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Windle A, Marshall A, de la Perrelle L, Champion S, Ross PD, Harvey G, Davy C. Factors that influence the implementation of innovation in aged care: a scoping review. JBI Evid Implement 2023; 22:02205615-990000000-00072. [PMID: 38153118 PMCID: PMC11163893 DOI: 10.1097/xeb.0000000000000407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
OBJECTIVE The objective of this scoping review is to identify factors that influence the implementation of innovation in aged care. INTRODUCTION Aged care is a dynamic sector experiencing rapid change. Implementation of innovations in aged care has received relatively little research attention compared to health care. INCLUSION CRITERIA This review included studies of any design, that examined the implementation of innovations in aged care settings. METHODS Searches were conducted in MEDLINE, CINAHL, AgeLine, and ProQuest Social Sciences Premium Collection for studies published between January 1, 2012 and December 31, 2022. The titles and abstracts of retrieved citations were screened by two independent reviewers. Full-text articles were screened by one reviewer to determine inclusion. Data were extracted in NVivo using a tool developed by the research team. Factors that influenced implementation were inductively coded, interpreted, and grouped into categories in a series of workshops. RESULTS Of the 2530 studies that were screened, 193 were included. Of the included papers, the majority (74%) related to residential aged care, 28% used an implementation theory or framework, and 15% involved consumers. Five key categories of factors influencing implementation were identified: organizational context including resourcing and culture; people's attitudes and capabilities; relationships between people; the intervention and its appropriateness; and implementation actions such as stakeholder engagement and implementation strategies. CONCLUSIONS Our findings can be used to develop practical resources to support implementation efforts, and highlight the importance of resourcing for successful implementation. Attention to community-based aged care, and greater engagement with theory and community is needed to promote research rigor, relevance and applicability.
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Affiliation(s)
- Alice Windle
- Aged Care Research and Industry Innovation Australia (ARIIA), Adelaide, SA, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Amy Marshall
- Aged Care Research and Industry Innovation Australia (ARIIA), Adelaide, SA, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
- Caring Futures Institute, Flinders University, Adelaide, SA, Australia
| | - Lenore de la Perrelle
- Aged Care Research and Industry Innovation Australia (ARIIA), Adelaide, SA, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Stephanie Champion
- Aged Care Research and Industry Innovation Australia (ARIIA), Adelaide, SA, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
- Caring Futures Institute, Flinders University, Adelaide, SA, Australia
| | - Paul D.S. Ross
- Aged Care Research and Industry Innovation Australia (ARIIA), Adelaide, SA, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Gillian Harvey
- Aged Care Research and Industry Innovation Australia (ARIIA), Adelaide, SA, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
- Caring Futures Institute, Flinders University, Adelaide, SA, Australia
| | - Carol Davy
- Aged Care Research and Industry Innovation Australia (ARIIA), Adelaide, SA, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
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O’Connell B, Ostaszkiewicz J, Ockerby C. Reflections on implementing an evidence-based educational intervention in residential aged care. Collegian 2021. [DOI: 10.1016/j.colegn.2020.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Walker P, Kifley A, Kurrle S, Cameron ID. Increasing the uptake of vitamin D supplement use in Australian residential aged care facilities: results from the vitamin D implementation (ViDAus) study. BMC Geriatr 2020; 20:383. [PMID: 33023492 PMCID: PMC7542101 DOI: 10.1186/s12877-020-01784-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 09/21/2020] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Adequate (≥800 IU/day) vitamin D supplement use in Australian residential aged care facilities (RACFs) is variable and non-optimal. The vitamin D implementation (ViDAus) study aimed to employ a range of strategies to support the uptake of this best practice in participating facilities. The aim of this paper is to report on facility level prevalence outcomes and factors associated with vitamin D supplement use. METHODS This trial followed a stepped wedge cluster, non-randomised design with 41 individual facilities serving as clusters pragmatically allocated into two wedges that commenced the intervention six months apart. This multifaceted, interdisciplinary knowledge translation intervention was led by a project officer, who worked with nominated champions at participating facilities to provide education and undertake quality improvement (QI) planning. Local barriers and responsive strategies were identified to engage stakeholders and promote widespread uptake of vitamin D supplement use. RESULTS This study found no significant difference in the change of vitamin D supplement use between the intervention (17 facilities with approx. 1500 residents) and control group (24 facilities with approx. 1900 residents) at six months (difference in prevalence change between groups was 1.10, 95% CI - 3.8 to 6.0, p = 0.6). The average overall facility change in adequate (≥800 IU/day) vitamin D supplement use over 12 months was 3.86% (95% CI 0.6 to 7.2, p = 0.02), which achieved a facility level average prevalence of 59.6%. The variation in uptake at 12 months ranged from 25 to 88% of residents at each facility. In terms of the types of strategies employed for implementation, there were no statistical differences between facilities that achieved a clinically meaningful improvement (≥10%) or a desired prevalence of vitamin D supplement use (80% of residents) compared to those that did not. CONCLUSIONS This work confirms the complex nature of implementation of best practice in the RACF setting and indicates that more needs to be done to ensure best practice is translated into action. Whilst some strategies appeared to be associated with better outcomes, the statistical insignificance of these findings and the overall limited impact of the intervention suggests that the role of broader organisational and governmental support for implementation should be investigated further. TRIAL REGISTRATION Retrospectively registered (ANZCTR ID: ACTRN12616000782437 ).
