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Saeidzadeh S, Minion JT, Bryan S, Norton PG, Estabrooks CA. Evaluating Real-World Implementation of INFORM (Improving Nursing Home Care through Feedback on Performance Data): An Improvement Initiative in Canadian Nursing Homes. Jt Comm J Qual Patient Saf 2024; 50:579-590. [PMID: 38845237 DOI: 10.1016/j.jcjq.2024.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 04/19/2024] [Accepted: 04/24/2024] [Indexed: 07/29/2024]
Abstract
BACKGROUND INFORM (Improving Nursing Home Care through Feedback on Performance Data) was a research intervention that equipped nursing home managers with skills to conduct local improvement projects and supported them in improving performance through modifiable elements in their units. Prior reports have found positive and sustained outcomes from INFORM intervention. In this article, the authors report findings from a formative service evaluation of INFORM as modified for implementation in real-world settings. METHODS INFORM was transformed for real-world implementation with an initial cohort of 26 nursing homes in British Columbia, Canada (INFORM BC). Three stakeholder groups were involved: nursing home teams, an academic team that modified INFORM for implementation, and a BC team that implemented INFORM and coached participating nursing home teams in applying it locally. Service evaluation was conducted drawing on participants from all three stakeholder groups, using convenience sampling, with numbers varying by data source. Using a mixed methods design, outcome data included qualitative and quantitative assessment of surveys, discussions, observations, and a review of documents and resources. RESULTS The majority of nursing home teams reported positive outcomes relative to the usefulness and relevance of the initiative for local needs despite a number of operational challenges during implementation. A key factor in their success was combining targeted external support with the opportunity to set goals and measure success locally. Challenges included a lack of time at the nursing home level, COVID-19-related disruptions, and issues with role clarity and alignment of expectations among the academic and BC teams. CONCLUSION INFORM BC advanced the processes of change planning and transferable learning among nursing home managers and their local teams. Success was facilitated externally but defined and achieved locally. Future iterations should probe outcome sustainability and how nursing home teams adapt the INFORM approach in practice.
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Estabrooks C, Song Y, Anderson R, Beeber A, Berta W, Chamberlain S, Cummings G, Duan Y, Hayduk L, Hoben M, Iaconi A, Lanham H, Perez J, Wang J, Norton P. The Influence of Context on Implementation and Improvement: Protocol for a Mixed Methods, Secondary Analyses Study. JMIR Res Protoc 2022; 11:e40611. [PMID: 36107475 PMCID: PMC9523530 DOI: 10.2196/40611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/13/2022] [Accepted: 07/30/2022] [Indexed: 12/05/2022] Open
Abstract
Background Caring for the well-being of older adults is one of the greatest challenges in modern societies. Improving the quality of care and life for older adults and the work lives of their care providers calls for effective knowledge translation of evidence-based best practices. Objective This study’s purpose is to contribute to knowledge translation by better understanding the roles of organizational context (workplace environment) and facilitation (process or role) in implementation and improvement success. Our study has 2 goals: (1) to advance knowledge translation science by further developing and testing the Promoting Action on Research Implementation in Health Services framework (which outlines how implementation relies on the interplay of context, facilitation, and evidence) and (2) to advance research by optimizing implementation success via tailoring of modifiable elements of organizational context and facilitation. Methods This is secondary analyses of 15 years of longitudinal data from the Translating Research in Elder Care (TREC) program’s multiple data sources. This research is ongoing in long-term care (LTC) homes in western Canada. TREC data include the following: 5 waves of survey collection, 2 clinical trials, and regular ongoing outcome data for LTC residents. We will use a sequential exploratory and confirmatory mixed methods design. We will analyze qualitative and quantitative data holdings in an iterative process: (1) comprehensive reanalysis of qualitative data to derive hypotheses, (2) quantitative modeling to test hypotheses, and (3) action cycles to further refine and integrate qualitative and quantitative analyses. The research team includes 4 stakeholder panels: (1) system decision- and policy makers, (2) care home managers, (3) direct care staff, and (4) a citizen engagement group of people living with dementia and family members of LTC residents. A fifth group is our panel of external scientific advisors. Each panel will engage periodically, providing their perspectives on project direction and findings. Results This study is funded by the Canadian Institutes of Health Research. Ethics approval was obtained from the University of Alberta (Pro00096541). The results of the secondary analyses are expected by the end of 2023. Conclusions The project will advance knowledge translation science by deepening our understanding of the roles of context, the interactions between context and facilitation, and their influence on resident and staff quality outcomes. Importantly, findings will inform understanding of the mechanisms by which context and facilitation affect the success of implementation and offer insights into factors that influence the implementation success of interventions in nursing homes. International Registered Report Identifier (IRRID) DERR1-10.2196/40611
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Affiliation(s)
| | - Yuting Song
- School of Nursing, Qingdao University, Qingdao, China
| | - Ruth Anderson
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Anna Beeber
- School of Nursing, Johns Hopkins University, Baltimore, MD, United States
| | - Whitney Berta
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | | | - Greta Cummings
