, aggregated at the care unit level based on the overall sample distribution of these scores. This ordinal variable was then summed across ACT scores. Context rank scores were assessed for associations with outcomes for NH staff and for quality of care (healthcare aides’ instrumental and conceptual research use, job satisfaction, rushed care, care left undone) using regression analyses. Second, we used a qualitative descriptive approach to elicit NH leaders’ perspectives on whether the methods were understandable, meaningful, relevant, and useful. With 16 leaders, we conducted focus groups between December 2017 and June 2018: one in Nova Scotia, one in Prince Edward Island, and one in Ontario, Canada. Data were analysed using content analysis.
Results
Composite scores generated using the context rank method had positive associations with healthcare aides’ instrumental research use (p < .0067) and conceptual research use and job satisfaction (p < .0001). Associations were negative between context rank summary scores and rushed care and care left undone (p < .0001). Overall, leaders indicated that data presented by both methods had value. They liked the binary method as a starting point but appreciated the greater level of detail in the context rank method.
Conclusions
We recommend careful selection of either the binary or context rank method based on purpose and audience. If a simple, high-level overview is the goal, the binary method has value. If improvement is the goal, the context rank method will give leaders more actionable details.
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Estabrooks C, Song Y, Anderson R, Beeber A, Berta W, Chamberlain S, Cummings G, Duan Y, Hayduk L, Hoben M, Iaconi A, Lanham H, Perez J, Wang J, Norton P. The Influence of Context on Implementation and Improvement: Protocol for a Mixed Methods, Secondary Analyses Study. JMIR Res Protoc 2022; 11:e40611. [PMID: 36107475 PMCID: PMC9523530 DOI: 10.2196/40611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/13/2022] [Accepted: 07/30/2022] [Indexed: 12/05/2022] Open
Abstract
Background Caring for the well-being of older adults is one of the greatest challenges in modern societies. Improving the quality of care and life for older adults and the work lives of their care providers calls for effective knowledge translation of evidence-based best practices. Objective This study’s purpose is to contribute to knowledge translation by better understanding the roles of organizational context (workplace environment) and facilitation (process or role) in implementation and improvement success. Our study has 2 goals: (1) to advance knowledge translation science by further developing and testing the Promoting Action on Research Implementation in Health Services framework (which outlines how implementation relies on the interplay of context, facilitation, and evidence) and (2) to advance research by optimizing implementation success via tailoring of modifiable elements of organizational context and facilitation. Methods This is secondary analyses of 15 years of longitudinal data from the Translating Research in Elder Care (TREC) program’s multiple data sources. This research is ongoing in long-term care (LTC) homes in western Canada. TREC data include the following: 5 waves of survey collection, 2 clinical trials, and regular ongoing outcome data for LTC residents. We will use a sequential exploratory and confirmatory mixed methods design. We will analyze qualitative and quantitative data holdings in an iterative process: (1) comprehensive reanalysis of qualitative data to derive hypotheses, (2) quantitative modeling to test hypotheses, and (3) action cycles to further refine and integrate qualitative and quantitative analyses. The research team includes 4 stakeholder panels: (1) system decision- and policy makers, (2) care home managers, (3) direct care staff, and (4) a citizen engagement group of people living with dementia and family members of LTC residents. A fifth group is our panel of external scientific advisors. Each panel will engage periodically, providing their perspectives on project direction and findings. Results This study is funded by the Canadian Institutes of Health Research. Ethics approval was obtained from the University of Alberta (Pro00096541). The results of the secondary analyses are expected by the end of 2023. Conclusions The project will advance knowledge translation science by deepening our understanding of the roles of context, the interactions between context and facilitation, and their influence on resident and staff quality outcomes. Importantly, findings will inform understanding of the mechanisms by which context and facilitation affect the success of implementation and offer insights into factors that influence the implementation success of interventions in nursing homes. International Registered Report Identifier (IRRID) DERR1-10.2196/40611
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Affiliation(s)
| | - Yuting Song
- School of Nursing, Qingdao University, Qingdao, China
| | - Ruth Anderson
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Anna Beeber
- School of Nursing, Johns Hopkins University, Baltimore, MD, United States
| | - Whitney Berta
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | | | - Greta Cummings
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Yinfei Duan
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Leslie Hayduk
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Matthias Hoben
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Alba Iaconi
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Holly Lanham
- Department of Medicine, University of Texas Health Sciences Center San Antonio, San Antonio, TX, United States
| | - Janelle Perez
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Jing Wang
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Peter Norton
- Department of Family Medicine, University of Calgary, Calgary, AB, Canada
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11
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Sabetsarvestani P, Mohammadi F, Tehranineshat B, Bijani M, Fereidouni Z. Barriers to efficient management of in-home care: A qualitative content analysis. Nurs Open 2021; 9:1200-1209. [PMID: 34908248 PMCID: PMC8859078 DOI: 10.1002/nop2.1161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 11/12/2021] [Accepted: 12/01/2021] [Indexed: 11/25/2022] Open
Abstract
Aim Inefficient management is one of the major barriers to development of in‐home care in the society. Accordingly, the present study aims to identify the barriers to efficient management of home care nursing using a qualitative approach. Design The present study is a qualitative‐descriptive work of research. Method Data were collected using semi‐structured, in‐depth, individual interviews with 19 nurses from November 2020 to May 2021. The collected data were analysed using Graneheim and Lundman's method. Results The findings of the study were categorized into four main themes, namely lack of effective standards, ineffective interactions, inappropriate cultural/social context and professional issues, and 15 subthemes. Conclusion In‐home care nurses in Iran experience various problems in their practice. Creating an appropriate cultural/social context in Iranian societies, providing the necessary infrastructure, including insurance, providing comprehensive, clear guidelines for in‐home care, encouraging teamwork and organizing workshops to promote effective interactions between the personnel and patients can improve the quality of in‐home care nursing.
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Affiliation(s)
| | - Fateme Mohammadi
- Chronic Diseases (Home Care) Research Center and Autism Spectrum Disorders Research Center, Department of Nursing, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Banafsheh Tehranineshat
- Community-based Psychiatric Care Research Center, Department of Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mostafa Bijani
- School of Nursing, Fasa University of Medical Sciences, Fasa, Iran
| | - Zhila Fereidouni
- School of Nursing, Fasa University of Medical Sciences, Fasa, Iran
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12
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Lo T, Boamah SA, Poss JW, Teare GF, Norton PG, Estabrooks CA. How Does the Facilitation Effort of Clinical Educators Interact With Aspects of Organizational Context to Affect Research Use in Long-term Care? Evidence From CHAID Analysis. J Nurs Scholarsh 2021; 53:762-771. [PMID: 34331390 DOI: 10.1111/jnu.12690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 02/27/2021] [Accepted: 06/11/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Organizational context influences the effect of facilitation efforts on research use in care settings. The interactions of these factors are complex. Therefore, the use of traditional statistical methods to examine their interrelationships is often impractical. Big Data analytics can automatically detect patterns within the data. We applied the chi-squared automatic interaction detection (CHAID) algorithm and classification tree technique to explore the dynamic and interdependent relationships between the implementation science concepts-context, facilitation, and research use. DESIGN Observational, cross-sectional study based on survey data collected from a representative sample of nursing homes in western Canada. METHODS We assessed three major constructs: (a) Conceptual research utilization (CRU) using the CRU scale; (b) facilitation of research use measured by the frequency of contacts between the frontline staff and a clinical educator, or person who brings new ideas to the care unit; and (c) organizational context at the unit level using the Alberta Context Tool (ACT). CHAID analysis was performed to detect the interactions between facilitation and context variables. Results were illustrated in a classification tree to provide a straightforward visualization. FINDINGS Data from 312 care units in three provinces were included in the final analysis. Results indicate significant multiway interactions between facilitation and various aspects of the organizational context, including leadership, culture, evaluation, structural resources, and organizational slack (staffing). Findings suggested the preconditions of the care settings where research use can be maximized. CONCLUSIONS CHAID analysis helped transform data into usable knowledge. Our findings provide insight into the dynamic relationships of facilitators' efforts and organizational context, and how these factors' interplay and their interdependence together may influence research use. CLINICAL RELEVANCE Knowledge of the combined effects of facilitators' efforts and various aspects of organizational context on research use can contribute to effective strategies to narrow the evidence-practice gap in care settings.
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Affiliation(s)
- Tkt Lo
- Investigator, Translating Research in Elder Care (TREC), Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alberta, Canada
| | - Sheila A Boamah
- Assistant Professor, Faculty of Health Sciences, School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Jeffrey W Poss
- Associate Professor, School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Gary F Teare
- Scientific Director, Program Knowledge, Evidence and Innovation, Provincial Population and Public Health, Alberta Health Services, Calgary, Alberta, Canada
| | - Peter G Norton
- Professor Emeritus Family Medicine, Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Carole A Estabrooks
- Professor, Faculty of Nursing, Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alberta, Canada
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13
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McArthur C, Bai Y, Hewston P, Giangregorio L, Straus S, Papaioannou A. Barriers and facilitators to implementing evidence-based guidelines in long-term care: a qualitative evidence synthesis. Implement Sci 2021; 16:70. [PMID: 34243789 PMCID: PMC8267230 DOI: 10.1186/s13012-021-01140-0] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 06/24/2021] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The long-term care setting poses unique challenges and opportunities for effective knowledge translation. The objectives of this review are to (1) synthesize barriers and facilitators to implementing evidence-based guidelines in long-term care, as defined as a home where residents require 24-h nursing care, and 50% of the population is over the age of 65 years; and (2) map barriers and facilitators to the Behaviour Change Wheel framework to inform theory-guided knowledge translation strategies. METHODS Following the guidance of the Cochrane Qualitative and Implementation Methods Group Guidance Series and the ENTREQ reporting guidelines, we systematically reviewed the reported experiences of long-term care staff on implementing evidence-based guidelines into practice. MEDLINE Pubmed, EMBASE Ovid, and CINAHL were searched from the earliest date available until May 2021. Two independent reviewers selected primary studies for inclusion if they were conducted in long-term care and reported the perspective or experiences of long-term care staff with implementing an evidence-based practice guideline about health conditions. Appraisal of the included studies was conducted using the Critical Appraisal Skills Programme Checklist and confidence in the findings with the GRADE-CERQual approach. FINDINGS After screening 2680 abstracts, we retrieved 115 full-text articles; 33 of these articles met the inclusion criteria. Barriers included time constraints and inadequate staffing, cost and lack of resources, and lack of teamwork and organizational support. Facilitators included leadership and champions, well-designed strategies, protocols, and resources, and adequate services, resources, and time. The most frequent Behaviour Change Wheel components were physical and social opportunity and psychological capability. We concluded moderate or high confidence in all but one of our review findings. CONCLUSIONS Future knowledge translation strategies to implement guidelines in long-term care should target physical and social opportunity and psychological capability, and include interventions such as environmental restructuring, training, and education.
