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Ginsburg LR, Easterbrook A, Massie A, Berta W, Doupe M, Hoben M, Norton P, Reid C, Song Y, Wagg A, Estabrooks C. Building a Program Theory of Implementation Using Process Evaluation of a Complex Quality Improvement Trial in Nursing Homes. THE GERONTOLOGIST 2024; 64:gnad064. [PMID: 37263265 PMCID: PMC10825831 DOI: 10.1093/geront/gnad064] [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: 01/31/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Significant quality problems exist in long-term care (LTC). Interventions to improve care are complex and often have limited success. Implementation remains a black box. We developed a program theory explaining how implementation of a complex intervention occurs in LTC settings-examining mechanisms of impact, effects of context on implementation, and implementation outcomes such as fidelity. RESEARCH DESIGN AND METHODS Concurrent process evaluation of Safer Care for Older Persons in residential Environments (SCOPE)-a frontline worker (care aide) led improvement trial in 31 Canadian LTC homes. Using a mixed-methods exploratory sequential design, qualitative data were analyzed using grounded theory to develop a conceptual model illustrating how teams implemented the intervention and how it produced change. Quantitative analyses (mixed-effects regression) tested aspects of the program theory. RESULTS Implementation fidelity was moderate. Implementation is facilitated by (a) care aide engagement with core intervention components; (b) supportive leadership (internal facilitation) to create positive team dynamics and help negotiate competing workplace priorities; (c) shifts in care aide role perceptions and power differentials. Mixed-effects model results suggest intervention acceptability, perceived intervention benefits, and leadership support predict implementation fidelity. When leadership support is high, fidelity is high regardless of intervention acceptability or perceived benefits. DISCUSSION AND IMPLICATIONS Our program theory addresses important knowledge gaps regarding implementation of complex interventions in nursing homes. Results can guide scaling of complex interventions and future research.
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Affiliation(s)
- Liane R Ginsburg
- School of Health Policy & Management, York University, Toronto, Ontario, Canada
| | - Adam Easterbrook
- Centre for Health Evaluation and Outcome Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ariane Massie
- School of Kinesiology & Health Science, York University, Toronto, Ontario, Canada
| | - Whitney Berta
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Malcolm Doupe
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Matthias Hoben
- School of Health Policy & Management, York University, Toronto, Ontario, Canada
| | - Peter Norton
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Colin Reid
- School of Health and Exercise Science, University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - Yuting Song
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Adrian Wagg
- Division of Geriatric Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Carole Estabrooks
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
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Wagg A, Hoben M, Ginsburg L, Doupe M, Berta W, Song Y, Norton P, Knopp-Sihota J, Estabrooks C. Safer Care for Older Persons in (residential) Environments (SCOPE): a pragmatic controlled trial of a care aide-led quality improvement intervention. Implement Sci 2023; 18:9. [PMID: 36991434 PMCID: PMC10054219 DOI: 10.1186/s13012-022-01259-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 12/20/2022] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND The increased complexity of residents and increased needs for care in long-term care (LTC) have not been met with increased staffing. There remains a need to improve the quality of care for residents. Care aides, providers of the bulk of direct care, are well placed to contribute to quality improvement efforts but are often excluded from so doing. This study examined the effect of a facilitation intervention enabling care aides to lead quality improvement efforts and improve the use of evidence-informed best practices. The eventual goal was to improve both the quality of care for older residents in LTC homes and the engagement and empowerment of care aides in leading quality improvement efforts. METHODS Intervention teams participated in a year-long facilitative intervention which supported care aide-led teams to test changes in care provision to residents using a combination of networking and QI education meetings, and quality advisor and senior leader support. This was a controlled trial with random selection of intervention clinical care units matched 1:1 post hoc with control units. The primary outcome, between group change in conceptual research use (CRU), was supplemented by secondary staff- and resident-level outcome measures. A power calculation based upon pilot data effect sizes resulted in a sample size of 25 intervention sites. RESULTS The final sample included 32 intervention care units matched to 32 units in the control group. In an adjusted model, there was no statistically significant difference between intervention and control units for CRU or in secondary staff outcomes. Compared to baseline, resident-adjusted pain scores were statistically significantly reduced (less pain) in the intervention group (p=0.02). The level of resident dependency significantly decreased statistically for residents whose teams addressed mobility (p<0.0001) compared to baseline. CONCLUSIONS The Safer Care for Older Persons in (residential) Environments (SCOPE) intervention resulted in a smaller change in its primary outcome than initially expected resulting in a study underpowered to detect a difference. These findings should inform sample size calculations of future studies of this nature if using similar outcome measures. This study highlights the problem with measures drawn from current LTC databases to capture change in this population. Importantly, findings from the trial's concurrent process evaluation provide important insights into interpretation of main trial data, highlight the need for such evaluations of complex trials, and suggest the need to consider more broadly what constitutes "success" in complex interventions. TRIAL REGISTRATION ClinicalTrials.gov , NCT03426072, registered August 02, 2018, first participant site April, 05, 2018.
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Affiliation(s)
- Adrian Wagg
- Division of Geriatric Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
| | - Matthias Hoben
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Liane Ginsburg
- School of Health Policy & Management, Faculty of Health, York University, Toronto, Ontario, Canada
| | - Malcolm Doupe
- Departments of Community Health Sciences, Emergency Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Whitney Berta
- Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, ON, Toronto, Canada
| | - Yuting Song
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Peter Norton
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jennifer Knopp-Sihota
- Faculty of Health Disciplines, Athabasca University & Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Carole Estabrooks
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
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Kuhnow J, Hoben M, Weeks LE, Barber B, Estabrooks CA. Factors Associated with Falls in Canadian Long Term Care Homes: a Retrospective Cohort Study. Can Geriatr J 2022; 25:328-335. [PMID: 36505912 PMCID: PMC9684024 DOI: 10.5770/cgj.25.623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background Half of Canadians living in long-term care (LTC) homes will fall each year resulting in consequences to independence, quality of life, and health. The objective in this study was to analyze factors that contribute to, or are protective against, falls in Canadian LTC homes. Methods We analyzed of a retrospective cohort of a stratified random sample of Canadian LTC homes in Western Canada from 2011-2017. We accessed variables from the RAI-MDS 2.0 to assess the association of the dependent variable "fall within the last 31-180 days" with multiple independent factors, using generalized estimating equation models. Results A total of 28,878 LTC residents were analyzed. Factors found to increase the odds of falling were other fractures (OR 3.64 [95% confidence interval; CI 3.27, 4.05]), hip fractures (OR 3.58 [3.27, 3.93]), moderately impaired cognitive skills (OR 2.45 [2.28, 2.64]), partial support to balance standing (OR 2.44 [2.30, 2.57]), wandering (OR 2.31 [2.18, 2.44]). Conclusion A range of factors identified were associated with falls for people living in LTC homes. Individual physical ability represented the largest group of independent factors contributing to falls. Residents who experience any fracture or an acute change in behaviour, mobility, or activities of daily living (ADL) should be considered at increased risk of falls.
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Affiliation(s)
- Jason Kuhnow
- Faculty of Medicine, Dalhousie University, Halifax, NS
| | - Matthias Hoben
- School of Health Policy & Management, York University, Toronto, ON
| | - Lori E. Weeks
- School of Nursing, Dalhousie University, Halifax, NS
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Holt K, Hoben M, Weeks L, Estabrooks C. Relationship between environmental factors and responsive behaviours in long-term care homes: a secondary data analysis. BMJ Open 2021; 11:e047364. [PMID: 34635514 PMCID: PMC8506873 DOI: 10.1136/bmjopen-2020-047364] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE Responsive behaviours (eg, wandering, resisting care and verbal abuse) are a continuing issue for staff and individuals living in long-term care (LTC) homes. The LTC environment can influence responsive behaviours and is a factor in determining the quality of life for those living there. The ways in which the quality of the environment might influence responsive behaviours has not been investigated yet. We hypothesised that better quality environments would be associated with reduced rates of responsive behaviours. We used a tool that simultaneously encompasses human and structural elements of the environment, a novel approach in this field of research. DESIGN Cross-sectional study, using data collected from September 2014 to May 2015 as part of the Translating Research in Elder Care research programme. SETTING A representative, stratified (size, owner-operator model and health region) random sample of 76 LTC homes in British Columbia, Alberta, Manitoba. PARTICIPANTS 13 224 individuals (67.3% females) living in participating LTC homes. OUTCOME MEASURES Quality of care unit work environment was assessed using the observable indicators of quality (OIQ) tool. Responsive behaviours were assessed using routinely collected Resident Assessment Instrument-Minimum Data Set V.2.0 data. RESULTS Adjusted regression coefficients of overall Aggressive Behaviour Scale score and interpersonal communication were 0.02 (95% CI -0.011 to 0.045), grooming 0.06 (95% CI -0.032 to 0.157), environment-basics 0.067 (95% CI 0.024 to 0.110), odour -0.066 (95% CI -0.137 to -0.004), care delivery -0.007 (95% CI -0.033 to 0.019), environment-access -0.027 (95% CI -0.062 to 0.007), environment-homelike -0.034 (95% CI -0.065 to -0.002) and total OIQ score 0.003 (95% CI -0.004 to 0.010). CONCLUSIONS We found small associations between the environmental quality and responsive behaviours in Western Canadian LTC homes. Higher scores on homelikeness were associated with decreased responsive behaviours. Higher scores on basic environmental quality were associated with increased responsive behaviours.
