Translation and validation of the Alberta Context Tool for use in Norwegian nursing homes

Purpose: Organizational context is recognized as important for facilitating evidence-based practice and improving patient outcomes. Organizational context is a complex construct to measure and appropriate instruments that can quantify and measure context are needed. The aim of this study was to translate and cross-culturally adapt the Alberta Context Tool (ACT) to Norwegian, and to test the reliability and structural validity among registered nurses (RNs) and licenced practice nurses (LPNs) working in nursing homes. Methods: This study was a validation study utilizing a cross-sectional design. The sample consisted of n = 956 healthcare personnel from 28 nursing homes from a municipality in Norway. In the first stage, the ACT was translated before being administered in 28 nursing homes. In the second stage, internal consistency and structural validity were explored using Cronbach’s alpha and confirmatory factor analysis. Results: A rigorous forward-and-back translation process was performed including a team of academics, experts, professional translators and the copyright holders, before an acceptable version of the ACT was piloted and finalized. The Norwegian version of the ACT showed good internal consistency with Chronbachs alpha above .75 for all concepts except for Formal interactions where the alpha was .69. Structural validity was acceptable for both RNs and LPNs with factors loadings more than .4 for most items. Conclusions: The Norwegian version of the ACT is a valid measure of organizational context in Norwegian nursing homes among RNs and LPNs.publishedVersio

Acute hospital admissions from nursing homes: predictors of unwarranted variation?

Background: The geriatric nursing home population is frail and vulnerable to sudden changes in their health condition. Very often, these incidents lead to hospitalization, in which many cases represent an unfavourable discontinuity of care. Analysis of variation in hospitalization rates among nursing homes where similar rates are expected may identify factors associated with unwarranted variation. Objectives: To 1) quantify the overall and diagnosis specific variation in hospitalization rates among nursing homes in a well-defined area over a two-year period, and 2) estimate the associations between the hospitalization rates and characteristics of the nursing homes. Method: The acute hospital admissions from 38 nursing homes to two hospitals were identified through ambulance records and linked to hospital patient journals (n = 2451). Overall variation in hospitalization rates for 2 consecutive years was tested using chi-square and diagnosis-specific variation using Systematic Component of Variation. Associations between rates and nursing home characteristics were tested using multiple regression and ANOVA. Results: Annual hospitalization rates varied significantly between 0.16 and 1.49 per nursing home. Diagnoses at discharge varied significantly between the nursing homes. The annual hospitalization rates correlated significantly with size (r = −0.38) and percentage short-term beds (r = 0.41), explaining 32% of the variation observed (R2 = 0.319). No association was found for ownership status (r = 0.05) or location of the nursing home (p = 0.52). Conclusion: A more than nine-fold variation in annual hospitalization rates among the nursing homes in one municipality suggests the presence of unwarranted variation. This finding demands for political action to improve the premises for a more uniform practice in nursing homes.måsjekke

Acute hospital admissions among nursing home residents: a population-based observational study

<p>Abstract</p> <p>Background</p> <p>Nursing home residents are prone to acute illness due to their high age, underlying illnesses and immobility. We examined the incidence of acute hospital admissions among nursing home residents versus the age-matched community dwelling population in a geographically defined area during a two years period. The hospital stays of the nursing home population are described according to diagnosis, length of stay and mortality. Similar studies have previously not been reported in Scandinavia.</p> <p>Methods</p> <p>The acute hospitalisations of the nursing home residents were identified through ambulance records. These were linked to hospital patient records for inclusion of demographics, diagnosis at discharge, length of stay and mortality. Incidence of hospitalisation was calculated based on patient-time at risk.</p> <p>Results</p> <p>The annual hospital admission incidence was 0.62 admissions per person-year among the nursing home residents and 0.26 among the community dwellers. In the nursing home population we found that dominant diagnoses were respiratory diseases, falls-related and circulatory diseases, accounting for 55% of the cases. The median length of stay was 3 days (interquartile range = 4). The in-hospital mortality rate was 16% and 30 day mortality after discharge 30%.</p> <p>Conclusion</p> <p>Acute hospital admission rate among nursing home residents was high in this Scandinavian setting. The pattern of diagnoses causing the admissions appears to be consistent with previous research. The in-hospital and 30 day mortality rates are high.</p

