Carole Estabrooks | University of Alberta (original) (raw)

Papers by Carole Estabrooks

BMC Medical Research Methodology, 2011

Background Organizational context has the potential to influence the use of new knowledge. Howeve... more Background Organizational context has the potential to influence the use of new knowledge. However, despite advances in understanding the theoretical base of organizational context, its measurement has not been adequately addressed, limiting our ability to quantify and assess context in healthcare settings and thus, advance development of contextual interventions to improve patient care. We developed the Alberta Context Tool (the ACT) to address this concern. It consists of 58 items representing 10 modifiable contextual concepts. We reported the initial validation of the ACT in 2009. This paper presents the second stage of the psychometric validation of the ACT. Methods We used the Standards for Educational and Psychological Testing to frame our validity assessment. Data from 645 English speaking healthcare aides from 25 urban residential long-term care facilities (nursing homes) in the three Canadian Prairie Provinces were used for this stage of validation. In this stage we focused...

F1000Research

Background: Multiple long-term care (LTC) reports have issued similar recommendations for improve... more Background: Multiple long-term care (LTC) reports have issued similar recommendations for improvement across Canadian LTC homes. Our primary objective was to identify the most common recommendations made over the past 10 years. Our secondary objective was to estimate the total cost of studying LTC issues repeatedly from 1998 to 2020. Methods: The qualitative and cost analyses were conducted in Canada from July to October 2020. Using a list of reports, inquiries and commissions from The Royal Society of Canada Working Group on Long-Term Care, we coded recurrent recommendations in LTC reports. We contacted the sponsoring organizations for a cost estimate, including direct and indirect costs. All costs were adjusted to 2020 Canadian dollar values. Results: Of the 80 Canadian LTC reports spanning the years of 1998 to 2020, 24 (30%) were based on a national level and 56 (70%) were focused on provinces or municipalities. Report length ranged from 4 to 1491 pages and the median number of c...

FACETS

The Royal Society of Canada Task Force on COVID-19 was formed in April 2020 to provide evidence-i... more The Royal Society of Canada Task Force on COVID-19 was formed in April 2020 to provide evidence-informed perspectives on major societal challenges in response to and recovery from COVID-19. The Task Force established a series of working groups to rapidly develop policy briefings, with the objective of supporting policy makers with evidence to inform their decisions. This paper reports the findings of the COVID-19 Long-Term Care (LTC) working group addressing a preferred future for LTC in Canada, with a specific focus on COVID-19 and the LTC workforce. First, the report addresses the research context and policy environment in Canada’s LTC sector before COVID-19 and then summarizes the existing knowledge base for integrated solutions to challenges that exist in the LTC sector. Second, the report outlines vulnerabilities exposed because of COVID-19, including deficiencies in the LTC sector that contributed to the magnitude of the COVID-19 crisis. This section focuses especially on the ...

Healthcare Policy | Politiques de Santé

International Journal of Health Policy and Management

Multi-sectoral, interdisciplinary health research is increasingly recognizing integrated knowledg... more Multi-sectoral, interdisciplinary health research is increasingly recognizing integrated knowledge translation (iKT) as essential. It is characterized by diverse research partnerships, and iterative knowledge engagement, translation processes and democratized knowledge production. This paper reviews the methodological complexity and decision-making of a large iKT project called Seniors - Adding Life to Years (SALTY), designed to generate evidence to improve late life in long-term care (LTC) settings across Canada. We discuss our approach to iKT by reviewing iterative processes of team development and knowledge engagement within the LTC sector. We conclude with a brief discussion of the important opportunities, challenges, and implications these processes have for LTC research, and the sector more broadly

BMC Geriatrics

Background The main objective is to better understand the prevalence of depressive symptoms, in l... more Background The main objective is to better understand the prevalence of depressive symptoms, in long-term care (LTC) residents with or without cognitive impairment across Western Canada. Secondary objectives are to examine comorbidities and other factors associated with of depressive symptoms, and treatments used in LTC. Methods 11,445 residents across a random sample of 91 LTC facilities, from 09/2014 to 05/2015, were stratified by owner-operator model (private for-profit, public or voluntary not-for-profit), size (small: 120 beds), location (Calgary and Edmonton Health Zones, Alberta; Fraser and Interior Health Regions, British Columbia; Winnipeg Health Region, Manitoba). Random intercept generalized linear mixed models with depressive symptoms as the dependent variable, cognitive impairment as primary independent variable, and resident, care unit and facility characteristics as covariates were used. Resident variables came from the Resident Assessment Instrument – Minimum Data S...