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Affiliation(s)
- Kelsey Holt
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Matthias Hoben
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Lori Weeks
- Faculty of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Carole Estabrooks
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
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Chamberlain SA, Gruneir A, Keefe JM, Berendonk C, Corbett K, Bishop R, Bond G, Forbes F, Kieloch B, Mann J, Thelker C, Estabrooks CA. Evolving partnerships: engagement methods in an established health services research team. RESEARCH INVOLVEMENT AND ENGAGEMENT 2021; 7:71. [PMID: 34627403 PMCID: PMC8502285 DOI: 10.1186/s40900-021-00314-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 09/24/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND The Translating Research in Elder Care (TREC) program is a partnered health services research team that aims to improve the quality of care and quality of life for residents and quality of worklife for staff in nursing homes. This team includes academic researchers, trainees, research staff, citizens (persons living with dementia and family/friend caregivers of persons living in nursing homes), and decision-makers (ministries of health, health authorities, operators of nursing homes). The TREC team has experience working with health system partners but wanted to undertake activities to enhance the collaboration between the academic researchers and citizen members. The aim of this paper is to describe the TREC team members' experiences and perceptions of citizen engagement and identify necessary supports to promote meaningful engagement in health research teams. METHODS We administered two online surveys (May 2018, July 2019) to all TREC team members (researchers, trainees, staff, decision-makers, citizens). The surveys included closed and open-ended questions guided by regional and international measures of engagement and related to respondents' experience with citizen engagement, their perceptions of the benefits and challenges of citizen engagement, and their needs for training and other tools to support engagement. We analyzed the closed-ended responses using descriptive statistics. RESULTS We had a 78% response rate (68/87) to the baseline survey, and 27% response rate (21/77) to the follow-up survey. At baseline, 30 (44%) of respondents reported they were currently engaged in a research project with citizen partners compared to 11(52%) in the follow-up survey. Nearly half (10(48%)) of the respondents in the follow-up reported an increase in citizen engagement over the previous year. Respondents identified many benefits to citizen engagement (unique perspectives, assistance with dissemination) and challenges (the need for specific communication skills, meeting organizing and facilitation, and financial/budget support), with little change between the two time points. Respondents reported that the amount of citizen engagement in their research (or related projects) had increased or stayed the same. CONCLUSIONS Despite increasing recognition of the benefits of including persons with lived experience and large-scale promotion efforts, the research team still lack sufficient training and resources to engage non-academic partners. Our research identified specific areas that could be addressed to improve the engagement of citizens in health research.
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Affiliation(s)
- Stephanie A. Chamberlain
- Department of Family Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta Canada
| | - Andrea Gruneir
- Department of Family Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta Canada
| | - Janice M. Keefe
- Department of Family Studies and Gerontology, Mount Saint Vincent University, Halifax, Nova Scotia Canada
| | | | - Kyle Corbett
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta Canada
| | - Roberta Bishop
- Voices Of Individuals, family and friend Caregivers Educating uS (VOICES), University of Alberta, Edmonton, Alberta Canada
| | - Graham Bond
- Voices Of Individuals, family and friend Caregivers Educating uS (VOICES), University of Alberta, Edmonton, Alberta Canada
| | - Faye Forbes
- Voices Of Individuals, family and friend Caregivers Educating uS (VOICES), University of Alberta, Edmonton, Alberta Canada
| | - Barbara Kieloch
- Voices Of Individuals, family and friend Caregivers Educating uS (VOICES), University of Alberta, Edmonton, Alberta Canada
| | - Jim Mann
- Voices Of Individuals, family and friend Caregivers Educating uS (VOICES), University of Alberta, Edmonton, Alberta Canada
| | - Christine Thelker
- Voices Of Individuals, family and friend Caregivers Educating uS (VOICES), University of Alberta, Edmonton, Alberta Canada
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Mann J, Bishop R, Bond G, Forbes F, Kieloch B, Thelker C, Chamberlain SA. The voices of lived experience: reflections from citizen team members in a long-term care research program. RESEARCH INVOLVEMENT AND ENGAGEMENT 2021; 7:69. [PMID: 34600593 PMCID: PMC8487564 DOI: 10.1186/s40900-021-00312-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 09/14/2021] [Indexed: 06/04/2023]
Abstract
BACKGROUND The Translating Research in Elder Care (TREC) program is a partnered health services research team that aims to improve the quality of care and quality of life for residents and quality of worklife for staff in nursing homes. The TREC team undertook several activities to enhance the collaboration between the academic researchers and us, the citizen members. Known as VOICES (Voice Of (potential) Incoming residents, Caregivers Educating uS) we aim to share our experience working with a large research team. METHODS We reflect on the findings reported in the paper by Chamberlain et al. (2021). They described the findings from two surveys (May 2018, July 2019) that were completed by TREC team members (researchers, trainees, staff, decision-makers, citizens). The survey questions asked about the respondents' experience with citizen engagement, their perceptions of the benefits and challenges of citizen engagement, and their unmet needs for training. RESULTS The paper reported on the survey findings from all the survey respondents (research team, decision-makers, citizens), but much of the results focused on the researcher perspective. They reported that respondents believed that citizen engagement was a benefit to their research but noted many challenges. While we appreciate the researchers' positive perceptions of citizen engagement, much work remains to fully integrate us into all stages of the research. We offer our reflections and suggestions for how to work with citizen members and identify areas for more training and support. CONCLUSIONS Despite the increased interest in citizen engagement, we feel there is a lack of understanding and support to truly integrate non-academic team members on research teams. We hope the discussion in this commentary identifies specific areas that need to be addressed to support the continued engagement of citizens and show how the lived experience can bring value to research teams.
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Affiliation(s)
- Jim Mann
- Translating Research in Elder Care (TREC) Research Program, Level 3, Edmonton Clinic Health Academy, Faculty of Nursing, Voices Of (potential) Incoming residents, Caregivers Educating uS (VOICES), University of Alberta, 11405 87 Ave, Edmonton, AB T6G 1C9 Canada
| | - Roberta Bishop
- Translating Research in Elder Care (TREC) Research Program, Level 3, Edmonton Clinic Health Academy, Faculty of Nursing, Voices Of (potential) Incoming residents, Caregivers Educating uS (VOICES), University of Alberta, 11405 87 Ave, Edmonton, AB T6G 1C9 Canada
| | - Graham Bond
- Translating Research in Elder Care (TREC) Research Program, Level 3, Edmonton Clinic Health Academy, Faculty of Nursing, Voices Of (potential) Incoming residents, Caregivers Educating uS (VOICES), University of Alberta, 11405 87 Ave, Edmonton, AB T6G 1C9 Canada
| | - Faye Forbes
- Translating Research in Elder Care (TREC) Research Program, Level 3, Edmonton Clinic Health Academy, Faculty of Nursing, Voices Of (potential) Incoming residents, Caregivers Educating uS (VOICES), University of Alberta, 11405 87 Ave, Edmonton, AB T6G 1C9 Canada
| | - Barbara Kieloch
- Translating Research in Elder Care (TREC) Research Program, Level 3, Edmonton Clinic Health Academy, Faculty of Nursing, Voices Of (potential) Incoming residents, Caregivers Educating uS (VOICES), University of Alberta, 11405 87 Ave, Edmonton, AB T6G 1C9 Canada
| | - Christine Thelker
- Translating Research in Elder Care (TREC) Research Program, Level 3, Edmonton Clinic Health Academy, Faculty of Nursing, Voices Of (potential) Incoming residents, Caregivers Educating uS (VOICES), University of Alberta, 11405 87 Ave, Edmonton, AB T6G 1C9 Canada
| | - Stephanie A. Chamberlain
- Department of Family Medicine, Faculty of Medicine and Dentistry, University of Alberta, 6-50 University Terrace, Edmonton, AB T6G 2T4 Canada
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Chamberlain SA, Estabrooks CA, Keefe JM, Hoben M, Berendonk C, Corbett K, Gruneir A. Citizen and stakeholder led priority setting for long-term care research: identifying research priorities within the Translating Research in Elder Care (TREC) Program. RESEARCH INVOLVEMENT AND ENGAGEMENT 2020; 6:24. [PMID: 32467774 PMCID: PMC7229578 DOI: 10.1186/s40900-020-00199-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 04/23/2020] [Indexed: 05/21/2023]
Abstract
BACKGROUND The Translating Research in Elder Care (TREC) program is a longitudinal partnered program of research in Western Canada that aims to improve the quality of care and quality of life for residents and quality of worklife for staff in long-term care settings. This program of research includes researchers, citizens (persons living with dementia and caregivers of persons living in long-term care), and stakeholders (representatives from provincial and regional health authorities, owner-operators of long-term care homes). The aim of this paper is to describe how we used priority setting methods with citizens and stakeholders to identify ten priorities for research using the TREC data. METHODS We adapted the James Lind Alliance Priority Setting Partnership method to ensure our citizens and stakeholders could identify priorities within the existing TREC data. We administered an online survey to our citizen and stakeholder partners. An in-person priority setting workshop was held in March 2019 in Alberta, Canada to establish consensus on ten research priorities. The in-person workshop used a nominal group technique and involved two rounds of small group prioritization and one final full group ranking. RESULTS We received 72 online survey respondents and 19 persons (citizens, stakeholders) attended the in-person priority setting workshop. The workshop resulted in an unranked list of their ten research priorities for the TREC program. These priorities encompassed a range of non-clinical topics, including: influence of staffing (ratios, type of care provider) on residents and staff work life, influence of the work environment on resident outcomes, and the impact of quality improvement activities on residents and staff. CONCLUSIONS This modified priority setting approach provided citizens and stakeholders with an opportunity to identify their own research priorities within the TREC program, without the external pressures of researchers. These priorities will inform the secondary analyses of the TREC data and the development of new projects. This modified priority setting may be a useful approach for research teams trying to engage their non-academic partners and to identify areas for future research.