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Affiliation(s)
- Pippy Walker
- Menzies Centre for Health Policy, University of Sydney, Charles Perkins Centre D17, Camperdown, NSW, 2006, Australia. .,John Walsh Centre for Rehabilitation Research, University of Sydney, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia.
| | - Annette Kifley
- John Walsh Centre for Rehabilitation Research, University of Sydney, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia
| | - Susan Kurrle
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Health Service, Hornsby, NSW, 2077, Australia
| | - Ian D Cameron
- John Walsh Centre for Rehabilitation Research, University of Sydney, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia
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Petriwskyj A, Power S. Supporting staff as change leaders in consumer engagement in aged care: Learnings from action research. J Nurs Manag 2020; 28:643-652. [PMID: 32011036 DOI: 10.1111/jonm.12968] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 01/26/2020] [Accepted: 01/30/2020] [Indexed: 11/29/2022]
Abstract
AIM The aim of this paper is to explore the process of staff leading change in consumer engagement practice in aged care. BACKGROUND Shifting expectations make engagement practice increasingly complex for service providers. This requires adaptive change within organisations. Organisations need to empower and support staff to critically assess practice, identify issues and pursue opportunities for innovation. METHOD Data were collected as part of an action research project addressing client engagement practice in Australian aged care. Staff worked together to identify issues for practice, generate solutions and create change within their organisations. RESULTS Staff identified innovative ways of generating change, demonstrating leadership. However, a range of technical, practical, systemic and philosophical factors impacted their progress. CONCLUSIONS Staff are effective, proactive change agents who can provide valuable insights into directions for their organisations and can lead practice improvement in engagement. However, they require support through the organisational environment. IMPLICATIONS FOR NURSING MANAGEMENT Staff in all roles can demonstrate adaptive leadership in changing engagement practice. However, those in traditional roles of authority need to recognize their own roles in showing leadership and supporting adaptive change. This provides a new insight into how managers can support practice change in consumer engagement.
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Affiliation(s)
- Andrea Petriwskyj
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Qld, Australia
| | - Stephanie Power
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Qld, Australia
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Walker P, Kifley A, Kurrle S, Cameron ID. Process outcomes of a multifaceted, interdisciplinary knowledge translation intervention in aged care: results from the vitamin D implementation (ViDAus) study. BMC Geriatr 2019; 19:177. [PMID: 31238882 PMCID: PMC6593532 DOI: 10.1186/s12877-019-1187-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 06/11/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Vitamin D supplement use is recommended best practice in residential aged care facilities (RACFs) for the prevention of falls, however has experienced delays in uptake. Following successful international efforts at implementing this evidence into practice, the ViDAus study sought to replicate this success for the Australian context. The aim of this paper is to report on the process outcomes of implementing this intervention. METHODS Forty-one RACFs were engaged in a multifaceted, interdisciplinary knowledge translation intervention. This focused on raising awareness to improve knowledge on vitamin D, and supporting facilities to identify barriers and implement locally devised strategies to improve the uptake of evidence based practice (EBP). RESULTS Staff members of participating facilities (n = 509 including nursing, care and allied health staff) were well engaged and accepting of the intervention, though engagement of servicing general practitioners (GPs) (n = 497) and pharmacists (n = 9) was poor. Facilities each identified between three and eight strategies focused on raising awareness, identifying residents to target for vitamin D and creating referral pathways depending upon their own locally identified barriers and capacity. There was variable success at implementing these over the 12-month intervention period. Whilst this study successfully raised awareness among staff, residents and their family members, barriers were identified that hindered engagement of GPs. CONCLUSIONS The intervention was overall feasible to implement and perceived as appropriate by GPs, pharmacists, facility staff, residents and family members. More facilitation, higher-level organisational support and strategies to improve RACF access to GPs however were identified as important improvements for the implementation of vitamin D supplement use. TRIAL REGISTRATION Retrospectively registered (ANZCTR ID: ACTRN12616000782437 ) on 15 June 2016.
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Affiliation(s)
- Pippy Walker
- Menzies Centre for Health Policy, University of Sydney, Charles Perkins Centre D17, Camperdown, NSW, 2006, Australia.,John Walsh Centre for Rehabilitation Research, University of Sydney, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia
| | - Annette Kifley
- John Walsh Centre for Rehabilitation Research, University of Sydney, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia
| | - Susan Kurrle
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Health Service, Hornsby, NSW, 2077, Australia
| | - Ian D Cameron
- John Walsh Centre for Rehabilitation Research, University of Sydney, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia.
