The purposes of this study were to describe and compare the emotional-social intelligence (ESI) of students in nursing, physical therapy and health science programs, and to determine the relationship between ESI and each of leadership,... more
The purposes of this study were to describe and compare the emotional-social intelligence (ESI) of students in nursing, physical therapy and health science programs, and to determine the relationship between ESI and each of leadership, caring and moral judgment. Subjects were 154 students from nursing, physical therapy and bachelor of health science (BHSc) programs in a Canadian university and a physical therapy program in an American college. Data were collected by means of self-report measures of ESI, leadership, caring, and moral judgment. The measures included the Bar-On Emotional Quotient Inventory Short (EQ-i:S), the Self-Assessment Leadership Inventory (SALI), the Caring Ability Inventory (CAI), the Caring Dimensions Inventory - 35 (CDI-35) [for nursing only] and the Defining Issues Test (DIT-2) [for physical therapy and BHSc only]. One-way analyses of variance (ANOVA ) revealed no differences between groups for the EQ-i:S, SALI, or DIT-2. There were significant differences f...
Research Interests: Psychology, Nursing, Emotional intelligence, Leadership, Courage, and 14 morePhysical Therapy, Social Intelligence, Moral Judgment, Health Science, Defining issues Test, Clinical Sciences, Caring, Bachelor, Public health systems and services research, Correlation coefficient, Health Science Education, Emotional Intelligence and Social Marketing, Moral Courage, and Medicine and Health Sciences
Youth with medical complexity (YMC) are a small subset of youth who have a combination of severe functional limitations and extensive health service use. As these youth become adults, they are required to transition to adult health,... more
Youth with medical complexity (YMC) are a small subset of youth who have a combination of severe functional limitations and extensive health service use. As these youth become adults, they are required to transition to adult health, education, and social services. The transition to adult services is especially difficult for YMC due to the sheer number of services that they access. Service disruptions can have profound impacts on YMC and their families, potentially leading to an unsuccessful transition to adulthood. This meta-ethnography aims to synthesize qualitative literature exploring how YMC and their families experience the transition to adulthood and transfer to adult services. An in-depth understanding of youth and family experiences can inform interventions and policies to optimize supports and services to address the needs of this population at risk for unsuccessful transition to adulthood. Using Noblit and Hare’s approach to meta-ethnography, a comprehensive search of Medl...
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Long-term care (LTC) staffing practices are poorly understood as is their influence on quality of care. We examined the relationship between staffing characteristics and residents' quality of care indicators at the unit level in LTC... more
Long-term care (LTC) staffing practices are poorly understood as is their influence on quality of care. We examined the relationship between staffing characteristics and residents' quality of care indicators at the unit level in LTC homes. This cross-sectional study collected data from administrative records and resident assessments from July 2014 to June 2015 at 11 LTC homes in Ontario, Canada comprising of 55 units and 32 residents in each unit. The sample included 69 registered nurses, 183 licensed/registered practical nurses, 858 nursing assistants, and 2173 residents. Practice sensitive, risk-adjusted quality indicators were described individually, then combined to create a quality of care composite ranking per unit. A multilevel regression model was used to estimate the association between staffing characteristics and quality of care composite ranking scores. Nursing assistants provided the majority of direct care hours in LTC homes (76.5%). The delivery of nursing assista...
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Person-centered care (PCC) is fundamental for providing high-quality care in long-term care homes. This study aimed to evaluate the psychometric properties of an 11-item Team Member Perspectives of Person-Centered Care (TM-PCC) survey,... more
Person-centered care (PCC) is fundamental for providing high-quality care in long-term care homes. This study aimed to evaluate the psychometric properties of an 11-item Team Member Perspectives of Person-Centered Care (TM-PCC) survey, adapted from White and colleagues (2008). In a cross-sectional study, 461 staff from four long-term care homes in Ontario, Canada, completed the TM-PCC. Construct validity and internal consistency of the TM-PCC were examined with a principal component analysis and Cronbach’s alpha coefficient. Findings revealed a three-component structure with factor 1, Supporting Social Relationships; factor 2, Familiarity with Residents’ Preferences; and factor 3, Meaningful Resident⁻Staff Relationships. The TM-PCC, as compared to the original survey, presented with less components (i.e., did not address Resident Autonomy, Personhood, Comfort, Work with Residents, Personal Environment, and Management Structure), yet included one new component (Meaningful...