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Affiliation(s)
- Stephanie A. Chamberlain
- Department of Family Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta T6G 2T4 Canada
| | | | - Janice M. Keefe
- Department of Family Studies and Gerontology, Mount Saint Vincent University, Halifax, Nova Scotia B3M 2J6 Canada
| | - Matthias Hoben
- Faculty of Nursing, University of Alberta, Edmonton, Alberta T6G 1C9 Canada
| | - Charlotte Berendonk
- Translating Research in Elder Care (TREC) program, University of Alberta, Edmonton, Alberta T6G 1C9 Canada
| | - Kyle Corbett
- Translating Research in Elder Care (TREC) program, University of Alberta, Edmonton, Alberta T6G 1C9 Canada
| | - Andrea Gruneir
- Department of Family Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta T6G 2T4 Canada
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Grooten L, Vrijhoef HJM, Alhambra-Borrás T, Whitehouse D, Devroey D. The transfer of knowledge on integrated care among five European regions: a qualitative multi-method study. BMC Health Serv Res 2020; 20:11. [PMID: 31900146 PMCID: PMC6942405 DOI: 10.1186/s12913-019-4865-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 12/23/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND To examine how the knowledge transfer processes unfolded within SCIROCCO, a EU funded project (3rd Health Programme (2014-2020)) that aimed to facilitate the process of knowledge sharing across five European regions, to speed up adoption and scaling-up of integrated care initiatives. METHODS A qualitative multi-method design was used. Data collection methods included focus groups, project documents and action plans of the regions. The data was analysed using a qualitative content-analysis procedure, which was guided by the frameworks of knowledge exchange and the why, whose, what, how framework for knowledge mobilisers. RESULTS All five components (including the themes) of knowledge exchange could be identified in the approach developed on the knowledge transfer processes. The four questions and accompanying categories of the framework of knowledge mobilisation were also identified to a large degree. CONCLUSIONS The observed incorporation of distinct forms of knowledge from multiple sources and the observed dynamic and fluid knowledge transfer processes both suggest that SCIROCCO developed a comprehensive knowledge transfer approach aiming to enable the adoption and scaling-up of integrated care. Overall, the multi-method qualitative nature of this research has allowed some new and practical insights in the knowledge transfer activities on integrated care between several European regions. To obtain a clear understanding of the content of the knowledge transfer approaches, which could assist the operationalising of models to support the evaluation of knowledge transfer activities, it is strongly recommended that further research of this type should be conducted in other research settings.
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Affiliation(s)
- Liset Grooten
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel, P.O. 103, B-1090, Brussels, Belgium
| | - Hubertus Johannes Maria Vrijhoef
- Department Patient & Care, Maastricht University Medical Center, Maastricht, the Netherlands
- Panaxea B.V, Amsterdam, the Netherlands
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel, Brussel, Belgium
| | | | - Diane Whitehouse
- European Health Telematics Association (EHTEL), Brussels, Belgium
| | - Dirk Devroey
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel, P.O. 103, B-1090, Brussels, Belgium
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Aloisio LD, Gifford WA, McGilton KS, Lalonde M, Estabrooks CA, Squires JE. Factors Associated With Nurses' Job Satisfaction In Residential Long-term Care: The Importance of Organizational Context. J Am Med Dir Assoc 2019; 20:1611-1616.e4. [PMID: 31399359 DOI: 10.1016/j.jamda.2019.06.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 02/11/2019] [Accepted: 06/23/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES We examined demographic, individual, and organizational context factors associated with nurses' job satisfaction in residential long-term care (LTC) settings. Job satisfaction has implications for staff turnover, staff health, and quality of care. DESIGN A cross-sectional analysis of survey data collected in the Translating Research in Elder Care program. SETTING AND PARTICIPANTS N = 756 nurses (registered nurses: n = 308; licensed practical nurses: n = 448) from 89 residential LTC settings in 3 Western Canadian provinces. METHODS We used a generalized estimating equation model to assess demographic, individual, and organizational context factors associated with job satisfaction. Job satisfaction was measured using the Michigan Organizational Assessment Questionnaire Job Satisfaction Scale. RESULTS Demographic, individual, and organizational context factors were associated with job satisfaction among nurses in residential LTC settings. At the demographic level, hours worked in 2 weeks (B = 0.002, P = .043) was associated with job satisfaction. At the individual level, emotional exhaustion-burnout (B = -0.063, P = .02) was associated with lower job satisfaction, while higher scores on empowerment (meaning) (B = 0.140, P = .015), work engagement (vigor) (B = 0.096, P = .01), and work engagement (dedication) (B = 0.129, P = .001) were associated with higher job satisfaction. With respect to organizational context, culture (B = 0.175, P < .001), organizational slack-space (eg, perceived availability and use of adequate space; B = 0.043, P = .040), and adequate orientation (B = 0.092, P < .001) were associated with higher job satisfaction. CONCLUSIONS AND IMPLICATIONS We identified previously unexamined modifiable organizational features (organizational slack-space and adequate orientation) as factors associated with LTC nurses' job satisfaction in the Canadian context. Our findings support future efforts to improve job satisfaction through improvements in organizational space and provision of adequate workplace orientation.
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Affiliation(s)
- Laura D Aloisio
- University of Ottawa, School of Nursing, Ottawa, Ontario, Canada.
| | - Wendy A Gifford
- University of Ottawa, School of Nursing, Ottawa, Ontario, Canada
| | - Katherine S McGilton
- Toronto Rehabilitation Institute, University Health Network Lawrence S. Bloomberg - Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Michelle Lalonde
- University of Ottawa, School of Nursing, Ottawa, Ontario, Canada
| | - Carole A Estabrooks
- Faculty of Nursing Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alberta, Canada
| | - Janet E Squires
- University of Ottawa, School of Nursing, Ottawa, Ontario, Canada
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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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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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Berta W, Laporte A, Perreira T, Ginsburg L, Dass AR, Deber R, Baumann A, Cranley L, Bourgeault I, Lum J, Gamble B, Pilkington K, Haroun V, Neves P. Relationships between work outcomes, work attitudes and work environments of health support workers in Ontario long-term care and home and community care settings. HUMAN RESOURCES FOR HEALTH 2018; 16:15. [PMID: 29566723 PMCID: PMC5863810 DOI: 10.1186/s12960-018-0277-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Accepted: 02/23/2018] [Indexed: 05/04/2023]
Abstract
BACKGROUND Our overarching study objective is to further our understanding of the work psychology of Health Support Workers (HSWs) in long-term care and home and community care settings in Ontario, Canada. Specifically, we seek novel insights about the relationships among aspects of these workers' work environments, their work attitudes, and work outcomes in the interests of informing the development of human resource programs to enhance elder care. METHODS We conducted a path analysis of data collected via a survey administered to a convenience sample of Ontario HSWs engaged in the delivery of elder care over July-August 2015. RESULTS HSWs' work outcomes, including intent to stay, organizational citizenship behaviors, and performance, are directly and significantly related to their work attitudes, including job satisfaction, work engagement, and affective organizational commitment. These in turn are related to how HSWs perceive their work environments including their quality of work life (QWL), their perceptions of supervisor support, and their perceptions of workplace safety. CONCLUSIONS HSWs' work environments are within the power of managers to modify. Our analysis suggests that QWL, perceptions of supervisor support, and perceptions of workplace safety present particularly promising means by which to influence HSWs' work attitudes and work outcomes. Furthermore, even modest changes to some aspects of the work environment stand to precipitate a cascade of positive effects on work outcomes through work attitudes.
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Affiliation(s)
- Whitney Berta
- Institute for Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th Floor, Toronto, ON M5T 3M6 Canada
| | - Audrey Laporte
- Institute for Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th Floor, Toronto, ON M5T 3M6 Canada
- Canadian Centre for Health Economics, University of Toronto, 155 College Street, 4th Floor, Toronto, ON M5T 3M6 Canada
| | - Tyrone Perreira
- Institute for Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th Floor, Toronto, ON M5T 3M6 Canada
| | - Liane Ginsburg
- School of Health Policy & Management, York University, 4700 Keele Street, Toronto, ON M3J 1P3 Canada
| | - Adrian Rohit Dass
- Institute for Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th Floor, Toronto, ON M5T 3M6 Canada
- Canadian Centre for Health Economics, University of Toronto, 155 College Street, 4th Floor, Toronto, ON M5T 3M6 Canada
| | - Raisa Deber
- Institute for Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th Floor, Toronto, ON M5T 3M6 Canada
| | - Andrea Baumann
- Faculty of Health Sciences, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1 Canada
| | - Lisa Cranley
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Suite 130, Toronto, ON M5T 1P8 Canada
| | - Ivy Bourgeault
- Telfer School of Management, 55 Laurier Ave E., Ottawa, ON K1N 6N5 Canada
| | - Janet Lum
- Department of Politics and Public Administration, Faculty of Arts, Ryerson University, 350 Victoria St., Toronto, ON M5B 2K3 Canada
| | - Brenda Gamble
- Faculty of Health Sciences, University of Ontario Institute of Technology, 2000 Simcoe Street, North Science Building, Oshawa, ON L1H 7K4 Canada
| | - Kathryn Pilkington
- Ontario Association of Non-Profit Homes & Services for Seniors, 7050 Weston Rd, Woodbridge, ON L4L 8G7 Canada
| | - Vinita Haroun
- Ontario Long Term Care Association, 425 University Avenue, Suite 500, Toronto, ON M5G 1T6 Canada
| | - Paula Neves
- Regional Geriatric Program of Toronto, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada
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Thompson GN, Doupe M, Reid RC, Baumbusch J, Estabrooks CA. Pain Trajectories of Nursing Home Residents Nearing Death. J Am Med Dir Assoc 2017; 18:700-706. [DOI: 10.1016/j.jamda.2017.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 03/01/2017] [Accepted: 03/01/2017] [Indexed: 01/08/2023]
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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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A Knowledge Translation framework on ageing and health. Health Policy 2017; 121:282-291. [DOI: 10.1016/j.healthpol.2016.12.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 12/05/2016] [Accepted: 12/31/2016] [Indexed: 12/14/2022]
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Dearing JW, Beacom AM, Chamberlain SA, Meng J, Berta WB, Keefe JM, Squires JE, Doupe MB, Taylor D, Reid RC, Cook H, Cummings GG, Baumbusch JL, Knopp-Sihota J, Norton PG, Estabrooks CA. Pathways for best practice diffusion: the structure of informal relationships in Canada's long-term care sector. Implement Sci 2017; 12:11. [PMID: 28159009 PMCID: PMC5291985 DOI: 10.1186/s13012-017-0542-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Accepted: 01/25/2017] [Indexed: 11/29/2022] Open
Abstract
Background Initiatives to accelerate the adoption and implementation of evidence-based practices benefit from an association with influential individuals and organizations. When opinion leaders advocate or adopt a best practice, others adopt too, resulting in diffusion. We sought to identify existing influence throughout Canada’s long-term care sector and the extent to which informal advice-seeking relationships tie the sector together as a network. Methods We conducted a sociometric survey of senior leaders in 958 long-term care facilities operating in 11 of Canada’s 13 provinces and territories. We used an integrated knowledge translation approach to involve knowledge users in planning and administering the survey and in analyzing and interpreting the results. Responses from 482 senior leaders generated the names of 794 individuals and 587 organizations as sources of advice for improving resident care in long-term care facilities. Results A single advice-seeking network appears to span the nation. Proximity exhibits a strong effect on network structure, with provincial inter-organizational networks having more connections and thus a denser structure than interpersonal networks. We found credible individuals and organizations within groups (opinion leaders and opinion-leading organizations) and individuals and organizations that function as weak ties across groups (boundary spanners and bridges) for all studied provinces and territories. A good deal of influence in the Canadian long-term care sector rests with professionals such as provincial health administrators not employed in long-term care facilities. Conclusions The Canadian long-term care sector is tied together through informal advice-seeking relationships that have given rise to an emergent network structure. Knowledge of this structure and engagement with its opinion leaders and boundary spanners may provide a route for stimulating the adoption and effective implementation of best practices, improving resident care and strengthening the long-term care advice network. We conclude that informal relational pathways hold promise for helping to transform the Canadian long-term care sector.