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Yinfei Duan
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Leslie Hayduk
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Matthias Hoben
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Alba Iaconi
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Holly Lanham
- Department of Medicine, University of Texas Health Sciences Center San Antonio, San Antonio, TX, United States
| | - Janelle Perez
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Jing Wang
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Peter Norton
- Department of Family Medicine, University of Calgary, Calgary, AB, Canada
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Levy C, Zimmerman S, Mor V, Gifford D, Greenberg SA, Klinger JH, Lieblich C, Linnebur S, McAllister A, Nazir A, Pace D, Stone R, Resnick B, Sloane PD, Ouslander J, Gaugler JE. Pragmatic Trials in Long-Term Care: Implementation and Dissemination Challenges and Opportunities. J Am Geriatr Soc 2022; 70:709-717. [PMID: 35195281 PMCID: PMC8944211 DOI: 10.1111/jgs.17698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 02/01/2022] [Indexed: 11/28/2022]
Abstract
Randomized controlled trials are considered the most rigorous research design in efficacy and effectiveness research; however, such trials present numerous challenges that limit their applicability in real-world settings. As a consequence, pragmatic trials are increasingly viewed as a research design that overcomes some of these barriers with the potential to produce findings that are more reproducible. Although pragmatic methodology in long-term care is receiving increasing attention as an approach to improve successful dissemination and implementation, pragmatic trials present complexities of their own. To address these complexities and related issues, experts with experience conducting pragmatic trials, developing nursing home policy, participating in advocacy efforts, and providing clinical care in long-term care settings participated in a virtual consensus conference funded by the National Institute on Aging in Spring 2021. Participants identified 4 cross-cutting principles key to dissemination and implementation of pragmatic trial interventions: (1) stakeholder engagement, (2) diversity and inclusion, (3) organizational strain and readiness, and (4) learn from adaptations. Participants emphasized that implementation processes must be grounded in the perspectives of the people who will ultimately be responsible for implementing the intervention once it is proven to be effective. In addition, messaging must speak to long-term care staff and all others who have a stake in its outcomes. Although our understanding of dissemination and implementation strategies remains underdeveloped, this article is designed to guide long-term care researchers and community providers who are increasingly aware of the need for pragmatism in disseminating and implementing evidence-based care interventions.
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Affiliation(s)
- Cari Levy
- Department of Veterans Affairs, Rocky Mountain Regional VA Medical Center, Aurora, CO, USA,University of Colorado, Aurora, CO, USA,Address correspondence to Cari Levy, MD, PhD, Division of Health Care Policy and Research, University of Colorado at Denver HSC, 13611 E Colfax Ave, Aurora, CO 80045, USA. (C. Levy)
| | - Sheryl Zimmerman
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Vincent Mor
- Center of Innovation in Long-term Services and Supports, Providence VA Medical Center, Providence, RI, USA,Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI, USA
| | - David Gifford
- Center for Health Policy Evaluation, American Health Care Association, Washington, DC, USA,Center for Quality and Innovation, School of Public Health, Brown University, Providence, RI, USA
| | | | | | | | | | | | - Arif Nazir
- Signature HealthCARE, Louisville, KY, USA
| | | | | | - Barbara Resnick
- University of Maryland School of Nursing, Baltimore, MD, USA
| | - Philip D. Sloane
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Joseph Ouslander
- Department of Integrated Medical Sciences, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Joseph E. Gaugler
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
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Levy C, Zimmerman S, Mor V, Gifford D, Greenberg SA, Klinger JH, Lieblich C, Linnebur S, McAllister A, Nazir A, Pace D, Stone R, Resnick B, Sloane PD, Ouslander J, Gaugler JE. Pragmatic trials in long-term care: Challenges, opportunities, recommendations. Geriatr Nurs 2022; 44:282-287. [DOI: 10.1016/j.gerinurse.2022.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Tang L, Bai Z, Ji K, Zhu Y, Chen R. Correlations of external social capital in social organizations providing integrated eldercare services with medical care in China. BMC Health Serv Res 2022; 22:101. [PMID: 35078463 PMCID: PMC8787872 DOI: 10.1186/s12913-022-07508-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 01/17/2022] [Indexed: 11/10/2022] Open
Abstract
Background This study aimed to explore the external social capital of social organizations (SOs) providing integrated eldercare services with medical care in Anhui Province, China. Specifically, we studied the current situation and influencing factors of external social capital and its six dimensions. Methods We conducted a cross-sectional study in Anhui Province, China using a multi-stage stratified random sampling method. We employed Pearson correlation analysis and a binary logistic regression model. Results The final analysis included 49 SOs. Most organizations had a high score in norm dimension (81.6%), participation (61.2%), trust (65.3%), common language (65.3%), and social capital (63.3%). After adjusting for all covariate variables, integrated eldercare services with medical care SOs which served more than 65 elderly people were likely to report lower score in social capital. Conclusions By examining the current situation of integrated eldercare services with medical care SOs in China, this study enriched the relevant evidence of integrated medical and nursing SOs and provides a certain reference value for relevant management departments when formulating policies. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07508-2.