Journal of the American Medical Directors Association

BMJ Open

IntroductionIn the last decade, increasing research interest has been expressed in responsive beh... more IntroductionIn the last decade, increasing research interest has been expressed in responsive behaviours of older adults living in long-term care (LTC) homes, including nursing homes and assisted living facilities. Responsive behaviours are not only a sign of underlying unmet needs, but when directed against (towards) paid staff can lead to decreased quality of work life, and may contribute to lower quality of care. In this systematic review, we aim to synthesise empirically based quantitative and qualitative evidence on factors and stakeholder (eg, staff and family members) experiences of factors associated with the responsive behaviours of people living in LTC directed towards staff.Methods and analysisThis study will be a systematic review of published and ‘grey’ literature. Twelve bibliographical databases will be searched, and for each database, we will use appropriate subject headings and keywords that cover two concepts: LTC and responsive behaviour. No publication date or la...

International Journal of Health Policy and Management

HealthcarePapers, 2017

Kuluski et al.'s (2017) argument for including a more advanced form of health system performa... more Kuluski et al.'s (2017) argument for including a more advanced form of health system performance management centred on "the experience of care," raises the major challenge of creating and sustaining engagement-capable environments. Here I briefly address frameworks that may be useful in meeting this challenge - Complex Adaptive Systems, Innovation Diffusion, Whole System Change. I also offer a personal perspective drawn from a successful citizen engagement experience, concluding with a perspective on the numerous challenges we have or are in the process of overcoming compared to the challenges of engagement-capable environments.

BMC health services research, Jun 25, 2018

Job satisfaction is a predictor of intention to stay and turnover among allied healthcare provide... more Job satisfaction is a predictor of intention to stay and turnover among allied healthcare providers. However, there is limited research examining job satisfaction among allied health professionals, specifically in residential long-term care (LTC) settings. The purpose of this study was to identify factors (demographic, individual, and organizational) that predict job satisfaction among allied healthcare providers in residential LTC. We conducted a secondary analysis of data from Phase 2 of the Translating Research in Elder Care program. A total of 334 allied healthcare providers from 77 residential LTC in three Western Canadian provinces were included in the analysis. Generalized estimating equation modeling was used to assess demographics, individual, and organizational context predictors of allied healthcare providers' job satisfaction. We measured job satisfaction using the Michigan Organizational Assessment Questionnaire Job Satisfaction Subscale. Both individual and organiz...

Healthcare policy = Politiques de sante, Aug 1, 2018

With provincial policy changing institutional care provision for older adults who are unable to s... more With provincial policy changing institutional care provision for older adults who are unable to safely remain at home, supportive living represents a new middle-ground to provide care for older adults. We compared characteristics of supportive living staff and residents to those in long-term care (LTC), using facility and staff surveys, as well as administrative Resident Assessment Instrument (RAI) data, to describe differences and similarities between facility types. Data analysis included t-tests, chi-square tests, ridit analyses and odds ratios. Participants from 15 supportive living facilities were compared to participants from eight LTC homes. Supportive living healthcare aides were younger, worked fewer years and were more likely to work full time than LTC healthcare aides. LTC residents were more likely than supportive living residents to have: cognitive impairment, medical instability, and activities of daily living dependence. This knowledge, which situates supportive livin...

Journal of Health Services Research & Policy

Background Scholarship cites health care managers (HCMs) as not using research evidence in their ... more Background Scholarship cites health care managers (HCMs) as not using research evidence in their management practice. The purpose of this review was to evaluate the effectiveness of interventions to enhance HCMs use of research evidence in practice. Methods We carried out a systematic review and focus groups to validate the review findings. We searched 10 electronic databases for studies reporting on interventions for HCMs to enhance research utilization in their practice. Qualitative studies were analysed using Hoon’s approach to meta-synthesis. Results Seven, primarily qualitative, studies of varying quality (reported in 11 articles) met our inclusion criteria. Interventions to enhance research use by HCMs included: informal and formal training, computer-based application, executive-level knowledge translation activities and residency programmes. Studies did not report efficacy of interventions or impacts of increasing managers’ use of research on staff or patient outcomes. Meta-s...

