Background: Prior to the pandemic, every day approximately 28 long term care (LTC) residents were transferred to an emergency department (ED) in Alberta. This was placing increasing strain on healthcare resources and potentially negatively impacting the health and wellness of residents (e.g., exposure to iatrogenic harms). Many residents’ conditions could be managed within LTC if appropriate supports were provided. Poor communication between LTC and EDs can also lead to long ED lengths of stay, unnecessary resource utilization, sub-optimal health outcomes, and exposure to iatrogenic harms for LTC residents. Two INTERACT® tools (tools for early identification of acute medical issues) and a new care and referral pathway were implemented to help identify and address changes in health status among LTC residents sooner, improve communication between LTC and ED providers, and reduce unnecessary ED transfers. Methods: Between October 2019 and April 2022, 40 LTC homes and 4 EDs within the Calgary zone implemented the standardized LTC-to-ED care and referral pathway supported by a centralized telephone advice and transfer system for healthcare providers, community paramedics, and two INTERACT® tools (Stop and Watch for healthcare aides; Change in Condition Cards for nursing). Using a randomized stepped-wedge design, the pathway was implemented within 9 cohorts of (4-5) LTC facilities every 3 months, supported by an implementation coach. Three-hour train the trainer implementation sessions were conducted in-person or online with over 325 health practitioners in the enrolled LTC homes using strategies adapted to consider local context and barriers, as well as considering pandemic-related challenges. Evaluation Methods: Evaluation of the intervention involved both qualitative and quantitative methods. The primary study outcome is change in transfers from LTC to ED; secondary (quantitative) outcomes include hospital admissions, utilization of the centralized telephone advice and transfer system, and community paramedic visits. Analysis of these quantitative outcomes utilized negative binomial regression to estimate the incident rate with 95% confidence intervals (per 1000 residents), while adjusting for the different cohorts. The quantitative evaluation also included an economic analysis to determine potential cost savings. Interviews with healthcare providers were conducted to provide context to their experience with the intervention and ways it can be improved. These interviews will be interpreted with the involvement of members of our project resident and family advisory council. Results: Quantitative results demonstrate a reduction in the LTC-to-ED transfer rate [1.70 (95%CI 1.61-1.79) post-intervention) vs 1.91 (95%CI 1.84-2.00) pre-intervention], along with reduction in hospital admission rates [0.94 (95%CI 0.88-1.00) vs 1.08 (95%CI 1.03-1.14)]. There was an increase in utilization of the centralized telephone advice and transfer system [0.18 (95%CI 0.16-0.22) vs. 0.13 (95%CI 0.11-0.16)], but no increase in the number of community paramedic visits [2.05 (95%CI 1.94-2.16) vs 2.50 (95%CI 2.39-2.61)]. Cost and qualitative outcome data is pending. Advice and Lessons Learned: LTC staff education and use of early warning tools for identifying a change in resident health status (INTERACT® tools) and/or utilization of a centralized telephone advice and transfer system may have played a role in reducing ED transfers. We did not observe the expected relationship between community paramedic visits and reduced LTC-to-ED transfers, possibly as a result of the pandemic-related facility outbreak restrictions. Teams should tailor implementation sessions and materials to site specific needs and contexts to help address their unique barriers and facilitators. Partnerships with key stakeholders across the care continuum are essential to ensure adequate support and effective uptake and sustainability of the mutli-faceted change intervention.
To examine the influence of hospital culture and authentic leadership on the effects of quality improvement practices on patient satisfaction.Nurses in formal leadership roles shape and are shaped by organizational culture to achieve high performance standards to influence quality of care.Using structural equation modelling, we tested a model on quality improvement practices across three participant groups that differed based on authentic leadership and hospital culture.We used survey data from a cross-sectional study conducted in 2015 measuring nurse. Managers' perceptions of authentic leadership, implementation of quality improvement, and organizational culture in Canadian hospitals.226 nurse managers participated. Our model estimations fit for the high-relational group and mixed group. Our model explained 50.7% and 39.5% variance in our outcome variable of patient satisfaction for the high-relational group and mixed group, respectively. Our model failed to fit the low-relational group.Authentic leadership and developmental/group hospital cultures improve quality management practices, quality of care and patient satisfaction. In organizations with low authentic leadership and hierarchical/rational cultures, strategies should target increasing authentic leadership and shifting to developmental cultures. Organizations with high authentic leadership and/or developmental/group cultures should target employee engagement, autonomy and teamwork.We examined how different combinations of authentic leadership and hospital culture influence the effects of quality management practices on quality improvement and patient satisfaction. Findings demonstrate that having both high authentic leadership and developmental or group hospital cultures are essential for quality improvement practices to enhance the quality of care and patient satisfaction. These organizations would benefit the most from systemic programs aimed at standardizing quality management practices as they have the culture and leadership to support these practices. For hospitals with hierarchical/rational cultures and/or low authentic leadership, enhancing hospital culture and leadership through leadership training and accreditation programs is critically needed.The College and Association of Registered Nurses of Alberta contributed to this study by facilitating data collection and supporting the conduct of the study through messaging to its members.