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Pragmatic Trials in Long-Term Care: Challenges, Opportunities, Recommendations. J Am Med Dir Assoc 2021; 23:339-344. [PMID: 34919838 DOI: 10.1016/j.jamda.2021.11.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 11/14/2021] [Accepted: 11/18/2021] [Indexed: 11/24/2022]
Abstract
Randomized controlled trials are considered the most rigorous research design in efficacy and effectiveness research; however, such trials present numerous challenges that limit their applicability in real-world settings. As a consequence, pragmatic trials are increasingly viewed as a research design that overcomes some of these barriers with the potential to produce data that are more reproducible. Although pragmatic methodology in long-term care is receiving increasing attention as an approach to improve successful dissemination and implementation, pragmatic trials present complexities of their own. To address these complexities and related issues, experts with experience conducting pragmatic trials, developing nursing home policy, participating in advocacy efforts, and providing clinical care in long-term care settings participated in a virtual consensus conference funded by the National Institute on Aging in Spring 2021. Participants recommended 4 cross-cutting principles key to dissemination and implementation of pragmatic trial interventions: (1) engage stakeholders, (2) ensure diversity and inclusion, (3) assess organizational strain and readiness, and (4) learn from adaptations. Specifically related to implementation, participants provided 2 recommendations: (1) integrate interventions into existing workflows and (2) maintain agility and responsiveness. Finally, participants had 3 recommendations specific to dissemination: (1) package the message for the audience, (2) engage diverse audiences, and (3) apply dissemination and diffusion tools. Participants emphasized that implementation processes must be grounded in the perspectives of the people who will ultimately be responsible for implementing the intervention once it is proven to be effective. In addition, messaging must speak to long-term care staff and all others who have a stake in its outcomes. Although our understanding of dissemination and implementation strategies remains underdeveloped, this article is designed to guide long-term care researchers and community providers who are increasingly aware of the need for pragmatism in disseminating and implementing evidence-based care interventions.
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Hoben M, Ginsburg LR, Norton PG, Doupe MB, Berta WB, Dearing JW, Keefe JM, Estabrooks CA. Sustained effects of the INFORM cluster randomized trial: an observational post-intervention study. Implement Sci 2021; 16:83. [PMID: 34425875 PMCID: PMC8381143 DOI: 10.1186/s13012-021-01151-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 08/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Numerous studies have examined the efficacy and effectiveness of health services interventions. However, much less research is available on the sustainability of study outcomes. The purpose of this study was to assess the lasting benefits of INFORM (Improving Nursing Home Care Through Feedback On perfoRMance data) and associated factors 2.5 years after removal of study supports. INFORM was a complex, theory-based, three-arm, parallel cluster-randomized trial. In 2015-2016, we successfully implemented two theory-based feedback strategies (compared to a simple feedback approach) to increase nursing home (NH) care aides' involvement in formal communications about resident care. METHODS Sustainability analyses included 51 Western Canadian NHs that had been randomly allocated to a simple and two assisted feedback interventions in INFORM. We measured care aide involvement in formal interactions (e.g., resident rounds, family conferences) and other study outcomes at baseline (T1, 09/2014-05/2015), post-intervention (T2, 01/2017-12/2017), and long-term follow-up (T3, 06/2019-03/2020). Using repeated measures, hierarchical mixed models, adjusted for care aide, care unit, and facility variables, we assess sustainability and associated factors: organizational context (leadership, culture, evaluation) and fidelity of the original INFORM intervention. RESULTS We analyzed data from 18 NHs (46 units, 529 care aides) in simple feedback, 19 NHs (60 units, 731 care aides) in basic assisted feedback, and 14 homes (41 units, 537 care aides) in enhanced assisted feedback. T2 (post-intervention) scores remained stable at T3 in the two enhanced feedback arms, indicating sustainability. In the simple feedback group, where scores were had remained lower than in the enhanced groups during the intervention, T3 scores rose to the level of the two enhanced feedback groups. Better culture (β = 0.099, 95% confidence interval [CI] 0.005; 0.192), evaluation (β = 0.273, 95% CI 0.196; 0.351), and fidelity enactment (β = 0.290, 95% CI 0.196; 0.384) increased care aide involvement in formal interactions at T3. CONCLUSIONS Theory-informed feedback provides long-lasting improvement in care aides' involvement in formal communications about resident care. Greater intervention intensity neither implies greater effectiveness nor sustainability. Modifiable context elements and fidelity enactment during the intervention period may facilitate sustained improvement, warranting further study-as does possible post-intervention spread of our intervention to simple feedback homes.
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Affiliation(s)
- Matthias Hoben
- Faculty of Nursing, University of Alberta, 11405 87 Avenue, Edmonton, AB, T6G 1C9, Canada.
| | - Liane R Ginsburg
- School of Health Policy & Management, Faculty of Health, York University, Toronto, Ontario, M3J 1P3, Canada
| | - Peter G Norton
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, T2N 4N1, Canada
| | - Malcolm B Doupe
- Department of Community Health Sciences, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, R3E 3P5, Canada
| | - Whitney B Berta
- Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, M5T 3M6, Canada
| | - James W Dearing
- Department of Communication, College of Communication Arts and Sciences, Michigan State University, East Lansing, MI, 48824, USA
| | - Janice M Keefe
- Department of Family Studies & Gerontology, Mount Saint Vincent University, Halifax, Nova Scotia, B3M 2J6, Canada
| | - Carole A Estabrooks
- Faculty of Nursing, University of Alberta, 11405 87 Avenue, Edmonton, AB, T6G 1C9, Canada
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He K, Li Q, Hou Y, He Y, Yue X. Effect of a refined nursing model based on nursing quality feedback on the postoperative mental state of patients with laryngeal cancer. Am J Transl Res 2021; 13:6525-6533. [PMID: 34306393 PMCID: PMC8290809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 02/24/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To evaluate the impact and effect of a refined nursing model based on nursing quality feedback on the postoperative mental state of patients with laryngeal cancer. METHODS According to the principle of a randomized controlled trial, 102 patients undergoing laryngeal cancer surgery were divided into two groups with 51 patients in each group. The control group received a conventional nursing model, and the research group received a refined nursing model based on nursing quality feedback. Patients' mental status, illness perception, finding of benefits, cancer-related fatigue, changes in quality of life before and 3 months after operation were observed, and postoperative complications and nursing satisfaction were collected. RESULTS The scores of the Self-Rating Anxiety Scale (SAS), the Self-Rating Depression Scale (SDS), the Brief Illness perception Questionnaire (BIPQ), and Revised Piper Fatigue Scale in the research group were lower than those in the control group at 3 months after operation, and the scores of benefit finding, EORTC QLQ-C30, and La Monica-Oberst Patient Satisfaction Scale (LOPSS) were higher than those in the control group (P < 0.05); and the complication rate of the research group (7.84%) was lower than that of the control group (23.53%) (P < 0.05). CONCLUSION For patients undergoing laryngeal cancer surgery, the use of the refined nursing model based on nursing quality feedback can reduce patients' negative emotions, increase the benefits found, reduce their negative perceptions and cancer-related fatigue, improve their quality of life, reduce complications, and enhance the nurse-patient relationship.