BMJ open, Jan 13, 2018

This study explored the effect of clinical educators as facilitators of research use and how it m... more This study explored the effect of clinical educators as facilitators of research use and how it may be modified by organisational context in the settings. Cross-sectional observational study. A representative sample of 91 residential long-term care (LTC) facilities across Western Canada. We used surveys to collect data from the frontline care aides and information about the organisational context of the care units. We assessed research use (the outcome) with the Conceptual Research Utilization (CRU) scale. Explanatory variables in the multiple regression analysis were facilitation, organisational context and the interaction terms. Facilitation was measured by the frequency of contacts between care aides and clinical educator or person who brings new ideas about resident care. Three core organisational context variables were measured using the Alberta Context Tool. We included data of 3873 care aides from 294 care units in the LTC facilities. We found significant associations between...

International journal of health policy and management, Jan 6, 2018

Implementing effective interventions in healthcare requires organizations to be ready to support ... more Implementing effective interventions in healthcare requires organizations to be ready to support change. This study aimed to develop, adapt transculturally, and assess the content and face validity of the Organizational Readiness for Knowledge Translation (OR4KT) tool. The OR4KT was designed to measure the readiness of healthcare organizations to implement evidence-informed change across a variety of services. Based on systematic reviews of the literature, a Delphi exercise, and expert consultation, we first generated an initial pool of items. Second, we developed and assessed content validity of the pilot OR4KT questionnaire in English. Third, we created French and Spanish versions using a sequential forward and backward translation approach, and transcultural adaptation by a consensus process. Finally, we conducted pilot studies in three contexts - the Basque country region (Spain), and the provinces of Québec and Ontario (Canada) - where 30 experts assessed the face validity of t...

Canadian journal on aging = La revue canadienne du vieillissement, Jan 9, 2018

ABSTRACTUnregulated care aides provide most of the direct care to nursing home residents. We prev... more ABSTRACTUnregulated care aides provide most of the direct care to nursing home residents. We previously reported the first demographic profile of care aides in Western Canada through the Translating Research in Elder Care (TREC) longitudinal research program (2007-2022) in applied health services. Here we describe demographic, health, and work life characteristics of aides from 91 nursing homes in Western Canada. Demographics and work life varied significantly across health regions and facility owner-operator models. Our longitudinal cohort of aides from Alberta and Winnipeg had higher emotional exhaustion (a negative attribute), professional efficacy (a positive attribute), and experience of dementia-related responsive behaviours from residents. Overall, results indicate little improvement or worsening of care aide health and quality of work life. Coupled with limited provincial or national initiatives for workforce planning and training of these workers, this signals a long-term c...

Canadian journal on aging = La revue canadienne du vieillissement, Mar 1, 2018

Older adults who have reduced decision-making capacity and no family or friends to compensate for... more Older adults who have reduced decision-making capacity and no family or friends to compensate for these deficiencies are known as unbefriended and require a public guardian. The purpose of this study was to review the peer-reviewed and grey literature to determine the scope of available research on unbefriended older adults in Canada and the United States. We found limited research examining unbefriended older adults. No Canadian studies or reports were located. Unbefriended older adults were childless or had fewer children, were more cognitively impaired, and were older than older adults who were not unbefriended. These findings demonstrate a stark scarcity of studies on unbefriended older adults. Research is urgently needed using standardized data collection of guardianship status in order to enable studies of the prevalence of public guardianship in Canada.

Canadian journal on aging = La revue canadienne du vieillissement, Jan 25, 2018

ABSTRACTAvailability of health professionals is fundamental to population health. Multiple trends... more ABSTRACTAvailability of health professionals is fundamental to population health. Multiple trends contribute to provider shortages. Develop and validate conceptual models of early and involuntary retirement among registered nurses (RNs) and allied health professionals (AHPs). A review of retirement literature (n = 23 studies). Any factor reported as predictive of early or involuntary retirement was incorporated into a model. To achieve face validity, we conducted interviews with Canadian RNs/AHPs (n = 14). The conceptual model of early retirement had eight categories (38 variables): workplace characteristics, socio-demographics, attitudes/beliefs, broader context, organizational factors, family, lifestyle/health, and work-related. The model of involuntary retirement had four categories (eight variables): broader context, socio-demographics, lifestyle/health, and family. Caregiving responsibilities (variable) was added based on interview data. RNs/AHPs consider many factors when cont...