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Affiliation(s)
- Caitlin McArthur
- Dalhousie University, 5869 University Avenue, Halifax, Nova Scotia, B3H 4R2, Canada. .,GERAS Centre for Aging Research, 88 Maplewood Avenue, Hamilton, Ontario, L8M 1W9, Canada.
| | - Yuxin Bai
- GERAS Centre for Aging Research, 88 Maplewood Avenue, Hamilton, Ontario, L8M 1W9, Canada.,Master University, 1280 Main Street West, Hamilton, Ontario, L8S 4L8, Canada
| | - Patricia Hewston
- GERAS Centre for Aging Research, 88 Maplewood Avenue, Hamilton, Ontario, L8M 1W9, Canada.,Master University, 1280 Main Street West, Hamilton, Ontario, L8S 4L8, Canada
| | - Lora Giangregorio
- University of Waterloo, 200 University Avenue West, Waterloo, Ontario, N2L 3G1, Canada.,Schlegel-UW Research Institute for Aging, 150 Laurelwood Drive, Waterloo, Ontario, N2J 0E2, Canada
| | - Sharon Straus
- University of Toronto, 27 King's College Circle, Toronto, Ontario, M5S 1A4, Canada
| | - Alexandra Papaioannou
- GERAS Centre for Aging Research, 88 Maplewood Avenue, Hamilton, Ontario, L8M 1W9, Canada.,Master University, 1280 Main Street West, Hamilton, Ontario, L8S 4L8, Canada
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14
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Ginsburg LR, Hoben M, Easterbrook A, Anderson RA, Estabrooks CA, Norton PG. Fidelity is not easy! Challenges and guidelines for assessing fidelity in complex interventions. Trials 2021; 22:372. [PMID: 34051830 PMCID: PMC8164256 DOI: 10.1186/s13063-021-05322-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 05/10/2021] [Indexed: 12/30/2022] Open
Abstract
Background Fidelity in complex behavioural interventions is underexplored and few comprehensive or detailed fidelity studies report on specific procedures for monitoring fidelity. Using Bellg’s popular Treatment Fidelity model, this paper aims to increase understanding of how to practically and comprehensively assess fidelity in complex, group-level, interventions. Approach and lessons learned Drawing on our experience using a mixed methods approach to assess fidelity in the INFORM study (Improving Nursing home care through Feedback On perfoRMance data—INFORM), we report on challenges and adaptations experienced with our fidelity assessment approach and lessons learned. Six fidelity assessment challenges were identified: (1) the need to develop succinct tools to measure fidelity given tools tend to be intervention specific, (2) determining which components of fidelity (delivery, receipt, enactment) to emphasize, (3) unit of analysis considerations in group-level interventions, (4) missing data problems, (5) how to respond to and treat fidelity ‘failures’ and ‘deviations’ and lack of an overall fidelity assessment scheme, and (6) ensuring fidelity assessment doesn’t threaten internal validity. Recommendations and conclusions Six guidelines, primarily applicable to group-level studies of complex interventions, are described to help address conceptual, methodological, and practical challenges with fidelity assessment in pragmatic trials. The current study offers guidance to researchers regarding key practical, methodological, and conceptual challenges associated with assessing fidelity in pragmatic trials. Greater attention to fidelity assessment and publication of fidelity results through detailed studies such as this one is critical for improving the quality of fidelity studies and, ultimately, the utility of published trials. Trial registration ClinicalTrials.gov NCT02695836. Registered on February 24, 2016 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05322-5.
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Affiliation(s)
- Liane R Ginsburg
- School of Health Policy & Management, Faculty of Health, York University, Toronto, Ontario, M3J 1P3, Canada.
| | - Matthias Hoben
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, T6G 1C9, Canada
| | - Adam Easterbrook
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, T6G 1C9, Canada
| | - Ruth A Anderson
- School of Nursing, University of North Carolina, Chapel Hill, North Carolina, 27599-7460, USA
| | - Carole A Estabrooks
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, T6G 1C9, Canada
| | - Peter G Norton
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, T2N 4N1, Canada
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15
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Fry M, Elliott R, Curtis K, Mei J, Fitzpatrick L, Groth R, Murphy S, Jones K, Hofman C. Family members' perceptions of older person discharge from emergency departments. Int J Older People Nurs 2021; 16:e12365. [PMID: 33543594 DOI: 10.1111/opn.12365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 12/10/2020] [Accepted: 12/22/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND People aged over 64 years account for approximately 20% of adult emergency presentations, with up to 60% of people discharged home from emergency departments (EDs). Many older people discharged home are supported by family. OBJECTIVES The objective of this study was to explore the family members' perspectives of older people's discharge from ED to inform new alternative or innovative models of care. METHODS The design was a descriptive exploratory study. A convenience sample of family members was recruited from three EDs across Sydney, New South Wales. Telephone interviews were conducted over a six-month period and data were analysed using statistics or thematic analysis. RESULTS Interviews were conducted with 133 family members of whom the majority were female (n = 80, 60%) with a median age of 70 years (IQR 91-35). Over 87% of family members were satisfied with ED care and discharge processes that were provided to the older person. The majority (n = 129, 97%) of family members reported that they understood the treatment and perceived that the older person's condition was well managed (n = 119, 86%). The majority (n = 114, 86%) of family members reported being informed of the medical diagnosis and were confident (87%, n = 115) to continue care of the older person at home. Three themes emerged from qualitative data: (a) a sense of time-moving through ED; (b) giving voice to the impact of clinician communication; and (c) the delivery of comfort and basic care. DISCUSSION Family members reported that they were engaged in and satisfied with the older person's ED treatment and discharge. However, family members suggested that there was opportunity to improve communication consistency for ED discharge and managing the wait. CONCLUSION Clinicians need to engage with family members to optimise quality and safety. Clinicians need to understand that family members considered comfort and fundamentals of care to be an important dimension of the older person's ED management plan.
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Affiliation(s)
- Margaret Fry
- Northern Sydney Local Health District, Faculty of Health, Royal North Shore Hospital, University of Technology Sydney, St Leonards, NSW, Australia.,Sydney Nursing School, University of Sydney, Camperdown, NSW, Australia.,Faculty of Health, University of Technology Sydney, St Leonards, NSW, Australia
| | - Rosalind Elliott
- Research & Practice Development Unit, Royal North Shore Hospital, Nursing and Midwifery Directorate, St Leonards, NSW, Australia
| | - Kate Curtis
- Sydney Nursing School, University of Sydney, Camperdown, NSW, Australia.,Emergency Services, ISLHD, Woollongong, NSW, Australia
| | - Joy Mei
- Aged Service in Emergency Team (ASET), Northern Sydney Local Health District, Hornsby Hospital, Hornsby, NSW, Australia
| | - Lesley Fitzpatrick
- Faculty of Health, University of Technology Sydney, St Leonards, NSW, Australia.,Emergency Department, Northern Sydney Local Health District, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Rachel Groth
- Aged Service in Emergency Team (ASET), Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Sandra Murphy
- Research & Practice Development Unit, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Keryn Jones
- Emergency Department, South East Local Health District, St George Hospital, Kogarah, NSW, Australia
| | - Catherine Hofman
- Aged Service in Emergency Team (ASET), Emergency Department, South East Sydney Local Health District, St George Hospital, Kogarah, NSW, Australia
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Holen-Rabbersvik E, Ullebust B, Ree E, Schibevaag L, Hurup-Thomsen L, Strømme T, Aase K, Aase I, Ellis LA, Wiig S. How to deal with context? Evaluation of the SAFE-LEAD Context Tool for quality and safety in nursing home and homecare services. TIDSSKRIFT FOR OMSORGSFORSKNING 2020. [DOI: 10.18261/issn.2387-5984-2020-02-07] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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17
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Masot O, Miranda J, Santamaría AL, Paraiso Pueyo E, Pascual A, Botigué T. Fluid Intake Recommendation Considering the Physiological Adaptations of Adults Over 65 Years: A Critical Review. Nutrients 2020; 12:E3383. [PMID: 33158071 PMCID: PMC7694182 DOI: 10.3390/nu12113383] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/29/2020] [Accepted: 10/31/2020] [Indexed: 01/17/2023] Open
Abstract
The aim of this critical review was to clarify recommended fluid intake for older people. A literature search of published articles and guidelines on fluid intake recommendations until April 2020 was carried out using PUBMED, Scopus, Cochrane, and Google Scholar. In this review, we focused on people over 65 years old at different care levels. The results show that the mean fluid intake ranges between 311 and 2390 mL/day. However, it is difficult to know whether this corresponds to the real pattern of fluid intake, due to the variability of data collection methods. With respect to the recommendations, most international organizations do not take into consideration the physiology of ageing or the health problems associated with an older population. In conclusions, we recommend to follow the guideline of the European Society for Clinical Nutrition and Metabolism (ESPEN) and the European Food Safety Authority (EFSA). ESPEN is the only guideline which takes into account age. It is also based on EFSA recommendations. This authority takes into consideration all fluids consumed (ranging from food to fluids). If it is known that around 20% of all fluids consumed come from food, the result would effectively be that the EFSA recommends the same as the ESPEN guidelines: 1.6 L/day for females and 2.0 L/day for males. The findings could help raise the awareness of professionals in the sector with respect to the required fluid intake of the elderly and, in this way, contribute to avoiding the consequences of dehydration.
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Affiliation(s)
- Olga Masot
- Department of Nursing and Physiotherapy, University of Lleida, 25198 Lleida, Spain; (O.M.); (A.L.S.); (E.P.P.); (A.P.); (T.B.)
- Health Care Research Group (GRECS), Biomedical Research Institute of Lleida, 25196 Lleida, Spain
| | - Jèssica Miranda
- Health Care Research Group (GRECS), Biomedical Research Institute of Lleida, 25196 Lleida, Spain
- Nursing Home and Day Center for the Elderly Balàfia II, Health services management (GSS), 25005 Lleida, Spain
| | - Ana Lavedán Santamaría
- Department of Nursing and Physiotherapy, University of Lleida, 25198 Lleida, Spain; (O.M.); (A.L.S.); (E.P.P.); (A.P.); (T.B.)
- Health Care Research Group (GRECS), Biomedical Research Institute of Lleida, 25196 Lleida, Spain
| | - Elena Paraiso Pueyo
- Department of Nursing and Physiotherapy, University of Lleida, 25198 Lleida, Spain; (O.M.); (A.L.S.); (E.P.P.); (A.P.); (T.B.)
- Health Care Research Group (GRECS), Biomedical Research Institute of Lleida, 25196 Lleida, Spain
| | - Alexandra Pascual
- Department of Nursing and Physiotherapy, University of Lleida, 25198 Lleida, Spain; (O.M.); (A.L.S.); (E.P.P.); (A.P.); (T.B.)
- Health Care Research Group (GRECS), Biomedical Research Institute of Lleida, 25196 Lleida, Spain
| | - Teresa Botigué
- Department of Nursing and Physiotherapy, University of Lleida, 25198 Lleida, Spain; (O.M.); (A.L.S.); (E.P.P.); (A.P.); (T.B.)