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The goal of this study was to examine current rates of resident deaths, Emergency Department (ED) use within the last year of life, and hospital deaths for long-term care (LTC) residents. Using a mixed-methods approach, we compared these... more
The goal of this study was to examine current rates of resident deaths, Emergency Department (ED) use within the last year of life, and hospital deaths for long-term care (LTC) residents. Using a mixed-methods approach, we compared these rates across four LTC homes in Ontario, Canada, and explored potential explanations of variations across homes to stimulate staff reflections and improve performance based on a quality improvement approach. Chart audits revealed that 59% of residents across sites visited EDs during the last month of life and 26% of resident deaths occurred in hospital. Staff expressed surprise at the amount of hospital use during end of life (EOL). Reflections suggested that clinical expertise, comfort with EOL communication, clinical resources (i.e., equipment), and family availability for EOL decision making could all affect nondesirable hospital transfers at EOL. Staff appeared motivated to address these areas of practice following this reflective process.
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Globally, as older adults are living longer and with more chronic conditions, there is a need to support their ability to age optimally in their homes and communities. Community-based interprofessional teams working closely with these... more
Globally, as older adults are living longer and with more chronic conditions, there is a need to support their ability to age optimally in their homes and communities. Community-based interprofessional teams working closely with these older adults, their families, and informal caregivers will be instrumental in achieving this goal. Interprofessional education (IPE) is the means through which these teams can develop expertise in collaboratively working together with older adults. However, most IPE occurs in academic settings, and acute and long-term care sectors and little is known about IPE in the context of home and community care of older adults. The purpose of this study was to describe perceptions of academic and practice experts related to the current state of IPE in home and community care of older adults and the changes that are necessary to meet the future needs of practitioners and older adults. Using a qualitative descriptive design, interviews were conducted with 32 national and international key informants representing practitioners, educators, researchers, and health system decision-makers in the field of IPE. Thematic analysis of the data identified six themes: (a) client and family-centred care at the core of IPE, (b) the community as a unique learning setting across the learning continuum; (c) an aging-relevant IPE curriculum; (d) faculty commitment and resources for IPE; (e) technological innovation to support IPE; and (f) comprehensive IPE programme evaluation and research. These findings are explored through the lens of an interprofessional learning continuum model. The article concludes with a discussion of the study implications for IPE practice and research specifically in the care of community-living older adults.
Research Interests: Program Evaluation, Geriatrics, Perception, Science Policy, Collaboration, and 15 moreAging, Community Health, Interprofessional Education, Medicine, Curriculum, Independent Living, Humans, Qualitative Study, InterProfessional Education in Health Care, Patient Care Team, Public health systems and services research, Patient Centered Care, Cooperative Behavior, Health Personnel, and interprofessional relations
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To characterize comorbid chronic conditions, describe health services use, and estimate health care costs among community-dwelling older adults with prior stroke. This is a retrospective cohort study using administrative data from... more
To characterize comorbid chronic conditions, describe health services use, and estimate health care costs among community-dwelling older adults with prior stroke. This is a retrospective cohort study using administrative data from Ontario, Canada. We identified all community-dwelling individuals aged 66 and over on April 1, 2008 (baseline), who had experienced a stroke at least 6 months prior. We estimated the prevalence of 14 comorbid conditions at baseline; we captured all physician visits, emergency department visits, hospital admissions, home care contacts, and associated costs over 5 years stratifying by number of comorbid conditions. Where possible, we distinguished between health services use for stroke- and non-stroke-related reasons. A total of 29,673 individuals met our criteria. Only 1% had no comorbid conditions, while 74.9% had 3 or more. The most common conditions were hypertension (89.8%) and arthritis (65.8%); 5 other conditions had a prevalence of 20% or more (ische...
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The majority of care for older adults with multiple chronic conditions (MCC) is provided by family (including friends) caregivers. Although caregivers have reported positive benefits to caregiving they also experience decreases in their... more
The majority of care for older adults with multiple chronic conditions (MCC) is provided by family (including friends) caregivers. Although caregivers have reported positive benefits to caregiving they also experience decreases in their physical and mental health. As there is a critical need for supportive interventions for this population, it is important to know what influences the health of family caregivers of persons with MCC. This research examined relationships among the changes from baseline to 6 months in health related quality of life (SF12v2) of family caregivers caring for older adults with multiple chronic conditions and the following factors: a) demographic variables, b) gender identity [Bem Sex Role Inventory (BSRI)] c) changes in general self-efficacy [General Self Efficacy Scale (GSES) (baseline to 6 months) and d)) changes in caregiver burden [Zarit Burden Inventory (ZBI)] baseline to 6 months. Specific hypothesis were based on a conceptual framework generated from...