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Abstract
BACKGROUND In 2005, Pearson et al. presented a developmental framework of evidence-based practice that sought to situate healthcare evidence and its role and use within the complexity of practice settings globally. A decade later, it was deemed timely to re-examine the Model and its component parts to determine whether they remain relevant and a true and accurate reflection of where the evidence-based movement is today. METHODS A two-phase process was employed for this project. Phase 1 involved a citation analysis, conducted using the index citation of the original source article on the Joanna Briggs Institute (JBI) Model by Pearson et al. The databases searched were Web of Science and Google Scholar from year of publication (2005) to July 2015. Duplicates and articles in languages other than English were removed, and all results were imported and combined in an Excel spreadsheet for review, coding and interpretation. Phase 2 (model revision) occurred in two parts. Part 1 involved revision of the Model by an internal working group. This revised version of the Model was then subjected to a process of focus group discussion (Part 2) that engaged staff of the Joanna Briggs Collaboration during the 2015 annual general meeting. These data were recorded then transcribed for review and consideration. RESULTS The citation analysis revealed that the Model was primarily utilized to conceptualize evidence and evidence-based healthcare, but that language used in relation to concepts within the Model was variable. Equally, the working group and focus group feedback confirmed that there was a need to ensure the language utilized in the Model was internationally appropriate and in line with current international trends. This feedback and analysis informed the revised version of the JBI Model. CONCLUSION Based on the citation analysis, working group and focus group feedback the new JBI Model for Evidence Based Healthcare attempts to utilize more internationally appropriate language to detail the intricacies of the relationships between systems and individuals across different settings and the need for contextual localization to enable policy makers and practitioners to make evidence-based decisions at the point of care.
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Penney S, Ryan A. The effect of a leadership support programme on care home managers. Nurs Older People 2018; 30:35-40. [PMID: 29376619 DOI: 10.7748/nop.2018.e979] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2017] [Indexed: 05/26/2023]
Abstract
AIM To explore the effect of the My Home Life 12-month leadership support programme on care home managers' leadership skills and professional development, and their relationships with staff, residents and relatives. METHOD A qualitative study of 15 care home managers was undertaken, using focus groups to explore the study's aims and objectives. Data were analysed using Colaizzi's phenomenological method. FINDINGS The leadership support programme enabled managers to develop their leadership skills, which had a positive effect for them and for their relationships with staff, residents and relatives. Conclusion Participation in the programme enabled managers to make real practice development improvements with meaningful effect for residents.
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Affiliation(s)
- Sarah Penney
- School of nursing, Ulster University, Northern Ireland
| | - Assumpta Ryan
- School of nursing, Ulster University, Northern Ireland
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Moniz-Cook E, Hart C, Woods B, Whitaker C, James I, Russell I, Edwards RT, Hilton A, Orrell M, Campion P, Stokes G, Jones RSP, Bird M, Poland F, Manthorpe J. Challenge Demcare: management of challenging behaviour in dementia at home and in care homes – development, evaluation and implementation of an online individualised intervention for care homes; and a cohort study of specialist community mental health care for families. PROGRAMME GRANTS FOR APPLIED RESEARCH 2017. [DOI: 10.3310/pgfar05150] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BackgroundDementia with challenging behaviour (CB) causes significant distress for caregivers and the person with dementia. It is associated with breakdown of care at home and disruption in care homes. Challenge Demcare aimed to assist care home staff and mental health practitioners who support families at home to respond effectively to CB.ObjectivesTo study the management of CB in care homes (ResCare) and in family care (FamCare). Following a conceptual overview, two systematic reviews and scrutiny of clinical guidelines, we (1) developed and tested a computerised intervention; (2) conducted a cluster randomised trial (CRT) of the intervention for dementia with CB in care homes; (3) conducted a process evaluation of implementation of the intervention; and (4) conducted a longitudinal observational cohort study of the management of people with dementia with CB living at home, and their carers.Review methodsCochrane review of randomised controlled trials; systematic meta-ethnographic review of quantitative and qualitative studies.DesignResCare – survey, CRT, process evaluation and stakeholder consultations. FamCare – survey, longitudinal cohort study, participatory development design process and stakeholder consultations. Comparative examination of baseline levels of CB in the ResCare trial and the FamCare study participants.SettingsResCare – 63 care homes in Yorkshire. FamCare – 33 community mental health teams for older people (CMHTsOP) in seven NHS organisations across England.ParticipantsResCare – 2386 residents and 861 staff screened for eligibility; 555 residents with dementia and CB; 277 ‘other’ residents; 632 care staff; and 92 staff champions. FamCare – every new referral (n = 5360) reviewed for eligibility; 157 patients with dementia and CB, with their carer; and 26 mental health practitioners. Stakeholder consultations – initial workshops with 83 practitioners and managers from participating organisations; and 70 additional stakeholders using eight group discussions and nine individual interviews.InterventionAn online application for case-specific action plans to reduce CB in dementia, consisting of e-learning and bespoke decision support care home and family care e-tools.Main outcome measuresResCare – survey with the Challenging Behaviour Scale; measurement of CB with the Neuropsychiatric Inventory (NPI) and medications taken from prescriptions; implementation