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The care unit in nursing home research: evidence in support of a definition.

https://arctichealth.org/en/permalink/ahliterature135283
Source
BMC Med Res Methodol. 2011;11:46
Publication Type
Article
Date
2011
Author
Carole A Estabrooks
Debra G Morgan
Janet E Squires
Anne-Marie Boström
Susan E Slaughter
Greta G Cummings
Peter G Norton
Author Affiliation
Faculty of Nursing, University of Alberta, Edmonton, Canada. carole.estabrooks@ualberta.ca
Source
BMC Med Res Methodol. 2011;11:46
Date
2011
Language
English
Publication Type
Article
Keywords
Administrative Personnel - psychology
Aged
Alberta
Data Collection - methods
Evidence-Based Nursing
Feasibility Studies
Health Services for the Aged
Humans
Long-Term Care - methods
Manitoba
Models, organizational
Nurses' Aides - psychology
Nursing Care - classification - manpower
Nursing Homes - classification - statistics & numerical data
Nursing Methodology Research
Qualitative Research
Questionnaires
Research Personnel - psychology
Saskatchewan
Terminology as Topic
Abstract
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.
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), ?², and ?²), and to assess the value of using the definition of unit in explanatory models, we performed multi-level modeling.
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.
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.
Notes
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PubMed ID
21492456 View in PubMed
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Contributions of environment, comorbidity, and stage of dementia to the onset of walking and eating disability in long-term care residents.

https://arctichealth.org/en/permalink/ahliterature120644
Source
J Am Geriatr Soc. 2012 Sep;60(9):1624-31
Publication Type
Article
Date
Sep-2012
Author
Susan E Slaughter
Leslie A Hayduk
Author Affiliation
University of Alberta, Edmonton, Alberta, Canada. susan.slaughter@ualberta.ca
Source
J Am Geriatr Soc. 2012 Sep;60(9):1624-31
Date
Sep-2012
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Aged
Aged, 80 and over
Alberta
Comorbidity
Dementia - drug therapy - physiopathology
Disability Evaluation
Eating Disorders - physiopathology
Environment
Humans
Likelihood Functions
Male
Nursing Homes
Prospective Studies
Psychotropic Drugs - administration & dosage
Risk factors
Walking - physiology
Abstract
To estimate the relative effects of environment, comorbidities, stage of dementia and other variables on disability onset.
A 1-year prospective cohort study was conducted in which the walking and eating abilities of long-term care residents were observed fortnightly. Structural equation modeling was used to assess the contributions of individual and environmental factors to the onset of disability.
Fifteen nursing homes in western Canada.
One hundred twenty residents with middle-stage Alzheimer disease or related dementia.
Environmental quality was assessed using the Professional Environmental Assessment Protocol, comorbidity using the Charlson Comorbidity Index, and stage of dementia using the Global Deterioration Scale.
More-advanced baseline dementia had a direct effect on onset of walking and eating disability (standardized maximum likelihood estimate (SMLE) = 0.24, P = .006). Resident environment (SMLE = -0.25, P = .007) and comorbidities (SMLE = 0.32, P
PubMed ID
22985138 View in PubMed
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Functional outcomes of nursing home residents in relation to features of the environment: validity of the Professional Environmental Assessment Protocol.

https://arctichealth.org/en/permalink/ahliterature127078
Source
J Am Med Dir Assoc. 2012 Jun;13(5):487.e1-7
Publication Type
Article
Date
Jun-2012
Author
Susan E Slaughter
Debra G Morgan
Author Affiliation
Faculty of Nursing, Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alberta, Canada. susan.slaughter@ualberta.ca
Source
J Am Med Dir Assoc. 2012 Jun;13(5):487.e1-7
Date
Jun-2012
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Canada
Cohort Studies
Dementia
Eating
Environment Design
Humans
Interviews as Topic
Nursing Homes
Proportional Hazards Models
Prospective Studies
Psychometrics
Walking
Abstract
The aim of this article was to examine associations between specific dimensions of nursing home environments and the functional ability (walking and eating) of residents with dementia, and to contribute to the ongoing psychometric development of the Professional Environmental Assessment Protocol (PEAP).
One-year prospective cohort study.
Fifteen nursing homes in a western Canadian province.
Convenience sample of 120 nursing home residents with middle-stage dementia.
Every 2 weeks we observed residents' abilities to walk to the dining room and to feed themselves. At the end of a year of observation and immediately following a brief interview with the unit managers, we used the PEAP to measure the extent to which 9 specific dimensions of nursing home environments support the ability of residents with dementia to walk and to eat. Cox proportional hazards models were used to evaluate the effect of specific environmental features on residents' walking and eating disability.
"Support of functional ability" was associated with a reduced hazard of both walking and eating disability. The environmental dimensions of "maximizing awareness and orientation" and better "quality of stimulation" were associated specifically with reduced hazard of walking disability, whereas the dimensions of the nursing home environment specifically associated with a reduced hazard of eating disability included improved "safety and security," "opportunities for personal control," and "regulation of stimulation." The Cox proportional hazards models using the 13-point PEAP scale were not significantly different from nested models using the 5-point PEAP scale, indicating that the 2 scales did not differ in their ability to discriminate between more and less supportive environments for residents with dementia.
Specific dimensions of the nursing home environment reduced the hazard of walking disability, whereas others reduced the hazard of eating disability. Modifying specific features of nursing home environments may reduce disability in nursing home residents with dementia. The 5-point PEAP scale is able to discriminate between nursing home environments as well as the 13-point scale.
PubMed ID
22326948 View in PubMed
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Incidence and predictors of excess disability in walking among nursing home residents with middle-stage dementia: a prospective cohort study.

