Barriers and facilitators in providing oral health care to nursing home residents, from the perspective of care aides—a systematic review protocol

PRISMA-P checklist. The checklist is composed of recommended items to address in a systematic review protocol. (PDF 218 kb

Organisationskontext und Forschungsanwendung in deutschen Pflegeheimen messen - Übersetzung, Adaptation und psychometrische Testung dreier kanadischer Assessmentinstrumente

Zur Untersuchung des Zusammenhangs zwischen Organisationskontext und der Nutzung wissenschaftlicher Erkenntnisse in der stationären Altenpflege stehen drei kanadische, international breit genutzte Forschungsinstrumente zur Verfügung. Auf Deutsch liegen keine Instrumente mit vergleichbarer Qualität und Eignung vor. Ziel dieser Arbeit war daher, die Instrumente auf Deutsch zu übersetzen, sie an den Kontext der deutschen stationären Altenpflege anzupassen und umfassend psychometrisch zu testen. Die Übersetzung der Instrumente erfolgte auf Basis internationaler Best-Practice-Leitlinien. In kognitiven Interviews mit 16 Pflegehilfskräften (PHK), 5 Pflegefachkräften (PFK), 7 Therapie-/ Betreuungskräften (TBK), 5 Experten (Exp.) und 6 Führungskräften (FK) aus 5 Pflegeheimen wurde die Verständlichkeit der übersetzten Instrumente untersucht. Die statistische Validierung umfasste konfirmatorische Faktorenanalysen, Reliabilitätsbestimmung auf Basis der Faktormodellparameter, Faktorinvarianzanalysen, Mehrebenenfaktorenmodelle sowie Strukturgleichungsmodelle. Fragebögen von 273 PHK, 196 PFK, 152 TBK, 6 Exp., 129 FK, 65 Altenpflegeschülern (APS) aus 38 Pflegeeinrichtungen wurden eingeschlossen. Experten beurteilten die Inhalte als adäquat, die Zielpersonen verstanden die Items wie intendiert, akzeptable konfirmatorische Faktorenmodelle verwiesen auf strukturelle Validität und die Instrumente erwiesen sich als partiell stark bzw. partiell strikt messinvariant. Die Aggregierbarkeit der Daten wird allerdings von den Befunden dieser Arbeit nicht gestützt und die Evidenz bzgl. der Zusammenhänge zwischen den Variablen ist ambivalent.Internationally, three Canadian research tools are widely used to assess the relationship between organisational context and research utilization in residential long term care (LTC) settings. No instruments with characteristics as optimal as those Canadian tools are available in German language. The objectives of this dissertation were thus to translate the three Canadian assessment instruments, to adapt them to the context of German residential LTC and to test their psychometric properties extensively. Translation methods followed international best practice guidelines for instrument translation. Comprehensibility of the translated tools was assessed in cognitive interviews with 16 health care aides (HCAs), 5 registered Nurses (RNs), 7 allied health providers (AHPs), 5 specialists, and 6 leaders from 5 LTC facilities. Statistical validation comprised confirmatory factor analyses, reliability calculations based on the parameters of the factor models, factor invariance analyses, multi-level factor models, and structural equation models. Questionnaires from 273 HCAs, 196 RNs, 152 AHPs, 6 specialists, 129 leaders, and 65 nursing students from 38 LTC facilities were included. Experts rated the contents of the translated tools as adequate, target persons understood the items as intended, acceptable fitting factor models indicated structural validity, and the tools demonstrated partially strong or partially strict measurement invariance, respectively. However, results of this thesis do not support the hypothesis that individual data can be aggregated on unit or facility level, and evidence with regard to the relationships between the variables is ambivalent.von Matthias Hobe