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Worldwide, the literature reports that many residents in long-term care (LTC) homes are sedentary. In Canada, personal support workers (PSWs) provide most of the direct care in LTC homes and could play a key role in promoting activity for... more
Worldwide, the literature reports that many residents in long-term care (LTC) homes are sedentary. In Canada, personal support workers (PSWs) provide most of the direct care in LTC homes and could play a key role in promoting activity for residents. The purpose of this institutional ethnographic study was to uncover the social organization of LTC work and to discover how this organization influenced the physical activity of residents. Data were collected in two LTC homes in Ontario, Canada through participant observations with PSWs and interviews with people within and external to the homes. Findings explicate the links between meals, lifts and transfers, and the LTC standards to reveal that physical activity is considered an add-on program in the purview of physiotherapists. Some of the LTC standards which are intended to product good outcomes for residents actually disrupt the work of PSWs making it difficult for them to respond to the physical activity needs of residents. This descriptive ethnographic account is an important first step in trying to find a solution to optimize real activities of daily living into life in LTC.
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Immigrants represent 28%of the Canadian population over 65,and older immigrants–more of them are women –now comprise the majority of the aging population in Canada’s large metropolitan cities. Despite ample research about abuse of older... more
Immigrants represent 28%of the Canadian population over 65,and older immigrants–more of them are women –now comprise the majority of the aging population in Canada’s large metropolitan cities. Despite ample research about abuse of older adults in general, few Canadian studies have focused on abuse of older immigrant women. This paper reports policy-relevant findings from a project that aimed to develop a shared program of research to prevent abuse of older immigrant women in Canada. The project involved a review of the literature on elder abuse and immigrant women, local meetings with key stakeholders in seven provinces, a public event in Toronto, and a two-day interdisciplinary symposium with provincial stakeholders. Two significant themes emerged from these activities: the value of bringing together professionals representing multiple disciplines and service sectors as well as older immigrant women and the need for changes in social policies to reduce older immigrant women’s vulne...
Research Interests: Sociology and Immigration
Community support services (CSSs) enable persons coping with health or social problems to maintain the highest possible level of social functioning and quality of life. Access to these services is challenging because of the multiplicity... more
Community support services (CSSs) enable persons coping with health or social problems to maintain the highest possible level of social functioning and quality of life. Access to these services is challenging because of the multiplicity of small agencies providing these services and the lack of a central access point. A review of the literature revealed that most service awareness studies are marred by acquiescence bias. To address this issue, service providers developed a series of 12 vignettes to describe common situations faced by older adults for which CSSs might be appropriate. In a telephone interview, 1152 older adults were presented with a series of vignettes and asked what they would do in that situation. They were also asked about their most important sources of information about CSSs. Findings show awareness of CSSs varied by the situation described and ranged from a low of 1% to 41%. The most important sources of information about CSSs included informational and referral...
Research Interests: Nursing, Perception, Forecasting, Qualitative Research, Medicine, and 15 moreCurriculum, Canada, Humans, Geriatric Nursing, Female, Male, Nursing Education and Research in Nursing, Middle Aged, Questionnaires, Adult, Gerontological Nursing, Perspectives, Clinical Competence, Cross Sectional Studies, and Nursing staff
The purpose of this systematic overview was to summarize evidence about the effectiveness of adolescent suicide prevention curricula programs. A comprehensive search of published and unpublished literature resulted in retrieval of 11... more
The purpose of this systematic overview was to summarize evidence about the effectiveness of adolescent suicide prevention curricula programs. A comprehensive search of published and unpublished literature resulted in retrieval of 11 relevant studies. The findings, of this overview indicate that there is currently insufficient evidence to support curriculum-based suicide prevention programs. The evidence suggests that there may be both beneficial and harmful effects of the programs on students. In most studies, knowledge related to suicide improved as a result of the programs. However, studies found both beneficial and harmful effects on attitudes related to suicide. One study found in increase in hopelessness and maladaptive coping for males following the intervention. The literature suggests that more broadly based comprehensive school health programs should be evaluated for their effectiveness in addressing the determinants of adolescent risk behaviour.
Research Interests: Program Evaluation, Research Design, Educational Measurement, Health Education, Suicide, and 13 moreSuicide prevention, Adolescent, Medicine, Curriculum, Canadian, Humans, Female, Male, School health services, Public health systems and services research, Curriculum and Pedagogy, Guidance and Counseling Intervention Programs, and Canadian Public Health Policy
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Research Interests: Nursing, Communication, Qualitative Research, Adolescent, Medicine, and 15 moreCritical Care, Humans, Child, Needs Assessment, Staffing, Focus Group, Infant, Ontario, Patient Care Team, Front Line Managers, Clinical Competence, Critically Ill Patients, Critical Illness, Child preschool, and Interviews as topic
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Background. Persons living with dementia in the long-term care home (LTCH) setting have a number of unique needs, including those related to planning for their futures. It is therefore important to understand the advance care planning... more
Background. Persons living with dementia in the long-term care home (LTCH) setting have a number of unique needs, including those related to planning for their futures. It is therefore important to understand the advance care planning (ACP) programs that have been developed and their impact in order for LTCH settings to select a program that best suits residents’ needs.Methods. Four electronic databases were searched from 1990 to 2013, for studies that evaluated the impact of advance care planning programs implemented in the LTCH setting. Studies were critically reviewed according to rigour, impact, and the consideration of the values of residents with dementia and their family members according to the Dementia Policy Lens Toolkit.Results and Conclusion. Six ACP programs were included in the review, five of which could be considered more “dementia friendly.” The programs indicated a variety of positive impacts in the planning and provision of end-of-life care for residents and their...