Acute hospital admissions from nursing homes. Rates and characteristics; unwarranted variation and effects of interventions to reduce them

Background: The geriatric nursing home population is vulnerable to acute incidences in their health condition, due to longevity, multiple chronic illnesses and a low level of physical and mental function. Aims: The overall aims of this study were to describe acute hospital admissions from nursing homes in Norway; investigate and explain the variation in admission rates between nursing homes, and systematically review the effects of interventions to reduce hospitalisations from nursing homes. Methods: Population-based observational data were used for papers I and II, with electronic patient journals as the main source of data. For two consecutive years (01.01.2007-31.12.2008), acute admissions from 38 nursing homes were identified through ambulance records (n=2 451). Paper I reports annual incidence rates of hospitalisation, describe characteristics of hospital stays and reports mortality. Paper II describes variation in hospitalisation between all nursing homes in one municipality and explores explanatory associations. Paper III is a systematic review of the effects of interventions to reduce hospitalisations from nursing homes. Results: The mean annual hospital admission incidence rate was 0.62 admissions per person-year. Of all admissions 55% were related to falls and respiratory and circulatory diseases. Length-of-stay was median 3 days. In-hospital and 30-days mortality rates were high; 16% and 29%, respectively. A nine-fold variation in admission rates were found among the nursing homes. Annual rates correlated significantly with size and percentage short-term beds of the institutions, but no associations were found between rate and ownership, suburb or age of the residents. There was a strong correlation between nursing homes’ admission rates two years in a row. The literature search generated 6 250 individual records. Four systematic reviews of high quality and five primary studies were included, evaluating 11 different interventions. The overall quality of the evidence was graded low or very low. Conclusions: Nursing home residents are hospitalised at a very high rate in this setting, and a more than nine-fold variation suggests the presence of unwarranted variation. Some interventions to reduce hospitalisations show promising results, but the evidence is of too low quality to provide clear recommendations

Reducing hospital admissions from nursing homes: a systematic review

Background: The geriatric nursing home population is vulnerable to acute and deteriorating illness due to advanced age, multiple chronic illnesses and high levels of dependency. Although the detriments of hospitalising the frail and old are widely recognised, hospital admissions from nursing homes remain common. Little is known about what alternatives exist to prevent and reduce hospital admissions from this setting. The objective of this study, therefore, is to summarise the effects of interventions to reduce acute hospitalisations from nursing homes. Methods: A systematic literature search was performed in Cochrane Library, PubMed, MEDLINE, EMBASE and ISI Web of Science in April 2013. Studies were eligible if they had a geriatric nursing home study population and were evaluating any type of intervention aiming at reducing acute hospital admission. Systematic reviews, randomised controlled trials, quasi randomised controlled trials, controlled before-after studies and interrupted time series were eligible study designs. The process of selecting studies, assessing them, extracting data and grading the total evidence was done by two researchers individually, with any disagreement solved by a third. We made use of meta-analyses from included systematic reviews, the remaining synthesis is descriptive. Based on the type of intervention, the included studies were categorised in: 1) Interventions to structure and standardise clinical practice, 2) Geriatric specialist services and 3) Influenza vaccination. Results: Five systematic reviews and five primary studies were included, evaluating a total of 11 different interventions. Fewer hospital admissions were found in four out of seven evaluations of structuring and standardising clinical practice; in both evaluations of geriatric specialist services, and in influenza vaccination of residents. The quality of the evidence for all comparisons was of low or very low quality, using the GRADE approach. Conclusions: Overall, eleven interventions to reduce hospital admissions from nursing homes were identified. None of them were tested more than once and the quality of the evidence was low for every comparison. Still, several interventions had effects on reducing hospital admissions and may represent important aspects of nursing home care to reduce hospital admissions