with thematic views from participants and stakeholders. FamCare – case identification from all referrals to CMHTsOP; measurement of CB with the Revised Memory and Behaviour Problems Checklist and NPI; medications taken from prescriptions; and thematic views from stakeholders. Costs of care calculated for both settings. Comparison of the ResCare trial and FamCare study participants used the NPI, Clinical Dementia Rating and prescribed medications.ResultsResCare – training with group discussion and decision support for individualised interventions did not change practice enough to have an impact on CB in dementia. Worksite e-learning opportunities were not readily taken up by care home staff. Smaller homes with a less hierarchical management appear more ready than others to engage in innovation. FamCare – home-dwelling people with dementia and CB are referred to specialist NHS services, but treatment over 6 months, averaging nine contacts per family, had no overall impact on CB. Over 60% of people with CB had mild dementia. Families bear the majority of the care costs of dementia with CB. A care gap in the delivery of post-diagnostic help for families supporting relatives with dementia and significant CB at home has emerged. Higher levels of CB were recorded in family settings; and prescribing practices were suboptimal in both care home and family settings.LimitationsFunctionality of the software was unreliable, resulting in delays. This compromised the feasibility studies and undermined delivery of the intervention in care homes. A planned FamCare CRT could not proceed because of insufficient referrals.ConclusionsA Cochrane review of individualised functional analysis-based interventions suggests that these show promise, although delivery requires a trained dementia care workforce. Like many staff training interventions, our interactive e-learning course was well received by staff when delivered in groups with facilitated discussion. Our e-learning and decision support e-tool intervention in care homes, in its current form, without ongoing review of implementation of recommended action plans, is not effective at reducing CB when compared with usual care. This may also be true for staff training in general. A shift in priorities from early diagnosis to early recognition of dementia with clinically significant CB could bridge the emerging gap and inequities of care to families. Formalised service improvements in the NHS, to co-ordinate such interventions, may stimulate better opportunities for practice models and pathways. Separate services for care homes and family care may enhance the efficiency of delivery and the quality of research on implementation into routine care.Future workThere is scope for extending functional analysis-based interventions with communication and interaction training for carers. Our clinical workbooks, video material of real-life episodes of CB and process evaluation tool resources require further testing. There is an urgent need for evaluation of interventions for home-dwelling people with dementia with clinically significant CB, delivered by trained dementia practitioners. Realist evaluation designs may illuminate how the intervention might work, and for whom, within varying service contexts.Trial registrationCurrent Controlled Trials ISRCTN02553381 (the ResCare trial) and ISRCTN58876649 (the FamCare study).FundingThis project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 5, No. 15. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Esme Moniz-Cook
- Faculty of Health Sciences, University of Hull, Hull, UK
- Research and Development, Humber NHS Foundation Trust, Hull and East Yorkshire, UK
| | - Cathryn Hart
- Research and Development, Humber NHS Foundation Trust, Hull and East Yorkshire, UK
| | - Bob Woods
- Dementia Services Development Centre, Bangor University, Bangor, UK
| | - Chris Whitaker
- North Wales Organisation for Randomised Trials in Health, Bangor University, Bangor, UK
| | - Ian James
- Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Ian Russell
- Swansea Trials Unit, Swansea University, Swansea, UK
| | | | - Andrea Hilton
- Faculty of Health Sciences, University of Hull, Hull, UK
| | - Martin Orrell
- Institute of Mental Health, The University of Nottingham, Nottingham, UK
| | - Peter Campion
- Faculty of Health Sciences, University of Hull, Hull, UK
| | | | - Robert SP Jones
- North Wales Clinical Psychology Programme, Bangor University, Bangor, UK
| | - Mike Bird
- Dementia Services Development Centre, Bangor University, Bangor, UK
| | - Fiona Poland
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Jill Manthorpe
- Social Care Workforce Research Unit, King’s College London, London, UK
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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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Lea E, Andrews S, Haines T, Nitz J, Haralambous B, Moore K, Hill K, Robinson A. Developing networks between residential aged care facilities as a result of engagement in a falls prevention project: an action research study. Contemp Nurse 2016; 52:163-75. [DOI: 10.1080/10376178.2015.1129911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Chow J, Waldon P, Lubiana A, Williams R, Loy G, Lim K, Larkin A, Kohler F. The establishment of the Triple I (Hub), an intake, information and intervention hub. Contemp Nurse 2015; 50:227-37. [PMID: 26552597 DOI: 10.1080/10376178.2015.1116371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE An integrated intake, information and intervention service, Triple I (Hub) was evaluated against its goal to be streamlined, co-ordinated and patient focussed. The integrated service co-located six previously disparate services, often accessed by the same patients and healthcare professionals. The service was evaluated five months after implementation. METHODS Review methods included satisfaction surveys and observations made by an external expert. RESULTS Survey findings from 118 participants indicated positive perceptions of all aspects of the service provided by Triple I (Hub), with similar ratings provided by staff (n = 56) and clients (n = 62). The external expert reported that there was improved job satisfaction expressed by staff, and there was significant reduction in processing time of aged care referrals from 3 weeks to less than 24 hours. CONCLUSIONS Evidence from mixed methods evaluation was used. Quantitative survey results only reported satisfaction by users, but observations provided supplementary indications for service development.