- Health Care Research Group (GRECS), Biomedical Research Institute of Lleida, 25196 Lleida, Spain
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18
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Measuring nurses' perceptions of their work environment and linking with behaviour change theories and implementation strategies to support evidence based practice change. Appl Nurs Res 2020; 56:151374. [PMID: 33280792 DOI: 10.1016/j.apnr.2020.151374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/28/2020] [Accepted: 10/09/2020] [Indexed: 11/22/2022]
Abstract
PURPOSE Survey tools, such as the Alberta Context Tool, reliably measure context but researchers have no process to map context to clinician behaviour and develop strategies to support practice change. Therefore, we aimed to map the Alberta Context Tool to the Theoretical Domains Framework and the Behaviour Change Wheel. METHOD The multi-centre study used the Alberta Context Tool to collect data from a convenience sample of nurses working in two emergency departments. These findings were categorised as barriers and enablers, and then mapped to the Theoretical Domains Framework to examine for behavioural domains. Using the Behaviour Change Wheel functions, strategies were developed to target clinician behaviour change. RESULTS Survey response rate was 42% (n = 68). Nurses perceived a positive work environment in the dimensions of Social Capital (median 4.00, IQR 0.33), Culture (median 3.83, IQR 1.16) and Leadership (median 3.60, IQR 1.1). Low scoring dimensions included Formal Interactions (median 2.75, IQR 1.00); Time (median 2.60, IQR 1.00) Staffing (median 3.0, IQR 2.00) and Space (median 3.0, IQR 2.00). Enablers (n = 77) and barriers (n = 25) were identified in both sites. The Theoretical Domains Framework was mapped to Alberta Context Tool barriers and enablers. The behaviour change strengths included: social and professional role; beliefs about capability; goals; and emotions. Using the Behaviour Change Wheel functions, 67 strategies were developed to address barriers and enablers. CONCLUSIONS The Alberta Context Tool successfully measured two emergency environments identifying barriers and enablers. This approach enabled environment dimensions to be targeted with practical solutions to support evidence-based practice implementation.
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Johannessen T, Ree E, Aase I, Bal R, Wiig S. Exploring challenges in quality and safety work in nursing homes and home care - a case study as basis for theory development. BMC Health Serv Res 2020; 20:277. [PMID: 32245450 PMCID: PMC7118914 DOI: 10.1186/s12913-020-05149-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 03/24/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Management, culture and systems for better quality and patient safety in hospitals have been widely studied in Norway. Nursing homes and home care, however have received much less attention. An increasing number of people need health services in nursing homes and at home, and the services are struggling with fragmentation of care, discontinuity and restricted resource availability. The aim of the study was to explore the current challenges in quality and safety work as perceived by managers and employees in nursing homes and home care services. METHOD The study is a multiple explorative case study of two nursing homes and two home care services in Norway. Managers and employees participated in focus groups and individual interviews. The data material was analyzed using directed content analysis guided by the theoretical framework 'Organizing for Quality', focusing on the work needed to meet quality and safety challenges. RESULTS Challenges in quality and safety work were interrelated and depended on many factors. In addition, they often implied trade-offs for both managers and employees. Managers struggled to maintain continuity of care due to sick leave and continuous external-facilitated change processes. Employees struggled with heavier workloads and fewer resources, resulting in less time with patients and poorer quality of patient care. The increased external pressure affected the possibility to work towards engagement and culture for improvement, and to maintain quality and safety as a collective effort at managerial and employee levels. CONCLUSION Despite contextual differences due to the structure, size, nature and location of the nursing homes and home care services, the challenges were similar across settings. Our study indicates a dualistic contextual dimension. Understanding contextual factors is central for targeting improvement interventions to specific settings. Context is, however, not independent from the work that managers do; it can be and is acted upon in negotiations and interactions to better support managers' and employees' work on quality and safety in nursing homes and home care.
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Affiliation(s)
- Terese Johannessen
- Faculty of Health Sciences, SHARE - Centre for Resilience in Healthcare, University of Stavanger, Kjell Arholms gate 39, 4021, Stavanger, Norway.
| | - Eline Ree
- Faculty of Health Sciences, SHARE - Centre for Resilience in Healthcare, University of Stavanger, Kjell Arholms gate 39, 4021, Stavanger, Norway
| | - Ingunn Aase
- Faculty of Health Sciences, SHARE - Centre for Resilience in Healthcare, University of Stavanger, Kjell Arholms gate 39, 4021, Stavanger, Norway
| | - Roland Bal
- Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, The Netherlands
| | - Siri Wiig
- Faculty of Health Sciences, SHARE - Centre for Resilience in Healthcare, University of Stavanger, Kjell Arholms gate 39, 4021, Stavanger, Norway
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20
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Management of constipation in long-term care hospitals and its ward manager and organization factors. BMC Nurs 2020; 19:5. [PMID: 31988637 PMCID: PMC6966903 DOI: 10.1186/s12912-020-0398-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 01/13/2020] [Indexed: 01/28/2023] Open
Abstract
Background Studies examining organizational factors that may influence constipation management in long-term care (LTC) hospitals are lacking. This study aimed to clarify the practice of constipation management in LTC hospitals and to explore its factors, including ward manager’s perception, organizational climate, and constipation assessment. Methods In this cross-sectional questionnaire survey of ward managers and staff nurses working in LTC wards, we determined daily assessment and practices regarding constipation management. We also conducted multivariate analyses to examine factors related to constipation management. Results There was a 20% response rate to the questionnaire. Nearly all LTC wards routinely assessed bowel movement frequency; other assessments were infrequent. Laxatives were used, but the use of dietary fiber and probiotic products was implemented in only 20–30% of wards. The implementation of non-pharmacological management and adequate use of stimulant laxatives were positively associated with the ward manager’s belief and knowledge, organizational climate, the existence of nursing records for constipation assessment, planned nursing care for constipation, and organized conferences and in-hospital study sessions on constipation management. Conclusion Areas to improve constipation management in LTC hospitals include altering the ward manager’s perception, improving hospital’s organizational climate, and introducing standardized assessment/care planning systems.
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White DL, Tunalilar O, Hasworth S, Winfree J. The Resident VIEW in Nursing Homes. Gerontol Geriatr Med 2019; 5:2333721419877975. [PMID: 31598539 PMCID: PMC6764029 DOI: 10.1177/2333721419877975] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 07/11/2019] [Accepted: 08/30/2019] [Indexed: 11/26/2022] Open
Abstract
This article presents the Resident VIEW (Voicing Importance, Experience, and
Well-Being), a measure designed to learn directly from long-term care residents
the extent to which they experience support that matters most to them. The
Resident VIEW contains 63 items across eight domains developed through cognitive
interviews with residents in different types of residential settings (e.g.,
nursing homes, assisted living, and adult foster care). Residents rate items on
both importance and their experience. In total, 258 nursing home residents
living in 32 Oregon nursing homes were selected through a two-stage random
sampling design and participated in the study. Results demonstrate that what
matters most to residents varies, emphasizing the value of asking residents
directly about their preferences. The relationship between importance and
experience differed by item. Residents who experienced support rated very
important within some domains, reported better quality of life and reported
lower levels of depressive symptoms than those who did not experience these
things. The interaction between importance and experience, however, did not
reach statistical significance, suggesting that positive experiences may provide
benefit even in some areas that are not perceived as important by residents.
Results underscore the value of incorporating the resident perspective into
measure development in long-term care.
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Predictors of Nurses' Research Use in Canadian Long-term Care Homes. J Am Med Dir Assoc 2019; 20:1185.e9-1185.e18. [PMID: 31255492 DOI: 10.1016/j.jamda.2019.04.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 04/26/2019] [Accepted: 04/27/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVES We examined the influence of individual characteristics and organizational context features on nurses' self-reported use of research evidence in long-term care (LTC) homes. DESIGN A cross-sectional analysis of survey data collected in the Translating Research in Elder Care program. SETTING AND PARTICIPANTS 756 nurses (registered nurses and licensed practical nurses) from 89 LTC homes in Western Canada. METHODS Generalized estimating equation modeling was used to identify which individual characteristics and organizational context features significantly predicted (P < .05) 3 kinds of self-reported research use by nurses: instrumental (the direct application of research findings), conceptual (using research findings to change thinking), and persuasive (using research findings to convince others). RESULTS Nurses reported a moderate to high level of research use. There were no significant differences in mean research use scores by nursing role. Only 2 variables were associated with all 3 kinds of research use: having a positive attitude toward research, and availability of structural and electronic resources. Additional variables associated with instrumental research use were problem-solving ability, engaging in formal interactions (eg, education sessions), and better perceptions of organizational slack-staff (the availability of sufficient staff). Additional variables associated with conceptual research use were self-determination and job efficacy. Finally, additional variables associated with persuasive research use were belief suspension (the ability to suspend previously held beliefs), organizational citizenship behavior (one's voluntary commitment to the organization), self-determination, job efficacy, evaluation, and better perceptions of organizational slack-time (perceived availability of extra time). CONCLUSIONS AND IMPLICATIONS Conceptual and persuasive research use were most strongly influenced by individual characteristics, whereas instrumental research use was predicted equally by individual and organizational variables. Nurses working in LTC are positioned in leadership roles; by targeting both the individual- and organizational-level predictors of nurses' research use, they can improve conditions for individuals living in LTC.
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Hayduk LA, Estabrooks CA, Hoben M. Fusion Validity: Theory-Based Scale Assessment via Causal Structural Equation Modeling. Front Psychol 2019; 10:1139. [PMID: 31231267 PMCID: PMC6559122 DOI: 10.3389/fpsyg.2019.01139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 04/30/2019] [Indexed: 11/13/2022] Open
Abstract
Fusion validity assessments employ structural equation models to investigate whether an existing scale functions in accordance with theory. Fusion validity parallels criterion validity by depending on correlations with non-scale variables but differs from criterion validity because it requires at least one theorized effect of the scale, and because both the scale and scaled-items are included in the model. Fusion validity, like construct validity, will be most informative if the scale is embedded in as full a substantive context as theory permits. Appropriate scale functioning in a comprehensive theoretical context greatly enhances a scale's validity. Inappropriate scale functioning questions the scale but the scale's theoretical embedding encourages detailed diagnostic investigations potentially challenging specific items, the procedure used to calculate scale values, or aspects of the theory, but also possibly recommends incorporating additional items into the scale. The scaled items should have survived prior content and methodological assessments but the items may or may not reflect a common factor because items having diverse causal backgrounds can sometimes fuse to form a unidimensional entity. Though items reflecting a common cause can be assessed for fusion validity, we illustrate fusion validity in the more challenging context of a scale comprised of diverse items and embedded in a complicated theory. Specifically we consider the Leadership scale from the Alberta Context Tool with care aides working in Canadian long-term care homes.
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Affiliation(s)
- Leslie A Hayduk
- Department of Sociology, University of Alberta, Edmonton, AB, Canada
| | | | - Matthias Hoben
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
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Wiig S, Aase K, Johannessen T, Holen-Rabbersvik E, Thomsen LH, van de Bovenkamp H, Bal R, Ree E. How to deal with context? A context-mapping tool for quality and safety in nursing homes and homecare (SAFE-LEAD Context). BMC Res Notes 2019; 12:259. [PMID: 31077219 PMCID: PMC6509797 DOI: 10.1186/s13104-019-4291-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 05/03/2019] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE The objective of this paper is to develop a context-mapping tool (SAFE-LEAD Context) adapted to the nursing home and homecare setting. These two contexts represent a substantial variability, but studies focusing on the types and roles of contextual factors in quality and safety in these care settings are lacking. RESULTS We conducted a step-wise collaborative design process consisting of mapping of key contextual factors as perceived by managers in Norwegian nursing homes and homecare, then created a draft tool discussed in a consortium workshop with co-researchers, and ran an international cross-country comparison. The SAFE-LEAD Context tool is inspired by the Consolidated Framework for Implementation Research (CFIR). The tool incorporates factors describing the outer setting of nursing homes and homecare at the national and local levels, in addition to factors describing the inner setting. The tool is flexible yet more detailed than current frameworks and capable of grading and describing the included contextual factors over time in the nursing home and homecare settings. A systematic approach using the SAFE-LEAD Context tool will support and improve the understanding and evaluation of quality and safety improvement interventions.