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Affiliation(s)
- James W Dearing
- Department of Communication, Michigan State University, Suite 473, 404 Wilson Road, East Lansing, MI, 48824-1212, USA.
| | - Amanda M Beacom
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | | | - Jingbo Meng
- Department of Communication, Michigan State University, Suite 473, 404 Wilson Road, East Lansing, MI, 48824-1212, USA
| | - Whitney B Berta
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Janice M Keefe
- Nova Scotia Centre on Aging, Mount Saint Vincent University, Halifax, Nova Scotia, Canada
| | - Janet E Squires
- School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
| | - Malcolm B Doupe
- Manitoba Center for Health Policy, University of Manitoba, Winnipeg, Canada
| | - Deanne Taylor
- Research Department, Interior Health Authority, Kelowna, British Columbia, Canada
| | - Robert Colin Reid
- School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - Heather Cook
- Hospitals and Communities Integrated Services, Interior Health Authority, Kelowna, British Columbia, Canada
| | - Greta G Cummings
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Jennifer L Baumbusch
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Peter G Norton
- Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada
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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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Chamberlain SA, Hoben M, Squires JE, Estabrooks CA. Individual and organizational predictors of health care aide job satisfaction in long term care. BMC Health Serv Res 2016; 16:577. [PMID: 27737672 PMCID: PMC5064796 DOI: 10.1186/s12913-016-1815-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 10/04/2016] [Indexed: 11/27/2022] Open
Abstract
Background Unregulated health care aides provide the majority of direct health care to residents in long term care homes. Lower job satisfaction as reported by care aides is associated with increased turnover of staff. Turnover leads to inferior job performance and negatively impacts quality of care for residents. This study aimed to determine the individual and organizational variables associated with job satisfaction in care aides. Methods We surveyed a sample of 1224 care aides from 30 long term care homes in three Western Canadian provinces. The care aides reported their job satisfaction and their perception of the work environment. We used a hierarchical, mixed-effects ordered logistic regression to model the relative odds of care aide job satisfaction for individual, care unit, and facility factors. Results Care aide exhaustion, professional efficacy, and cynicism were associated with job satisfaction. Factors in the organizational context that are associated with increased care aide job satisfaction include: leadership, culture, social capital, organizational slack—staff, organizational slack—space, and organizational slack—time. Conclusions Our findings suggest that organizational factors account for a greater increase in care aide job satisfaction than do individual factors. These features of the work environment are modifiable and predict care aide job satisfaction. Efforts to improve care aide work environment and quality of care should focus on organizational context.
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Affiliation(s)
| | - Matthias Hoben
- Faculty of Nursing, University of Alberta, 11405-87 Ave, Edmonton, AB, T6G 1C9, Canada
| | - Janet E Squires
- University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada.,Ottawa Hospital Research Institute, Centre for Practice-Changing Research (CPCR), 501 Smyth Road, Room 1282, Box 711, Ottawa, ON, K1H 8L6, Canada
| | - Carole A Estabrooks
- Faculty of Nursing, University of Alberta, 11405-87 Ave, Edmonton, AB, T6G 1C9, 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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Estabrooks CA, Knopp-Sihota JA, Cummings GG, Norton PG. Making Research Results Relevant and Useable: Presenting Complex Organizational Context Data to Nonresearch Stakeholders in the Nursing Home Setting. Worldviews Evid Based Nurs 2016; 13:270-6. [DOI: 10.1111/wvn.12158] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2015] [Indexed: 11/26/2022]
Affiliation(s)
| | - Jennifer A. Knopp-Sihota
- Assistant Professor, Faculty of Health Disciplines; Athabasca University; Athabasca Alberta Canada
- Assistant Adjunct Professor, Faculty of Nursing; University of Alberta; Edmonton Alberta Canada
| | - Greta G. Cummings
- Professor, Faculty of Nursing; University of Alberta; Edmonton Alberta Canada
| | - Peter G. Norton
- Professor Emeritus, Department of Family Medicine; University of Calgary; Calgary Alberta Canada
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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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Estabrooks CA, Squires JE, Hayduk L, Morgan D, Cummings GG, Ginsburg L, Stewart N, McGilton K, Kang SH, Norton PG. The influence of organizational context on best practice use by care aides in residential long-term care settings. J Am Med Dir Assoc 2015; 16:537.e1-10. [PMID: 25899110 DOI: 10.1016/j.jamda.2015.03.009] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 02/10/2015] [Accepted: 03/10/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE This study assessed individual and organizational context (work environment) factors that influence use of best practices by care aides (nursing assistants) in nursing homes. Little scientific attention has been focused on understanding best practice use in nursing homes and almost none on care aides. SETTING AND PARTICIPANTS A total of 1262 care aides in 25 nursing homes in the 3 Canadian prairie provinces. Care aides are unregulated workers who provide 80% of direct care to residents in Canadian nursing homes. METHOD We used hierarchical linear modeling to (1) assess the amount of variance in use of best practices, as reported by care aides, that could be attributed to individual or organizational factors, and (2) identify predictors of best practices use by care aides. RESULTS At the individual level, statistically significant predictors of instrumental use of best practices included sex, age, shift worked, job efficacy, and belief suspension. At the unit level, significant predictors were social capital, organizational slack (staffing and time), number of informal interactions, and unit type. At the facility level, ownership model and province were significant. Significant predictors of conceptual use of best practices at the individual level included English as a first language, job efficacy, belief suspension, intent to use research, adequate knowledge, and number of information sources used. At the unit level, significant predictors were evaluation (feedback mechanisms), structural resources, and organizational slack (time). At the facility level, province was significant. The R(2) was 18.3% for instrumental use of best practices and 43.4% for conceptual use. Unit level factors added a substantial amount of explained variance whereas facility level factors added relatively little explained variance. CONCLUSIONS Our study suggests that context plays an important role in care aides' use of best practices in nursing homes. Individual characteristics played a more prominent role than contextual factors in predicting conceptual use of best practices.
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Affiliation(s)
| | - Janet E Squires
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Leslie Hayduk
- Department of Sociology, University of Alberta, Edmonton, Alberta, Canada
| | - Debra Morgan
- Canadian Center for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, Saskatchewan, Canada; College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Greta G Cummings
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Liane Ginsburg
- School of Health Policy and Management, York University, Toronto, Ontario, Canada
| | - Norma Stewart
- College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Katherine McGilton
- Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada
| | - Sung Hyun Kang
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Peter G Norton
- Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
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Abstract
BACKGROUND Systematic evaluations of knowledge translation interventions in nursing homes to improve practice are scarce. There is also a lack of studies focusing on creating sustainable evidence-based practice in the setting of residential dementia care. METHODS The aim of this paper is to describe a model for implementing national evidence-based guidelines for care of persons with dementia in nursing homes. The secondary aim is to outline the nursing home staff experiences during the first year of the implementation process. The intervention had a participatory action research approach. This included educational activities such as: (i) thematic seminars introducing national guidelines for dementia care, (ii) regular unit-based seminars; and (iii) later dissemination of information in reflective seminars and several days of poster-exhibitions. Areas of practice development were selected on each of the 24 units, based on unit-specific needs, and a quality improvement strategy was applied and evaluated. Each unit met ten times during a period of eight months. Data for this study were extracted from the reflective seminars and poster presentations, analyzed using a qualitative content analysis. RESULTS Findings showed that implementation of guidelines were perceived by staff as beneficial for both staff and the residents. However, barriers to identification of relevant sources of evidence and barriers to sustainable implementation were experienced. CONCLUSIONS One of our assumptions was that dementia nursing homes can benefit from becoming knowledge driven, with care practices founded in evidence-based sources. Our findings show that to be partly true, even though most staff units found their efforts to pursue and utilize knowledge adversely impacted by time-logistics and practical workload challenges.
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Abstract
Older adults living in residential long-term care or nursing homes have increasingly complex needs, including more dementia than in the past, yet we know little about the unregulated workforce providing care. We surveyed 1,381 care aides in a representative sample of 30 urban nursing homes in the three Canadian Prairie provinces and report demographic, health and well-being, and work-related characteristics. Over 50 per cent of respondents were not born in Canada and did not speak English as their first language. They reported moderately high levels of burnout and a strong sense of their work's worth. Few respondents reported attending educational sessions. This direct caregiver workforce is poorly understood, has limited training or standards for minimum education, and training varies widely across provinces. Workplace characteristics affecting care aides reflect factors that precipitate burnout in allied health professions, with implications for quality of care, staff health, and staff retention.