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Affiliation(s)
- Josephine Chow
- a Clinical Innovation & Business Unit, South Western Sydney Local Health District , Locked Bag 7103, BC 1871, Liverpool , NSW 2170 , Australia.,g School of nursing, University of Sydney , Sydney , Australia.,h School of Health Science, University of Tasmania , Hobart , Australia
| | - Penny Waldon
- b Primary & Community Health, South Western Sydney Local Health District , Locked Bag 7103, BC 1871, Liverpool , NSW 2170 , Australia
| | - Adele Lubiana
- c Aged Care & Rehabilitation South Western Sydney Local Health District , Locked Bag 7103, BC 1871, Liverpool , NSW 2170 , Australia
| | - Robin Williams
- b Primary & Community Health, South Western Sydney Local Health District , Locked Bag 7103, BC 1871, Liverpool , NSW 2170 , Australia
| | - Graeme Loy
- d Operations, South Western Sydney Local Health District , Locked Bag 7103, BC 1871, Liverpool , NSW 2170 , Australia
| | - Kung Lim
- e Nursing & Midwifery Service, South Western Sydney Local Health District , Locked Bag 7103, BC 1871, Liverpool , NSW 2170 , Australia
| | - Amanda Larkin
- f South Western Sydney Local Health District , South Western Sydney Local Health District , Locked Bag 7103, BC 1871, Liverpool , NSW 2170 , Australia
| | - Friedbert Kohler
- c Aged Care & Rehabilitation South Western Sydney Local Health District , Locked Bag 7103, BC 1871, Liverpool , NSW 2170 , Australia.,i School of Medicine, University of New South Wales , Sydney , Australia
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Hoben M, Bär M, Mahler C, Berger S, Squires JE, Estabrooks CA, Kruse A, Behrens J. Linguistic validation of the Alberta Context Tool and two measures of research use, for German residential long term care. BMC Res Notes 2014; 7:67. [PMID: 24479645 PMCID: PMC3913324 DOI: 10.1186/1756-0500-7-67] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 01/28/2014] [Indexed: 11/18/2022] Open
Abstract
Background To study the association between organizational context and research utilization in German residential long term care (LTC), we translated three Canadian assessment instruments: the Alberta Context Tool (ACT), Estabrooks’ Kinds of Research Utilization (RU) items and the Conceptual Research Utilization Scale. Target groups for the tools were health care aides (HCAs), registered nurses (RNs), allied health professionals (AHPs), clinical specialists and care managers. Through a cognitive debriefing process, we assessed response processes validity–an initial stage of validity, necessary before more advanced validity assessment. Methods We included 39 participants (16 HCAs, 5 RNs, 7 AHPs, 5 specialists and 6 managers) from five residential LTC facilities. We created lists of questionnaire items containing problematic items plus items randomly selected from the pool of remaining items. After participants completed the questionnaires, we conducted individual semi-structured cognitive interviews using verbal probing. We asked participants to reflect on their answers for list items in detail. Participants’ answers were compared to concept maps defining the instrument concepts in detail. If at least two participants gave answers not matching concept map definitions, items were revised and re-tested with new target group participants. Results Cognitive debriefings started with HCAs. Based on the first round, we modified 4 of 58 ACT items, 1 ACT item stem and all 8 items of the RU tools. All items were understood by participants after another two rounds. We included revised HCA ACT items in the questionnaires for the other provider groups. In the RU tools for the other provider groups, we used different wording than the HCA version, as was done in the original English instruments. Only one cognitive debriefing round was needed with each of the other provider groups. Conclusion Cognitive debriefing is essential to detect and respond to problematic instrument items, particularly when translating instruments for heterogeneous, less well educated provider groups such as HCAs. Cognitive debriefing is an important step in research tool development and a vital component of establishing response process validity evidence. Publishing cognitive debriefing results helps researchers to determine potentially critical elements of the translated tools and assists with interpreting scores.
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Affiliation(s)
- Matthias Hoben
- Network Aging Research (NAR), Ruprecht-Karls-University Heidelberg, Bergheimer Str, 20, 69115 Heidelberg, Germany.
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Masso M, McCarthy G, Kitson A. Mechanisms which help explain implementation of evidence-based practice in residential aged care facilities: a grounded theory study. Int J Nurs Stud 2013; 51:1014-26. [PMID: 24355297 DOI: 10.1016/j.ijnurstu.2013.11.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Revised: 10/19/2013] [Accepted: 11/22/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND The context for the study was a nation-wide programme in Australia to implement evidence-based practice in residential aged care, in nine areas of practice, using a wide range of implementation strategies and involving 108 facilities. The study drew on the experiences of those involved in the programme to answer the question: what mechanisms influence the implementation of evidence-based practice in residential aged care and how do those mechanisms interact? METHODS The methodology used grounded theory from a critical realist perspective, informed by a conceptual framework that differentiates between the context, process and content of change. People were purposively sampled and invited to participate in semi-structured interviews, resulting in 44 interviews involving 51 people during 2009 and 2010. Participants had direct experience of implementation in 87 facilities, across nine areas of practice, in diverse locations. Sampling continued until data saturation was reached. The quality of the research was assessed using four criteria for judging trustworthiness: credibility, transferability, dependability and confirmability. RESULTS Data analysis resulted in the identification of four mechanisms that accounted for what took place and participants' experiences. The core category that provided the greatest understanding of the data was the mechanism On Common Ground, comprising several constructs that formed a 'common ground' for change to occur. The mechanism Learning by Connecting recognised the ability to connect new knowledge with existing practice and knowledge, and make connections between actions and outcomes. Reconciling Competing Priorities was an ongoing mechanism whereby new practices had to compete with an existing set of constantly shifting priorities. Strategies for reconciling priorities ranged from structured approaches such as care planning to more informal arrangements such as conversations during daily work. The mechanism Exercising Agency bridged the gap between agency and action. It was the human dimension of change, both individually and collectively, that made things happen. CONCLUSIONS The findings are consistent with the findings of others, but fit together in a novel way and add to current knowledge about how to improve practices in residential aged care. Each of the four mechanisms is necessary but none are sufficient for implementation to occur.