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Affiliation(s)
- Siri Wiig
- SHARE-Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Karina Aase
- SHARE-Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Terese Johannessen
- SHARE-Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Elisabeth Holen-Rabbersvik
- SHARE-Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- Department of Health and Nursing Sciences, University of Agder, Songdalen Municipality, Kristiansand, Norway
| | - Line Hurup Thomsen
- Center for Developing Institutional and Home Care Services Rogaland, Stavanger municipality, Stavanger, Norway
| | | | - Roland Bal
- Erasmus University, School of Health Policy & Management, Rotterdam, The Netherlands
| | - Eline Ree
- SHARE-Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
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Schadewaldt V, McElduff B, D’Este C, McInnes E, Dale S, Gunaratne A, Squires J, Cadilhac DA, Middleton S. Validating the Alberta Context Tool in a multi-site Australian Emergency Department nurse population. PLoS One 2019; 14:e0215153. [PMID: 30964916 PMCID: PMC6456203 DOI: 10.1371/journal.pone.0215153] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 03/27/2019] [Indexed: 11/26/2022] Open
Abstract
The organisational context of healthcare settings has an essential role in how research evidence is used in clinical practice. The Alberta Context Tool (ACT) measures 10 concepts of organisational context with higher scores indicating a more positive work environment and potentially better use of research evidence in patient care. We assessed the psychometric properties of the ACT in Emergency Departments (EDs). This validation study was conducted as part of a multi-centre trial of triage, treatment and transfer (T3 Trial) of patients with stroke admitted to EDs. Stratified sampling with proportional allocation was used to recruit ED nurses from 26 participating hospitals at baseline. Nurses completed a survey containing the ACT. Structural validity was investigated by exploratory and confirmatory factor analysis. Reliability was assessed using Cronbach’s alpha and intraclass correlation coefficients. Item-rest correlations and the average inter-item correlations were also assessed. 558 ED nurses completed the survey, comprised of 433 surveys without missing data. Our exploratory factor analysis produced a 14-factor structure, explaining 62% of variance of organisational context. For eight of ten concepts, item loadings matched the factor structure of the original ACT. Confirmatory factor analysis of the 10 ACT concepts showed moderate model fit (p = 0.001, root mean square error of approximation: 0.049, standardised root mean squared residual: 0.048). Cronbach’s alphas showed very good internal consistency for nine of ten ACT concepts (α>0.7; 0.45–0.90). Item-rest correlations indicated that most ACT items (50 of 56 items) within any concept related well to the total score of the concept. Average inter-item correlations indicated potential redundant items for three concepts (feedback processes, leadership, staffing) that were above the threshold of 0.5. While identifying a few shortcomings for some ACT concepts in an ED context, the majority of findings confirm reliability and validity of the original ACT in an Australian population of ED nurses.
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Affiliation(s)
- Verena Schadewaldt
- Nursing Research Institute, Australian Catholic University and St Vincent’s Health Australia Sydney, Darlinghurst, New South Wales, Australia
| | - Benjamin McElduff
- Nursing Research Institute, Australian Catholic University and St Vincent’s Health Australia Sydney, Darlinghurst, New South Wales, Australia
| | - Catherine D’Este
- National Centre for Epidemiology and Population Health (NCEPH), Australian National University, Canberra, Australian Capital Territory, Australia
- School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Elizabeth McInnes
- Nursing Research Institute, Australian Catholic University and St Vincent’s Health Australia Sydney, Darlinghurst, New South Wales, Australia
| | - Simeon Dale
- Nursing Research Institute, Australian Catholic University and St Vincent’s Health Australia Sydney, Darlinghurst, New South Wales, Australia
| | - Anoja Gunaratne
- Nursing Research Institute, Australian Catholic University and St Vincent’s Health Australia Sydney, Darlinghurst, New South Wales, Australia
| | - Janet Squires
- School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Dominique A. Cadilhac
- Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia
| | - Sandy Middleton
- Nursing Research Institute, Australian Catholic University and St Vincent’s Health Australia Sydney, Darlinghurst, New South Wales, Australia
- * E-mail:
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Kuiper D, Steverink N, Stewart RE, Reijneveld SA, Sanderman R, Goedendorp MM. Pace and determinants of implementation of the self-management of well-being group intervention: a multilevel observational study. BMC Health Serv Res 2019; 19:67. [PMID: 30683092 PMCID: PMC6346574 DOI: 10.1186/s12913-019-3891-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 01/09/2019] [Indexed: 02/02/2023] Open
Abstract
Background When implementing an empirically supported intervention (ESI) arrays of influencing factors operate on the professional and organizational level, but so far dependency between these levels has often been ignored. The aim of this study is to describe the pace and identify determinants of implementation of the Self-Management of Well-being (SMW) group intervention while taking the dependency between professionals and organizations into account. Methods Pace of implementation was measured as the time between training of professionals and first use of the SMW intervention in months. Determinants of first use were derived from the Fleuren framework and assessed using web-based questionnaires and telephone interviews. First, univariate analyses, Fisher’s exact tests and t-tests, were performed to identify determinants of first use of the SMW intervention on the individual professional and the organizational level independently. Second, multilevel analyses were performed to correct for the dependency between professionals and organizations. Simple multilevel logistic regression analyses were performed with determinants found significant in the univariate analyses as independent variables, first use as dependent variable, professionals entered in the first level, and organizations in the second level. Results Forty-eight professionals from 18 organizations were trained to execute the SMW intervention. Thirty-two professionals achieved first use, at a mean pace of 7.5 months ± 4.2. Determinants on the professional level were ‘ownership’, ‘relative advantage’, ‘support from colleagues’ and ‘compatibility’. Determinants on the organizational level were ‘organizational size’ and ‘innovation-task orientation fit’. Multilevel analysis showed that ‘compatibility’, a factor on the professional level, was the only significant determinant contributing to first use in the multilevel model. Conclusions This implementation study revealed a strong dependency between professionals and organizations. Results showed that a majority of professionals used the SMW intervention in about 8 months. When the dependency between professionals and organization was taken into account, the professionals’ perception of compatibility was the only remaining determinant of implementation on the professional level. Organizational size and managers’ perception of ‘innovation-task orientation fit’ were determinants of implementation on the organizational level. It is advisable to discuss the compatibility between new and current tasks among managers and professionals before adopting a new intervention. Electronic supplementary material The online version of this article (10.1186/s12913-019-3891-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Daphne Kuiper
- Service Desk Clinical Research Office, UMC staff, University Medical Center Groningen, P.O. Box 30.001, AB41, 9700 RB, Groningen, The Netherlands.,Department of Health Psychology, University Medical Center Groningen, University of Groningen, P.O. Box 196, FA12, 9700 AD, Groningen, The Netherlands
| | - Nardi Steverink
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, P.O. Box 196, FA12, 9700 AD, Groningen, The Netherlands.,Department of Sociology, University of Groningen, Grote Rozenstraat 31, 9712 TG, Groningen, The Netherlands
| | - Roy E Stewart
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, P.O. Box 196, FA10, 9700 AD, Groningen, The Netherlands
| | - Sijmen A Reijneveld
- Department of Health Sciences, (Community & Occupational Medicine) University Medical Center Groningen, University of Groningen, P.O. Box 196, FA10, 9700 AD, Groningen, The Netherlands
| | - Robbert Sanderman
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, P.O. Box 196, FA12, 9700 AD, Groningen, The Netherlands.,Department of Psychology, Health & Technology, University of Twente, P.O. Box 217, 7500 AE, Enschede, The Netherlands
| | - Martine M Goedendorp
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, P.O. Box 196, FA12, 9700 AD, Groningen, The Netherlands. .,Department of Health Science, Faculty of Sciences, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, De Boelelaan 1105, 1081 HV, Amsterdam, The Netherlands.
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Wu S, Morrison JM, Dunn-Ridgeway H, Vucea V, Iuglio S, Keller H. Mixed methods developmental evaluation of the CHOICE program: a relationship-centred mealtime intervention for long-term care. BMC Geriatr 2018; 18:277. [PMID: 30424725 PMCID: PMC6234643 DOI: 10.1186/s12877-018-0964-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 10/24/2018] [Indexed: 02/02/2023] Open
Abstract
Background Mealtimes are important to quality of life for residents in long-term care (LTC). CHOICE (which stands for Connecting, Honouring dignity, Offering support, supporting Identity, Creating opportunities, and Enjoyment) is a multi-component intervention to improve relationship-centred care (RCC) and overall mealtime experience for residents. The objective of this developmental evaluation was to determine: a) if the dining experience (e.g. physical, social and RCC practices) could be modified with the CHOICE Program, and b) how program components needed to be adapted and/or if new components were required. Methods A mixed methods study conducted between April–November 2016 included two home areas (64 residents; 25 care staff/home management) within a single LTC home in Ontario. Mealtime Scan (MTS), which measures mealtime experience at the level of the dining room, was used to evaluate the effectiveness of CHOICE implementation at four time points. Change in physical, social, RCC dining environment ratings and overall quality of the mealtime experience over time was determined with linear mixed-effects analyses (i.e., repeated measures). Semi-structured interviews (n = 9) were conducted with home staff to identify what components of the intervention worked well and what improvements could be made. Results Physical and overall mealtime environment ratings showed improvement over time in both areas; one home area also improved social ratings (p < 0.05). Interviews revealed in-depth insights into the program and implementation process: i) Knowing the context and culture to meet staff and resident needs; ii) Getting everyone on board, including management; iii) Keeping communication lines open throughout the process; iv) Sharing responsibility and accountability for mealtime goals and challenges; v) Empowering and supporting staff’s creative mealtime initiatives. Conclusions This developmental evaluation demonstrated the potential value of CHOICE. Findings suggest a need to: extend the time to tailor program components; empower home staff in change management; and provide increased coaching. Electronic supplementary material The online version of this article (10.1186/s12877-018-0964-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sarah Wu
- University of Waterloo, 200 University Avenue West, Waterloo, Ontario, N2L 3G1, Canada
| | - Jill M Morrison
- University of Waterloo, 200 University Avenue West, Waterloo, Ontario, N2L 3G1, Canada
| | - Hilary Dunn-Ridgeway
- Research Institute for Aging, 250 Laurelwood Drive, Waterloo, Ontario, N2J 0E2, Canada
| | - Vanessa Vucea
- University of Waterloo, 200 University Avenue West, Waterloo, Ontario, N2L 3G1, Canada
| | - Sabrina Iuglio
- University of Waterloo, 200 University Avenue West, Waterloo, Ontario, N2L 3G1, Canada
| | - Heather Keller
- University of Waterloo, 200 University Avenue West, Waterloo, Ontario, N2L 3G1, Canada. .,Research Institute for Aging, 250 Laurelwood Drive, Waterloo, Ontario, N2J 0E2, Canada.