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Norton PG, Murray M, Doupe MB, Cummings GG, Poss JW, Squires JE, Teare GF, Estabrooks CA. Facility versus unit level reporting of quality indicators in nursing homes when performance monitoring is the goal. BMJ Open 2014; 4:e004488. [PMID: 24523428 PMCID: PMC3927709 DOI: 10.1136/bmjopen-2013-004488] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES To demonstrate the benefit of defining operational management units in nursing homes and computing quality indicators on these units as well as on the whole facility. DESIGN Calculation of adjusted Resident Assessment Instrument - Minimum Data Set 2.0 (RAI-MDS 2.0) quality indicators for: PRU05 (prevalence of residents with a stage 2-4 pressure ulcer), PAI0X (prevalence of residents with pain) and DRG01 (prevalence of residents receiving an antipsychotic with no diagnosis of psychosis), for quarterly assessments between 2007 and 2011 at unit and facility levels. Comparisons of these risk-adjusted quality indicators using statistical process control (control charts). SETTING A representative sample of 30 urban nursing homes in the three Canadian Prairie Provinces. MEASUREMENTS Explicit decision rules were developed and tested to determine whether the control charts demonstrated improving, worsening, unchanging or unclassifiable trends over the time period. Unit and facility performance were compared. RESULTS In 48.9% of the units studied, unit control chart performance indicated different changes in quality over the reporting period than did the facility chart. Examples are provided to illustrate that these differences lead to quite different quality interventions. CONCLUSIONS Our results demonstrate the necessity of considering facility-level and unit-level measurement when calculating quality indicators derived from the RAI-MDS 2.0 data, and quite probably from any RAI measures.
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Affiliation(s)
- Peter G Norton
- Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Michael Murray
- Knowledge for Improvement Consulting, Stratford, Ontario, Canada
| | - Malcolm B Doupe
- Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Greta G Cummings
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Jeff W Poss
- University of Waterloo, Waterloo, Ontario, Canada
| | - Janet E Squires
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
| | - Gary F Teare
- Health Quality Council (Saskatchewan), Saskatoon, Saskatchewan, Canada
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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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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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Estabrooks CA, Knopp-Sihota JA, Norton PG. Practice sensitive quality indicators in RAI-MDS 2.0 nursing home data. BMC Res Notes 2013; 6:460. [PMID: 24220213 PMCID: PMC3831872 DOI: 10.1186/1756-0500-6-460] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 11/05/2013] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND In recent years, improving the quality of care for nursing home residents has generated a considerable amount of attention. In response, quality indicators (QIs), based on available evidence and expert consensus, have been identified within the Resident Assessment Instrument-Minimum Data Set 2.0 (RAI-MDS 2.0), and validated as proxy measures for quality of nursing home care. We sought to identify practice sensitive QIs; that is, those QIs believed to be the most sensitive to clinical practice. METHOD We enlisted two experts to review a list of 35 validated QIs and to select those that they believed to be the most sensitive to practice. We then asked separate groups of practicing physicians, nurses, and policy makers to (1) rank the items on the list for overall "practice sensitivity" and then, (2) to identify the domain to which the QI was most sensitive (nursing care, physician care, or policy maker). RESULTS After combining results of all three groups, pressure ulcers were identified as the most practice sensitive QI followed by worsening pain, physical restraint use, the use of antipsychotic medications without a diagnosis of psychosis, and indwelling catheters. When stratified by informant group, although the top five QIs stayed the same, the ranking of the 13 QIs differed by group. CONCLUSIONS In addition to identifying a reduced and manageable set of QIs for regular reporting, we believe that focusing on these 13 practice sensitive QIs provides both the greatest potential for improving resident function and slowing the trajectory of decline that most residents experience.
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Affiliation(s)
- Carole A Estabrooks
- Faculty of Nursing, University of Alberta, Edmonton, Alberta T6G 1C9, Canada
| | - Jennifer A Knopp-Sihota
- Faculty of Nursing, University of Alberta, Edmonton, Alberta T6G 1C9, Canada
- Faculty of Health Disciplines, Athabasca University, Edmonton, Alberta T5K 2J8, Canada
| | - Peter G Norton
- Department of Family Medicine, University of Calgary, Calgary, Alberta T2N 4N1, Canada
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Abstract
RÉSUMÉLes maisons de soins infirmiers sont devenues des environnements offrant des soins complexes, dont les habitants ont des besoins importants et la plupart souffrent de la démence liée a l’âge. S’appuyant sur les recherches de Hirdes et al. (2011), nous décrivons un profil des résidents dans un échantillon représentatif de 30 maisons de soins infirmiers en milieu urbain dans les provinces des Prairies, en utilisant des données de L’Instrument d’évaluation des résidents/le recueil de données minimum (Resident Assistant Instrument – Minimum Data Set 2.0) de 5 196 évaluations résidents accomplies entre le 1ier octobre et le 31ieme décembre 3011. Les résidents avaient principalement plus de 85 ans, étaient des femmes, et souffraient d’une démence liée à l’âge. Nous avons comparé le soutien et les services connexes des établissements et les caractéristiques des résidents par province, par les modèles du propriétaire-gérant, et par le nombre d’unités dans une installation. Nous avons également constaté que les établissements publics ont tendance à s’occuper des résidents ayant des caractéristiques plus exigeants : notamment, la déficience cognitive, un comportement aggressif, et l’incontinence. Aucune tendance claire n’a été observée reliant le nombre d’unités dans un établissement aux caractéristiques des résidents.
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Cammer A, Morgan D, Stewart N, McGilton K, Rycroft-Malone J, Dopson S, Estabrooks C. The Hidden Complexity of Long-Term Care: how context mediates knowledge translation and use of best practices. THE GERONTOLOGIST 2013; 54:1013-23. [PMID: 23856027 DOI: 10.1093/geront/gnt068] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
PURPOSE Context is increasingly recognized as a key factor to be considered when addressing healthcare practice. This study describes features of context as they pertain to knowledge use in long-term care (LTC). DESIGN AND METHODS As one component of the research program Translating Research in Elder Care, an in-depth qualitative case study was conducted to examine the research question "How does organizational context mediate the use of knowledge in practice in long-term care facilities?" A representative facility was chosen from the province of Saskatchewan, Canada. Data included document review, direct observation of daily care practices, and interviews with direct care, allied provider, and administrative staff. RESULTS The Hidden Complexity of Long-Term Care model consists of 8 categories that enmesh to create a context within which knowledge exchange and best practice are executed. These categories range from the most easily identifiable to the least observable: physical environment, resources, ambiguity, flux, relationships, and philosophies. Two categories (experience and confidence, leadership and mentoring) mediate the impact of other contextual factors. Inappropriate physical environments, inadequate resources, ambiguous situations, continual change, multiple relationships, and contradictory philosophies make for a complicated context that impacts care provision. IMPLICATIONS A hidden complexity underlays healthcare practices in LTC and each care provider must negotiate this complexity when providing care. Attending to this complexity in which care decisions are made will lead to improvements in knowledge exchange mechanisms and best practice uptake in LTC settings.
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Affiliation(s)
- Allison Cammer
- Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, Canada.
| | - Debra Morgan
- Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, Canada
| | - Norma Stewart
- College of Nursing, University of Saskatchewan, Saskatoon, Canada
| | | | | | - Sue Dopson
- Said Business School, University of Oxford, UK
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Cummings GG, Reid RC, Estabrooks CA, Norton PG, Cummings GE, Rowe BH, Abel SL, Bissell L, Bottorff JL, Robinson CA, Wagg A, Lee JS, Lynch SL, Masaoud E. Older Persons' Transitions in Care (OPTIC): a study protocol. BMC Geriatr 2012; 12:75. [PMID: 23241360 PMCID: PMC3570479 DOI: 10.1186/1471-2318-12-75] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2012] [Accepted: 11/30/2012] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Changes in health status, triggered by events such as infections, falls, and geriatric syndromes, are common among nursing home (NH) residents and necessitate transitions between NHs and Emergency Departments (EDs). During transitions, residents frequently experience care that is delayed, unnecessary, not evidence-based, potentially unsafe, and fragmented. Furthermore, a high proportion of residents and their family caregivers report substantial unmet needs during transitions. This study is part of a program of research whose overall aim is to improve quality of care for frail older adults who reside in NHs. The purpose of this study is to identify successful transitions from multiple perspectives and to identify organizational and individual factors related to transition success, in order to inform improvements in care for frail elderly NH residents during transitions to and from acute care. Specific objectives are to: 1. define successful and unsuccessful elements of transitions from multiple perspectives; 2. develop and test a practical tool to assess transition success; 3. assess transition processes in a discrete set of transfers in two study sites over a one year period; 4. assess the influence of organizational factors in key practice locations, e.g., NHs, emergency medical services (EMS), and EDs, on transition success; and 5. identify opportunities for evidence-informed management and quality improvement decisions related to the management of NH - ED transitions. METHODS/DESIGN This is a mixed-methods observational study incorporating an integrated knowledge translation (IKT) approach. It uses data from multiple levels (facility, care unit, individual) and sources (healthcare providers, residents, health records, and administrative databases). DISCUSSION Key to study success is operationalizing the IKT approach by using a partnership model in which the OPTIC governance structure provides for team decision-makers and researchers to participate equally in developing study goals, design, data collection, analysis and implications of findings. As preliminary and ongoing study findings are developed, their implications for practice and policy in study settings will be discussed by the research team and shared with study site administrators and staff. The study is designed to investigate the complexities of transitions and to enhance the potential for successful and sustained improvement of these transitions.