Indivdual and organizational features of a favourable work environment in nursing homes: a cross-sectional study

Background: The organizational context in healthcare (i.e., the work environment) is associated with patient outcomes and job satisfaction. Long-term care is often considered to be a challenging work environment, characterized by high job demands, low job control, a fast work pace and job dissatisfaction, which may affect patient care and increase staff turnover.This study aims to investigate the organizational context in nursing homes and the features of favorable or less favorable work environments. Methods: This study is a cross-sectional study of registered nurses and licensed practical nurses in Bergen, Norway (n = 1014). The K-means clustering algorithm was used to differentiate between favorable and less favorable work environments, based on the Alberta Context Tool. Multilevel logistic regression analysis was used to investigate the associations between individual sociodemographic factors, nursing home factors and the probability of experiencing a favorable work environment. Results: 45% of the sample (n = 453) experienced working in a favorable work environment. Contextual features (especially a supportive work culture, more evaluation mechanisms and greater organizational slack resources) and individual features (having a native language other than Norwegian, working day shifts, working full time and belonging to a younger age group) significantly increased the likelihood of experiencing a favorable work environment. Conclusion: The work environment in nursing homes is composed of modifiable contextual features. Action in relation to less favorable features and their associated factors should be a priority for nursing home management. This survey indicates that specific steps can be taken to reduce the reliance on part-time workers and to promote the work environment among staff working the night shift.publishedVersio

Effekter av tiltak for å redusere akutte sykehusinnleggelser fra sykehjem

Sykehjemsbeboere har ofte høy alder, flere kroniske sykdommer og lavt funksjonsnivå, noe som gjør dem sårbare for akutte forverringer i helsetilstanden. Gjeldende politiske føringer er å behandle lokalt i sykehjemmet så langt som mulig. Sykehusinnleggelser fra sykehjem kan være både riktig og helt nødvendig for at de eldre skal få best mulig helsehjelp. Formålet med denne rapporten er å gi en oversikt over effekt av tiltak for å redusere unødvendige sykehusinnleggelser fra sykehjem, det vil si kun der det finnes medisinsk forsvarlige alternativer til sykehusinnleggelse ved sykehjemmet. Vi inkluderte fire systematiske oversikter og fem primærstudier i oversikten. Til sammen ble 11 ulike tiltak vurdert og samlet i tre hovedkategorier. Tiltak for å strukturere og standardisere behandling og omsorg: - Fire av syv tiltak for å strukturere og standardisere behandling og omsorg viste færre sykehusinnleggelser for intervensjonsgruppene, men resultatene for dødelighet var uklare. Kvaliteten på dokumentasjonen ble bedømt til lav eller svært lav. Geriatriske spesialisttjenester: - Geriatriske spesialistteam sammenlignet med vanlig praksis viste færre sykehusinnleggelser i intervensjonsgruppene. Kvaliteten på dokumentasjonen ble bedømt til svært lav. Influensavaksinering: - Det er uklart om tilbud om influensavaksinering av helsepersonell i sykehjem påvirket antall sykehusinnleggelser, men resultatene viste færre tilfeller av influensalignende sykdom og færre dødsfall for pasientene i intervensjonsgruppen. Kvaliteten på dokumentasjonen ble bedømt til lav. - Influensavaksinering av sykehjemsbeboere viste færre sykehusinnleggelser og færre tilfeller av influensalignende sykdom og dødsfall for intervensjonsgruppen, men det er uklart om det påvirket bekreftet influensa. Kvaliteten på dokumentasjonen ble bedømt til svært lav. Få studier har evaluert effekt av tiltak for å redusere sykehusinnleggelser fra sykehjem. Selv om resultatene fra evalueringen av flere av tiltakene viste reduksjon i innleggelser, var dokumentasjonen for resultatene hovedsakelig av svært lav kvalitet. Dette gjør at vår tillit til resultatene også blir svært lav og vi kan derfor ikke trekke noen sikre konklusjoner om effekt på sykehusinnleggelse for noen av tiltakene