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Botigué T, Masot O, Miranda J, Nuin C, Viladrosa M, Lavedán A, Zwakhalen S. Prevalence and Risk Factors Associated With Low Fluid Intake in Institutionalized Older Residents. J Am Med Dir Assoc 2018; 20:317-322. [PMID: 30337227 DOI: 10.1016/j.jamda.2018.08.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 08/18/2018] [Accepted: 08/24/2018] [Indexed: 01/17/2023]
Abstract
OBJECTIVE The aim of this study was to determine the prevalence of low fluid intake in institutionalized older residents and the associated factors. DESIGN This was a cross-sectional study. SETTING AND PARTICIPANTS The study was carried out at a nursing home with a capacity for 156 residents, all of whom were older than 65 years. MEASURES Data were collected on the fluids consumed by each resident over a period of 1 week. Information relating to sociodemographic variables and to residents' health, nutrition, and hydration status was also collected. RESULTS Of 53 residents, 34% ingested less than 1500 mL/d. The factors with the greatest correlation associated with low fluid intake were cognitive and functional impairment, the risk of suffering pressure ulcers, being undernourished, a texture-modified diet, dysphagia, impaired swallowing safety, and BUN:creatinine ratio. CONCLUSIONS/IMPLICATIONS The results obtained highlight the scale of low fluid intake in nursing homes and also aid to identify and understand the factors associated with this problem. The findings could help us to develop specific strategies to promote the intake of liquids and thereby reduce the incidence of dehydration in nursing homes.
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Affiliation(s)
- Teresa Botigué
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Catalonia, Spain; Health Care Research Group (GRECS), Biomedical Research Institute of Lleida, Lleida, Catalonia, Spain
| | - Olga Masot
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Catalonia, Spain; Health Care Research Group (GRECS), Biomedical Research Institute of Lleida, Lleida, Catalonia, Spain.
| | - Jèssica Miranda
- Health Care Research Group (GRECS), Biomedical Research Institute of Lleida, Lleida, Catalonia, Spain; Residència i Centre de dia Lleida-Balàfia, GSS, Lleida, Catalonia, Spain
| | - Carmen Nuin
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Catalonia, Spain; Health Care Research Group (GRECS), Biomedical Research Institute of Lleida, Lleida, Catalonia, Spain
| | - Maria Viladrosa
- Health Care Research Group (GRECS), Biomedical Research Institute of Lleida, Lleida, Catalonia, Spain; Arnau de Vilanova University Hospital of Lleida, Lleida, Catalonia, Spain
| | - Ana Lavedán
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Catalonia, Spain; Health Care Research Group (GRECS), Biomedical Research Institute of Lleida, Lleida, Catalonia, Spain
| | - Sandra Zwakhalen
- Research School CAPHRI, Department of Health Services Research, Maastricht University, Maastricht, the Netherlands
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Who Is (Still) Looking After Mom and Dad? Few Improvements in Care Aides' Quality-of-Work Life. Can J Aging 2018; 38:35-50. [PMID: 30298797 DOI: 10.1017/s0714980818000338] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
ABSTRACTUnregulated care aides provide most of the direct care to nursing home residents. We previously reported the first demographic profile of care aides in Western Canada through the Translating Research in Elder Care (TREC) longitudinal research program (2007-2022) in applied health services. Here we describe demographic, health, and work life characteristics of aides from 91 nursing homes in Western Canada. Demographics and work life varied significantly across health regions and facility owner-operator models. Our longitudinal cohort of aides from Alberta and Winnipeg had higher emotional exhaustion (a negative attribute), professional efficacy (a positive attribute), and experience of dementia-related responsive behaviours from residents. Overall, results indicate little improvement or worsening of care aide health and quality of work life. Coupled with limited provincial or national initiatives for workforce planning and training of these workers, this signals a long-term care system ill-prepared to care effectively for Canada's aging population.
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Lo TKT, Hoben M, Norton PG, Teare GF, Estabrooks CA. Importance of clinical educators to research use and suggestions for better efficiency and effectiveness: results of a cross-sectional survey of care aides in Canadian long-term care facilities. BMJ Open 2018; 8:e020074. [PMID: 30007925 PMCID: PMC6082467 DOI: 10.1136/bmjopen-2017-020074] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE This study explored the effect of clinical educators as facilitators of research use and how it may be modified by organisational context in the settings. DESIGN Cross-sectional observational study. SETTING A representative sample of 91 residential long-term care (LTC) facilities across Western Canada. PARTICIPANTS We used surveys to collect data from the frontline care aides and information about the organisational context of the care units. OUTCOME MEASURE AND EXPLANATORY VARIABLES We assessed research use (the outcome) with the Conceptual Research Utilization (CRU) scale. Explanatory variables in the multiple regression analysis were facilitation, organisational context and the interaction terms. Facilitation was measured by the frequency of contacts between care aides and clinical educator or person who brings new ideas about resident care. Three core organisational context variables were measured using the Alberta Context Tool. RESULTS We included data of 3873 care aides from 294 care units in the LTC facilities. We found significant associations between CRU and facilitation, leadership, culture and evaluation. Interactions of facilitation x leadership and facilitation x culture were negative. The coefficient of the facilitation x evaluation term in the regression model was positive (0.019, 95% CI 0.012 to 0.026), suggesting synergistic effects between facilitation and a well-developed process to evaluate care quality using relevant data. CONCLUSIONS Findings indicate clinical educators are effective facilitators of research use among the care aides, but the effect is modified by organisational context. For greatest impact, managers can direct efforts of the clinical educators to care units where leadership and culture ratings are lowest, but a proficient feedback and evaluation process is in place. This understanding enables managers to deploy clinical educators (a scarce resource in LTC settings) most efficiently.
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Affiliation(s)
- T K T Lo
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, Edmonton, Alberta, Canada
| | - Matthias Hoben
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, Edmonton, Alberta, Canada
| | - Peter G Norton
- Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Gary F Teare
- Saskatchewan Health Quality Council, Saskatoon, Saskatchewan, Canada
| | - Carole A Estabrooks
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, Edmonton, Alberta, Canada
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Li SA, Jeffs L, Barwick M, Stevens B. Organizational contextual features that influence the implementation of evidence-based practices across healthcare settings: a systematic integrative review. Syst Rev 2018; 7:72. [PMID: 29729669 PMCID: PMC5936626 DOI: 10.1186/s13643-018-0734-5] [Citation(s) in RCA: 150] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 04/18/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Organizational contextual features have been recognized as important determinants for implementing evidence-based practices across healthcare settings for over a decade. However, implementation scientists have not reached consensus on which features are most important for implementing evidence-based practices. The aims of this review were to identify the most commonly reported organizational contextual features that influence the implementation of evidence-based practices across healthcare settings, and to describe how these features affect implementation. METHODS An integrative review was undertaken following literature searches in CINAHL, MEDLINE, PsycINFO, EMBASE, Web of Science, and Cochrane databases from January 2005 to June 2017. English language, peer-reviewed empirical studies exploring organizational context in at least one implementation initiative within a healthcare setting were included. Quality appraisal of the included studies was performed using the Mixed Methods Appraisal Tool. Inductive content analysis informed data extraction and reduction. RESULTS The search generated 5152 citations. After removing duplicates and applying eligibility criteria, 36 journal articles were included. The majority (n = 20) of the study designs were qualitative, 11 were quantitative, and 5 used a mixed methods approach. Six main organizational contextual features (organizational culture; leadership; networks and communication; resources; evaluation, monitoring and feedback; and champions) were most commonly reported to influence implementation outcomes in the selected studies across a wide range of healthcare settings. CONCLUSIONS We identified six organizational contextual features that appear to be interrelated and work synergistically to influence the implementation of evidence-based practices within an organization. Organizational contextual features did not influence implementation efforts independently from other features. Rather, features were interrelated and often influenced each other in complex, dynamic ways to effect change. These features corresponded to the constructs in the Consolidated Framework for Implementation Research (CFIR), which supports the use of CFIR as a guiding framework for studies that explore the relationship between organizational context and implementation. Organizational culture was most commonly reported to affect implementation. Leadership exerted influence on the five other features, indicating it may be a moderator or mediator that enhances or impedes the implementation of evidence-based practices. Future research should focus on how organizational features interact to influence implementation effectiveness.
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Affiliation(s)
- Shelly-Anne Li
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada. .,Child Health Evaluative Sciences, Research Institute, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, ON, Canada.
| | - Lianne Jeffs
- St Michael's Hospital Volunteer Association Chair in Nursing Research, Li Ka Shing Knowledge Institute, Toronto, ON, Canada.,Lawrence S. Bloomberg Faculty of Nursing and Institute of Health, Policy Management and Evaluation, University of Toronto, Toronto, Canada
| | - Melanie Barwick
- Child Health Evaluative Sciences, Research Institute, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada.,The Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Bonnie Stevens
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada.,Child Health Evaluative Sciences, Research Institute, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, ON, Canada.,Faculties of Medicine and Dentistry, University of Toronto Centre for the Study of Pain, University of Toronto, Toronto, Canada
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Cranley LA, Hoben M, Yeung J, Estabrooks CA, Norton PG, Wagg A. SCOPEOUT: sustainability and spread of quality improvement activities in long-term care- a mixed methods approach. BMC Health Serv Res 2018. [PMID: 29530038 PMCID: PMC5848563 DOI: 10.1186/s12913-018-2978-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Interventions to improve quality of care for residents of long-term care facilities, and to examine the sustainability and spread of such initiatives, remain a top research priority. The purpose of this exploratory study was to assess the extent to which activities initiated in a quality improvement (QI) collaborative study using care aide led teams were sustained or spread following cessation of the initial project and to identify factors that led to its success. METHODS This study used an exploratory mixed methods study design and was conducted in seven residential long-term care facilities in two Canadian provinces. Sustainability and spread of QI activities were assessed by a questionnaire over five time points for 18 months following the collaborative study with staff from both intervention with non-intervention units. Semi-structured interviews were conducted with care managers at six and 12 months. QI team success in applying the QI model was ranked as high, medium, or low using criteria developed by the research team. Descriptive statistics, bivariate analyses, and General Estimating Equations were used to analyze the data. Interview data were analyzed using thematic analysis. RESULTS In total, 683 surveys were received over the five time periods from 476 unique individuals on a facility unit. Seven managers were interviewed. A total of 533 surveys were analyzed. While both intervention and non-intervention units experienced a decline over time in all outcome measures, this decline was significantly less pronounced on intervention units. Facilities with medium and high success ranking had significantly higher scores in all four outcomes than facilities with a low success ranking. Care aides reported significantly less involvement of others in QI activities, less empowerment and less satisfaction with the quality of their work life than regulated care providers. Manager interviews provided evidence of sustainability of QI activities on the intervention units in four of the seven facilities up to 18 months following the intervention and demonstrated the need for continued staff and leadership engagement. CONCLUSION Sustainability of a QI project which empowers and engages care aides is possible and achievable, but requires ongoing staff and leadership engagement.