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Poor or inconsistent research utilization into clinical practice is a recurrent theme across study contexts, rendering leaders disillusioned with how best to foster the uptake of research into nursing practice. This makes it imperative to... more
Poor or inconsistent research utilization into clinical practice is a recurrent theme across study contexts, rendering leaders disillusioned with how best to foster the uptake of research into nursing practice. This makes it imperative to look to new approaches. Research utilization involves a learning process engaging attitudes, beliefs, and behaviors; yet, this is often overlooked in approaches and models used to facilitate research use. This oversight may offer some explanation to the limited progress in research utilization to date. Transformation Theory offers an explanatory theory and specific strategies (critical reflection and critical discourse) to explore attitudes, beliefs, and behaviors so that they are understood, validated, and can better guide actions. The purpose of this article was to explore what Transformation Theory can contribute to research utilization initiatives in nursing practice. Transformation Theory and transformative learning strategies are discussed and critically analyzed in consideration of their potential roles in fostering research utilization in clinical nursing practice. (1) Research utilization is a learning process that involves knowledge, skills, feelings, attitudes, and beliefs. (2) Transformative learning strategies of critical reflection and discourse can facilitate insight into experiences, finding shared meanings among groups of people, and understanding/validating beliefs, attitudes, and feelings so they can more consciously guide future actions. This dimension is frequently neglected in research utilization efforts. (3) In combination with research utilization theories, Transformation Theory may be a missing link to make research utilization initiatives more effective in rendering and sustaining nursing practice change, thus enhancing client care and well-being. (4) Research and further consideration are both warranted and needed.
Research Interests: Nursing, Communication, Transformative Learning, Organizational Culture, Leadership, and 14 moreEducational Psychology, Evidence Based Practice, Social Support, Medicine, Learning, Knowledge, Nursing Research, Thinking, Humans, Diffusion of Innovation, Feeling, Educational Models, Psychological Theory, and Clinical Competence
There is a current push to use best practice guidelines (BPGs) in health care to enhance client care and outcomes. Even though intensive resources have been invested internationally to develop BPGs, a gap in knowledge exists about how to... more
There is a current push to use best practice guidelines (BPGs) in health care to enhance client care and outcomes. Even though intensive resources have been invested internationally to develop BPGs, a gap in knowledge exists about how to consistently and efficiently move them into practice. Constructivist grounded theory was used to explore the complex processes of a breastfeeding BPG implementation and uptake in three acute care hospitals. Interviews (n = 120) with 112 participants representing clients, nurses, lactation consultants, midwives, physicians, managers, administrators, and nurse educators as well as document and field note analysis informed this study. Data were analyzed using constant comparison and coding steps outlined by Charmaz: initial coding, selective (focused) coding, then theoretical coding. Triangulation of data types and sources were used as well as theoretical sampling. Data were collected from 2009 to 2010. Two sites showed BPG uptake while one did not. Factors present in the uptake sites included, ongoing passionate frontline leaders, the use of multifaceted strategies, and processes that occurred at organizational, leadership, individual and social levels. Particularly noteworthy was the transformation of individual nurses to believing in and using the BPG. Impacts occurred at client, nurse, unit, inter-professional, organizational and system levels. A conceptual framework: Supporting the Uptake of Nursing Guidelines, was developed that reveals essential processes used to facilitate BPG uptake into nursing practice and a process of nurse transformation to believing in and using the BPG.