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Affiliation(s)
- Kailian He
- Affilited Hospital of North Sichuan Medical CollegeNanchong, Sichua Province, China
| | - Quanqing Li
- Affilited Hospital of North Sichuan Medical CollegeNanchong, Sichua Province, China
| | - Yuqing Hou
- Affilited Hospital of North Sichuan Medical CollegeNanchong, Sichua Province, China
| | - Yulin He
- The Fifth People’s Hospital of NanchongNanchong, Sichuan Province, China
| | - Xiaozhen Yue
- The Fifth People’s Hospital of NanchongNanchong, Sichuan Province, China
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Ginsburg LR, Hoben M, Easterbrook A, Anderson RA, Estabrooks CA, Norton PG. Fidelity is not easy! Challenges and guidelines for assessing fidelity in complex interventions. Trials 2021; 22:372. [PMID: 34051830 PMCID: PMC8164256 DOI: 10.1186/s13063-021-05322-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 05/10/2021] [Indexed: 12/30/2022] Open
Abstract
Background Fidelity in complex behavioural interventions is underexplored and few comprehensive or detailed fidelity studies report on specific procedures for monitoring fidelity. Using Bellg’s popular Treatment Fidelity model, this paper aims to increase understanding of how to practically and comprehensively assess fidelity in complex, group-level, interventions. Approach and lessons learned Drawing on our experience using a mixed methods approach to assess fidelity in the INFORM study (Improving Nursing home care through Feedback On perfoRMance data—INFORM), we report on challenges and adaptations experienced with our fidelity assessment approach and lessons learned. Six fidelity assessment challenges were identified: (1) the need to develop succinct tools to measure fidelity given tools tend to be intervention specific, (2) determining which components of fidelity (delivery, receipt, enactment) to emphasize, (3) unit of analysis considerations in group-level interventions, (4) missing data problems, (5) how to respond to and treat fidelity ‘failures’ and ‘deviations’ and lack of an overall fidelity assessment scheme, and (6) ensuring fidelity assessment doesn’t threaten internal validity. Recommendations and conclusions Six guidelines, primarily applicable to group-level studies of complex interventions, are described to help address conceptual, methodological, and practical challenges with fidelity assessment in pragmatic trials. The current study offers guidance to researchers regarding key practical, methodological, and conceptual challenges associated with assessing fidelity in pragmatic trials. Greater attention to fidelity assessment and publication of fidelity results through detailed studies such as this one is critical for improving the quality of fidelity studies and, ultimately, the utility of published trials. Trial registration ClinicalTrials.gov NCT02695836. Registered on February 24, 2016 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05322-5.
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Affiliation(s)
- Liane R Ginsburg
- School of Health Policy & Management, Faculty of Health, York University, Toronto, Ontario, M3J 1P3, Canada.
| | - Matthias Hoben
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, T6G 1C9, Canada
| | - Adam Easterbrook
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, T6G 1C9, Canada
| | - Ruth A Anderson
- School of Nursing, University of North Carolina, Chapel Hill, North Carolina, 27599-7460, USA
| | - Carole A Estabrooks
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, T6G 1C9, Canada
| | - Peter G Norton
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, T2N 4N1, Canada
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Ginsburg LR, Hoben M, Easterbrook A, Andersen E, Anderson RA, Cranley L, Lanham HJ, Norton PG, Weeks LE, Estabrooks CA. Examining fidelity in the INFORM trial: a complex team-based behavioral intervention. Implement Sci 2020; 15:78. [PMID: 32938481 PMCID: PMC7493316 DOI: 10.1186/s13012-020-01039-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 08/31/2020] [Indexed: 11/11/2022] Open
Abstract
Background Fidelity in complex behavioral interventions is underexplored. This study examines the fidelity of the INFORM trial and explores the relationship between fidelity, study arm, and the trial’s primary outcome—care aide involvement in formal team communications about resident care. Methods A concurrent process evaluation of implementation fidelity was conducted in 33 nursing homes in Western Canada (Alberta and British Columbia). Study participants were from 106 clinical care units clustered in 33 nursing homes randomized to the Basic and Enhanced-Assisted Feedback arms of the INFORM trial. Results Fidelity of the INFORM intervention was moderate to high, with fidelity delivery and receipt higher than fidelity enactment for both study arms. Higher enactment teams experienced a significantly larger improvement in formal team communications between baseline and follow-up than lower enactment teams (F(1, 70) = 4.27, p = .042). Conclusions Overall fidelity enactment was associated with improvements in formal team communications, but the study arm was not. This suggests that the intensity with which an intervention is offered and delivered may be less important than the intensity with which intervention participants enact the core components of an intervention. Greater attention to fidelity assessment and publication of fidelity results through studies such as this one is critical to improving the utility of published trials.