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Affiliation(s)
- Lisa A Cranley
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Toronto, ON, Canada.
| | - Matthias Hoben
- Faculty of Nursing, University of Alberta, 11405 87 Avenue NW, Edmonton, AB, Canada
| | - Jasper Yeung
- Faculty of Medicine and Dentistry, Department of Medicine, University of Alberta, 11405 87 Avenue NW, Edmonton, AB, Canada
| | - Carole A Estabrooks
- Faculty of Nursing, University of Alberta, 11405 87 Avenue NW, Edmonton, AB, Canada
| | - Peter G Norton
- Department of Family Medicine, University of Calgary, 2500 University Drive NW, Calgary, AB, Canada
| | - Adrian Wagg
- Faculty of Medicine and Dentistry, Department of Medicine, University of Alberta, 11405 87 Avenue NW, Edmonton, AB, Canada
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Eltaybani S, Noguchi-Watanabe M, Igarashi A, Saito Y, Yamamoto-Mitani N. Factors related to intention to stay in the current workplace among long-term care nurses: A nationwide survey. Int J Nurs Stud 2018; 80:118-127. [PMID: 29407345 DOI: 10.1016/j.ijnurstu.2018.01.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 01/13/2018] [Accepted: 01/16/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Keeping long-term care nurses employed is necessary to sustain the current and future demand for high-quality long-term care services. Understanding the factors relating to intention to stay among long-term care nurses is limited by the scarcity of studies in long-term care settings, lack of investigation of multiple factors, and the weakness of existing explanatory models. OBJECTIVE To identify the factors associated with long-term care nurses' intention to stay in their current workplace. DESIGN A cross-sectional questionnaire survey. SETTING Two hundred and fifty-seven hospitals with long-term care wards across Japan. PARTICIPANTS A total of 3128 staff nurses and 257 nurse managers from the long-term care wards of the participating hospitals. METHOD The questionnaire assessed nurses' intention to continue working in the current workplace as well as potential related factors, including individual factors (demographic data, reason for choosing current workplace, burnout, work engagement, somatic symptom burden) and unit factors (unit size, nurse-manager-related data, patients' medical acuity, average number of overtime hours, recreational activities, social support, perceived quality of care process, educational opportunities, feeling of loneliness, and ability to request days off). Multilevel logistic regression analysis was used to determine which variables best explained nurses' intention to stay in their workplace. RESULTS Only 40.1% of the respondents reported wanting to continue working at their current workplace. The regression analysis revealed that long-term care nurses' intention to stay was positively associated with nurses' age (odds ratio [95% confidence interval]: 1.02 [1.01-1.03]), work engagement (1.24 [1.14-1.35]), getting appropriate support from nurse managers (2.78 [1.60-4.82]), perceived quality of care process (1.04 [1.01-1.06]), educational opportunities (1.06 [1.0-1.13]), and various specific reasons for choosing their workplace (e.g., a good workplace atmosphere, being interested in gerontological nursing, and a high salary). By contrast, intention to stay was negatively associated with emotional exhaustion (0.93 [0.91-0.95]) and depersonalization (0.91 [0.89-0.93]). Intention to stay was associated with neither nurses' qualifications nor patient medical acuity. CONCLUSION Reason for choosing the workplace, work engagement, getting support from the nurse manager, and perceived quality of care process are significant predictors of long-term care nurses' intention to stay in the workplace. Promoting such nurses' work engagement, provision of high-quality care, and access to educational opportunities might augment long-term care nurses' intention to stay.
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Affiliation(s)
- Sameh Eltaybani
- Department of Gerontological Home Care and Long-Term Care Nursing, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan; Department of Critical Care and Emergency Nursing, Faculty of Nursing, Alexandria University, Egypt.
| | - Maiko Noguchi-Watanabe
- Department of Gerontological Home Care and Long-Term Care Nursing, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan.
| | - Ayumi Igarashi
- Department of Gerontological Home Care and Long-Term Care Nursing, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan.
| | - Yumiko Saito
- Department of Gerontological Home Care and Long-Term Care Nursing, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan.
| | - Noriko Yamamoto-Mitani
- Department of Gerontological Home Care and Long-Term Care Nursing, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan.
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Woo K, Milworm G, Dowding D. Characteristics of Quality Improvement Champions in Nursing Homes: A Systematic Review With Implications for Evidence-Based Practice. Worldviews Evid Based Nurs 2017; 14:440-446. [PMID: 29028282 DOI: 10.1111/wvn.12262] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND Improving care quality while reducing cost has always been a focus of nursing homes. Certified nursing assistants comprise the largest proportion of the workforce in nursing homes and have the potential to contribute to the quality of care provided. Quality improvement (QI) initiatives using certified nursing assistants as champions have the potential to improve job satisfaction, which has been associated with care quality. AIMS To identify the role, use and preparation of champions in a nursing home setting as a way of informing future QI strategies in nursing homes. METHODS A systematic literature review. Medical Subject Headings and text words for "quality improvement" were combined with those for "champion*" to search Medline, CINAHL, Joanna Briggs Institute, MedLine In-Process, and other Nonindexed Citations. After duplicates were removed, a total of 337 potential articles were identified for further review. After full text review, seven articles from five original studies met inclusion criteria and were included in the synthesis. RESULTS Various types of QI initiatives and implementation strategies were used together with champions. Champions were identified by study authors as one of the single most effective strategies employed in all studies. The majority of studies described the champion role as that of a leader, who fosters and reinforces changes for improvement. Although all the included studies suggested that implementing nurse or aid champions in their QI initiatives were important facilitators of success, how the champions were selected and trained in their role is either missing or not described in any detail in the studies included in the review. LINKING EVIDENCE TO ACTION Utilizing certified nursing assistants as QI champions can increase participation in QI projects and has the potential to improve job satisfaction and contribute to improve quality of care and improved patient outcomes in nursing homes.
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Affiliation(s)
- Kyungmi Woo
- Doctoral Candidate, Columbia University School of Nursing, New York, NY, USA
| | - Gvira Milworm
- Chief Process Officer, Elderly Health Promotion Inc. and DBA Institute for Pressure Injury Prevention, Sydney, NSW, Australia
| | - Dawn Dowding
- Professor of Nursing, Columbia University School of Nursing, and Center for Home Care Policy and Research, Visiting Nurse Service of New York, New York, NY, USA
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Implementing early mobilisation in the intensive care unit: An integrative review. Int J Nurs Stud 2017; 77:91-105. [PMID: 29073462 DOI: 10.1016/j.ijnurstu.2017.09.019] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 09/28/2017] [Accepted: 09/29/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND The intensive care unit provides complex care for critically ill patients. Consequently, due to the nature of critical illness and the therapies administered in intensive care, patients are often on prolonged periods of bed rest with limited mobility. It has been recognised that mobilising critically ill patients is beneficial to patients' recovery, however implementing early mobility as a standard of care remains challenging in practice. OBJECTIVES To identify the key factors that underpin successful implementation and sustainability of early mobilisation in adult intensive care units. DESIGN Integrative Review. DATA SOURCE A systematic search strategy guided by SPICE framework (Setting, Perspective, Intervention, Comparison, Evaluation) was used to formulate the research question, identify study inclusion and exclusion criteria, and guide the database search strategy. Computerised databases were searched from August-September 2016. Quality improvement articles that identified project implementation of early mobilisation of mechanically ventilated adult intensive care patients were included. REVIEW METHODS After screening the articles, extracting project data and completing summary tables, critical appraisal of the quality improvement projects was completed using the Quality Improvement Minimum Quality Criteria Set. A modified version of the Cochrane Effective Practice and Organisation of Care taxonomy was used to synthesise the multifaceted implementation strategies the projects utilised to help bring about changes in clinician behaviour. RESULTS Thirteen articles, reflecting 12 projects meeting the inclusion criteria were included in the final analysis. Eleven projects were conducted in the United States, and one in the United Kingdom. Quality scores ranged from 6 to 15. A formal framework to guide the quality improvement process was used in 9 projects. The three most frequently used groups of implementation strategies were educational meetings, clinical practice guidelines and tailored interventions. Managing the change process through strong leadership, designing strategies and interventions to overcome barriers to implementation, multidisciplinary team collaboration and data collection and feedback underpinned successful and sustainable early mobility practice change. CONCLUSION The use of a quality improvement appraisal tool can help identify high quality projects when planning a similar mobility program. Even though projects were conducted in a variety of intensive care unit settings, and implementation frameworks and strategies varied, all began with strong leadership commitment to early mobilisation. This along with using the quality improvement process and multidisciplinary team approach ensured success and sustainability of mobilising ventilated patients.
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Goodenough B, Fleming R, Young M, Burns K, Jones C, Forbes F. Raising awareness of research evidence among health professionals delivering dementia care: Are knowledge translation workshops useful? GERONTOLOGY & GERIATRICS EDUCATION 2017; 38:392-406. [PMID: 27775487 DOI: 10.1080/02701960.2016.1247064] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Providing information about the latest research via educational sessions to health professionals caring for people with dementia may be insufficient to drive change. This project explored self-reported impacts on practice change of adding information about knowledge translation (KT) to a national dementia education program. Six national workshop days were held. Each provided the option of participating in a Principles of KT and innovation implementation seminar in addition to a clinical topic update (sexualities and dementia, or managing behavioral and psychological symptoms of dementia). Six months postworkshop, 321 participants were invited to complete a research utilization survey. Seventy-five responded. KT seminar participants were more likely to report instrumental outcomes (e.g. changed policies, procedures) than those who did not participate in the KT seminar. Including KT information in educational sessions for health professionals may increase the likelihood of practice change in the field of dementia care and warrants further research.
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Affiliation(s)
- Belinda Goodenough
- a School of Nursing , University of Wollongong , Wollongong , New South Wales , Australia
- b Dementia Collaborative Research Centres , University of New South Wales , Sydney , New South Wales , Australia
| | - Richard Fleming
- a School of Nursing , University of Wollongong , Wollongong , New South Wales , Australia
| | - Michael Young
- c School of Psychology , University of New South Wales , Sydney , New South Wales , Australia
| | - Kim Burns
- b Dementia Collaborative Research Centres , University of New South Wales , Sydney , New South Wales , Australia
| | - Cindy Jones
- d Menzies Health Institute Queensland , Griffith University , Gold Coast , Queensland , Australia
| | - Fallon Forbes
- a School of Nursing , University of Wollongong , Wollongong , New South Wales , Australia
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Cummings GG, Hewko SJ, Wang M, Wong CA, Laschinger HKS, Estabrooks CA. Impact of Managers' Coaching Conversations on Staff Knowledge Use and Performance in Long-Term Care Settings. Worldviews Evid Based Nurs 2017; 15:62-71. [PMID: 28755472 DOI: 10.1111/wvn.12233] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Extended lifespans and complex resident care needs have amplified resource demands on nursing homes. Nurse managers play an important role in staff job satisfaction, research use, and resident outcomes. Coaching skills, developed through leadership skill-building, have been shown to be of value in nursing. AIMS To test a theoretical model of nursing home staff perceptions of their work context, their managers' use of coaching conversations, and their use of instrumental, conceptual and persuasive research. METHODS Using a two-group crossover design, 33 managers employed in seven Canadian nursing homes were invited to attend a 2-day coaching development workshop. Survey data were collected from managers and staff at three time points; we analyzed staff data (n = 333), collected after managers had completed the workshop. We used structural equation modeling to test our theoretical model of contextual characteristics as causal variables, managers' characteristics, and coaching behaviors as mediating variables and staff use of research, job satisfaction, and burnout as outcome variables. RESULTS The theoretical model fit the data well (χ2 = 58, df = 43, p = .06) indicating no significant differences between data and model-implied matrices. Resonant leadership (a relational approach to influencing change) had the strongest significant relationship with manager support, which in turn influenced frequency of coaching conversations. Coaching conversations had a positive, non-significant relationship with staff persuasive use of research, which in turn significantly increased instrumental research use. Importantly, coaching conversations were significantly, negatively related to job satisfaction. LINKING EVIDENCE TO ACTION Our findings add to growing research exploring the role of context and leadership in influencing job satisfaction and use of research by healthcare practitioners. One-on-one coaching conversations may be difficult for staff not used to participating in such conversations. Resonant leadership, as expected, has a significant impact on manager support and job satisfaction among nursing home staff.