Abstract The organizational context in nursing homes is associated with quality of care and residents’ quality of life. Our objective was to examine nursing home staff perceptions of unit organizational context. We conducted a secondary analysis of cross-sectional data. Participants were 3765 unregulated (health care aides (HCAs)) and 1130 regulated staff (managers, registered nurses, registered psychiatric nurses (RN/RPNs) and licensed practical nurses (LPNs)) from 91 nursing homes in Western Canada. We measured nursing home staff’s perceptions of organizational context via the Alberta Context Tool (ACT), comprised of ten concepts: leadership, culture, evaluation, social capital, formal interactions, informal interactions, organizational slack (staff, space, time). Differences between groups were examined via one-way ANOVA. Managers reported significantly higher organizational context scores compared to all other staff members in care homes, followed by RN/RPNs. LPNs and HCAs reported the lowest scores. Specifically, LPNs reported the lowest scores on all organizational context measures except for structural resources and organizational slack space, for which HCAs reported the lowest scores. HCAs reported higher scores than LPNs on unit leadership, culture, evaluation, social capital. When compared with managers and RN/RPNs in the nursing home, LPNs reported the lowest SF-8 mental health scores (49.30 (10.05)) and HCAs reported the lowest physical health scores (48.53 (8.16)). Our work demonstrates the need for improvement of staffing and time for staff in nursing homes. Specific attention is needed to focus on modifiable organizational unit context factors for LPNs and HCAs, who are responsible for providing the majority of the direct care for residents.
Understanding antecedents and consequences of incivility across higher education is necessary to create and implement strategies that prevent and slow uncivil behaviors.
Abstract Background/Objectives Transitions to and from Emergency Departments (EDs) can be detrimental to long‐term care (LTC) residents and burden the healthcare system. While reducing avoidable transfers is imperative, various terms are used interchangeably including inappropriate, preventable, or unnecessary transitions. Our study objectives were to develop a conceptual definition of avoidable LTC‐ED transitions and to verify the level of stakeholder agreement with this definition. Methods The EX amining A ged C are T ransitions study adopted an exploratory sequential mixed‐method design. The study was conducted in 2015–2016 in 16 LTC facilities, 1 ED, and 1 Emergency Medical Service (EMS) in a major urban center in western Canada. Phase 1 included 80 participants, (healthcare aides, licensed practical nurses, registered nurses, LTC managers, family members of residents, and EMS staff). We conducted semistructured interviews ( n = 25) and focus groups ( n = 19). In Phase 2, 327 ED staff, EMS staff, LTC staff, and medical directors responded to a survey based on the qualitative findings. Results Avoidable transitions were attributed to limited resources in LTC, insufficient preventive care, and resident or family wishes. The definition generated was: A transition of an LTC resident to the ED is considered avoidable if: (a) Diagnostic testing, medical assessment, and treatment can be accessed in a timely manner by other means; (b) the reasons for a transfer are unclear and the transition would increase the disorientation, pain, or discomfort of a resident, outweighing a clear benefit of a transfer; and (c) the transition is against the wishes expressed by the resident over time, including through informal and undocumented conversations. There was a high level of agreement with the definition across the four participant groups. Conclusions and Implications To effectively reduce LTC resident avoidable transitions, stakeholders must share a common definition. Our conceptual definition may significantly contribute to improved care for LTC residents.
Introduction Decisions about nurse staffing models are a concern for health systems globally due to workforce retention and well-being challenges. Nurse staffing models range from all Registered Nurse workforce to a mix of differentially educated nurses and aides (regulated and unregulated), such as Licensed Practical or Vocational Nurses and Health Care Aides. Systematic reviews have examined relationships between specific nurse staffing models and client, staff and health system outcomes (eg, mortality, adverse events, retention, healthcare costs), with inconclusive or contradictory results. No evidence has been synthesised and consolidated on how, why and under what contexts certain staffing models produce different outcomes. We aim to describe how we will (1) conduct a realist review to determine how nurse staffing models produce different client, staff and health system outcomes, in which contexts and through what mechanisms and (2) coproduce recommendations with decision-makers to guide future research and implementation of nurse staffing models. Methods and analysis Using an integrated knowledge translation approach with researchers and decision-makers as partners, we are conducting a three-phase realist review. In this protocol, we report on the final two phases of this realist review. We will use C itation tracking, tracing L ead authors, identifying U npublished materials, Google S cholar searching, T heory tracking, ancestry searching for E arly examples, and follow-up of R elated projects (CLUSTER) searching, specifically designed for realist searches as the review progresses. We will search empirical evidence to test identified programme theories and engage stakeholders to contextualise findings, finalise programme theories document our search processes as per established realist review methods. Ethics and dissemination Ethical approval for this study was provided by the Health Research Ethics Board of the University of Alberta (Study ID Pro00100425). We will disseminate the findings through peer-reviewed publications, national and international conference presentations, regional briefing sessions, webinars and lay summary.
There is a gap in studies examining formal mentorship programs designed for ongoing faculty support.A mixed-methods explanatory research design was used to examine nurse educators' experiences of a navigation-based mentoring program in a baccalaureate nursing program in Western Canada. Descriptive statistics were used to examine the means of three subsets of the Capabilities of Nurse Educators (CONE) questionnaire. Interviews were conducted, and data were analyzed using qualitative descriptive methods.The findings highlight the positive effects the faculty navigator program had on faculty's confidence and development as educators. The most significant finding was the in-time relational support that faculty navigators provided to prevent new faculty from feeling alone in their new role.The faculty navigator program is effective for its setting. This program could be expanded to facilitate stronger learner-centered approaches to teaching in various settings with faculty of varying expertise. [J Nurs Educ. 2022;61(10):587-590.].
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