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Affiliation(s)
- Malcolm Masso
- Centre for Health Service Development, Australian Health Services Research Institute, Building 234 (iC Enterprise 1), Innovation Campus, University of Wollongong, NSW 2522, Australia.
| | - Grace McCarthy
- Faculty of Business, University of Wollongong, NSW 2522, Australia.
| | - Alison Kitson
- School of Nursing, The University of Adelaide, South Australia 5005, Australia.
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Hoben M, Mahler C, Bär M, Berger S, Squires JE, Estabrooks CA, Behrens J. German translation of the Alberta Context Tool and two measures of research use: methods, challenges and lessons learned. BMC Health Serv Res 2013; 13:478. [PMID: 24238613 PMCID: PMC3893410 DOI: 10.1186/1472-6963-13-478] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Accepted: 11/14/2013] [Indexed: 11/30/2022] Open
Abstract
Background Understanding the relationship between organizational context and research utilization is key to reducing the research-practice gap in health care. This is particularly true in the residential long term care (LTC) setting where relatively little work has examined the influence of context on research implementation. Reliable, valid measures and tools are a prerequisite for studying organizational context and research utilization. Few such tools exist in German. We thus translated three such tools (the Alberta Context Tool and two measures of research use) into German for use in German residential LTC. We point out challenges and strategies for their solution unique to German residential LTC, and demonstrate how resolving specific challenges in the translation of the health care aide instrument version streamlined the translation process of versions for registered nurses, allied health providers, practice specialists, and managers. Methods Our translation methods were based on best practices and included two independent forward translations, reconciliation of the forward translations, expert panel discussions, two independent back translations, reconciliation of the back translations, back translation review, and cognitive debriefing. Results We categorized the challenges in this translation process into seven categories: (1) differing professional education of Canadian and German care providers, (2) risk that German translations would become grammatically complex, (3) wordings at risk of being misunderstood, (4) phrases/idioms non-existent in German, (5) lack of corresponding German words, (6) limited comprehensibility of corresponding German words, and (7) target persons’ unfamiliarity with activities detailed in survey items. Examples of each challenge are described with strategies that we used to manage the challenge. Conclusion Translating an existing instrument is complex and time-consuming, but a rigorous approach is necessary to obtain instrument equivalence. Essential components were (1) involvement of and co-operation with the instrument developers and (2) expert panel discussions, including both target group and content experts. Equivalent translated instruments help researchers from different cultures to find a common language and undertake comparative research. As acceptable psychometric properties are a prerequisite for that, we are currently carrying out a study with that focus.
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Affiliation(s)
- Matthias Hoben
- Network Aging Research (NAR), Ruprecht-Karls-University Heidelberg, Bergheimer Str, 20, Heidelberg 69115, Germany.
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16
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Etheridge F, Couturier Y, Denis JL, Tremblay L, Tannenbaum C. Explaining the success or failure of quality improvement initiatives in long-term care organizations from a dynamic perspective. J Appl Gerontol 2013; 33:672-89. [PMID: 24652889 DOI: 10.1177/0733464813492582] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The purpose of this study was to better understand why change initiatives succeed or fail in long-term care organizations. Four case studies from Québec, Canada were contrasted retrospectively. A constipation and restraints program succeeded, while an incontinence and falls program failed. Successful programs were distinguished by the use of a change strategy that combined "let-it happen," "help-it happen," and "make-it happen" interventions to create senses of urgency, solidarity, intensity, and accumulation. These four active ingredients of the successful change strategies propelled their respective change processes forward to completion. This paper provides concrete examples of successful and unsuccessful combinations of "let-it happen," "help-it happen," and "make-it happen" change management interventions. Change managers (CM) can draw upon these examples to best tailor and energize change management strategies in their own organizations.