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Affiliation(s)
- Greta G Cummings
- Professor, Level 3, Edmonton Clinic Health Academy, Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Sarah J Hewko
- Doctoral Candidate, Level 3, Edmonton Clinic Health Academy, Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Mengzhe Wang
- Manager, Health Information Analysis, Alberta Health, Edmonton, Alberta, Canada
| | - Carol A Wong
- Associate Professor, Arthur Labatt Family School of Nursing, University of Western Ontario, London, Ontario, Canada
| | - Heather K Spence Laschinger
- Distinguished University Professor, Arthur Labatt Family School of Nursing, University of Western Ontario, London, Ontario, Canada
| | - Carole A Estabrooks
- Professor, Canada Research Chair in Knowledge Translation, Level 3, Edmonton Clinic Health Academy, Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
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Arain MA, Deutschlander S, Charland P. Are healthcare aides underused in long-term care? A cross-sectional study on continuing care facilities in Canada. BMJ Open 2017; 7:e015521. [PMID: 28515199 PMCID: PMC5736087 DOI: 10.1136/bmjopen-2016-015521] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES Over the last 10 years, appropriate workforce utilisation has been an important discussion among healthcare practitioners and policy-makers. The role of healthcare aides (HCAs) has also expanded to improve their utilisation. This evolving role of HCAs in Canada has prompted calls for standardised training, education and scope of practice for HCAs. The purpose of this research was to examine the differences in HCAs training and utilisation in continuing care facilities. DESIGN From June 2014 to July 2015, we conducted a mixed-method study on HCA utilisation in continuing care. This paper presents findings gathered solely from the prospective cross-sectional survey of continuing care facilities (long-term care (LTC) and supportive living (SL)) on HCA utilisation. SETTING AND PARTICIPANTS We conducted this study in a Western Canadian province. The managers of the continuing care facilities (SL and LTC) were eligible to participate in the survey. PRIMARY OUTCOME MEASURES The pattern of HCAs involvement in medication assistance and other care activities in SL and LTC facilities. RESULTS We received 130 completed surveys (LTC=64 and SL=52). Our findings showed that approximately 81% of HCAs were fully certified. We found variations in how HCAs were used in SL and LTC facilities. Overall, HCAs in SL were more likely to be involved in medication management such as assisting with inhaled medication and oral medication delivery. A significantly larger proportion of survey respondents from SL facilities reported that medication assistance training was mandatory for their HCAs (86%) compared with the LTC facilities (50%) (p value <0.01). CONCLUSION The utilisation of HCAs varies widely between SL and LTC facilities. HCAs in SL facilities may be considered better used according to their required educational training and competencies. Expanding the role of HCAs in LTC facilities may lead to a cost-effective and more efficient utilisation of workforce in continuing care facilities.
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Affiliation(s)
- Mubashir A Arain
- Workforce Research & Evaluation, Alberta Health Services, Calgary, Alberta, Canada
| | | | - Paola Charland
- Workforce Research & Evaluation, Alberta Health Services, Calgary, Alberta, Canada
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Hoben M, Clarke A, Huynh KT, Kobagi N, Kent A, Hu H, Pereira RAC, Xiong T, Yu K, Xiang H, Yoon MN. Barriers and facilitators in providing oral care to nursing home residents, from the perspective of care aides: A systematic review and meta-analysis. Int J Nurs Stud 2017; 73:34-51. [PMID: 28531550 DOI: 10.1016/j.ijnurstu.2017.05.003] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 04/30/2017] [Accepted: 05/08/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND Oral health of nursing home residents is generally poor, with severe consequences for residents' general health and quality of life and for the health care system. Care aides in nursing homes provide up to 80% of direct care (including oral care) to residents, but providing oral care is often challenging. Interventions to improve oral care must tailor to identified barriers and facilitators to be effective. This review identifies and synthesizes the evidence on barriers and facilitators care aides perceive in providing oral care to nursing home residents. METHODS We systematically searched the databases MEDLINE, Embase, Evidence Based Reviews-Cochrane Central Register of Controlled Trials, CINAHL, and Web of Science. We also searched by hand the contents of key journals, publications of key authors, and reference lists of all studies included. We included qualitative and quantitative research studies that assess barriers and facilitators, as perceived by care aides, to providing oral care to nursing home residents. We conducted a thematic analysis of barriers and facilitators, extracted prevalence of care aides reporting certain barriers and facilitators from studies reporting quantitative data, and conducted random-effects meta-analyses of prevalence. RESULTS We included 45 references that represent 41 unique studies: 15 cross-sectional studies, 13 qualitative studies, 7 mixed methods studies, 3 one-group pre-post studies, and 3 randomized controlled trials. Methodological quality was generally weak. We identified barriers and facilitators related to residents, their family members, care providers, organization of care services, and social interactions. Pooled estimates (95% confidence intervals) of barriers were: residents resisting care=45% (15%-77%); care providers' lack of knowledge, education or training in providing oral care=24% (7%-47%); general difficulties in providing oral care=26% (19%-33%); lack of time=31% (17%-47%); general dislike of oral care=19% (8%-33%); and lack of staff=22% (13%-31%). CONCLUSIONS We found a lack of robust evidence on barriers and facilitators that care aides perceive in providing oral care to nursing home residents, suggesting a need for robust research studies in this area. Effective strategies to overcome barriers and to increase facilitators in providing oral care are one of the most critical research gaps in the area of improving oral care for nursing home residents. Strategies to prevent or manage residents' responsive behaviors and to improve care aides' oral care knowledge are especially needed.
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Affiliation(s)
- Matthias Hoben
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.
| | - Alix Clarke
- School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
| | - Kha Tu Huynh
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.
| | - Nadia Kobagi
- School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
| | - Angelle Kent
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.
| | - Huimin Hu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
| | | | - Tianyuan Xiong
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
| | - Kexin Yu
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou, Zhejiang, China.
| | - Hongjin Xiang
- Ultrasound Department, West China School of Medicine, Sichuan University, Chengdu, Sichuan, China.
| | - Minn N Yoon
- School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
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Slaughter SE, Bampton E, Erin DF, Ickert C, Jones CA, Estabrooks CA. A Novel Implementation Strategy in Residential Care Settings to Promote EBP: Direct Care Provider Perceptions and Development of a Conceptual Framework. Worldviews Evid Based Nurs 2017; 14:237-245. [PMID: 28449400 DOI: 10.1111/wvn.12224] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Innovative approaches are required to facilitate the adoption and sustainability of evidence-based care practices. We propose a novel implementation strategy, a peer reminder role, which involves offering a brief formal reminder to peers during structured unit meetings. AIMS This study aims to (a) identify healthcare aide (HCA) perceptions of a peer reminder role for HCAs, and (b) develop a conceptual framework for the role based on these perceptions. METHODS In 2013, a qualitative focus group study was conducted in five purposively sampled residential care facilities in western Canada. A convenience sample of 24 HCAs agreed to participate in five focus groups. Concurrent with data collection, two researchers coded the transcripts and identified themes by consensus. They jointly determined when saturation was achieved and took steps to optimize the trustworthiness of the findings. Five HCAs from the original focus groups commented on the resulting conceptual framework. RESULTS HCAs were cautious about accepting a role that might alienate them from their co-workers. They emphasized feeling comfortable with the peer reminder role and identified circumstances that would optimize their comfort including: effective implementation strategies, perceptions of the role, role credibility and a supportive context. These intersecting themes formed a peer reminder conceptual framework. LINKING EVIDENCE TO ACTION We identified HCAs' perspectives of a new peer reminder role designed specifically for them. Based on their perceptions, a conceptual framework was developed to guide the implementation of a peer reminder role for HCAs. This role may be a strategic implementation strategy to optimize the sustainability of new practices in residential care settings, and the related framework could offer guidance on how to implement this role.
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Affiliation(s)
- Susan E Slaughter
- Associate Professor, Faculty of Nursing, University of Alberta, Edmonton, Canada
| | - Erin Bampton
- Research Assistant, Faculty of Nursing, University of Alberta, Edmonton, Canada
| | - Daniel F Erin
- Research Assistant, Faculty of Nursing, University of Alberta, Edmonton, Canada
| | - Carla Ickert
- Research Manager, Faculty of Nursing, University of Alberta, Edmonton, Canada
| | - C Allyson Jones
- Professor, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
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Chamberlain SA, Gruneir A, Hoben M, Squires JE, Cummings GG, Estabrooks CA. Influence of organizational context on nursing home staff burnout: A cross-sectional survey of care aides in Western Canada. Int J Nurs Stud 2017; 71:60-69. [PMID: 28334686 DOI: 10.1016/j.ijnurstu.2017.02.024] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 02/10/2017] [Accepted: 02/28/2017] [Indexed: 10/24/2022]
Abstract
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.
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Affiliation(s)
| | - Andrea Gruneir
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada.
| | - Matthias Hoben
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.
| | - Janet E Squires
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada.
| | - Greta G Cummings
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.
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Yamada J, Squires JE, Estabrooks CA, Victor C, Stevens B. The role of organizational context in moderating the effect of research use on pain outcomes in hospitalized children: a cross sectional study. BMC Health Serv Res 2017; 17:68. [PMID: 28114940 PMCID: PMC5259896 DOI: 10.1186/s12913-017-2029-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 01/17/2017] [Indexed: 11/23/2022] Open
Abstract
Background Despite substantial research on pediatric pain assessment and management, health care professionals do not adequately incorporate this knowledge into clinical practice. Organizational context (work environment) is a significant factor in influencing outcomes; however, the nature of the mechanisms are relatively unknown. The objective of this study was to assess how organizational context moderates the effect of research use and pain outcomes in hospitalized children. Methods A cross-sectional survey was undertaken with 779 nurses in 32 patient care units in 8 Canadian pediatric hospitals, following implementation of a multifaceted knowledge translation intervention, Evidence-based Practice for Improving Quality (EPIQ). The influence of organizational context was assessed in relation to pain process (assessment and management) and clinical (pain intensity) outcomes. Organizational context was measured using the Alberta Context Tool that includes: leadership, culture, evaluation, social capital, informal interactions, formal interactions, structural and electronic resources, and organizational slack (staff, space, and time). Marginal modeling estimated the effects of instrumental research use (direct use of research knowledge) and conceptual research use (indirect use of research knowledge) on pain outcomes while examining the effects of context. Results Six of the 10 organizational context factors (culture, social capital, informal interactions, resources, and organizational slack [space and time]) significantly moderated the effect of instrumental research use on pain assessment; four factors (culture, social capital, resources and organizational slack time) moderated the effect of conceptual research use and pain assessment. Only two factors (evaluation and formal interactions) moderated the effect of instrumental research use on pain management. All organizational factors except slack space significantly moderated the effect of instrumental research use on pain intensity; informal interactions and organizational slack space moderated the effect of conceptual research use and pain intensity. Conclusions Many aspects of organizational context consistently moderated the effects of instrumental research use on pain assessment and pain intensity, while only a few influenced conceptual use of research on pain outcomes. Organizational context factors did not generally influence the effect of research use on pain management. Further research is required to further explore the relationships between organizational context and pain management outcomes.