https://arctichealth.org/en/permalink/ahliterature145097
Source
Int Psychogeriatr. 2011 Feb;23(1):54-64
Publication Type
Article
Date
Feb-2011
Author
Susan E Slaughter
Misha Eliasziw
Debra Morgan
Neil Drummond
Author Affiliation
Faculty of Nursing, University of Alberta, Edmonton, Canada. susan.slaughter@ualberta.ca
Source
Int Psychogeriatr. 2011 Feb;23(1):54-64
Date
Feb-2011
Language
English
Publication Type
Article
Keywords
Age Factors
Aged
Aged, 80 and over
Antidepressive Agents - adverse effects
Canada - epidemiology
Cognition
Dementia - complications - nursing - physiopathology
Depression - drug therapy - prevention & control
Disability Evaluation
Female
Homes for the Aged
Humans
Incidence
Male
Mobility Limitation
Nursing Homes
Prospective Studies
Risk factors
Walking
Abstract
Inability to walk compromises the well-being of the growing number of nursing home residents with dementia. The purpose of this study was to estimate the incidence and identify predictors of walking disability that may be remediable.
A cohort was followed fortnightly for a year in 15 nursing homes in western Canada. The study participants comprised 120 ambulatory residents with middle-stage Alzheimer's, vascular or mixed dementia. Standardized measures of potential predictors of disability included the Charlson Comorbidity Index, Global Deterioration Scale, and Professional Environment Assessment Protocol. Walking disability was defined as using a wheelchair to go to meals in the dining room.
Incidence of walking disability was 40.8% (95% confidence interval (CI): 32.7-50.2). Approximately half of this (27.0%; 95% CI: 19.7-36.5) was excess disability. Residents with more advanced dementia and living in a less supportive nursing home environment experienced an increased hazard of walking disability (Hazard Ratio (HR): 2.1; 95% CI: 1.2-3.8 and HR: 2.4; 95% CI: 1.3-4.4 respectively). After adjusting for age, comorbidity and stage of dementia, predictors of excess disability in walking included using antidepressants (HR: 2.2; 95% CI: 1.02-4.6), and not using cognitive enhancers (HR: 2.6; 95% CI: 1.03-6.4).
Over half of walking disability in nursing home residents with middle-stage dementia may be modifiable. Creating supportive environments, ensuring access to cognitive enhancer drugs, and preventing and treating depression and the adverse effects of antidepressants, may help to reduce walking disability and excess disability.
PubMed ID
20199700 View in PubMed
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Optimizing the mobility of residents with dementia: a pilot study promoting healthcare aide uptake of a simple mobility innovation in diverse nursing home settings.