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Affiliation(s)
- Liane R Ginsburg
- School of Health Policy & Management, Faculty of Health, York University, Toronto, Ontario, M3J 1P3, Canada.
| | - Matthias Hoben
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, T6G 1C9, Canada
| | - Adam Easterbrook
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, T6G 1C9, Canada
| | - Elizabeth Andersen
- School of Nursing, Thompson Rivers University, Kamloops, British Columbia, V2C 0C8, Canada
| | - Ruth A Anderson
- School of Nursing, University of North Carolina, Chapel Hill, North Carolina, 27599-7460, USA
| | - Lisa Cranley
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, M5T 1P8, Canada
| | - Holly J Lanham
- University of Texas Health Science Center San Antonio, University of Texas, San Antonio, Texas, 78229, USA
| | - Peter G Norton
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, T2N 4 N1, Canada
| | - Lori E Weeks
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, B3H 4R2, Canada
| | - Carole A Estabrooks
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, T6G 1C9, Canada
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Hoben M, Ginsburg LR, Easterbrook A, Norton PG, Anderson RA, Andersen EA, Boström AM, Cranley LA, Lanham HJ, Weeks LE, Cummings GG, Holroyd-Leduc JM, Squires JE, Wagg AS, Estabrooks CA. Comparing effects of two higher intensity feedback interventions with simple feedback on improving staff communication in nursing homes-the INFORM cluster-randomized controlled trial. Implement Sci 2020; 15:75. [PMID: 32912323 PMCID: PMC7488270 DOI: 10.1186/s13012-020-01038-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 08/31/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Effective communication among interdisciplinary healthcare teams is essential for quality healthcare, especially in nursing homes (NHs). Care aides provide most direct care in NHs, yet are rarely included in formal communications about resident care (e.g., change of shift reports, family conferences). Audit and feedback is a potentially effective improvement intervention. This study compares the effect of simple and two higher intensity levels of feedback based on goal-setting theory on improving formal staff communication in NHs. METHODS This pragmatic three-arm parallel cluster-randomized controlled trial included NHs participating in TREC (translating research in elder care) across the Canadian provinces of Alberta and British Columbia. Facilities with at least one care unit with 10 or more care aide responses on the TREC baseline survey were eligible. At baseline, 4641 care aides and 1693 nurses cared for 8766 residents in 67 eligible NHs. NHs were randomly allocated to a simple (control) group (22 homes, 60 care units) or one of two higher intensity feedback intervention groups (based on goal-setting theory): basic assisted feedback (22 homes, 69 care units) and enhanced assisted feedback 2 (23 homes, 72 care units). Our primary outcome was the amount of formal communication about resident care that involved care aides, measured by the Alberta Context Tool and presented as adjusted mean differences [95% confidence interval] between study arms at 12-month follow-up. RESULTS Baseline and follow-up data were available for 20 homes (57 care units, 751 care aides, 2428 residents) in the control group, 19 homes (61 care units, 836 care aides, 2387 residents) in the basic group, and 14 homes (45 care units, 615 care aides, 1584 residents) in the enhanced group. Compared to simple feedback, care aide involvement in formal communications at follow-up was 0.17 points higher in both the basic ([0.03; 0.32], p = 0.021) and enhanced groups ([0.01; 0.33], p = 0.035). We found no difference in this outcome between the two higher intensity groups. CONCLUSIONS Theoretically informed feedback was superior to simple feedback in improving care aides' involvement in formal communications about resident care. This underlines that prior estimates for efficacy of audit and feedback may be constrained by the type of feedback intervention tested. TRIAL REGISTRATION ClinicalTrials.gov ( NCT02695836 ), registered on March 1, 2016.
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Affiliation(s)
- Matthias Hoben
- Faculty of Nursing, University of Alberta, 11405 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada.
| | - Liane R Ginsburg
- School of Health Policy & Management, Faculty of Health, York University, Toronto, Ontario, M3J 1P3, Canada
| | - Adam Easterbrook
- Faculty of Nursing, University of Alberta, 11405 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada
| | - Peter G Norton
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, T2N 4 N1, Canada
| | - Ruth A Anderson
- School of Nursing, University of North Carolina, Chapel Hill, NC, 27599-7460, USA
| | - Elizabeth A Andersen
- School of Nursing, Thompson Rivers University, Kamloops, British Columbia, V2C 0C8, Canada
| | - Anne-Marie Boström
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, SE-104 35, Stockholm, Sweden
| | - Lisa A Cranley
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, M5T 1P8, Canada
| | - Holly J Lanham
- University of Texas Health Science Center San Antonio, University of Texas, San Antonio, TX, 78229, USA
| | - Lori E Weeks
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, B3H 4R2, Canada
| | - Greta G Cummings
- Faculty of Nursing, University of Alberta, 11405 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada
| | - Jayna M Holroyd-Leduc
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, T2N 4 N1, Canada
