Using Video-Reflexive Ethnography to Engage Hospital Staff to Improve Dementia Care

In this article, we discuss how video-reflexive ethnography may be useful in engaging staff to improve dementia care in a hospital medical unit. Seven patients with dementia were involved in the production of patient-story videos, and fifty members of staff (nurses, physicians, and allied health practitioners) participated in video-reflexive groups. We identified five substantial themes to describe how video-reflexive groups might contribute to enacting person-centered care for improving dementia care: (a) seeing through patients’ eyes, (b) seeing normal strange and surprised, (c) seeing inside and between, (d) seeing with others inspires actions, and (e) seeing with the team builds a culture of learning. Our findings suggest that video reflexivity is not only useful for staff engagement but also effective in enhancing team capacity to enact person-centered care in the hospital setting

Environments for People with Dementia: Annotated Bibliography, Vol. II

This monograph reviews current literature published since 1986 about people with dementia, therapeutic goals for this population, and the social, organizational, and physical environments in which they live. This volume is a continuation of annotations of literature published prior to 1989 which follows the same conceptual framework.https://dc.uwm.edu/caupr_mono/1010/thumbnail.jp

Victoria Plaza Revisited: Lessons for the Evaluation of Housing for the Elderly

This monograph is based upon a workshop sponsored by the Institute on Aging and Environment at the 1994 EDRA Conference. San Antonio is the home of the first public housing facility specifically designed for older persons and the authors took the opportunity to reflect on the substantive and methodological issues that can be learned from Victoria Plaza. Frances Carp, who conducted the original longitudinal study, presents reflections on the early fray into Post Occupancy Evaluation and the lessons applicable today. Min Kantrowitz and Gerald Weisman present their comments and conclusions.https://dc.uwm.edu/caupr_mono/1020/thumbnail.jp

Appreciative Inquiry: Bridging Research and Practice in a Hospital Setting

Purpose:  In this action study, researchers worked with a team of interdisciplinary practitioners to co-develop knowledge and practice in a medical unit of a large urban hospital in Canada. An appreciative inquiry approach was utilized to guide the project. This article specifically focuses on examining the research experiences of practitioners and their accounts on how the research influenced their practice development to enact person-centered care. Method:  The project took place in the hospital’s medical unit. A total of 50 staff participants attended focus groups including nursing staff, allied health practitioners, unit leaders, and physicians. One senior hospital administrator was interviewed individually. In total, 36 focus groups were conducted to bring participants together to co-vision and co-develop person-centered care. Results:  Analysis of the data produced three themes: (a) appreciating the power of co-inquiry, (b) building team capacity, and (c) continuous development. Furthermore, 10 key enablers for engaging staff in the research process were developed from the data. A conceptual tool, “team Engagement Action Making” (TEAM) has been created to support others to do similar work in practice development. Conclusion:  An appreciative inquiry approach has the potential to address gaps in knowledge by revealing ways to take action. Future research should further investigate how the appreciative inquiry approach may be used to support bridging research and practice

Impact of Design Interventions in Nursing Home on Residents with Dementia, Their Families, and the Staff

The purpose of this study was to determine whether certain design interventions in a nursing home affected resident with dementia outcomes, family involvement and interaction, and staff perceptions of care delivery. The study was conducted in a nursing home. The study site included dining and bathing facilities that serve smaller groups of residents. The new design promised to contrast the medical orientation of the existing nursing home with a more residential environment. The study design involved a two-group pretest-posttest comparison in which a sample of residents who eventually were relocated to the newly designed wing of the facility (Treatment Group) was compared with a sample that remained in the existing setting (Control Group). Findings and implication of this study provide new knowledge integrating the diverse professional aspects that contribute to a responsive long-term care setting.https://dc.uwm.edu/caupr_mono/1011/thumbnail.jp

Everyday Walking Among Older Adults and the Neighborhood Built Environment: A Comparison Between Two Cities in North America

A walkable neighborhood becomes particularly important for older adults for whom physical activity and active transportation are critical for healthy aging-in-place. For many older adults, regular walking takes place in the neighborhood and is the primary mode of mobility. This study took place in eight neighborhoods in Metro Portland (USA) and Metro Vancouver (Canada), examining older adults\u27 walking behavior and neighborhood built environmental features. Older adults reported walking for recreation and transport in a cross-sectional telephone survey. Information on physical activity was combined with audits of 355 street segments using the Senior Walking Environmental Audit Tool-Revised (SWEAT-R). Multi-level regression models examined the relationship between built environmental characteristics and walking for transport or recreation. Older adults [N = 434, mean age: 71.6 (SD = 8.1)] walked more for transport in high-density neighborhoods and in Metro Vancouver compared to Metro Portland (M = 12.8 vs. M = 2.2 min/day; p < 0.001). No relationship was found between population density and walking for recreation. Older adults spent more time walking for transport if pedestrian crossing were present (p = 0.037) and if parks or outdoor fitness amenities were available (p = 0.022). The immediate neighborhood built environment supports walking for transport in older adults. Comparing two similar metropolitan areas highlighted that high population density is necessary, yet not a sufficient condition for walking in the neighborhood

