ERA

Health Systems

The Health Systems Area of Excellence (AoE) develops knowledge about health system learning and innovation to guide evidence-based practice and evidence-informed decision- and policy making across health care sectors and acute, continuing, ambulatory and community settings.
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  1. The potential for nurses to contribute to and lead improvement science in health care [Download]

    Title: The potential for nurses to contribute to and lead improvement science in health care
    Creator: Flynn, Rachel
    Description: Aim. A discussion of how nurses can contribute to and lead improvement science activities in healthcare. Background. Quality failures in healthcare have led to the urgent need for healthcare quality improvement. However, too often quality improvement interventions proceed to practice implementation without rigorous methods or sufficient empirical evidence. This lack of evidence for quality improvement has led to the development of improvement science, which embodies quality improvement research and quality improvement practice. This paper discusses how the discipline of nursing and the nursing profession possesses many strengths that enable nurses to lead and to play an integral role in improvement science activities. However, we also discuss that there are insufficiencies in nursing education that require attention for nurses to truly contribute to and lead improvement science in healthcare. Design. Discussion paper Data Sources. This paper builds on a collection of our previous work, a 12-month scoping review (March 2013-March 2014), baseline study on a quality improvement management system (Lean), interviews with nurses on quality improvement implementation and supporting literature. Implications for Nursing. This paper highlights how nurses have the philosophical, theoretical, political and ethical positioning to contribute to and lead improvement science activities. However up to now, the potential for nurses to lead improvement science activities has not been fully used. Conclusion. We suggest that one starting point is to include improvement science in nursing education curricula. Specifically, there needs to be increased focus on the nursing roles and skills needed to contribute to and lead healthcare improvement science activities.
    Subjects: Improvement science, Quality improvement, Nursing, Nursing education
    Date Created: 2017
  2. Hearing loss and cognitive-communication test performance of long-term care residents with dementia: Effects of amplification [Download]

    Title: Hearing loss and cognitive-communication test performance of long-term care residents with dementia: Effects of amplification
    Creator: Hopper, Tammy
    Description: Purpose: The study aims were: 1) to explore the relationship between hearing loss and cognitive-communication performance of individuals with dementia, and 2) to determine if hearing loss is accurately identified by long-term care (LTC) staff. The research questions were: 1) What is the effect of amplification on cognitive-communication test performance of LTC residents with early to middle-stage dementia and mild-to-moderate hearing loss? 2) What is the relationship between measured hearing ability and hearing ability recorded by staff using Resident Assessment Instrument-Minimum Data Set 2.0 (RAI-MDS)? Method: Thirty-one residents from five long-term care facilities participated in this quasi-experimental cross-over study. Residents participated in cognitive-communication testing with and without amplification. RAI-MDS ratings of participants’ hearing were compared to audiological assessment results. Results: Participants’ Speech Intelligibility Index scores significantly improved with amplification; however, participants did not demonstrate significant improvement in cognitive communication test scores with amplification. A significant correlation was found between participants’ average pure-tone thresholds and RAI-MDS ratings of hearing, yet misclassification of hearing loss occurred for 44% of participants. Conclusions: Measuring short-term improvement of performance-based cognitive communication may not be the most effective means to assess amplification for individuals with dementia. Hearing screenings and staff education remain necessary to promote hearing health for LTC residents.
    Subjects: Hearing loss, Amplification, Dementia
    Date Created: 12/2016
  3. Forms of Capital as Facilitators of Internationally Educated Nurses’ Integration into the Registered Nursing Workforce in Canada [Download]

    Title: Forms of Capital as Facilitators of Internationally Educated Nurses’ Integration into the Registered Nursing Workforce in Canada
    Creator: Covell, Christine L.
    Description: We used interview data to explore internationally educated nurses’ perceptions of the factors that facilitated their integration into the registered nursing workforce in Canada. The participants perceived that a variety of interrelated factors facilitated their integration. The identified factors seem to reflect forms of capital. Economic capital (availability of financial resources) and cultural capital (language proficiency and competency in professional vocabulary) enabled the participants to use other forms of capital to become registered and employed in Canada. Providing financial resources and interventions to develop their language skills may assist internationally educated nurses with more rapidly integrating into the country’s nursing workforce.
    Subjects: Capital, Employment, Integration, Internationally educated nurses, Migration, Registration
    Date Created: 2015/08
  4. Nurse Dose: Linking Staffing Variables to Adverse Patient Outcomes [Download]