Ceci n’est pas une ville

Treballs Finals de Grau de Belles Arts. Facultat de Belles Arts. Universitat de Barcelona, Curs: 2015-16, Tutor: Bibiana Crespo[cat] El títol de l’obra d’aquest Treball Final de Grau, Ceci n’est pas une ville, fa al·lusió a la paradoxa proposada per René Magritte al quadre La Trahison des images (La traïció de les imatges), atès que la incapacitat de distingir realitat i ficció ha sobrepassat el territori de la mera representació, convertint-se en un dels dilemes més presents a la nostra contemporaneïtat, fent-se evident tant en les imatges i la informació que ens envolta com en els paisatges que habitem.La peça és un dibuix en el que es representa un paisatge de gran format, introduint l’espectador dins la vivència d’un lloc fictici, simulat. En el dibuix es presenta el carrer principal de La Roca Village, un centre comercial construït imitant l’arquitectura catalana del segle XIX i dedicat a la venda de grans marques de roba i altres complements. Amb més de 4 milions de visitants a l’any aquest “no-poble” ja és el més visitat de Catalunya. Mitjançant el suport d’un material transparent, pintura blanca i una il·luminació dirigida, es crea una projecció d’ombra del grafisme del dibuix a la paret que domina la visió, fet que suscita una confusió a l’espectador, ja que no sap si està veient el dibuix mateix o l’ombra que genera aquest. L’ obra constitueix una crítica al capitalisme cultural i convida a l’espectador a reflexionar sobre el paisatge que habita, tot considerant que els carrers de La Roca Village, habitats per marques i transitats per consumidors, podrien ser un model per una societat en potència, que amaga les seves diferències sota un espectacle dedicat exclusivament a vendre productes lluents i experiències fictícies.[eng] The work’s title of this Final Degree Dissertation project, Ceci n’est pas une ville, refers to René Magritte’s paradox proposed in his painting La Trahison des images (The image betrayal), since the inability to distinguish reality and fiction has exceeded the territory of the mere representation, becoming one of our most noticeable contemporary dilemmas, making itself evident both in images and information that surround us, as in the landscapes that we inhabit. This piece is a drawing representing a large landscape, aiming to introduce the viewer into the experience of a fictitious and simulated place. The drawing shows the main street of La Roca Village, a shopping center built imitating the Catalan architecture of the 19th Century, devoted to selling big clothing brands. With more than 4 million of visitors per year, this “no-village” is already the most visited one in Catalonia. Through a transparent material support, white painting and a directed light, the shadow of the graphism is projected onto the wall and dominates the vision, this fact causes a confusion to the viewer as he/she doesn’t know if is watching the drawing itself or the shadow that it generates. The work constitutes a critic to cultural capitalism and invites the viewers to think about the landscapes they inhabit. Considering that La Roca Village streets, inhabited by brands and crowded by consumers, could be a potential model for a society that hides its differences under a performance exclusively dedicated to sell shiny products and fictitious experiences

PHYSICAL ACTIVITY GUIDELINE ADHERENCE AMONG CANADIAN IMMIGRANT YOUTH: A QUALITATIVE EXPLORATORY STUDY

The Canadian Society for Exercise Physiology (CSEP) Youth Physical Activity Guidelines are the national criterion standard for youth physical activity. Minimal research exists regarding CSEP Guideline adherence in immigrant youth despite this population’s significance in Canada. The purpose of this study was to foster an understanding of physical activity guideline adherence in Canadian immigrant youth. The study objectives were to determine Canadian immigrant youth’s adherence levels, barriers to adherence, recommendations to improve adherence, and the impact of the COVID-19 pandemic on adherence. A qualitative exploratory design was used. Purposive sampling from Edmonton community-agencies occurred to generate a sample of 6 community service-workers who have experience with Canadian immigrant youth and physical activity. Data collection occurred through virtual semi-structured interviews. Data analysis occurred via Braun and Clarke’s Six Thematic Analysis Steps. Three primary themes emerged: (1) Multiple Barriers to CSEP Guideline Adherence including low familiarity with physical activity, inaccessibility, finances, and competing responsibilities, (2) Low Adherence Level to CSEP Guidelines indicating significant under-adherence that was worsened by the pandemic, and (3) Recommendations to improve CSEP Guideline Adherence include increase accessibility to physical activities, increase education, and promote mentorship. This study’s findings can optimize nursing health promotion efforts and organizational policies, inform health promotion protocols in nursing education, and guide further research that would enhance the breadth of current literature. Collectively, this study helps provide a foundation for promoting the health of Canadian immigrant youth

Older high-cost patients in Norwegian somatic hospitals: A register-based study of patient characteristics

Objective Two-thirds of the economic resources in Norwegian hospitals are used on 10% of the patients. Most of these high-cost patients are older adults, which experience more unplanned hospital admissions, longer hospital stays and higher readmission rates than other patients. This study aims to examine the individual and clinical characteristics of older patients with unplanned admissions to Norwegian somatic hospitals and how these characteristics differ between high-cost and low-cost older patients. Design Observational cross-sectional study. Setting Norwegian somatic hospitals. Participants National registry data of older Norwegian patients (≥65 years) with ≥1 unplanned contact with somatic hospitals in 2019 (n=2 11 738). Primary outcome measure High-cost older patients were defined as those within the 10% of the highest diagnosis-related group weights in 2019 (n=21 179). We compared high-cost to low-cost older patients using bivariate analyses and logistic regression analysis. Results Men were more likely to be high-cost older patients than women (OR=1.25, 95% CI 1.21 to 1.29) and the oldest (90+ years) compared with the youngest older adults (65–69 years) were less likely to cause high costs (OR=0.47, 95%CI 0.43 to 0.51). Those with the highest level of education were less likely to cause high costs than those with primary school degrees (OR=0.74, 95%CI 0.69 to 0.80). Main diagnosis group (OR=3.50, 95%CI 3.37 to 3.63) and dying (OR=4.13, 95%CI 3.96 to 4.30) were the clinical characteristics most strongly associated with the likelihood of being a high-cost older patient. Conclusion Several of the observed patient characteristics in this study may warrant further investigation as they might contribute to high healthcare costs. For example, MDGs, reflecting comprehensive healthcare needs and lower education, which is associated with poorer health status, increase the likelihood of being high-cost older patients. Our results indicate that Norwegian hospitals function according to the intentions of those having the highest needs receiving most services

