Development, evaluation, and implementation of an online pain assessment training program for staff in rural long-term care facilities: a case series approach

Data Quality of Resident Documentation in Long-Term Care: A Systematic Review and Meta-analysis

OBJECTIVES

To evaluate the impact of interventions aimed at improving data quality in resident documentation in the residential long-term care setting, and to explore the experiences related with the implementation strategies and key determinants influencing data quality.

DESIGN

A systematic review.

SETTING AND PARTICIPANTS

Residential long-term care.

METHODS

PubMed and Embase were searched from inception to January 2025. This search was supplemented with screening study registries, references, prospective citation searching, and reviewing gray literature. Studies were selected and data were abstracted by 2 researchers. A narrative synthesis and random effects meta-analyses were performed. The GRADE level of evidence was determined. A thematic analysis was conducted for the qualitative data.

RESULTS

A total of 30 studies were included. The introduction of electronic health records, educational strategies, incident reporting systems, and reminder strategies were associated with small to moderate improvements. The average effect across interventions was an improvement of 13% (95% CI, 7%-20%, I2 = 60%, very low GRADE) in data completeness. Overall data quality was improved in 3 studies, accuracy of data was improved in 1 study, and 1 study observed a nonsignificant improvement in reliability. Small effect sizes and very low-GRADE evidence were observed. Key determinants influencing data quality included the perceived usefulness of documentation systems, access to electronic health records, staff knowledge about clinical assessments, and perceptions of the appropriateness of quality indicators and data reliability. Implementation of interventions was supported by the following strategies: (1) identify and prepare champions, (2) audit and feedback on implementation, (3) provide ongoing consultation, and (4) disseminate implementation materials.

CONCLUSIONS AND IMPLICATIONS

Small to moderate improvements in data quality were observed, with a very low GRADE of evidence. Most findings were limited to the completeness of documentation, although aspects such as timeliness and accuracy remain understudied. It remains unclear what interventions are effective in ensuring solid data quality.

Implementation and evaluation of a pain assessment app and novel community platform for long-term care health professionals

OBJECTIVE

A tablet app, based on the Pain Assessment Checklist for Seniors with Limited Ability to Communicate-II (PACSLAC-II), has been shown to have clinical utility and unique advantages. We aimed to replicate and extend the previous validation of the app through the implementation and evaluation of a new community platform involving a quality indicator (QI) monitoring feature and a resource community portal (CP) that work in conjunction with an updated version of the app.

METHODS

We employed a mixed-methods multiple-baseline design across 11 long-term care (LTC) units. Units were randomly assigned to conditions which varied in number of app features available. Data included unit-level QIs as well as questionnaires and semi-structured interviews with health professionals.

RESULTS

Following use of the app, we found improvements in unit-level QIs regardless of availability of the QI/CP features. During interviews, participants expressed a preference for the app over a paper version of the PACSLAC-II due to reasons such as the app's ability to summarize information. Utilization of the community portal websites was unrelated to staff questionnaire-assessed stress/burnout.

CONCLUSIONS

Despite the positive effects on the care of residents, the COVID-19 pandemic presented challenges and interfered with the long-term maintenance of the QI results.

Initiatives Targeting Health Care Professionals: A Systematic Review of Knowledge Translation Pain Assessment and Management Studies Focusing on Older Adults

OBJECTIVES

Pain is often undertreated in older adult populations due to factors, such as insufficient continuing education and health care resources. Initiatives to increase knowledge about pain assessment and management are crucial for the incorporation of research evidence into practice. Knowledge translation (KT) studies on pain management for older adults and relevant knowledge users have been conducted; however, the wide variety of KT program formats and outcomes underscores a need to evaluate and systematically report on the relevant literature.

MATERIALS AND METHODS

Using a systematic review methodology, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDLINE, PsycInfo, and Web of Science databases were searched from inception to June 2023. Pain-related KT programs targeted towards older adults, their informal caregivers, and health care professionals were examined. Initiatives focusing on health care professionals are the focus of this review. Initiatives focusing on older adults are reported in a companion article.

RESULTS

From an initial 21,669 search results, 172 studies met our inclusion criteria. These studies varied widely in focus and delivery format but the majority were associated with significant risk of bias. In this report, we are focusing on 124 studies targeting health care professionals; 48 studies involving initiatives targeting older adults are reported in a companion article. Moreover, most programs were classified as knowledge mobilization studies without an implementation component. Across all studies, knowledge user satisfaction with the initiative and the suitability of the material presented were most commonly assessed. Patient outcomes, however, were underemphasized in the literature.

CONCLUSION

Patient and clinical outcomes must be a focus of future research to fully conceptualize the success of KT programs for older adult individuals. Without implementation plans, disseminated knowledge does not tend to translate effectively into practice.

Dementia Education for Workforce Excellence: Evaluation of a Novel Bichronous Approach

Dementia education and training for workforce development is becoming increasingly important in bridging knowledge gaps among health and social care practitioners in the UK and internationally. Dementia Education for Workforce Excellence (DEWE) was developed during the COVID-19 pandemic, blending both synchronous and asynchronous instruction and delivered across three different contexts: care homes, home care, and nurse education within the UK and India. This study aimed to evaluate DEWE using mixed methods with online survey data analyzed descriptively and interview data analyzed thematically. Integration of survey and interview data aimed toward a comprehensive evaluation of this novel approach for dementia workforce development. Thirty-four social care practitioners and nurse educators completed the online survey demonstrating high-level learner satisfaction, learning gains, behavioral change, and motivation to share new knowledge. Four key themes developed from the analysis of interviews (n = 9) around participants' pursuit of new knowledge; delivery modes in DEWE; learning gains and impact of DEWE; and adaptations for future program implementation. Findings suggest DEWE is an innovative resource that promotes person- and relationship-centered dementia care across all stages of one's dementia journey. Cultural adaptations are recommended for international delivery to ensure contextual alignment and maximum impact.