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Affiliation(s)
| | | | | | - Lucie Tremblay
- Donald Berman Maimonides Geriatric Centre and Jewish Eldercare, Montréal, QC Canada
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17
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Unintended adverse consequences of introducing electronic health records in residential aged care homes. Int J Med Inform 2013; 82:772-88. [PMID: 23770027 DOI: 10.1016/j.ijmedinf.2013.05.008] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Revised: 05/17/2013] [Accepted: 05/18/2013] [Indexed: 11/22/2022]
Abstract
PURPOSE The aim of this study was to investigate the unintended adverse consequences of introducing electronic health records (EHR) in residential aged care homes (RACHs) and to examine the causes of these unintended adverse consequences. METHOD A qualitative interview study was conducted in nine RACHs belonging to three organisations in the Australian Capital Territory (ACT), New South Wales (NSW) and Queensland, Australia. A longitudinal investigation after the implementation of the aged care EHR systems was conducted at two data points: January 2009 to December 2009 and December 2010 to February 2011. Semi-structured interviews were conducted with 110 care staff members identified through convenience sampling, representing all levels of care staff who worked in these facilities. Data analysis was guided by DeLone and McLean Information Systems Success Model, in reference with the previous studies of unintended consequences for the introduction of computerised provider order entry systems in hospitals. RESULTS Eight categories of unintended adverse consequences emerged from 266 data items mentioned by the interviewees. In descending order of the number and percentage of staff mentioning them, they are: inability/difficulty in data entry and information retrieval, end user resistance to using the system, increased complexity of information management, end user concerns about access, increased documentation burden, the reduction of communication, lack of space to place enough computers in the work place and increasing difficulties in delivering care services. The unintended consequences were caused by the initial conditions, the nature of the EHR system and the way the system was implemented and used by nursing staff members. CONCLUSIONS Although the benefits of the EHR systems were obvious, as found by our previous study, introducing EHR systems in RACH can also cause adverse consequences of EHR avoidance, difficulty in access, increased complexity in information management, increased documentation burden, reduction of communication and the risks of lacking care follow-up, which may cause negative effects on aged care services. Further research can focus on investigating how the unintended adverse consequences can be mitigated or eliminated by understanding more about nursing staff's work as well as the information flow in RACH. This will help to improve the design, introduction and management of EHR systems in this setting.
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McConnell T, O'Halloran P, Porter S, Donnelly M. Systematic realist review of key factors affecting the successful implementation and sustainability of the Liverpool care pathway for the dying patient. Worldviews Evid Based Nurs 2013; 10:218-37. [PMID: 23489967 DOI: 10.1111/wvn.12003] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND The Liverpool Care Pathway (LCP) is recommended internationally as a best practice model for the care of patients and their families at the end of life. However, a recent national audit in the United Kingdom highlighted shortcomings; and understanding is lacking regarding the processes and contextual factors that affect implementation. AIM To identify and investigate factors that help or hinder successful implementation and sustainability of the LCP. METHODS Electronic databases (Medline, CINAHL, British Nursing Index, Science Direct) and grey literature were searched, supplemented by citation tracking, in order to identify English language papers containing information relevant to the implementation of the LCP. Using a realist review approach, we systematically reviewed all relevant studies that focused on end of life care and integrated care pathway processes and identified theories that explained how the LCP and related programmes worked. RESULTS Fifty-eight papers were included in the review. Key factors identified were: a dedicated facilitator, education and training, audit and feedback, organisational culture, and adequate resources. DISCUSSION We discuss how these factors change behaviour by influencing the beliefs, attitudes, motivation and confidence of staff in relation to end of life care, and how contextual factors moderate behaviour change. CONCLUSIONS The implementation process recommended by the developers of the LCP is necessary but not sufficient to ensure successful implementation and sustainability of the pathway. The key components of the intervention (a dedicated facilitator, education and training, audit and feedback) must be configured to influence the beliefs of staff in relation to end of life care, and increase their motivation and self-efficacy in relation to using the LCP. The support of senior managers is vital to the release of necessary resources, and a dominant culture of cure, which sees every death as a failure, works against effective communication and collaboration in relation to the LCP.
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Affiliation(s)
- Tracey McConnell
- Doctoral student, School of Nursing and Midwifery, Queen's University of Belfast, Belfast, Northern Ireland
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19
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Bamford C, Heaven B, May C, Moynihan P. Implementing nutrition guidelines for older people in residential care homes: a qualitative study using Normalization Process Theory. Implement Sci 2012; 7:106. [PMID: 23110857 PMCID: PMC3514214 DOI: 10.1186/1748-5908-7-106] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Accepted: 10/22/2012] [Indexed: 04/12/2023] Open
Abstract
Background Optimizing the dietary intake of older people can prevent nutritional deficiencies and diet-related diseases, thereby improving quality of life. However, there is evidence that the nutritional intake of older people living in care homes is suboptimal, with high levels of saturated fat, salt, and added sugars. The UK Food Standards Agency therefore developed nutrient- and food-based guidance for residential care homes. The acceptability of these guidelines and their feasibility in practice is unknown. This study used the Normalization Process Theory (NPT) to understand the barriers and facilitators to implementing the guidelines and inform future implementation. Methods We conducted a process evaluation in five care homes in the north of England using qualitative methods (observation and interviews) to explore the views of managers, care staff, catering staff, and domestic staff. Data were analyzed thematically and discussed in data workshops; emerging themes were then mapped to the constructs of NPT. Results Many staff perceived the guidelines as unnecessarily restrictive and irrelevant to older people. In terms of NPT, the guidelines simply did not make sense (coherence), and as a result, relatively few staff invested in the guidelines (cognitive participation). Even where staff supported the guidelines, implementation was hampered by a lack of nutritional knowledge and institutional support (collective action). Finally, the absence of observable benefits to clients confirmed the negative preconceptions of many staff, with limited evidence of reappraisal following implementation (reflexive monitoring). Conclusions The successful implementation of the nutrition guidelines requires that the fundamental issues relating to their perceived value and fit with other priorities and goals be addressed. Specialist support is needed to equip staff with the technical knowledge and skills required for menu analysis and development and to devise ways of evaluating the outcomes of modified menus. NPT proved useful in conceptualizing barriers to implementation; robust links with behavior-change theories would further increase the practical utility of NPT.