| | - Janet E Squires
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, K1H 8 M5, Canada
| | - Adrian S Wagg
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, T6G 2P4, Canada
| | - Carole A Estabrooks
- Faculty of Nursing, University of Alberta, 11405 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada
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Yoon MN, Lu L(L, Ickert C, Estabrooks CA, Hoben M. If we cannot measure it, we cannot improve it: Understanding measurement problems in routine oral/dental assessments in Canadian nursing homes—Part II. Gerodontology 2020; 37:164-176. [DOI: 10.1111/ger.12467] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 01/23/2020] [Accepted: 01/27/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Minn N. Yoon
- School of Dentistry University of Alberta Edmonton Alberta Canada
| | - Lily (Ling) Lu
- Faculty of Nursing University of Alberta Edmonton Alberta Canada
| | - Carla Ickert
- School of Dentistry University of Alberta Edmonton Alberta Canada
| | | | - Matthias Hoben
- Faculty of Nursing University of Alberta Edmonton Alberta Canada
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13
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Berta WB, Wagg A, Cranley L, Doupe MB, Ginsburg L, Hoben M, MacEachern L, Chamberlain S, Clement F, Easterbrook A, Keefe JM, Knopp-Sihota J, Rappon T, Reid C, Song Y, Estabrooks CA. Sustainment, Sustainability, and Spread Study (SSaSSy): protocol for a study of factors that contribute to the sustainment, sustainability, and spread of practice changes introduced through an evidence-based quality-improvement intervention in Canadian nursing homes. Implement Sci 2019; 14:109. [PMID: 31856880 PMCID: PMC6923960 DOI: 10.1186/s13012-019-0959-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 12/02/2019] [Indexed: 11/16/2022] Open
Abstract
Background Implementation scientists and practitioners, alike, recognize the importance of sustaining practice change, however post-implementation studies of interventions are rare. This is a protocol for the Sustainment, Sustainability and Spread Study (SSaSSy). The purpose of this study is to contribute to knowledge on the sustainment (sustained use), sustainability (sustained benefits), and spread of evidence-based practice innovations in health care. Specifically, this is a post-implementation study of an evidence-informed, Care Aide-led, facilitation-based quality-improvement intervention called SCOPE (Safer Care for Older Persons (in long-term care) Environments). SCOPE has been implemented in nursing homes in the Canadian Provinces of Manitoba (MB), Alberta (AB) and British Columbia (BC). Our study has three aims: (i) to determine the role that adaptation/contextualization plays in sustainment, sustainability and spread of the SCOPE intervention; (ii) to study the relative effects on sustainment, sustainability and intra-organizational spread of high-intensity and low-intensity post-implementation “boosters”, and a “no booster” condition, and (iii) to compare the relative costs and impacts of each booster condition. Methods/design SSaSSy is a two-phase mixed methods study. The overarching design is convergent, with qualitative and quantitative data collected over a similar timeframe in each of the two phases, analyzed independently, then merged for analysis and interpretation. Phase 1 is a pilot involving up to 7 units in 7 MB nursing homes in which SCOPE was piloted in 2016 to 2017, in preparation for phase 2. Phase 2 will comprise a quasi-experiment with two treatment groups of low- and high-intensity post-implementation “boosters”, and an untreated control group (no booster), using pretests and post-tests of the dependent variables relating to sustained care and management practices, and resident outcomes. Phase 2 will involve 31 trial sites in BC (17 units) and AB (14 units) nursing homes, where the SCOPE trial concluded in May 2019. Discussion This project stands to advance understanding of the factors that influence the sustainment of practice changes introduced through evidence-informed practice change interventions, and their associated sustainability. Findings will inform our understanding of the nature of the relationship of fidelity and adaptation to sustainment and sustainability, and afford insights into factors that influence the intra-organizational spread of practice changes introduced through complex interventions.
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Affiliation(s)
- Whitney B Berta
- Institute of Health Policy, Management & Evaluation, University of Toronto, Dalla Lana School of Public Health, 155 College Street, Suite 425, Toronto, Ontario, M5T 3M6, Canada.
| | - Adrian Wagg
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, 1-198 Clinical Sciences Building, 11350 - 83 Avenue, Edmonton, Alberta, T6G 2P4, Canada
| | - Lisa Cranley
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street - Suite 130, Toronto, Ontario, M5T 1P8, Canada
| | - Malcolm B Doupe
- Departments of Community Health Sciences and Emergency Medicine, Manitoba Centre for Health Policy, Manitoba Training Program for Health Services Research, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, 408-727 McDermot Avenue, Winnipeg, Manitoba, R3E 3P5, Canada
| | - Liane Ginsburg
- School of Health Policy & Management, Faculty of Health, York University, HNES 413, Toronto, Ontario, Canada
| | - Matthias Hoben
- Faculty of Nursing, University of Alberta, 5-305 Edmonton Clinic Health Academy (ECHA), 11405 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada
| | - Lauren MacEachern