    Title: Nurse Dose: Linking Staffing Variables to Adverse Patient Outcomes
    Creator: Manojlovich, Milisa
    Description: Background: Inconsistent findings in over 100 studies have made it difficult to explain how variation in nurse staffing affects patient outcomes. Nurse dose, defined as the level of nurses required to provide patient care in hospital settings, draws on variables used in staffing studies to describe the influence of many staffing variables on outcomes. Objectives: The purpose of this study was to examine the construct validity of nurse dose by determining its association with MRSA infections and reported patient falls on a sample of inpatient adult acute care units. Method: Staffing data came from 26 units in Ontario Canada and Michigan. Financial and human resource data were data sources for staffing variables. Sources of data for MRSA came from Infection Control departments. Incident reports were the data source for patient falls. Data analysis consisted of bivariate correlations and Poisson regression. Results: Bivariate correlations revealed that nurse dose attributes (active ingredient and intensity) were significantly associated with both outcomes. Active ingredient (education, experience, skill mix), and intensity (FTE, RN-patient ratio, RN-HPPD) were significant predictors of MRSA. Coefficients for both attributes were negative and almost identical. Both attributes were significant predictors of reported patient falls and coefficients were again negative, but coefficient sizes differed. Discussion: By conceptualizing nurse and staffing variables (education, experience, skill mix, FTEs, RN-patient ratio, RN-HPPD) as components of nurse dose, and by including these in the same analysis, we were able to determine their relative influence on MRSA infections and reported patient falls.
    Subjects: Outcome assessment, Personnel staffing, Nursing theory
    Date Created: 2011
  5. Nursing Intellectual Capital Theory: Testing selected propositions [Download]

    Title: Nursing Intellectual Capital Theory: Testing selected propositions
    Creator: Covell, Christine L.
    Description: Aims: To test selected propositions of the middle-range theory of nursing intellectual capital. Background: The nursing intellectual capital theory conceptualizes nursing knowledge’s influence on patient and organizational outcomes. The theory proposes nursing human capital, nurses’ knowledge, skills and experience, is related to the quality of patient care and nurse recruitment and retention of an inpatient care unit. Two factors within the work environment, nurse staffing and employer support for nurse continuing professional development, are proposed to influence nursing human capital’s association with patient and organizational outcomes. Design: A cross-sectional survey design. Methods: The study took place in 2008 in 6 Canadian acute care hospitals. Financial, human resource and risk data were collected from hospital departments and unit managers. Clearly specified empirical indicators quantified the study variables. The propositions of the theory were tested with data from 91 inpatient care units using structural equation modeling. Results: The propositions associated with the nursing human capital concept were supported. The propositions associated with the employer support for nurse continuing professional development concept were not. The proposition that nurse staffing’s influences on patient outcomes was mediated by the nursing human capital of an inpatient unit, was partially supported. Conclusion: Some of the theory’s propositions were empirically validated. Additional theoretical work required to refine the operationalization and measurement of some of the theory’s concepts. Additional research with larger samples of data from different geographical settings and types of hospitals is required to determine if the theory can withstand empirical scrutiny.
    Subjects: Nursing Theory, Continuing Education, Human Capital, Nurse Staffing, Structural Equation Modeling
    Date Created: 2013/03/05
  6. Nursing Intellectual Capital Theory: Operationalization and Empirical Validation of Concepts [Download]

    Title: Nursing Intellectual Capital Theory: Operationalization and Empirical Validation of Concepts
    Creator: Covell, Christine L.
    Description: Aims: This paper presents the operationalization of concepts in the nursing intellectual capital theory and the results of a methodological study aimed to empirically validate the concepts. Background: The nursing intellectual capital theory proposes the stocks of nursing knowledge within an organization are embedded in two concepts, nursing human capital and nursing structural capital. The theory also proposes that two concepts within the work environment, nurse staffing and employer support for nursing continuing professional development influence nursing human capital. Methods: A systematic three-step process was used to operationalize the concepts of the theory. In 2008, a cross-sectional design was used to collect data for 147 inpatient units from administrative departments and unit managers in 6 Canadian hospitals. Exploratory factor analyses were conducted to determine if the indicator variables accurately reflect their respective concepts. Results: The proposed indicator variables collectively measured the nurse staffing concept. Three indicators were retained to construct nursing human capital: clinical expertise and experience concept. The nursing structural capital and employer support for nursing continuing professional development concepts were not validated empirically. Conclusion: The nurse staffing and the nursing human capital: clinical expertise and experience concepts will be brought forward for further model testing. Refinement for some of the indicator variables of the concepts is indicated. Additional research is required with different sources of data to confirm the findings.
    Subjects: Nursing Theory, Continuing Education, Human Capital, Nurse Staffing, Exploratory Factor Analysis
    Date Created: 2012/11/16
  7. Scoping the Literature about Internationally Educated Nurses in Canada: Mapping a Research Agenda [Download]