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for quality improvement. Public deliberation has been proposed as a way to integrate lay and expert knowledge, but it has not been studied in the context of quality indicator (QI) prioritization. LEARNING OBJECTIVES (TRAINING GOALS): 1.... more
for quality improvement. Public deliberation has been proposed as a way to integrate lay and expert knowledge, but it has not been studied in the context of quality indicator (QI) prioritization. LEARNING OBJECTIVES (TRAINING GOALS): 1. Understand how deliberative methods can be used to prioritize quality indicators for planning and evaluating local quality improvement activities. 2. Discuss preliminary results of the impact of public involvement on quality indicator prioritization. METHODS: We are conducting a cluster randomized controlled trial within a regional health authority in Canada. We pilot-tested our intervention and developed a “menu” of 36 quality indicators for chronic disease prevention and management from a systematic review of existing indicators. Public representatives (chronic disease patients and healthy adults), health professionals, and managers will be recruited by snowballing technique from six participating communities. A twostep intervention will be conducted between April and June 2010: 1) public expectations for chronic care delivery will be discussed in a public representative meeting; 2) a deliberative meeting will be held to prioritize items from our menu of quality indicators. In intervention sites, public representatives, professionals, and managers will be involved in step #2 deliberative meetings, while control sites will only include health professionals and managers. RESULTS: Our pilot test demonstrated the feasibility of the intervention. We will report preliminary results of the impact of public involvement on QI prioritization, as well as observations from our process evaluation. DISCUSSION (CONCLUSION): Deliberative methods can be used to prioritize indicators for quality improvement. TARGET AUDIENCE(S): 1. Clinical researcher 2. Guideline developer 3. Guideline implementer 4. Developer of guideline-based products 5. Quality improvement manager/facilitator 6. Health care policy analyst/policymaker 7. Health insurance payers and purchasers 8. Medical providers and executives 9. Allied health professionals 10. Consumers’ and patients’ representatives 11. Nurses
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Research Interests: Nursing, Long Term Care, Quality of life, Quality Improvement, Health Services Research, and 15 moreMedicine, Quality of Care, Policy making, Humans, Demographics, Infectious Disease, Nursing Homes, Feedback, Ontario, Clinical Sciences, Home Range, Public health systems and services research, Information Need, Decision Maker, and Cooperative Behavior
The research question explored was what are the processes and strategies used by frontline leaders to support the uptake of the Breastfeeding Best Practice Guideline by nurses in maternity care practice settings? Best Practice Guidelines... more
The research question explored was what are the processes and strategies used by frontline leaders to support the uptake of the Breastfeeding Best Practice Guideline by nurses in maternity care practice settings? Best Practice Guidelines have been shown to enhance client care and outcomes. Leadership is known to have a key role in moving Best Practice Guidelines into nursing practice yet how this happens is poorly understood. This insight is needed to consistently and efficiently facilitate Best Practice Guideline uptake into clinical practice. Constructivist grounded theory was used to explore the social processes and strategies involved in facilitating Best Practice Guideline uptake. Purposive, criterion-based, theoretical and negative case sampling were used recruiting 58 health professionals and 54 clients. Triangulation and constant comparison of data sources and types (interviews, documents and field notes) were used for analysis and rigour. Passionate, persistent, respected frontline leaders using tailored, multifaceted strategies aimed at three groups of nurse adopters effectively support the uptake of the Breastfeeding Best Practice Guideline in nursing practice. Successful uptake strategies used by frontline leaders that are new or underdeveloped in the previous literature are presented. The study findings illuminated multidimensional, tailored strategies that frontline leaders use to facilitate the uptake of Best Practice Guidelines. Attention to individual attitudes and beliefs, as well as organisational, interorganisational and interprofessional partnerships are vital to uptake. Organisations that aspire to foster Best Practice Guideline uptake must invest in frontline leaders to 'make it happen' and sustain Best Practice Guideline uptake in practice. Understanding how frontline leaders facilitate Best Practice Guideline uptake is essential to selecting, educating and supporting them to foster desired practice changes. Strategies are explicated that frontline leaders can adopt and tailor to their own practice contexts.
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To analyse critically the barriers and facilitators to new graduate nurse engagement in interprofessional collaboration. The acculturation of new graduate nurses must be considered in strategies that address the global nursing shortage.... more
To analyse critically the barriers and facilitators to new graduate nurse engagement in interprofessional collaboration. The acculturation of new graduate nurses must be considered in strategies that address the global nursing shortage. Interprofessional collaboration may support the transition and retention of new graduate nurses. Whittemore and Knafl's revised framework for integrative reviews guided the analysis. A comprehensive multi-step search (published 2000-2012) of the North American interprofessional collaboration and new graduate literature indexed in the CINAHL, Proquest, Pubmed, PsychINFO and Cochrane databases was performed. A sample of 26 research and non-research reports met the inclusion criteria. All 26 articles were included in the review. A systematic and iterative approach was used to extract and reduce the data to draw conclusions. The analysis revealed several barriers and facilitators to new graduate engagement in interprofessional collaboration. These factors exist at the individual, team and organizational levels and are largely consistent with conceptual and empirical analyses of interprofessional collaboration conducted in other populations. However, knowledge and critical thinking emerged as factors not identified in previous analyses. Despite a weak-to-moderate literature sample, this review suggests implications for team and organizational development, education and research that may support new graduate nurse engagement in IPC.