- Institute of Health Policy, Management & Evaluation, University of Toronto, Dalla Lana School of Public Health, 155 College Street, Suite 425, Toronto, Ontario, M5T 3M6, Canada
| | - Stephanie Chamberlain
- Department of Family Medicine, University of Alberta, Alzheimer Society of Canada Postdoctoral Fellow, 6-50 University Terrace, University of Alberta, Edmonton, Alberta, T6G 2T4, Canada
| | - Fiona Clement
- O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, 3rd Floor Training Research and Wellness Building, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada
| | - Adam Easterbrook
- Centre for Health Evaluation and Outcome Sciences (CHÉOS), St. Paul's Hospital, 588-1081 Burrard Street, Vancouver, British Columbia, V6Z 1Y6, Canada
| | - Janice M Keefe
- Nova Scotia Centre on Aging, Department of Family Studies and Gerontology, Mount Saint Vincent University, Halifax, Nova Scotia, BEM 2J6, Canada
| | - Jennifer Knopp-Sihota
- Faculty of Health Disciplines, Athabasca University, 6th Floor, South Campus, 345 - 6 Avenue SE, Calgary, Alberta, T2G 4V1, Canada
| | - Tim Rappon
- Institute of Health Policy, Management & Evaluation, University of Toronto, Dalla Lana School of Public Health, 155 College Street, Suite 425, Toronto, Ontario, M5T 3M6, Canada
| | - Colin Reid
- School of Health and Exercise Sciences, Faculty of Health and Social Development, University of British Columbia - Okanagan, 1147 Research Road, Kelowna, British Columbia, V1V 1V7, Canada
| | - Yuting Song
- Translating Research in Elder Care (TREC), Faculty of Nursing, University of Alberta, 5-007D Edmonton Clinic Health Academy (ECHA), 11405 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada
| | - Carole A Estabrooks
- Faculty of Nursing, University of Alberta, 5-183, Edmonton Clinic Health Academy, 11405 87 Ave, Edmonton, Alberta, T6G 1C9, Canada
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Quality of care to nursing home residents with incontinence. Geriatr Nurs 2018; 40:166-173. [PMID: 30322735 DOI: 10.1016/j.gerinurse.2018.09.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 09/10/2018] [Accepted: 09/13/2018] [Indexed: 11/22/2022]
Abstract
Quality of care for residents with urinary incontinence (UI) living in nursing facilities was analyzed using data collected from 815 facilities for the Nursing Facility Quality Review in Texas. Overall, of the 1,560 residents, 48.4% (n = 755) experienced UI. The risk of developing UI over a ten-year-period in a nursing facility was 6%. Only 54% of residents with UI had a care plan for their incontinence. For those with a UI plan in their chart, 143 (35%) had a person entered UI plan developed based on that resident's voiding pattern and needs. Further, the creation of a UI plan of care by a RN for a person with UI was associated with a higher perceived level of health after controlling for gender, and age. Finally, the more satisfied the resident was with the response to their calls for help with voiding the more satisfied with the nursing facility.
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15
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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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Panza F, Solfrizzi V, Lozupone M, Barulli MR, D'Urso F, Stallone R, Dibello V, Noia A, Di Dio C, Daniele A, Bellomo A, Seripa D, Greco A, Logroscino G. An Old Challenge with New Promises: A Systematic Review on Comprehensive Geriatric Assessment in Long-Term Care Facilities. Rejuvenation Res 2017. [PMID: 28635539 DOI: 10.1089/rej.2017.1964] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Comprehensive geriatric assessment (CGA) is a multidimensional and multidisciplinary diagnostic process focused on determining the clinical profile, pathological risk, residual skills, short- and long-term prognosis, and personalized therapeutic and care plan of the functionally compromised and frail older subjects. Previous evidence suggested that the effectiveness of CGA programs may be influenced by settings where the CGA is performed [i.e., hospital, posthospital discharge/long-term care facilities (LTCFs), or community/home] as well as the specific clinical conditions of older frail individuals. In this scenario, CGA and quality of care in LTCFs have been a challenge for decades. In the present article, we systematically reviewed evidence from the last three decades of clinical research devoted to systematic implementation of CGA programs in LTCFs, that is, nursing homes, care homes, residential homes, and rehabilitation facilities. In the United States, all LTC residents must undergo a CGA on a regular basis on admission to a facility, prompting the development of the Resident Assessment Instrument (RAI) Minimum Data Set, a specific CGA-based assessment tool in this population. In the LTCF setting, the present reviewed evidence suggested that most complex older subjects may benefit from a CGA in terms of improved quality of care and reduced hospitalization events and that CGA must be standardized across healthcare settings to promote greater health system integration and coordination. In the LTCF setting, particularly in nursing homes, other new and promising CGA programs have also been proposed to develop rapid screening CGA-based tools to enhance in the future the ability of primary care physicians to recognize and treat geriatric syndromes in this setting. However, at present, the interRAI suite of instruments represented an integrated health information system that has the potential to provide person-centered information transcending healthcare settings.