https://arctichealth.org/en/permalink/ahliterature106618
Source
BMC Geriatr. 2013;13:110
Publication Type
Article
Date
2013
Author
Susan E Slaughter
Carole A Estabrooks
Author Affiliation
Edmonton Clinic Health Academy, Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada. susan.slaughter@ualberta.ca.
Source
BMC Geriatr. 2013;13:110
Date
2013
Language
English
Publication Type
Article
Keywords
Activities of Daily Living - psychology
Adult
Aged
Aged, 80 and over
Alberta - epidemiology
Dementia - psychology - rehabilitation
Female
Homes for the Aged
Humans
Male
Middle Aged
Mobility Limitation
Nurses' Aides
Nursing Homes
Pilot Projects
Professional Role - psychology
Abstract
Almost 90 percent of nursing home residents have some type of mobility limitation. Many spend most of their waking hours lying in bed or sitting. Such inactivity can negatively affect residents' health and general well-being. This pilot study aimed to assess (1) the effect of the sit-to-stand activity on mobility outcomes of nursing home residents, (2) the effect of an audit-and-feedback intervention on uptake of the sit-to-stand activity by healthcare aides, and (3) the contextual factors influencing uptake of the sit-to-stand activity by healthcare aides.
This quasi-experimental pilot study was conducted in two nursing homes in western Canada. Twenty-six residents with dementia completed the sit-to-stand activity with 56 healthcare aides during daily care; separately, 71 healthcare aides completed a research use and context survey. Preliminary mobility feedback was presented to healthcare aides in one site. Resident mobility was measured using the 30-second sit-to-stand test. Healthcare aide uptake of the activity was measured using documentation flowsheets and a survey-based measure. Context was measured using the Alberta Context Tool. Mobility and uptake outcomes were analyzed over time and by site with analysis of covariance. Spearman and Pearson correlations were used to correlate context data with research use.
Residents who more frequently completed the sit-to-stand activity were more likely to maintain or improve mobility compared with those who completed it less frequently (F=4.46; p=0.046, after adjustment for age). Uptake for one site was significantly different from the other (t-score=2.67; p=0.01, after adjustment for resident covariates). The audit-and-feedback intervention was associated with increased uptake of the activity from pre-intervention to post-intervention (t-score=-2.48; p=0.02). More context domains correlated significantly with aides' use of conceptual research and information sources in one site than the other.
The sit-to-stand activity is a promising means to maintain or improve transfer ability of nursing home residents with dementia. In the nursing home with initially weak uptake, strengthened uptake followed an audit-and-feedback intervention. Activity participation was higher in the site with stronger correlations between context and measured research use. Results are sufficiently promising to warrant proceeding with a full clinical trial.
Notes
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PubMed ID
24138586 View in PubMed
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Sustaining Transfers through Affordable Research Translation (START): study protocol to assess knowledge translation interventions in continuing care settings.

https://arctichealth.org/en/permalink/ahliterature106495
Source
Trials. 2013;14:355
Publication Type
Article
Date
2013
Author
Susan E Slaughter
Carole A Estabrooks
C Allyson Jones
Adrian S Wagg
Misha Eliasziw
Author Affiliation
Faculty of Nursing, Edmonton Clinic Health Academy, University of Alberta, Edmonton, AB T6G 1C9, Canada. susan.slaughter@ualberta.ca.
Source
Trials. 2013;14:355
Date
2013
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Aged
Alberta
Allied Health Personnel - psychology
Attitude of Health Personnel
Continuity of Patient Care
Evidence-Based Medicine
Health Knowledge, Attitudes, Practice
Health Services Research
Homes for the Aged
Humans
Long-Term Care
Motor Activity
Perception
Reminder Systems
Research Design
Time Factors
Translational Medical Research
Abstract
Bridging the research-practice gap is an important research focus in continuing care facilities, because the population of older adults (aged 65 years and over) requiring continuing care services is the fastest growing demographic among countries in the Organisation for Economic Co-operation and Development (OECD). Unlicensed practitioners, known as health care aides, provide the majority of care for residents living in continuing care facilities. However, little research examines how to sustain health care aide behavior change following initial adoption of current research evidence.
We will conduct a phase III, multicentre, cluster randomized controlled trial (RCT) using a stratified 2 × 2 additive factorial design, including an embedded process evaluation, in 24 supportive living facilities within the health zone of Edmonton, AB, Canada. We will determine which combination of frequency and intensity of reminders most effectively sustains the completion of the sit-to-stand activity by health care aides with residents. Frequency refers to how often a reminder is implemented; intensity refers to whether a reminder is social or paper-based. We will compare monthly reminders with reminders implemented every 3 months, and we will compare low intensity, paper-based reminders and high intensity reminders provided by a health care aide peer.Using interviews, questionnaires, and observations, Sustaining Transfers through Affordable Research Translation (START) will evaluate the processes that inhibit or promote the mobility innovation's sustainability among health care aides in daily practice. We will examine how the reminders are implemented and perceived by health care aides and licensed practical nurses, as well as how health care aides providing peer reminders are identified, received by their peers, and supported by their supervisors.
START will connect up-to-date innovation research with the practice of health care aides providing direct care to a growing population of older Albertans. The project's reach extends to both supportive living and long-term care settings. Furthermore, START has the potential to introduce and sustain a broad range of innovations in various care areas, such as dementia care, wound care, and pain management - domains where the uptake and sustainability of innovations also encounter significant challenges. By identifying the optimal frequency and intensity of knowledge translation interventions, we hope to enable continuing care organizations to efficiently integrate care innovations into the day-to-day care of residents.
ClinicalTrials.gov, NCT01746459.
PubMed ID
24160483 View in PubMed
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