BMC Medical Research Methodology, 2011

F1000Research

FACETS

Healthcare Policy | Politiques de Santé

International Journal of Health Policy and Management

BMC Geriatrics

Journal of the American Medical Directors Association

BMJ Open

International Journal of Health Policy and Management

HealthcarePapers, 2017

BMC health services research, Jun 25, 2018

Healthcare policy = Politiques de sante, Aug 1, 2018

Journal of Health Services Research & Policy

BMJ open, Jan 13, 2018

International journal of health policy and management, Jan 6, 2018

Canadian journal on aging = La revue canadienne du vieillissement, Jan 9, 2018

Canadian journal on aging = La revue canadienne du vieillissement, Mar 1, 2018

Canadian journal on aging = La revue canadienne du vieillissement, Jan 25, 2018

urses of many different titles provide the majority of healthcare globally. In Canada alone nearl... more urses of many different titles provide the majority of healthcare globally. In Canada alone nearly 300,000 regulated individuals provided nursing care including 230,957 Registered Nurses 1 , 5132 Registered Psychiatric Nurses 2 , and 60,123 Licensed Practical Nurses 3 [2002 data]. In addition, many thousands of unregulated workers (e.g., nursing aides, patient care aids, etc.) also deliver nursing care. Increasingly, we read reports documenting how the organization of nursing services influences patient and system outcomes. Lower mortality, decreased length of stay, reduced complications, fewer readmissions in acute care facilities, and decreased restraint use, contractures, and pressure ulcers in long-term care settings are examples of outcomes that we now know are affected by nursing service delivery 4-9 . To state that improving care improves patient and system outcomes is obvious. What is less obvious are the mechanisms by which this is accomplished. Our team believes that one important approach to improving care is to increase the use of research at the point of care deliveryto systematically improve the care provided by individual delivering nursing serviceseven incrementallywill have a dramatic effect on patient and system outcomes.

European Journal of Cancer, 2011

Background: Seniors living in long-term residential facilities are among the frailest, ill and el... more Background: Seniors living in long-term residential facilities are among the frailest, ill and elderly citizens of our society. Many have dementia and cancer, and are most often cared for by an unregulated workforce − healthcare aides (HCA) supervised by a small number of nurses and managers. For most HCA, English is a second language and role training was either informal job training or a 6−9 month course. Responsibilities for strengthening HCA performance falls largely on nurses and care managers, yet they rarely see this as their role, nor receive formal training in how to coach performance. In this project, we investigated impact of a 2-day workshop for managers to develop coaching skills.
The purpose of this pilot was to examine experiences of becoming coaches of staff performance, and potential impact on HCA performance that can inﬂuence outcomes for residents. Our objectives were to a) identify opportunities for managers to coach performance in residential care facilities, b) understand managers’ experiences in developing coaching skills, c) examine opportunities where managers have used coaching skills in practice following the workshop, and d) obtain funding for a full research study using a 2-group crossover design to further assess effectiveness of this intervention.
Materials and Methods: 26 managers from 6 long term care residential settings were recruited to participate in a 2-day workshop facilitated by a master trainer in coaching. Survey data were collected 2 weeks prior and 6 months post workshop. Data sources also included email reminders to use coaching skills and two focus groups 8 weeks post workshop. Results: The majority of participants reported many more opportunities to coach their after the workshop than they had seen before. Statistically signiﬁcant differences in many critical feedback processes were seen post workshop, particularly in the willingness of managers to take on the coaching role, and to provide speciﬁc feedback on how HCAs could communicate and interact more effectively with residents to improve their quality of life. The full two group cross-over design study is currently
underway.
Conclusions: The pilot outcomes yield a rich understanding of the processes of becoming a coach and its potential inﬂuence on staff performance in order to improve quality of life outcomes for seniors, most of whom will never leave this residential care facility. The program provides managers with speciﬁc skills and techniques to support and reinforce efforts by staff to improve health care services. Developing coaching skills is complex, relational, timely and easier when participants work together to share experiences of their own learning to help staff change behavior.