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Affiliation(s)
- Greta G Cummings
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
- Faculty of Nursing, Edmonton Clinic Health Academy, University of Alberta, 11405-87 Ave, Edmonton, AB, T6G 0C1, Canada
| | - R Colin Reid
- School of Health and Exercise Sciences, University of British Columbia’s Okanagan campus, Kelowna, BC, Canada
| | | | - Peter G Norton
- Department of Family Medicine, Faculty of Medicine, University of Calgary, Calgary, AB, Canada
| | - Garnet E Cummings
- Department of Emergency Medicine, Faculty of Medicine and Dentistry and School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Brian H Rowe
- Department of Emergency Medicine, Faculty of Medicine and Dentistry and School of Public Health, University of Alberta, Edmonton, AB, Canada
| | | | - Laura Bissell
- School of Health and Exercise Sciences, University of British Columbia’s Okanagan campus, Kelowna, BC, Canada
| | - Joan L Bottorff
- School of Nursing, University of British Columbia’s Okanagan campus, Kelowna, BC, Canada
| | - Carole A Robinson
- School of Nursing, University of British Columbia’s Okanagan campus, Kelowna, BC, Canada
| | - Adrian Wagg
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Jacques S Lee
- Department of Emergency Services, Sunnybrook Health Sciences Center, Toronto, ON, Canada
| | - Susan L Lynch
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
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A data quality control program for computer-assisted personal interviews. Nurs Res Pract 2012; 2012:303816. [PMID: 23304481 PMCID: PMC3529418 DOI: 10.1155/2012/303816] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Revised: 10/24/2012] [Accepted: 10/29/2012] [Indexed: 11/18/2022] Open
Abstract
Researchers strive to optimize data quality in order to ensure that study findings are valid and reliable. In this paper, we describe a data quality control program designed to maximize quality of survey data collected using computer-assisted personal interviews. The quality control program comprised three phases: (1) software development, (2) an interviewer quality control protocol, and (3) a data cleaning and processing protocol. To illustrate the value of the program, we assess its use in the Translating Research in Elder Care Study. We utilize data collected annually for two years from computer-assisted personal interviews with 3004 healthcare aides. Data quality was assessed using both survey and process data. Missing data and data errors were minimal. Mean and median values and standard deviations were within acceptable limits. Process data indicated that in only 3.4% and 4.0% of cases was the interviewer unable to conduct interviews in accordance with the details of the program. Interviewers' perceptions of interview quality also significantly improved between Years 1 and 2. While this data quality control program was demanding in terms of time and resources, we found that the benefits clearly outweighed the effort required to achieve high-quality data.
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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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Rahman AN, Applebaum RA, Schnelle JF, Simmons SF. Translating research into practice in nursing homes: can we close the gap? THE GERONTOLOGIST 2012; 52:597-606. [PMID: 22394494 PMCID: PMC3463418 DOI: 10.1093/geront/gnr157] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Accepted: 12/05/2011] [Indexed: 11/14/2022] Open
Abstract
PURPOSE A gap between research and practice in many nursing home (NH) care areas persists despite efforts by researchers, policy makers, advocacy groups, and NHs themselves to close it. The reasons are many, but two factors that have received scant attention are the dissemination process itself and the work of the disseminators or change agents. This review article examines these two elements through the conceptual lens of Roger's innovation dissemination model. DESIGN AND METHODS The application of general principles of innovation dissemination suggests that NHs are characteristically slow to innovate and thus may need more time as well as more contact with outside change agents to adopt improved practices. RESULTS A review of the translation strategies used by NH change agents to promote adoption of evidence-based practice in NHs suggests that their strategies inconsistently reflect lessons learned from the broader dissemination literature. IMPLICATIONS NH-related research, policy, and practice recommendations for improving dissemination strategies are presented. If we can make better use of the resources currently devoted to disseminating best practices to NHs, we may be able to speed NHs' adoption of these practices.
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Affiliation(s)
- Anna N Rahman
- Davis School of Gerontology, University of Southern California, 3715 McClintock Ave., Los Angeles, CA 90089-0191, USA.
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Cranley LA, Norton PG, Cummings GG, Barnard D, Batra-Garga N, Estabrooks CA. Identifying resident care areas for a quality improvement intervention in long-term care: a collaborative approach. BMC Geriatr 2012; 12:59. [PMID: 23009173 PMCID: PMC3502415 DOI: 10.1186/1471-2318-12-59] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Accepted: 09/22/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Canada, healthcare aides (also referred to as nurse aides, personal support workers, nursing assistants) are unregulated personnel who provide 70-80% of direct care to residents living in nursing homes. Although they are an integral part of the care team their contributions to the resident care planning process are not always acknowledged in the organization. The purpose of the Safer Care for Older Persons [in residential] Environments (SCOPE) project was to evaluate the feasibility of engaging front line staff (primarily healthcare aides) to use quality improvement methods to integrate best practices into resident care. This paper describes the process used by teams participating in the SCOPE project to select clinical improvement areas. METHODS The study employed a collaborative approach to identify clinical areas and through consensus, teams selected one of three areas. To select the clinical areas we recruited two nursing homes not involved in the SCOPE project and sampled healthcare providers and decision-makers within them. A vote counting method was used to determine the top five ranked clinical areas for improvement. RESULTS Responses received from stakeholder groups included gerontology experts, decision-makers, registered nurses, managers, and healthcare aides. The top ranked areas from highest to lowest were pain/discomfort management, behaviour management, depression, skin integrity, and assistance with eating. CONCLUSIONS Involving staff in selecting areas that they perceive as needing improvement may facilitate staff engagement in the quality improvement process.
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Affiliation(s)
- Lisa A Cranley
- Faculty of Nursing, University of Alberta, Level 3 Edmonton Clinic Health Academy, 11405 87 Avenue, Alberta, Edmonton, T6G 1C9, Canada
| | - Peter G Norton
- Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada, Mailing address: 56 George Street, Creemore, Ontario, L0M 1G0, Canada
| | - Greta G Cummings
- Faculty of Nursing, University of Alberta, Level 3 Edmonton Clinic Health Academy, 11405 87 Avenue, Alberta, Edmonton, T6G 1C9, Canada
| | - Debbie Barnard
- Quality and Patient Safety, Health Sciences North, 41 Ramsey Lake Road, Sudbury, Ontario, P3E 5J1, Canada
| | - Neha Batra-Garga
- Strategy and Knowledge, Community Treatment and Support, Addiction and Mental Health, Alberta Health Services, #210, 10909 Jasper Avenue, Associated Engineering Plaza, Edmonton, Alberta, T5J 3M9, Canada
| | - Carole A Estabrooks
- Faculty of Nursing, University of Alberta, Level 3 Edmonton Clinic Health Academy, 11405 87 Avenue, Alberta, Edmonton, T6G 1C9, Canada
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Estabrooks CA, Teare GF, Norton PG. Should we feed back research results in the midst of a study? Implement Sci 2012; 7:87. [PMID: 22974318 PMCID: PMC3495890 DOI: 10.1186/1748-5908-7-87] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Accepted: 07/26/2012] [Indexed: 11/10/2022] Open
Abstract
Background This report is an introduction to a series of three research papers that describe the evolution of the approaches taken by the Translating Research in Elder Care (TREC) research team during its first four years to feed back the research findings to study participants. TREC is an observational multi-method health services research project underway in 36 nursing homes in the prairie provinces of Canada. TREC has actively involved decision makers from the sector in all stages from initial planning, through data collection to dissemination activities. However, it was not planned as a fully integrated knowledge translation project. These three papers describe our progress towards fully integrated knowledge translation—with respect to timely and requested feedback processes. The first paper reports on the process and outcomes of creating and evaluating the feedback of research findings to healthcare aides (unregulated health professionals). These aides provide over 80% of the direct care in our sample and actively requested the feedback as a condition of their continued cooperation in the data acquisition process. The second paper describes feedback from nursing home administrators on preliminary research findings (a facility annual report) and evaluation of the reports’ utility. The third paper discusses an approach to providing a more in-depth form of feedback (expanded feedback report) at one of the TREC nursing homes. Findings Survey and interview feedback from healthcare aides is presented in the first paper. Overall, healthcare aides’ opinions about presentation of the feedback report and the understand ability, usability, and usefulness of the content were positive. The second paper describes the use of telephone interviews with facility administrators and indicates that the majority of contextual areas (e.g., staff job satisfaction) addressed in facility annual report to be useful, meaningful, and understandable. More than one-half of the administrators would have liked to have received information on additional areas. The third paper explores how a case study that examined how involvement with the TREC study influenced management and staff at one of the TREC nursing homes. The importance of understanding organizational routines and the impact of corporate restructuring were key themes emerging from the case study. In addition, the Director of Care suggested changes to the structure and format of the feedback report that would have improved its usefulness. Conclusions We believe that these findings will inform others undertaking integrated knowledge translation activities and will encourage others to become more engaged in feedback processes.
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Affiliation(s)
- Carole A Estabrooks
- Faculty of Nursing, University of Alberta, Edmonton, Alberta T6G 1C9, Canada.
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Hutchinson AM, Batra-Garga N, Cranley L, Bostrom AM, Cummings G, Norton P, Estabrooks CA. Feedback reporting of survey data to healthcare aides. Implement Sci 2012; 7:89. [PMID: 22974485 PMCID: PMC3495892 DOI: 10.1186/1748-5908-7-89] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Accepted: 07/26/2012] [Indexed: 11/23/2022] Open
Abstract
Background This project occurred during the course of the Translating Research in Elder Care (TREC) program of research. TREC is a multilevel and longitudinal research program being conducted in the three Canadian Prairie Provinces of Alberta, Saskatchewan, and Manitoba. The main purpose of TREC is to increase understanding about the role of organizational context in influencing knowledge use in residential long-term care settings. The purpose of this study was to evaluate healthcare aides’ (HCAs) perceptions of a one-page poster designed to feed back aggregated data (including demographic information and perceptions about influences on best practice) from the TREC survey they had recently completed. Methods A convenience sample of 7 of the 15 nursing homes participating in the TREC research program in Alberta were invited to participate. Specific facility-level summary data were provided to each facility in the form of a one-page poster report. Two weeks following delivery of the report, a convenience sample of HCAs was surveyed using one-to-one structured interviews. Results One hundred twenty-three HCAs responded to the evaluation survey. Overall, HCAs’ opinions about presentation of the feedback report and the understandability, usability, and usefulness of the content were positive. For each report, analysis of data and production and inspection of the report took up to one hour. Information sessions to introduce and explain the reports averaged 18 minutes. Two feedback reports (minimum) were supplied to each facility at a cost of CAN$2.39 per report, for printing and laminating. Conclusions This study highlights not only the feasibility of producing understandable, usable, and useful feedback reports of survey data but also the value and importance of providing feedback to survey respondents. More broadly, the findings suggest that modest strategies may have a positive and desirable effect in participating sites.