Development and validation of the Overall Fidelity Enactment Scale for Complex Interventions (OFES-CI)

Background In many quality improvement (QI) and other complex interventions, assessing the fidelity with which participants ‘enact’ intervention activities (ie, implement them as intended) is underexplored. Adapting the evaluative approach used in objective structured clinical examinations, we aimed to develop and validate a practical approach to assessing fidelity enactment—the Overall Fidelity Enactment Scale for Complex Interventions (OFES-CI). Methods We developed the OFES-CI to evaluate enactment of the SCOPE QI intervention, which teaches nursing home teams to use plan-do-study-act (PDSA) cycles. The OFES-CI was piloted and revised early in SCOPE with good inter-rater reliability, so we proceeded with a single rater. An intraclass correlation coefficient (ICC) was used to assess inter-rater reliability. For 27 SCOPE teams, we used ICC to compare two methods for assessing fidelity enactment: (1) OFES-CI ratings provided by one of five trained experts who observed structured 6 min PDSA progress presentations made at the end of SCOPE, (2) average rating of two coders’ deductive content analysis of qualitative process evaluation data collected during the final 3 months of SCOPE (our gold standard). Results Using Cicchetti’s classification, inter-rater reliability between two coders who derived the gold standard enactment score was ‘excellent’ (ICC=0.93, 95% CI=0.85 to 0.97). Inter-rater reliability between the OFES-CI and the gold standard was good (ICC=0.71, 95% CI=0.46 to 0.86), after removing one team where open-text comments were discrepant with the rating. Rater feedback suggests the OFES-CI has strong face validity and positive implementation qualities (acceptability, easy to use, low training requirements). Conclusions The OFES-CI provides a promising novel approach for assessing fidelity enactment in QI and other complex interventions. It demonstrates good reliability against our gold standard assessment approach and addresses the practicality problem in fidelity assessment by virtue of its suitable implementation qualities. Steps for adapting the OFES-CI to other complex interventions are offered.publishedVersio

Prioritizing supports and services to help older adults age in place: A Delphi study comparing the perspectives of family/friend care partners and healthcare stakeholders

Aging in place (AIP) is a policy strategy designed to help older adults remain in their community. While planners internationally have modified aspects of the older adult care continuum (e.g., home care, assisted living, nursing homes) to facilitate AIP, further improvements to community-based supports and services are also required. This study compared and constrasted the community-based factors (e.g., supports, services and personal strategies or characteristics) that family/friend care partners and healthcare stakeholders (i.e., planners/providers) view as most important to help older adults successfully AIP.; An initial list of factors shown to influence AIP was created from the academic literature. These factors were used to develop a Delphi survey implemented separately on care partners and healthcare stakeholders. Respondents rated the importance of each factor using a 10-point Likert Scale (1 = not important; 10 = absolutely critical). Consensus in each group was defined when at least 80% of participants scored a factor ≥8 ("very important"), with an interquartile range ≤2. Respondents suggested additional factors during Delphi round one.; Care partners (N = 25) and healthcare stakeholders (N = 36) completed two and three Delphi rounds, respectively. These groups independently agreed that the following 3 (out of 27) factors were very important to help older adults age in place: keeping one's home safe, maintaining strong inter-personal relationships, and coordinating care across formal providers. While healthcare stakeholders did not reach consensus on other factors, care partners agreed that 7 additional factors (e.g., access to affordable housing, having mental health programs) were important for AIP.; Compared to healthcare stakeholders, care partners felt that more and diverse community-based factors are important to support older adults to successfully AIP. Future research should replicate these findings in other jurisdictions, examine the availability and accessibility of the priority factors, and develop sustainable solutions to enhance their effectiveness

Measurement invariance and differential item functioning of a care staff proxy measure of nursing home resident dementia-specific quality of life (DEMQOL-CH): do care aides' first language, and care aides' and residents’ ethno-cultural background matter?