Indivdual and organizational features of a favourable work environment in nursing homes: a cross-sectional study

Background: The organizational context in healthcare (i.e., the work environment) is associated with patient outcomes and job satisfaction. Long-term care is often considered to be a challenging work environment, characterized by high job demands, low job control, a fast work pace and job dissatisfaction, which may affect patient care and increase staff turnover.This study aims to investigate the organizational context in nursing homes and the features of favorable or less favorable work environments. Methods: This study is a cross-sectional study of registered nurses and licensed practical nurses in Bergen, Norway (n = 1014). The K-means clustering algorithm was used to differentiate between favorable and less favorable work environments, based on the Alberta Context Tool. Multilevel logistic regression analysis was used to investigate the associations between individual sociodemographic factors, nursing home factors and the probability of experiencing a favorable work environment. Results: 45% of the sample (n = 453) experienced working in a favorable work environment. Contextual features (especially a supportive work culture, more evaluation mechanisms and greater organizational slack resources) and individual features (having a native language other than Norwegian, working day shifts, working full time and belonging to a younger age group) significantly increased the likelihood of experiencing a favorable work environment. Conclusion: The work environment in nursing homes is composed of modifiable contextual features. Action in relation to less favorable features and their associated factors should be a priority for nursing home management. This survey indicates that specific steps can be taken to reduce the reliance on part-time workers and to promote the work environment among staff working the night shift

Evidence-based practice profiles among bachelor students in four health disciplines: a cross-sectional study

Background: Despite the recognition of integrating evidence-based practice (EBP) in educational programs, there is limited research about bachelor students’ EBP profiles (EBP knowledge, attitudes and behaviour) in the health disciplines nursing, occupational therapy, physiotherapy and radiography. The aim of this study was to assess EBP profiles among bachelor students in health disciplines, and explore differences between health disciplines, educational institutions, students’ assessment of EBP teaching and expectations of EBP performance. Methods: A survey using the ‘Evidence-Based Practice Profile - Norwegian version’ (EBP2-N) was conducted among final year bachelor students in health disciplines from four educational institutions. The questionnaire consisted of five domains (Relevance, Terminology, Confidence, Practice and Sympathy) and assessed the five steps of EBP. We performed regression analyses to analyse mean differences in domain scores between health disciplines, Cohen’s d to illustrate the magnitude of the largest difference in each domain, Omega squared to describe portion of variance in domain scores, and Spearman’s rho (rs) to assess the monotonic relationship between EBP2-N domains and assessment of EBP teaching and expectations of EBP performance, respectively. Results: Students reported highest overall mean score for Relevance, with an estimated standardized mean of 81.2 (CI 95% = 80.4–82.0). The other EBP2–N domains had estimated standardized means of 54 and less. Statistically significant differences (p < 0.03) between health disciplines were observed for all domains. The largest mean difference was found for Relevance with highest score for occupational therapy and lowest for radiography, with an estimated Cohen’s d of 1.11. Moderate positive associations were observed between Relevance scores and students’ assessment of EBP teaching (rs = 0.31), and expectations of EBP performance from teachers (rs = 0.36). We also observed a moderate positive correlation between Confidence and students’ assessment of EBP teaching (rs = 0.46). Conclusion: Bachelor students in health disciplines found EBP relevant, but revealed low understanding of EBP terminology, low confidence with EBP skills, and low use of EBP in clinical situations. We observed differences in EBP profiles between health disciplines and between educational institutions. The differences in scores raise questions about the understanding of EBP within disciplines, and the complexity of EBP in educational settings