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Affiliation(s)
- Alison M Hutchinson
- School of Nursing and Midwifery, Deakin University, Melbourne, Victoria, Australia.
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Rahman AN, Schnelle JF, Applebaum R, Lindabury K, Simmons S. Distance coursework and coaching to improve nursing home incontinence care: lessons learned. J Am Geriatr Soc 2012; 60:1157-64. [PMID: 22642640 DOI: 10.1111/j.1532-5415.2012.03939.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To determine whether a distance coaching course on improving nursing home incontinence care could be replicated and brought to scale with a larger group of nursing homes without sacrificing outcomes. DESIGN The study collected descriptive and comparative data. SETTING Fourteen nursing homes in the original course and 34 in the replication course. PARTICIPANTS Participants in the study were supervisors and staff from enrolled nursing homes who completed the distance coaching courses on incontinence management. MEASUREMENTS Data for both courses were collected using a resident assessment form to evaluate implementation of new practices, pre- and posttraining quizzes, a course evaluation survey, and a supervisor's report. RESULTS There were few significant differences between the course groups with respect to course participation, knowledge transfer, and training program preferences. Although Course 1 nursing homes reported assessing more residents on average than Course 2 homes (22 vs 12), this difference is probably an artifact of differences in the reporting methodologies for the two courses. CONCLUSION This study found qualified support for using a distance coaching course to facilitate adoption of evidence-based incontinence care practices in nursing homes. The findings also underscore the challenges associated with designing dissemination and implementation programs that are effective and feasible to implement with nursing homes. Nursing home educators should consider this study's findings when designing new training programs. Outcomes may improve if some dissemination resources are diverted to distance coaching activities that support nursing home improvement efforts over extended periods.
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Affiliation(s)
- Anna N Rahman
- Davis School of Gerontology, University of Southern California, Los Angeles, California, USA.
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Kennedy CC, Ioannidis G, Giangregorio LM, Adachi JD, Thabane L, Morin SN, Crilly RG, Marr S, Josse RG, Lohfeld L, Pickard LE, King S, van der Horst ML, Campbell G, Stroud J, Dolovich L, Sawka AM, Jain R, Nash L, Papaioannou A. An interdisciplinary knowledge translation intervention in long-term care: study protocol for the vitamin D and osteoporosis study (ViDOS) pilot cluster randomized controlled trial. Implement Sci 2012; 7:48. [PMID: 22624776 PMCID: PMC3533817 DOI: 10.1186/1748-5908-7-48] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Accepted: 05/24/2012] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Knowledge translation (KT) research in long-term care (LTC) is still in its early stages. This protocol describes the evaluation of a multifaceted, interdisciplinary KT intervention aimed at integrating evidence-based osteoporosis and fracture prevention strategies into LTC care processes. METHODS AND DESIGN The Vitamin D and Osteoporosis Study (ViDOS) is underway in 40 LTC homes (n = 19 intervention, n = 21 control) across Ontario, Canada. The primary objectives of this study are to assess the feasibility of delivering the KT intervention, and clinically, to increase the percent of LTC residents prescribed ≥800 IU of vitamin D daily. Eligibility criteria are LTC homes that are serviced by our partner pharmacy provider and have more than one prescribing physician. The target audience within each LTC home is the Professional Advisory Committee (PAC), an interdisciplinary team who meets quarterly. The key elements of the intervention are three interactive educational sessions led by an expert opinion leader, action planning using a quality improvement cycle, audit and feedback reports, nominated internal champions, and reminders/point-of-care tools. Control homes do not receive any intervention, however both intervention and control homes received educational materials as part of the Ontario Osteoporosis Strategy. Primary outcomes are feasibility measures (recruitment, retention, attendance at educational sessions, action plan items identified and initiated, internal champions identified, performance reports provided and reviewed), and vitamin D (≥800 IU/daily) prescribing at 6 and 12 months. Secondary outcomes include the proportion of residents prescribed calcium supplements and osteoporosis medications, and falls and fractures. Qualitative methods will examine the experience of the LTC team with the KT intervention. Homes are centrally randomized to intervention and control groups in blocks of variable size using a computer generated allocation sequence. Randomization is stratified by home size and profit/nonprofit status. Prescribing data retrieval and analysis are performed by blinded personnel. DISCUSSION Our study will contribute to an improved understanding of the feasibility and acceptability of a multifaceted intervention aimed at translating knowledge to LTC practitioners. Lessons learned from this study will be valuable in guiding future research and understanding the complexities of translating knowledge in LTC.
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Affiliation(s)
- Courtney C Kennedy
- Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
- Hamilton Health Sciences - St. Peter's Hospital, Juravinski Research Centre, 88 Maplewood Avenue, Hamilton, Ontario L8M 1W9, Canada
- Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main St. West, Hamilton, Ontario, L8S 4K1, Canada
| | - George Ioannidis
- Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
- Charlton Medical Centre, 25 Charlton Ave East, Hamilton, Ontario, L8N 1Y2, Canada
| | - Lora M Giangregorio
- Department of Kinesiology, Faculty of Applied Health Sciences, University of Waterloo, 200 University Ave West, Waterloo, Ontario, N2L 3G1, Canada
| | - Jonathan D Adachi
- Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
- Charlton Medical Centre, 25 Charlton Ave East, Hamilton, Ontario, L8N 1Y2, Canada
| | - Lehana Thabane
- Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main St. West, Hamilton, Ontario, L8S 4K1, Canada
| | - Suzanne N Morin
- Department of Medicine, Division of General Internal Medicine, MUHC-Montreal General Hospital, 1650 Cedar Avenue, Montreal, QC, H3G 1A4, Canada
| | - Richard G Crilly
- Schulich School of Medicine & Dentistry, The University of Western Ontario, Parkwood Hospital, 801 Commissioners Rd. East, London, Ontario, N6C 5J1, Canada
| | - Sharon Marr
- Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
- Hamilton Health Sciences - St. Peter's Hospital, Juravinski Research Centre, 88 Maplewood Avenue, Hamilton, Ontario L8M 1W9, Canada
| | - Robert G Josse
- Department of Medicine, Division of Endocrinology and Metabolism, University of Toronto, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Lynne Lohfeld
- Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main St. West, Hamilton, Ontario, L8S 4K1, Canada
| | - Laura E Pickard
- Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
- Hamilton Health Sciences - St. Peter's Hospital, Juravinski Research Centre, 88 Maplewood Avenue, Hamilton, Ontario L8M 1W9, Canada
| | - Susanne King
- Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
- Hamilton Health Sciences - St. Peter's Hospital, Juravinski Research Centre, 88 Maplewood Avenue, Hamilton, Ontario L8M 1W9, Canada
| | - Mary-Lou van der Horst
- Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
- Hamilton Health Sciences - St. Peter's Hospital, Juravinski Research Centre, 88 Maplewood Avenue, Hamilton, Ontario L8M 1W9, Canada
| | - Glenda Campbell
- Medical Pharmacies Group Limited, 590 Granite Court, Pickering, Ontario, L1W 3X6, Canada
| | - Jackie Stroud
- Medical Pharmacies Group Limited, 590 Granite Court, Pickering, Ontario, L1W 3X6, Canada
| | - Lisa Dolovich
- Department of Family Medicine, McMaster Innovation Park, 175 Longwood Road South, Hamilton, Ontario, L8P 0A1, Canada
| | - Anna M Sawka
- Department of Medicine, Division of Endocrinology and Metabolism, Toronto General Hospital, 200 Elizabeth Street, Toronto, Ontario, M5G 2C4, Canada
| | - Ravi Jain
- Ontario Osteoporosis Strategy, Osteoporosis Canada, 1090 Don Mills Road, Suite 301, Toronto, Ontario, M3C 3R6, Canada
| | - Lynn Nash
- Department of Family Medicine, McMaster Innovation Park, 175 Longwood Road South, Hamilton, Ontario, L8P 0A1, Canada
| | - Alexandra Papaioannou
- Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada
- Hamilton Health Sciences - St. Peter's Hospital, Juravinski Research Centre, 88 Maplewood Avenue, Hamilton, Ontario L8M 1W9, Canada
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Estabrooks CA, Squires JE, Hayduk LA, Cummings GG, Norton PG. Advancing the argument for validity of the Alberta Context Tool with healthcare aides in residential long-term care. BMC Med Res Methodol 2011; 11:107. [PMID: 21767378 PMCID: PMC3156800 DOI: 10.1186/1471-2288-11-107] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Accepted: 07/18/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Organizational context has the potential to influence the use of new knowledge. However, despite advances in understanding the theoretical base of organizational context, its measurement has not been adequately addressed, limiting our ability to quantify and assess context in healthcare settings and thus, advance development of contextual interventions to improve patient care. We developed the Alberta Context Tool (the ACT) to address this concern. It consists of 58 items representing 10 modifiable contextual concepts. We reported the initial validation of the ACT in 2009. This paper presents the second stage of the psychometric validation of the ACT. METHODS We used the Standards for Educational and Psychological Testing to frame our validity assessment. Data from 645 English speaking healthcare aides from 25 urban residential long-term care facilities (nursing homes) in the three Canadian Prairie Provinces were used for this stage of validation. In this stage we focused on: (1) advanced aspects of internal structure (e.g., confirmatory factor analysis) and (2) relations with other variables validity evidence. To assess reliability and validity of scores obtained using the ACT we conducted: Cronbach's alpha, confirmatory factor analysis, analysis of variance, and tests of association. We also assessed the performance of the ACT when individual responses were aggregated to the care unit level, because the instrument was developed to obtain unit-level scores of context. RESULTS Item-total correlations exceeded acceptable standards (> 0.3) for the majority of items (51 of 58). We ran three confirmatory factor models. Model 1 (all ACT items) displayed unacceptable fit overall and for five specific items (1 item on adequate space for resident care in the Organizational Slack-Space ACT concept and 4 items on use of electronic resources in the Structural and Electronic Resources ACT concept). This prompted specification of two additional models. Model 2 used the 7 scaled ACT concepts while Model 3 used the 3 count-based ACT concepts. Both models displayed substantially improved fit in comparison to Model 1. Cronbach's alpha for the 10 ACT concepts ranged from 0.37 to 0.92 with 2 concepts performing below the commonly accepted standard of 0.70. Bivariate associations between the ACT concepts and instrumental research utilization levels (which the ACT should predict) were statistically significant at the 5% level for 8 of the 10 ACT concepts. The majority (8/10) of the ACT concepts also showed a statistically significant trend of increasing mean scores when arrayed across the lowest to the highest levels of instrumental research use. CONCLUSIONS The validation process in this study demonstrated additional empirical support for construct validity of the ACT, when completed by healthcare aides in nursing homes. The overall pattern of the data was consistent with the structure hypothesized in the development of the ACT and supports the ACT as an appropriate measure for assessing organizational context in nursing homes. Caution should be applied in using the one space and four electronic resource items that displayed misfit in this study with healthcare aides until further assessments are made.