    Title: Scoping the Literature about Internationally Educated Nurses in Canada: Mapping a Research Agenda
    Creator: Covell, Christine L.
    Description: The purpose of this scoping review was to map the key themes in the Canadian literature about the professional integration of internationally educated nurses (IENs), identify the types, sources and gaps in evidence, and provide recommendations for research. The review was guided by a six-step methodological framework for scoping reviews. The search and selection of the academic and grey literature published between 2000 -2013 resulted in the retention of 157 papers for full-text screening. Major themes derived from the literature reflect stages of IENs’ professional integration: pre-immigration and early arrival, professional recertification, workforce integration, and workplace integration. Data were extracted, coded and collated using electronic charts. Numerical and qualitative thematic summaries were used to analyze the data. Recommendations for research include: creating data systems to track IEN immigration and integration; determining the effectiveness of programs and policies for IENs, examining the influence of language proficiency on professional recertification, workplace integration and patient safety.
    Subjects: Human resources, Internationally educated nurses, Integration, Recertification, Scoping review, Canada
    Date Created: 2014
  8. ICU and non-ICU cost per day. [Download]

    Title: ICU and non-ICU cost per day.
    Creator: Norris, C. M.
    Description: The purpose of this study was to compare the cost of a day spent in an intensive care unit and a day spent on a general nursing unit. A descriptive design was used, based on patient level data, to examine and compare unit costs per day for each of the ICU and non-ICU portions of a patient’s hospital stay. Records from 386 patients who were treated in a general medical/surgical ICU were analyzed. Records for patients who received both ICU and non-ICU care during their stay were retained. Patients were categorized according to whether they had received surgical care prior to admission to the ICU (surgical group) or had no surgical care (medical group). The groups were further divided, based on whether they were discharged from hospital (survivors), or died following transfers from the ICU (non-survivors). All four groups; surgical or medical, survivors and non-survivors, were analyzed separately. The ICU direct costs per day for survivors were between six and seven times those for non-ICU care. A one day substitution of general ward for ICU care would result in a cost reduction of $1,200 per patient for survivors. The results suggest that the savings achieved by moving a patient from ICU to non-ICU care are considerable, particularly for less severe surviving patients. In making such decisions, however, clinicians must examine prospective benefits as well as costs. If the health outcomes are not influenced, the savings from substitution are considerable, and there is a strong economic argument for substitution.
    Subjects: intensive care, costs, nursing research
  9. Preoperative Statin use and outcomes after cardiac surgery. [Download]

    Title: Preoperative Statin use and outcomes after cardiac surgery.
    Creator: Mohamed, R.
    Description: Background. It has been suggested that the routine use of statins preoperatively would reduce the risk of postoperative infection. We conducted this study to explore whether preoperative statin use was associated with infection after cardiac surgery (recipients of which have a higher-than-average risk of postoperative infection). Methods. We performed secondary analysis of data collected in a prospective cohort study of adults who underwent nontransplant cardiac surgery in a university hospital during the period January 1999 through December 2005. Outcomes were ascertained in a blinded and independent fashion. Results. Of the 7733 patients, 2657 (34%) were taking statins preoperatively; the proportion increased from 16% during 1999–2000 to 53% during 2003–2005 (P
    Subjects: disease, trials, complications, population-based cohort, outcomes, sepsis, mortality, vascular surgery, bypass graft-surgery, therapy
  10. Quality of Life after Coronary Revascularization in the Elderly. [Download]

    Title: Quality of Life after Coronary Revascularization in the Elderly.
    Creator: Graham, M.M.
    Description: Aims: To describe health status outcomes at 4 years for a cohort of elderly patients with cardiac disease. Methods and results: Using the Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease, an outcomes initiative capturing all patients undergoing cardiac catheterization in Alberta, Canada, health status was measured using the Seattle Angina Questionnaire (SAQ) and crude and risk-adjusted outcomes were determined and compared for patients treated with percutaneous coronary intervention or coronary artery bypass surgery (CABG) vs. medical therapy. Response rates among surviving, consenting patients were 64.8% for patients <70 years (n=7883), 77.3% for patients aged 70–79 years (n=2940), and 77.7% for patients ≥80 years of age (n=439). For patients aged <70 years, and those aged 70–79 years, for all dimensions of the SAQ, scores were significantly better for patients treated with revascularization procedures than with medical therapy. For patients over the age of 80 years, scores for patients treated with CABG in particular were significantly better, with the exception of exertional capacity. At 3 years, all scores remained stable or improved, and continued to favour revascularization. Conclusion: Elderly patients undergoing revascularization have better health status at 4 years than do those in the same age group who do not undergo revascularization. These findings suggest that age should not deter against revascularization given the combined survival and quality-of-life benefits.
    Subjects: morbidity, revascularization, aging, coronary disease