Research Interests: Psychology, Nursing, Social Support, Interprofessional Education, Acculturation, and 11 moreMedicine, Humans, Advanced Nursing Practice, Nurses, Professional Practice, Self Concept, Patient Care Team, Communication barriers, Professional Competence, Cooperative Behavior, and interprofessional relations
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In addition to having academic knowledge and clinical skills, health professionals need to be caring, ethical practitioners able to understand the emotional concerns of their patients and to effect change. The purpose of this study was to... more
In addition to having academic knowledge and clinical skills, health professionals need to be caring, ethical practitioners able to understand the emotional concerns of their patients and to effect change. The purpose of this study was to determine whether emotional-social intelligence, caring, leadership and moral judgment of health science students change from the beginning to the end of their programs. Students from nursing, bachelor of health science and two physical therapy programs completed self-report questionnaires to evaluate emotional-social intelligence [BarOn Emotional Quotient Inventory: Short (EQ-i:S)], caring [Caring Ability Inventory (CAI)] and leadership [Self-Assessment Leadership Inventory] at the beginning and end of their programs. Students in three of the programs also completed a test of moral decision-making [Defining Issues Test (DIT-2)] at both time points. Two-way analyses of variance (program versus time) demonstrated significant time effects for the tot...
Research Interests: Psychology, Health Sciences, Nursing, Ethics, Education, and 12 moreScholarship of Teaching and Learning, Emotional intelligence, Leadership, Health Care, Statistical Analysis, Health Education, Physical Therapy, Social Intelligence, Defining issues Test, Questionnaires, Bachelor, and Leadership Qualities
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The goal of the Aging, Community and Health Research Unit (ACHRU) is to promote optimal aging at home for older adults with multimorbidity (≥2 chronic conditions) and to support their family/friend caregivers. This protocol paper reports... more
The goal of the Aging, Community and Health Research Unit (ACHRU) is to promote optimal aging at home for older adults with multimorbidity (≥2 chronic conditions) and to support their family/friend caregivers. This protocol paper reports the rationale and plan for this patient-oriented, cross-jurisdictional research program. The objectives of the ACHRU research program are (i) to codesign integrated and person-centered interventions with older adults, family/friend caregivers, and providers; (ii) to examine the feasibility of newly designed interventions; (iii) to determine the intervention effectiveness on Triple Aim outcomes: health, patient/caregiver experience, and cost; (iv) to examine intervention context and implementation barriers and facilitators; (v) to use diverse integrated knowledge translation (IKT) strategies to engage knowledge users to support scalability and sustainability of effective interventions; and (vi) to build patient-oriented research capacity. The researc...
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Nurse practitioners (NPs) can play an important role in providing primary care to residents in long-term care (LTC) homes. However, relatively little is known about the day-to-day collaboration between NPs and physicians (MDs) in LTC, or... more
Nurse practitioners (NPs) can play an important role in providing primary care to residents in long-term care (LTC) homes. However, relatively little is known about the day-to-day collaboration between NPs and physicians (MDs) in LTC, or factors that may influence this collaboration. Survey data from NPs in Canadian LTC homes were used to explore these issues. Thirty-seven of the 45 (82%) identified LTC NPs across Canada completed the survey. NPs worked with an average of 3.4 MDs, ranging from 1-26 MDs. The most common reasons for collaborating included managing acute and chronic conditions, and updating MDs on resident status changes. Satisfaction with NP-MD collaboration was high, and did not significantly differ among NPs working full versus part time, NPs working in a single versus multiple homes, or NPs with more versus less experience. By understanding the nature of NP-MD collaboration, we can identify ways of supporting and enhancing collaboration between these professionals.
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To compare the effect of a 6-month community-based intervention with that of usual care on quality of life, depressive symptoms, anxiety, self-efficacy, self-management, and healthcare costs in older adults with type 2 diabetes mellitus... more
To compare the effect of a 6-month community-based intervention with that of usual care on quality of life, depressive symptoms, anxiety, self-efficacy, self-management, and healthcare costs in older adults with type 2 diabetes mellitus (T2DM) and 2 or more comorbidities. Multisite, single-blind, parallel, pragmatic, randomized controlled trial. Four communities in Ontario, Canada. Community-dwelling older adults (≥65) with T2DM and 2 or more comorbidities randomized into intervention (n = 80) and control (n = 79) groups (N = 159). Client-driven, customized self-management program with up to 3 in-home visits from a registered nurse or registered dietitian, a monthly group wellness program, monthly provider team case conferences, and care coordination and system navigation. Quality-of-life measures included the Physical Component Summary (PCS, primary outcome) and Mental Component Summary (MCS, secondary outcome) scores of the Medical Outcomes Study 12-item Short-Form Health Survey (...