Involving patients and families in a social robot study

Innovative research in care practice for older people can benefit from the active involvement of patient and family partners. Involvement may begin with identifying priorities, then move to formulate research questions and to plan the research methods, to data collection, and finally to analysis and knowledge dissemination. However, in the field of dementia care, actively engaging patients and families in co-research is a novel practice that needs exploration. This paper describes the experiences and perspectives of two patient researchers and three family researchers, along with four clinicians (two physicians, a nurse, and an occupational therapist) within a social robot project in dementia care. Meeting notes, team reflection focus groups, follow–up interviews, and a research journal were used to document the research process. The results are presented in three themes: (a) identify challenges and lessons learned, (b) co-inquire enriched learning, (c) co-produce knowledge for care improvement. All team members agreed that an inclusive environment was important to facilitate meaningful partnerships for undertaking research together. Trust and respect were seen as vital for a rewarding and productive experience in the co-inquiry journey. Some of the challenges to sustaining participant engagement were competing priorities and a risk of tokenism. This article provides a rich description as well as practical details of the research experiences among team members. We offer examples of lessons learned and practical tips to help others increase the engagement of patients and families in research. Experience Framework This article is associated with the Innovation & Technology lens of The Beryl Institute Experience Framework. (http://bit.ly/ExperienceFramework) Access other PXJ articles related to this lens. Access other resources related to this len

Aging in the Right Place

Background: This project builds upon a pilot study that documented innovative shelter/housing solutions that have not undergone rigorous evaluation but hold the promise of supporting “aging in the right place” for older persons (50+) with experiences of homelessness (OPEH) in Montreal, Calgary, and Vancouver. “Aging in the right place” means older adults remain in their homes and communities supported by housing, health, social services responsive to their unique lifestyles and needs. While our pilot study identified innovative shelter/housing solutions that support OPEH to establish and maintain a home and work towards aging in the right place, there remains a knowledge gap regarding what works, why it works, and for whom it works. Methods/Design: Through a community-based participatory research approach, we will conduct evaluations of 11 different promising shelter/housing practices to determine the types of practices that appear most useful in supporting aging in the right place, and the groups of OPEH for whom the promising practices work based on intersections of risk (e.g., age, gender, sexual orientation, race/ethnicity, disability, Indigenous status, and immigrant status). Our overall goal is to improve the shelter/housing options to meet the unique and complex health and social needs of OPEH across Canada. Discussion: Program evaluations will offer practice-based evidence of ways in which promising practices of shelter/housing might serve as best practices for supporting OPEH to establish and maintain a home and work towards aging in the right place. Project findings will inform housing, homelessness, health, and social service providers’ design and delivery of programs for OPEH to improve the sustainability of community housing, build provider capacity, and ensure supports that promote aging in the right place are sustained

Aging in the Right Place

Background: This project builds upon a pilot study that documented innovative shelter/housing solutions that have not undergone rigorous evaluation but hold the promise of supporting “aging in the right place” for older persons (50+) with experiences of homelessness (OPEH) in Montreal, Calgary, and Vancouver. “Aging in the right place” means older adults remain in their homes and communities supported by housing, health, social services responsive to their unique lifestyles and needs. While our pilot study identified innovative shelter/housing solutions that support OPEH to establish and maintain a home and work towards aging in the right place, there remains a knowledge gap regarding what works, why it works, and for whom it works. Methods/Design: Through a community-based participatory research approach, we will conduct evaluations of 11 different promising shelter/housing practices to determine the types of practices that appear most useful in supporting aging in the right place, and the groups of OPEH for whom the promising practices work based on intersections of risk (e.g., age, gender, sexual orientation, race/ethnicity, disability, Indigenous status, and immigrant status). Our overall goal is to improve the shelter/housing options to meet the unique and complex health and social needs of OPEH across Canada. Discussion: Program evaluations will offer practice-based evidence of ways in which promising practices of shelter/housing might serve as best practices for supporting OPEH to establish and maintain a home and work towards aging in the right place. Project findings will inform housing, homelessness, health, and social service providers’ design and delivery of programs for OPEH to improve the sustainability of community housing, build provider capacity, and ensure supports that promote aging in the right place are sustained

Making the Most of Mealtimes (M3): protocol of a multi-centre cross-sectional study of food intake and its determinants in older adults living in long term care homes

Background: Older adults living in long term care (LTC) homes are nutritionally vulnerable, often consuming insufficient energy, macro-and micronutrients to sustain their health and function. Multiple factors are proposed to influence food intake, yet our understanding of these diverse factors and their interactions are limited. The purpose of this paper is to fully describe the protocol used to examine determinants of food and fluid intake among older adults participating in the Making the Most of Mealtimes (M3) study. Methods: A conceptual framework that considers multi-level influences on mealtime experience, meal quality and meal access was used to design this multi-site cross-sectional study. Data were collected from 639 participants residing in 32 LTC homes in four Canadian provinces by trained researchers. Food intake was assessed with three-days of weighed food intake (main plate items), as well as estimations of side dishes, beverages and snacks and compared to the Dietary Reference Intake. Resident-level measures included: nutritional status, nutritional risk; disease conditions, medication, and diet prescriptions; oral health exam, signs of swallowing difficulty and olfactory ability; observed eating behaviours, type and number of staff assisting with eating; and food and foodservice satisfaction. Function, cognition, depression and pain were assessed using interRAI LTCF with selected items completed by researchers with care staff. Care staff completed a standardized person-directed care questionnaire. Researchers assessed dining rooms for physical and psychosocial aspects that could influence food intake. Management from each site completed a questionnaire that described the home, menu development, food production, out-sourcing of food, staffing levels, and staff training. Hierarchical regression models, accounting for clustering within province, home and dining room will be used to determine factors independently associated with energy and protein intake, as proxies for intake. Proportions of residents at risk of inadequate diets will also be determined. Discussion: This rigorous and comprehensive data collection in a large and diverse sample will provide, for the first time, the opportunity to consider important modifiable factors associated with poor food intake of residents in LTC. Identification of factors that are independently associated with food intake will help to develop effective interventions that support food intake.Canadian Institutes of Health Research (CIHR) , The PI is an endowed research chair with the Schlegel-University of Waterloo Research Institute for Aging; half of her salary is provided by this non-profit organizatio