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Squires JE, Estabrooks CA, Newburn-Cook CV, Gierl M. Validation of the conceptual research utilization scale: an application of the standards for educational and psychological testing in healthcare. BMC Health Serv Res 2011; 11:107. [PMID: 21595888 PMCID: PMC3117685 DOI: 10.1186/1472-6963-11-107] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Accepted: 05/19/2011] [Indexed: 11/10/2022] Open
Abstract
Background There is a lack of acceptable, reliable, and valid survey instruments to measure conceptual research utilization (CRU). In this study, we investigated the psychometric properties of a newly developed scale (the CRU Scale). Methods We used the Standards for Educational and Psychological Testing as a validation framework to assess four sources of validity evidence: content, response processes, internal structure, and relations to other variables. A panel of nine international research utilization experts performed a formal content validity assessment. To determine response process validity, we conducted a series of one-on-one scale administration sessions with 10 healthcare aides. Internal structure and relations to other variables validity was examined using CRU Scale response data from a sample of 707 healthcare aides working in 30 urban Canadian nursing homes. Principal components analysis and confirmatory factor analyses were conducted to determine internal structure. Relations to other variables were examined using: (1) bivariate correlations; (2) change in mean values of CRU with increasing levels of other kinds of research utilization; and (3) multivariate linear regression. Results Content validity index scores for the five items ranged from 0.55 to 1.00. The principal components analysis predicted a 5-item 1-factor model. This was inconsistent with the findings from the confirmatory factor analysis, which showed best fit for a 4-item 1-factor model. Bivariate associations between CRU and other kinds of research utilization were statistically significant (p < 0.01) for the latent CRU scale score and all five CRU items. The CRU scale score was also shown to be significant predictor of overall research utilization in multivariate linear regression. Conclusions The CRU scale showed acceptable initial psychometric properties with respect to responses from healthcare aides in nursing homes. Based on our validity, reliability, and acceptability analyses, we recommend using a reduced (four-item) version of the CRU scale to yield sound assessments of CRU by healthcare aides. Refinement to the wording of one item is also needed. Planned future research will include: latent scale scoring, identification of variables that predict and are outcomes to conceptual research use, and longitudinal work to determine CRU Scale sensitivity to change.
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Affiliation(s)
- Janet E Squires
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
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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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Estabrooks CA, Morgan DG, Squires JE, Boström AM, Slaughter SE, Cummings GG, Norton PG. The care unit in nursing home research: evidence in support of a definition. BMC Med Res Methodol 2011; 11:46. [PMID: 21492456 PMCID: PMC3098823 DOI: 10.1186/1471-2288-11-46] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2010] [Accepted: 04/14/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Defining what constitutes a resident care unit in nursing home research is both a conceptual and practical challenge. The aim of this paper is to provide evidence in support of a definition of care unit in nursing homes by demonstrating: (1) its feasibility for use in data collection, (2) the acceptability of aggregating individual responses to the unit level, and (3) the benefit of including unit level data in explanatory models. METHODS An observational study design was used. Research (project) managers, healthcare aides, care managers, nursing home administrators and directors of care from thirty-six nursing homes in the Canadian prairie provinces of Alberta, Saskatchewan and Manitoba provided data for the study. A definition of care unit was developed and applied in data collection and analyses. A debriefing session was held with research managers to investigate their experiences with using the care unit definition. In addition, survey responses from 1258 healthcare aides in 25 of the 36 nursing homes in the study, that had more than one care unit, were analyzed using a multi-level modeling approach. Trained field workers administered the Alberta Context Tool (ACT), a 58-item self-report survey reflecting 10 organizational context concepts, to healthcare aides using computer assisted personal interviews. To assess the appropriateness of obtaining unit level scores, we assessed aggregation statistics (ICC(1), ICC(2), η², and ω²), and to assess the value of using the definition of unit in explanatory models, we performed multi-level modeling. RESULTS In 10 of the 36 nursing homes, the care unit definition developed was used to align the survey data (for analytic purposes) to specific care units as designated by our definition, from that reported by the facility administrator. The aggregation statistics supported aggregating the healthcare aide responses on the ACT to the realigned unit level. Findings from the multi-level modeling further supported unit level aggregation. A significantly higher percentage of variance was explained in the ACT concepts at the unit level compared to the individual and/or nursing home levels. CONCLUSIONS The statistical results support the use of our definition of care unit in nursing home research in the Canadian prairie provinces. Beyond research convenience however, the results also support the resident unit as an important Clinical Microsystem to which future interventions designed to improve resident quality of care and staff (healthcare aide) worklife should be targeted.
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Affiliation(s)
| | - Debra G Morgan
- Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Janet E Squires
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Anne-Marie Boström
- Department of Neurobiology, Care Sciences and Science, Division of Nursing, Karolinska Institute, Stockholm, Sweden
| | | | | | - Peter G Norton
- Department of Family Medicine, University of Calgary, Calgary, Canada
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Estabrooks CA, Squires JE, Cummings GG, Teare GF, Norton PG. Study protocol for the translating research in elder care (TREC): building context - an organizational monitoring program in long-term care project (project one). Implement Sci 2009; 4:52. [PMID: 19671166 PMCID: PMC2744651 DOI: 10.1186/1748-5908-4-52] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2009] [Accepted: 08/11/2009] [Indexed: 11/19/2022] Open
Abstract
Background While there is a growing awareness of the importance of organizational context (or the work environment/setting) to successful knowledge translation, and successful knowledge translation to better patient, provider (staff), and system outcomes, little empirical evidence supports these assumptions. Further, little is known about the factors that enhance knowledge translation and better outcomes in residential long-term care facilities, where care has been shown to be suboptimal. The project described in this protocol is one of the two main projects of the larger five-year Translating Research in Elder Care (TREC) program. Aims The purpose of this project is to establish the magnitude of the effect of organizational context on knowledge translation, and subsequently on resident, staff (unregulated, regulated, and managerial) and system outcomes in long-term care facilities in the three Canadian Prairie Provinces (Alberta, Saskatchewan, Manitoba). Methods/Design This study protocol describes the details of a multi-level – including provinces, regions, facilities, units within facilities, and individuals who receive care (residents) or work (staff) in facilities – and longitudinal (five-year) research project. A stratified random sample of 36 residential long-term care facilities (30 urban and 6 rural) from the Canadian Prairie Provinces will comprise the sample. Caregivers and care managers within these facilities will be asked to complete the TREC survey – a suite of survey instruments designed to assess organizational context and related factors hypothesized to be important to successful knowledge translation and to achieving better resident, staff, and system outcomes. Facility and unit level data will be collected using standardized data collection forms, and resident outcomes using the Resident Assessment Instrument-Minimum Data Set version 2.0 instrument. A variety of analytic techniques will be employed including descriptive analyses, psychometric analyses, multi-level modeling, and mixed-method analyses. Discussion Three key challenging areas associated with conducting this project are discussed: sampling, participant recruitment, and sample retention; survey administration (with unregulated caregivers); and the provision of a stable set of study definitions to guide the project.
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Rycroft-Malone J, Dopson S, Degner L, Hutchinson AM, Morgan D, Stewart N, Estabrooks CA. Study protocol for the translating research in elder care (TREC): building context through case studies in long-term care project (project two). Implement Sci 2009; 4:53. [PMID: 19671167 PMCID: PMC2742509 DOI: 10.1186/1748-5908-4-53] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2009] [Accepted: 08/11/2009] [Indexed: 11/13/2022] Open
Abstract
Background The organizational context in which healthcare is delivered is thought to play an important role in mediating the use of knowledge in practice. Additionally, a number of potentially modifiable contextual factors have been shown to make an organizational context more amenable to change. However, understanding of how these factors operate to influence organizational context and knowledge use remains limited. In particular, research to understand knowledge translation in the long-term care setting is scarce. Further research is therefore required to provide robust explanations of the characteristics of organizational context in relation to knowledge use. Aim To develop a robust explanation of the way organizational context mediates the use of knowledge in practice in long-term care facilities. Design This is longitudinal, in-depth qualitative case study research using exploratory and interpretive methods to explore the role of organizational context in influencing knowledge translation. The study will be conducted in two phases. In phase one, comprehensive case studies will be conducted in three facilities. Following data analysis and proposition development, phase two will continue with focused case studies to elaborate emerging themes and theory. Study sites will be purposively selected. In both phases, data will be collected using a variety of approaches, including non-participant observation, key informant interviews, family perspectives, focus groups, and documentary evidence (including, but not limited to, policies, notices, and photographs of physical resources). Data analysis will comprise an iterative process of identifying convergent evidence within each case study and then examining and comparing the evidence across multiple case studies to draw conclusions from the study as a whole. Additionally, findings that emerge through this project will be compared and considered alongside those that are emerging from project one. In this way, pattern matching based on explanation building will be used to frame the analysis and develop an explanation of organizational context and knowledge use over time. An improved understanding of the contextual factors that mediate knowledge use will inform future development and testing of interventions to enhance knowledge use, with the ultimate aim of improving the outcomes for residents in long-term care settings.
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