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Older adults in Canada who have multiple illnesses and are awaiting placement in long-term care are greatly impacted by alternate level of care (ALC). The purpose of this narrative study was to record the experiences of hospitalized older... more
Older adults in Canada who have multiple illnesses and are awaiting placement in long-term care are greatly impacted by alternate level of care (ALC). The purpose of this narrative study was to record the experiences of hospitalized older adults and their family caregivers after the patient is designated as requiring ALC. The researchers conducted 21 interviews with 5 older patients and 4 of their family caregivers. The interviews were transformed into stories summarizing the participants' experiences and analyzed for common themes. An overall finding was that uncertainty is integral to the experience of ALC as expressed under 3 themes: I never thought I'd end up like this, I don't know, and waiting. To improve the ALC experience, comprehensive strategies should be developed at the individual, organizational, and structural level to better manage uncertainty while seeking to reduce the occurrence of ALC among older patients.
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Family carers of older persons with Alzheimer's' disease and related dementia (ADRD) and multiple chronic conditions (MCC) experience significant, complex, and distressing transitions such as changes to their environment, roles... more
Family carers of older persons with Alzheimer's' disease and related dementia (ADRD) and multiple chronic conditions (MCC) experience significant, complex, and distressing transitions such as changes to their environment, roles and relationships, physical health, and mental health. An online intervention (My Tools 4 Care) was developed for family carers of persons with ADRD and MCC living at home, with the aim of supporting these carers through transitions and increasing their self-efficacy, hope, and health related quality of life (HRQoL). This study will evaluate My Tools 4 Care (MT4C) by asking the following research questions: 1. Does use of MT4C result in a 3 month (immediately post intervention) and 6-month (3 months after intervention) increase in HRQoL, self-efficacy, and hope, in carers of persons with ADRD and MCC compared to an educational control group? 2. Does use of MT4C help carers of community-dwelling older adults with ADRD and MCC deal with significant chan...
Research Interests: Research Design, Quality of life, Medicine, Canada, Independent Living, and 14 moreHumans, Computer Assisted Instruction, Female, Male, Psychological Intervention, Caregivers, Intergenerational Relations, Clinical Sciences, Aged, Adult, Randomized Controlled Trial, Guidance and Counseling Intervention Programs, Alzheimer Disease, and Psychological Stress
Nursing overtime is being integrated into the normal landscape of practice to ensure optimal staffing levels and addresses variations in patient volume and acuity. This is particularly true in critical care where fluctuations in either... more
Nursing overtime is being integrated into the normal landscape of practice to ensure optimal staffing levels and addresses variations in patient volume and acuity. This is particularly true in critical care where fluctuations in either are difficult to predict. The goal of this study was to explore critical care nurses' perceptions of the outcomes of working overtime. Sally Thorne's interpretive description guided the collection and analysis of data. Participants were recruited from 11 different critical care units within three large teaching hospitals in Southern Ontario, Canada. A total of 28 full- and part-time registered nurses who had worked in an intensive care unit for at least one year took part in this study. Data were collected through semistructured, audio-recorded, individual interviews that took place in rooms adjacent to participants' critical care units. Template analysis facilitated the determination and abstraction of themes using NVivo for Mac 10.1.1. M...
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Many community-based self-management programs have been developed for older adults with type-2 diabetes mellitus (T2DM), bolstered by evidence from randomized controlled trials (RCTs) that T2DM can be prevented and managed through... more
Many community-based self-management programs have been developed for older adults with type-2 diabetes mellitus (T2DM), bolstered by evidence from randomized controlled trials (RCTs) that T2DM can be prevented and managed through lifestyle modifications. However, the evidence for their effectiveness is contradictory and weakened by reliance on single-group designs and/or small samples. Additionally, older adults with multiple chronic conditions (MCC) are often excluded because of recruiting and retention challenges. This paper presents a protocol for a two-armed, multisite, pragmatic, mixed-methods RCT examining the effectiveness and implementation of the Aging, Community and Health Research Unit-Community Partnership Program (ACHRU-CPP), a new 6-month interprofessional, nurse-led program to promote self-management in older adults (aged 65 years or older) with T2DM and MCC and support their caregivers (including family and friends). The study will enroll 160 participants in two Can...
Research Interests: Research Design, Aging, Quality of life, Medicine, Humans, and 15 moreFemale, Male, Ontario, Caregivers, Clinical Sciences, Aged, Alberta, Randomized Controlled Trial, Cost Benefit Analysis, Age Factors, Health Care Costs, Clinical Protocols, Healthy Lifestyle, Community health services, and Cardiovascular medicine and haematology
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The purpose of this study was to explore how nurses provide bedtime oral hygiene care, how they decide on interventions provided, and what factors influence their ability to provide oral care. Current evidence links poor oral hygiene to... more
The purpose of this study was to explore how nurses provide bedtime oral hygiene care, how they decide on interventions provided, and what factors influence their ability to provide oral care. Current evidence links poor oral hygiene to systemic and infectious diseases such as pneumonia. Hospitalised patients, who now retain their teeth into older adulthood, often rely on nurses to provide oral hygiene care. Nurses have the potential to impact oral health outcomes and quality of life by controlling plaque. However, oral hygiene care practices of nurses in postacute hospital settings are relatively unknown. A qualitative, exploratory multiple-case study was conducted with 25 nurses working on five inpatient units at different hospitals. Nurses were accompanied on their evening rounds to observe oral care practices, the physical environment and workflow. Thematic analysis was used to analyse the case study data including transcripts of guided conversations, field notes and documents. ...