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Affiliation(s)
- Francesco Panza
- 1 Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro , Bari, Italy .,2 Unit of Neurodegenerative Disease, Department of Clinical Research in Neurology, University of Bari "Aldo Moro" at "Pia Fondazione Card. G. Panico," Tricase, Lecce, Italy .,3 Geriatric Unit and Gerontology-Geriatrics Research Laboratory, Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza , San Giovanni Rotondo, Foggia, Italy
| | - Vincenzo Solfrizzi
- 4 Geriatric Medicine-Memory Unit and Rare Disease Centre, University of Bari Aldo Moro , Bari, Italy
| | - Madia Lozupone
- 1 Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro , Bari, Italy
| | - Maria Rosaria Barulli
- 2 Unit of Neurodegenerative Disease, Department of Clinical Research in Neurology, University of Bari "Aldo Moro" at "Pia Fondazione Card. G. Panico," Tricase, Lecce, Italy
| | - Francesca D'Urso
- 5 Psychiatric Unit, Department of Clinical and Experimental Medicine, University of Foggia , Foggia, Italy
| | - Roberta Stallone
- 1 Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro , Bari, Italy
| | - Vittorio Dibello
- 6 Interdisciplinary Department of Medicine (DIM), Section of Dentistry, University of Bari Aldo Moro , Bari, Italy
| | - Alessia Noia
- 4 Geriatric Medicine-Memory Unit and Rare Disease Centre, University of Bari Aldo Moro , Bari, Italy
| | - Cristina Di Dio
- 2 Unit of Neurodegenerative Disease, Department of Clinical Research in Neurology, University of Bari "Aldo Moro" at "Pia Fondazione Card. G. Panico," Tricase, Lecce, Italy
| | - Antonio Daniele
- 7 Institute of Neurology, Catholic University of Sacred Heart , Rome, Italy
| | - Antonello Bellomo
- 5 Psychiatric Unit, Department of Clinical and Experimental Medicine, University of Foggia , Foggia, Italy
| | - Davide Seripa
- 3 Geriatric Unit and Gerontology-Geriatrics Research Laboratory, Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza , San Giovanni Rotondo, Foggia, Italy
| | - Antonio Greco
- 3 Geriatric Unit and Gerontology-Geriatrics Research Laboratory, Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza , San Giovanni Rotondo, Foggia, Italy
| | - Giancarlo Logroscino
- 1 Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro , Bari, Italy .,2 Unit of Neurodegenerative Disease, Department of Clinical Research in Neurology, University of Bari "Aldo Moro" at "Pia Fondazione Card. G. Panico," Tricase, Lecce, Italy
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17
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Song Y, Scales K, Anderson RA, Wu B, Corazzini KN. Resident challenges with daily life in Chinese long-term care facilities: A qualitative pilot study. Geriatr Nurs 2017. [PMID: 28633954 DOI: 10.1016/j.gerinurse.2017.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
As traditional family-based care in China declines, the demand for residential care increases. Knowledge of residents' experiences with long-term care (LTC) facilities is essential to improving quality of care. This pilot study aimed to describe residents' experiences in LTC facilities, particularly as it related to physical function. Semi-structured open-ended interviews were conducted in two facilities with residents stratified by three functional levels (n = 5). Directed content analysis was guided by the Adaptive Leadership Framework. A two-cycle coding approach was used with a first-cycle descriptive coding and second-cycle dramaturgical coding. Interviews provided examples of challenges faced by residents in meeting their daily care needs. Five themes emerged: staff care, care from family members, physical environment, other residents in the facility, and personal strategies. Findings demonstrate the significance of organizational context for care quality and reveal foci for future research.
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Affiliation(s)
| | - Kezia Scales
- Duke University School of Nursing, USA; Duke University Center for the Study of Aging and Human Development, USA
| | - Ruth A Anderson
- University of North Carolina at Chapel Hill, School of Nursing, USA
| | - Bei Wu
- New York University Rory Meyers College of Nursing, USA
| | - Kirsten N Corazzini
- Duke University School of Nursing, USA; Duke University Center for the Study of Aging and Human Development, USA
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18
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Hoben M, Clarke A, Huynh KT, Kobagi N, Kent A, Hu H, Pereira RAC, Xiong T, Yu K, Xiang H, Yoon MN. Barriers and facilitators in providing oral care to nursing home residents, from the perspective of care aides: A systematic review and meta-analysis. Int J Nurs Stud 2017; 73:34-51. [PMID: 28531550 DOI: 10.1016/j.ijnurstu.2017.05.003] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 04/30/2017] [Accepted: 05/08/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND Oral health of nursing home residents is generally poor, with severe consequences for residents' general health and quality of life and for the health care system. Care aides in nursing homes provide up to 80% of direct care (including oral care) to residents, but providing oral care is often challenging. Interventions to improve oral care must tailor to identified barriers and facilitators to be effective. This review identifies and synthesizes the evidence on barriers and facilitators care aides perceive in providing oral care to nursing home residents. METHODS We systematically searched the databases MEDLINE, Embase, Evidence Based Reviews-Cochrane Central Register of Controlled Trials, CINAHL, and Web of Science. We also searched by hand the contents of key journals, publications of key authors, and reference lists of all studies included. We included qualitative and quantitative research studies that assess barriers and facilitators, as perceived by care aides, to providing oral care to nursing home residents. We conducted a thematic analysis of barriers and facilitators, extracted prevalence of care aides reporting certain barriers and facilitators from studies reporting quantitative data, and conducted random-effects meta-analyses of prevalence. RESULTS We included 45 references that represent 41 unique studies: 15 cross-sectional studies, 13 qualitative studies, 7 mixed methods studies, 3 one-group pre-post studies, and 3 randomized controlled trials. Methodological quality was generally weak. We identified barriers and facilitators related to residents, their family members, care providers, organization of care services, and social interactions. Pooled estimates (95% confidence intervals) of barriers were: residents resisting care=45% (15%-77%); care providers' lack of knowledge, education or training in providing oral care=24% (7%-47%); general difficulties in providing oral care=26% (19%-33%); lack of time=31% (17%-47%); general dislike of oral care=19% (8%-33%); and lack of staff=22% (13%-31%). CONCLUSIONS We found a lack of robust evidence on barriers and facilitators that care aides perceive in providing oral care to nursing home residents, suggesting a need for robust research studies in this area. Effective strategies to overcome barriers and to increase facilitators in providing oral care are one of the most critical research gaps in the area of improving oral care for nursing home residents. Strategies to prevent or manage residents' responsive behaviors and to improve care aides' oral care knowledge are especially needed.
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Affiliation(s)
- Matthias Hoben
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.
| | - Alix Clarke
- School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
| | - Kha Tu Huynh
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.
| | - Nadia Kobagi
- School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
| | - Angelle Kent
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.
| | - Huimin Hu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
| | | | - Tianyuan Xiong
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
| | - Kexin Yu
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou, Zhejiang, China.
| | - Hongjin Xiang
- Ultrasound Department, West China School of Medicine, Sichuan University, Chengdu, Sichuan, China.
| | - Minn N Yoon
- School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
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