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Affiliation(s)
- Claire Bamford
- Institute of Health and Society, Newcastle University, UK.
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20
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Venturato L, Moyle W, Steel A. Exploring the gap between rhetoric and reality in dementia care in Australia: Could practice documents help bridge the great divide? DEMENTIA 2011; 12:251-67. [DOI: 10.1177/1471301211421837] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Quality of care, and indeed, quality of life, for people living with dementia in long-term care is often underpinned by philosophies of care, such as person-centred care and relationship-centred care. The translation of these philosophies into practice is influenced by a range of individual and organizational features, including the context in which such care occurs. Within modern care organizations, the context of care is evidenced through organizational documents. This study sought to identify the key documents guiding dementia care within one large Australian long-term care organization and to explore points of consistency and tension within the documented system of care. Results highlight a lack of consistency and clarity in the philosophy of dementia care and a disconnection between the key documents guiding practice. This disconnection creates tension for clinicians and carers, and may contribute to the gap between rhetoric and reality in dementia care. This study suggests that a congruent documented dementia system can help bridge the gap between espoused philosophies of care and everyday care practices.
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Affiliation(s)
| | - Wendy Moyle
- Griffith University, Australia
- RSL Care, Queensland, Australia
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Perry L, Bellchambers H, Howie A, Moxey A, Parkinson L, Capra S, Byles J. Examination of the utility of the promoting action on research implementation in health services framework for implementation of evidence based practice in residential aged care settings. J Adv Nurs 2011; 67:2139-50. [PMID: 21535089 DOI: 10.1111/j.1365-2648.2011.05655.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM This study examined the relevance and fit of the PARiHS framework (Promoting Action on Research Implementation in Health Services) as an explanatory model for practice change in residential aged care. BACKGROUND Translation of research knowledge into routine practice is a complex matter in health and social care environments. Examination of the environment may identify factors likely to support and hinder practice change, inform strategy development, predict and explain successful uptake of new ways of working. Frameworks to enable this have been described but none has been tested in residential aged care. METHODS This paper reports preliminary qualitative analyses from the Encouraging Best Practice in Residential Aged Care Nutrition and Hydration project conducted in New South Wales in 2007-2009. We examined congruence with the PARiHS framework of factors staff described as influential for practice change during 29 digitally recorded and transcribed staff interviews and meetings at three facilities. FINDINGS Unique features of the setting were flagged, with facilities simultaneously filling the roles of residents' home, staff's workplace and businesses. Participants discussed many of the same characteristics identified by the PARiHS framework, but in addition temporal dimensions of practice change were flagged. CONCLUSION Overall factors described by staff as important for practice change in aged care settings showed good fit with those of the PARiHS framework. This framework can be recommended for use in this setting. Widespread adoption will enable cross-project and international synthesis of findings, a major step towards building a cumulative science of knowledge translation and practice change.
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Affiliation(s)
- Lin Perry
- Midwifery and Health, University of Technology Sydney, New South Wales, Australia.
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Moodie ST, Kothari A, Bagatto MP, Seewald R, Miller LT, Scollie SD. Knowledge translation in audiology: promoting the clinical application of best evidence. Trends Amplif 2011; 15:5-22. [PMID: 22194314 PMCID: PMC4040836 DOI: 10.1177/1084713811420740] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The impetus for evidence-based practice (EBP) has grown out of widespread concern with the quality, effectiveness (including cost-effectiveness), and efficiency of medical care received by the public. Although initially focused on medicine, EBP principles have been adopted by many of the health care professions and are often represented in practice through the development and use of clinical practice guidelines (CPGs). Audiology has been working on incorporating EBP principles into its mandate for professional practice since the mid-1990s. Despite widespread efforts to implement EBP and guidelines into audiology practice, gaps still exist between the best evidence based on research and what is being done in clinical practice. A collaborative dynamic and iterative integrated knowledge translation (KT) framework rather than a researcher-driven hierarchical approach to EBP and the development of CPGs has been shown to reduce the knowledge-to-clinical action gaps. This article provides a brief overview of EBP and CPGs, including a discussion of the barriers to implementing CPGs into clinical practice. It then offers a discussion of how an integrated KT process combined with a community of practice (CoP) might facilitate the development and dissemination of evidence for clinical audiology practice. Finally, a project that uses the knowledge-to-action (KTA) framework for the development of outcome measures in pediatric audiology is introduced.
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Affiliation(s)
- Sheila T Moodie
- National Centre for Audiology, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada.
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RAWLINGS DEB, HENDRY KATHY, MYLNE SUSAN, BANFIELD MAREE, YATES PATSY. Using Palliative Care Assessment Tools to Influence and Enhance Clinical Practice. ACTA ACUST UNITED AC 2011; 29:139-45; quiz 146-7. [DOI: 10.1097/nhh.0b013e31820ba808] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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