Research Interests:
Research Interests:
To analyse, critically, methods employed to explore the relationship between nursing overtime and patient outcomes to strengthen future research. Nursing overtime hours have been increasing in the Western world since the... more
To analyse, critically, methods employed to explore the relationship between nursing overtime and patient outcomes to strengthen future research. Nursing overtime hours have been increasing in the Western world since the 1980's; however, research detailing its implications for patient outcomes has not kept pace. Studies exploring the relationship between nursing overtime and patient outcomes have produced conflicting results and are deficient in number and rigour. Whittemore and Knafl's revised framework for integrative reviews guided the analysis. A comprehensive multi-step search (1980-2012) of literature related to nursing overtime and patient outcomes in the CINAHL, Medline, PubMED, EMBASE and PsychInfo databases was performed. Reference lists and Google searches were completed for additional sources. Nine research papers met the inclusion criteria. All nine articles were included in the review. A systematic, iterative approach was used to extract and reduce the data to draw conclusions. There appears to be a positive relationship between nursing overtime and patient outcomes, however, eight of the nine studies revealed limitations in: (1) the definition and measurement of overtime; (2) data aggregation (organizationally and temporally) and (3) recognition or control of potential confounding variables. The quality in this research sample limits the ability of this body of work to be the basis of staffing policies. Future researchers need to be explicit in detailing their methods alongside a renewed commitment from administration to develop a tracking system of important parameters at the individual and bedside level.
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Research Interests: Psychology and Medicine
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The number of people living longer is increasing, and those with physical or cognitive impairments may need admission into long-term care settings. In long-term care there is a need to increase nursing... more
The number of people living longer is increasing, and those with physical or cognitive impairments may need admission into long-term care settings. In long-term care there is a need to increase nursing staff's capacity to meet the care needs of residents, develop a team approach to providing care and provide opportunities for staff to improve their knowledge and skills. One approach to meet these needs has been to employ a nurse practitioner (NP). The purpose of this paper is to examine nursing staff's perceptions of how working with an NP affected their ability to provide care, function as a team and increase their knowledge and skill. Data used in this paper were obtained from nursing staff and managers who participated in focus groups that were part of case studies conducted in the second phase of a larger sequential, two-phase mixed-methods study. NPs used multiple approaches to increase staff knowledge and skills and improve quality of care. These findings describe the benefits of employing NPs in long-term care settings.
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Research Interests:
Research Interests:
The purpose of this article is to determine whether middle-aged and older adults would identify community support services (CSSs) as a source of assistance for difficulties with the instrumental activities of daily living (IADLs).... more
The purpose of this article is to determine whether middle-aged and older adults would identify community support services (CSSs) as a source of assistance for difficulties with the instrumental activities of daily living (IADLs). Furthermore, we determine factors related to the identification of home health and CSSs.Telephone interviews were conducted with 768 adults aged 50 and older. Respondents were presented with a vignette describing a situation where loss of independence is threatened. They were asked what they would do in that situation. Although less than 20% mentioned CSSs, nearly 50% mentioned either a home health or CSS. Findings suggest those less likely to mention a home health or CSS include men, older adults, and the foreign born. In addition, those with less education, functional health limitations, no social support, and a lack of knowledge of where to find information about CSSs mentioned home health or CSSs less often.
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Despite the benefits of physical activity, residents living in long-term care (LTC) are relatively sedentary. Designing successful physical activity and restorative care programs requires a good understanding of implementation barriers. A... more
Despite the benefits of physical activity, residents living in long-term care (LTC) are relatively sedentary. Designing successful physical activity and restorative care programs requires a good understanding of implementation barriers. A database search (2002–2013) yielded seven studies (nine articles) that met our inclusion criteria. We also reviewed 31 randomized controlled trials (RCTs) to determine if the authors explicitly discussed the barriers encountered while implementing their interventions. Eleven RCTs (13 articles) included a discussion of the barriers. Hence, a total of 18 studies (22 articles) were included in this review. Barriers occurred at resident (e.g., health status), environmental (e.g., lack of space for physical activity), and organizational (e.g., staffing and funding constraints) levels. These barriers intersect to adversely affect the physical activity of older people living in LTC. Future studies targeting physical activity interventions for residents li...