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Affiliation(s)
- Janet Yamada
- Daphne Cockwell School of Nursing, Ryerson University, Ottawa, ON, Canada
| | - Janet E Squires
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, ON, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | | | | | - Bonnie Stevens
- Lawrence S Bloomberg, Faculty of Nursing, University of Toronto, Ottawa, ON, Canada. .,Child Health Evaluation Sciences, Research Institute, The Hospital for Sick Children, 686 Bay Street, Room 06.9712, Ottawa, ON, M5G 1X8, Canada.
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Kuk NO, den Ouden M, Zijlstra GAR, Hamers JPH, Kempen GIJM, Bours GJJW. Do nursing staff encourage functional activity among nursing home residents? A cross-sectional study of nursing staff perceived behaviors and associated factors. BMC Geriatr 2017; 17:18. [PMID: 28088168 PMCID: PMC5237509 DOI: 10.1186/s12877-017-0412-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 01/04/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Nursing home residents are mainly inactive. Nursing staff can encourage residents to perform functional activities during daily care activities. This study examines 1) the extent to which nursing staff perceive that they encourage functional activity in nursing home residents and 2) the associations between these nursing behaviors and professional characteristics, contextual factors, and information-seeking behaviors. METHODS In this cross-sectional study, 368 registered nurses and certified nurse assistants, working in somatic and psychogeriatric wards of forty-one nursing homes throughout the Netherlands participated. Self-reported data were collected with a questionnaire, comprising the MAINtAIN-behaviors, which assesses the extent to which nursing staff encourage functional activities, including different activities of daily living (ADL), household activities, and miscellaneous encouraging activities (e.g., discouraging informal caregivers from taking over activities residents can do themselves). Additional data collected included professional characteristics (e.g., age), contextual factors (e.g., ward type), and information-seeking behaviors (e.g., reading professional journals). Descriptive statistics were used to determine the extent to which functional activities were encouraged. Hierarchical linear regression analyses were performed to determine the associations between the encouragement of functional activities and other factors. RESULTS Nursing staff perceived that household activities (mean 4.1 (scale range 1-9), SD 1.9) were less often encouraged than ADL (mean 6.9, SD 1.2) or miscellaneous activities (mean 6.7, SD 1.5). The percentage of nursing staff stating that different household activities, ADL, or miscellaneous activities were almost always encouraged ranged from 11 to 45%, 41 to 86%, and 50 to 83% per activity, respectively. The extent to which these activities were encouraged differed for some of the professional characteristics, contextual factors, or information-seeking behaviors, but no consistent pattern in associations emerged. CONCLUSIONS According to nursing staff, household activities are not as often encouraged as ADL or miscellaneous activities. Professional characteristics, contextual factors, and information-seeking behaviors are not consistently associated with the encouragement of functional activity. Nursing staff should also focus on improving the encouragement of household activities. Future research could examine the role of other factors in encouraging functional activity, such as experienced barriers, and assess to what extent the perception of nursing staff corresponds with their actual behavior.
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Affiliation(s)
- Nienke O Kuk
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, Maastricht, MD, 6200, The Netherlands.
| | - Mirre den Ouden
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, Maastricht, MD, 6200, The Netherlands
| | - G A Rixt Zijlstra
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, Maastricht, MD, 6200, The Netherlands
| | - Jan P H Hamers
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, Maastricht, MD, 6200, The Netherlands
| | - Gertrudis I J M Kempen
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, Maastricht, MD, 6200, The Netherlands
| | - Gerrie J J W Bours
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, P.O. Box 616, Maastricht, MD, 6200, The Netherlands.,Research Centre for Autonomy and Participation of People with a Chronic Illness, Zuyd University of Applied Sciences, Faculty of Health, Heerlen, The Netherlands
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Hoben M, Norton PG, Ginsburg LR, Anderson RA, Cummings GG, Lanham HJ, Squires JE, Taylor D, Wagg AS, Estabrooks CA. Improving Nursing Home Care through Feedback On PerfoRMance Data (INFORM): Protocol for a cluster-randomized trial. Trials 2017; 18:9. [PMID: 28069045 PMCID: PMC5223357 DOI: 10.1186/s13063-016-1748-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 12/08/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Audit and feedback is effective in improving the quality of care. However, methods and results of international studies are heterogeneous, and studies have been criticized for a lack of systematic use of theory. In TREC (Translating Research in Elder Care), a longitudinal health services research program, we collect comprehensive data from care providers and residents in Canadian nursing homes to improve quality of care and life of residents, and quality of worklife of caregivers. The study aims are to a) systematically feed back TREC research data to nursing home care units, and b) compare the effectiveness of three different theory-based feedback strategies in improving performance within care units. METHODS INFORM (Improving Nursing Home Care through Feedback On PerfoRMance Data) is a 3.5-year pragmatic, three-arm, parallel, cluster-randomized trial. We will randomize 67 Western Canadian nursing homes with 203 care units to the three study arms, a standard feedback strategy and two assisted and goal-directed feedback strategies. Interventions will target care unit managerial teams. They are based on theory and evidence related to audit and feedback, goal setting, complex adaptive systems, and empirical work on feeding back research results. The primary outcome is the increased number of formal interactions (e.g., resident rounds or family conferences) involving care aides - non-registered caregivers providing up to 80% of direct care. Secondary outcomes are a) other modifiable features of care unit context (improved feedback, social capital, slack time) b) care aides' quality of worklife (improved psychological empowerment, job satisfaction), c) more use of best practices, and d) resident outcomes based on the Resident Assessment Instrument - Minimum Data Set 2.0. Outcomes will be assessed at baseline, immediately after the 12-month intervention period, and 18 months post intervention. DISCUSSION INFORM is the first study to systematically assess the effectiveness of different strategies to feed back research data to nursing home care units in order to improve their performance. Results of this study will enable development of a practical, sustainable, effective, and cost-effective feedback strategy for routine use by managers, policy makers and researchers. The results may also be generalizable to care settings other than nursing homes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02695836 . Date of registration: 24 February 2016.
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Affiliation(s)
- Matthias Hoben
- Faculty of Nursing, University of Alberta, Edmonton, Alberta Canada
- Alberta Innovates-Health Solutions (AIHS) post-doctoral fellow, Translating Research in Elder Care (TREC), Faculty of Nursing, University of Alberta, 5-006 Edmonton Clinic Health Academy (ECHA), 11405 87 Avenue, Edmonton, AB T6G 1C9 Canada
| | - Peter G. Norton
- Department of Family Medicine, University of Calgary, Cumming School of Medicine, Calgary, Alberta Canada
| | - Liane R. Ginsburg
- Faculty of Health, York University, School of Health Policy and Management, Toronto, Ontario Canada
| | - Ruth A. Anderson
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina USA
| | | | - Holly J. Lanham
- Department of Medicine and Department of Family and Community Medicine, University of Texas, Health Science Center San Antonio, San Antonio, Texas USA
| | | | - Deanne Taylor
- Interior Health Authority, Kelowna, British Columbia Canada
| | - Adrian S. Wagg
- Faculty of Medicine and Dentistry, University of Alberta, Division of Geriatric Medicine, Edmonton, Alberta Canada
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Hoben M, Estabrooks CA, Squires JE, Behrens J. Factor Structure, Reliability and Measurement Invariance of the Alberta Context Tool and the Conceptual Research Utilization Scale, for German Residential Long Term Care. Front Psychol 2016; 7:1339. [PMID: 27656156 PMCID: PMC5013130 DOI: 10.3389/fpsyg.2016.01339] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 08/22/2016] [Indexed: 11/13/2022] Open
Abstract
We translated the Canadian residential long term care versions of the Alberta Context Tool (ACT) and the Conceptual Research Utilization (CRU) Scale into German, to study the association between organizational context factors and research utilization in German nursing homes. The rigorous translation process was based on best practice guidelines for tool translation, and we previously published methods and results of this process in two papers. Both instruments are self-report questionnaires used with care providers working in nursing homes. The aim of this study was to assess the factor structure, reliability, and measurement invariance (MI) between care provider groups responding to these instruments. In a stratified random sample of 38 nursing homes in one German region (Metropolregion Rhein-Neckar), we collected questionnaires from 273 care aides, 196 regulated nurses, 152 allied health providers, 6 quality improvement specialists, 129 clinical leaders, and 65 nursing students. The factor structure was assessed using confirmatory factor models. The first model included all 10 ACT concepts. We also decided a priori to run two separate models for the scale-based and the count-based ACT concepts as suggested by the instrument developers. The fourth model included the five CRU Scale items. Reliability scores were calculated based on the parameters of the best-fitting factor models. Multiple-group confirmatory factor models were used to assess MI between provider groups. Rather than the hypothesized ten-factor structure of the ACT, confirmatory factor models suggested 13 factors. The one-factor solution of the CRU Scale was confirmed. The reliability was acceptable (>0.7 in the entire sample and in all provider groups) for 10 of 13 ACT concepts, and high (0.90-0.96) for the CRU Scale. We could demonstrate partial strong MI for both ACT models and partial strict MI for the CRU Scale. Our results suggest that the scores of the German ACT and the CRU Scale for nursing homes are acceptably reliable and valid. However, as the ACT lacked strict MI, observed variables (or scale scores based on them) cannot be compared between provider groups. Rather, group comparisons should be based on latent variable models, which consider the different residual variances of each group.
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Affiliation(s)
- Matthias Hoben
- Knowledge Utilization Studies Program, Faculty of Nursing, University of AlbertaEdmonton, AB, Canada; Medical Faculty, Institute of Health and Nursing Sciences, Martin Luther University of Halle-WittenbergHalle, Germany; Network Aging Research, Heidelberg UniversityHeidelberg, Germany
| | - Carole A Estabrooks
- Knowledge Utilization Studies Program, Faculty of Nursing, University of Alberta Edmonton, AB, Canada
| | - Janet E Squires
- Faculty of Health Sciences, School of Nursing, University of OttawaOttawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa HospitalOttawa, ON, Canada
| | - Johann Behrens
- Medical Faculty, Institute of Health and Nursing Sciences, Martin Luther University of Halle-Wittenberg Halle, Germany
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Shannon K, McKenzie-Green B. Current role challenges in New Zealand aged residential care: the potential consequences for healthcare assistant role expansion. Contemp Nurse 2016; 52:140-51. [DOI: 10.1080/10376178.2016.1221322] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Cummings GG, Doupe M, Ginsburg L, McGregor MJ, Norton PG, Estabrooks CA. Development and Validation of A Scheduled Shifts Staffing (ASSiST) Measure of Unit-Level Staffing in Nursing Homes. THE GERONTOLOGIST 2016; 57:509-516. [DOI: 10.1093/geront/gnv682] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 09/30/2015] [Indexed: 11/14/2022] Open
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