Quality of life (QoL) is a priority goal of dementia care, but measuring QoL becomes increasingly difficult as a person's ability to self-report declines. QoL measurement is particularly challenging among Nursing home (NH) residents, due to their often advanced cognitive impairment. The DEMQOL-CH is a validated tool to assess NH residents' QoL, using care staff proxy reports. Care staff and residents often have diverse ethno-cultural backgrounds, which may affect the measurement of QoL. Our objective was to assess measurement invariance and differential item functioning (DIF) of the DEMQOL-CH based on care staff ethno-cultural background, language, and resident ethno-cultural background. In a convenience sample of 9 NHs in the Canadian province of Alberta, research assistants conducted structured interviews with 119 care staff between July and September 2021 to complete DEMQOL-CH assessments of 612 residents. We performed confirmatory factor analyses, multiple group item response theory analyses, and DIF analyses. Measurement of the overall DEMQOL-CH score was affected by care staff ethno-cultural background and language (lack of scalar measurement invariance), but not by resident ethno-cultural background. Six of the 31 DEMQOL-CH items had DIF based on both, care staff ethno-cultural background and language, 2 items had DIF based on care staff ethno-cultural background, 4 items had DIF based on care staff language. Resident ethno-cultural background did not lead to DIF. The lack of measurement invariance and the presence of DIF affects the comparability of DEMQOL-CH assessments collected from care staff with diverse ethno-cultural and/or language backgrounds. However, the extent of the issues identified is small and the tool's other psychometric properties are robust. Therefore, we suggest that it is reasonable to continue to use the DEMQOL-CH in its current form, with careful consideration of methods to deal with and adjust for measurement invariance

Job Satisfaction among Care Aides in Residential Long-Term Care: A Systematic Review of Contributing Factors, Both Individual and Organizational

Despite an increasing literature on professional nurses’ job satisfaction, job satisfaction by nonprofessional nursing care providers and, in particular, in residential long-term care facilities, is sparsely described. The purpose of this study was to systematically review the evidence on which factors (individual and organizational) are associated with job satisfaction among care aides, nurse aides, and nursing assistants, who provide the majority of direct resident care, in residential long-term care facilities. Nine online databases were searched. Two authors independently screened, and extracted data and assessed the included publications for methodological quality. Decision rules were developed a priori to draw conclusions on which factors are important to care aide job satisfaction. Forty-two publications were included. Individual factors found to be important were empowerment and autonomy. Six additional individual factors were found to be not important: age, ethnicity, gender, education level, attending specialized training, and years of experience. Organizational factors found to be important were facility resources and workload. Two additional factors were found to be not important: satisfaction with salary/benefits and job performance. Factors important to care aide job satisfaction differ from those reported among hospital nurses, supporting the need for different strategies to improve care aide job satisfaction in residential long-term care

German translation of the Alberta context tool and two measures of research use: methods, challenges and lessons learned

Background: Understanding the relationship between organizational context and research utilization is key to reducing the research-practice gap in health care. This is particularly true in the residential long term care (LTC) setting where relatively little work has examined the influence of context on research implementation. Reliable, valid measures and tools are a prerequisite for studying organizational context and research utilization. Few such tools exist in German. We thus translated three such tools (the Alberta Context Tool and two measures of research use) into German for use in German residential LTC. We point out challenges and strategies for their solution unique to German residential LTC, and demonstrate how resolving specific challenges in the translation of the health care aide instrument version streamlined the translation process of versions for registered nurses, allied health providers, practice specialists, and managers. Methods: Our translation methods were based on best practices and included two independent forward translations, reconciliation of the forward translations, expert panel discussions, two independent back translations, reconciliation of the back translations, back translation review, and cognitive debriefing. Results: We categorized the challenges in this translation process into seven categories: (1) differing professional education of Canadian and German care providers, (2) risk that German translations would become grammatically complex, (3) wordings at risk of being misunderstood, (4) phrases/idioms non-existent in German, (5) lack of corresponding German words, (6) limited comprehensibility of corresponding German words, and (7) target persons’ unfamiliarity with activities detailed in survey items. Examples of each challenge are described with strategies that we used to manage the challenge. Conclusion: Translating an existing instrument is complex and time-consuming, but a rigorous approach is necessary to obtain instrument equivalence. Essential components were (1) involvement of and co-operation with the instrument developers and (2) expert panel discussions, including both target group and content experts. Equivalent translated instruments help researchers from different cultures to find a common language and undertake comparative research. As acceptable psychometric properties are a prerequisite for that, we are currently carrying out a study with that focus