Browsing by Author "Holroyd-Leduc, Jayna M."
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- ItemOpen AccessAn Interpretive Ethnography: Nursing Culture for People with Dementia and Behavioral and Psychological Symptoms of Dementia in the Acute Care Environment(2018-09-12) Hannaford, Sara Anne Dellarie; Venturato, Lorraine; Fox, Loralee; Holroyd-Leduc, Jayna M.; Raffin Bouchal, ShelleyObjectives: Acute care nurses care for people with dementia (PWD) who suffer from behavioral and psychological symptoms of dementia (BPSD) in care environments that may worsen BPSD. The purpose of this study is to understand the nursing culture of care that exists for PWD with BPSD, and align this culture of care with the theory of person-centered dementia care (PCC). Methods: An interpretive ethnography approach was used, and data was collected on a general medicine unit at one acute hospital through 75 hours of participant observation and five semi-structured interviews with registered nurses and licensed practical nurses. Data was thematically analyzed. Results: A number of facilitators (teamwork, creativity, knowing the person, care plans, flexibility) and barriers (time constraints, safety, restraint use) for prevision of PCC to PWD and BPSD were identified. The culture of care for PWD with BPSD is shaped by formal protocols, informal protocols or unwritten rules, and beliefs about PWD and the nurses’ role in acute care. Nurses’ ability to provide PCC is limited by the incompatibility between the needs of the PWD and the acute care environment, and risk-averse safety culture that promotes physical safety over the needs and wants of the PWD. Conclusion: PWD with BPSD should be supported outside of the acute care environment when possible. The acute care environment needs to become more dementia friendly, and nurses need support and permission on a systems and individual level to re-conceptualize the meaning of risk for PWD with BPSD.
- ItemOpen AccessThe Development of Patient Safety Indicators for Critically Ill Patients Admitted to the Intensive Care Unit(2020-07-09) Wu, Guosong; Stelfox, Henry Thomas; Wu, Qunhong; Quan, Hude; Ronksley, Paul Everett; Holroyd-Leduc, Jayna M.Patient safety is a top priority in critical care. Patient safety indicators (PSIs) have been developed to measure critical care safety. Despite several approaches have been used to develop PSIs (deductive, inductive, and joint approach), PSIs are widely applied to measure the care performance in Intensive Care Units (ICUs). The overall objective of this thesis was to use a joint approach to develop a PSI that can be used to evaluate the safety of critical care and to assess the reliability and validity of this PSI. Three studies were conducted to achieve this objective. In the first study, we systematically reviewed the literature of PSIs proposed for patients admitted to an ICU. Heterogeneity of PSI definitions were observed. Among 44 unique PSIs identified from 21 studies, reliability and validity of four PSIs was only reported in one study. In the second study, a panel of ICU experts evaluated the 44 unique PSIs identified in our systematic review. The expert panel proposed an additional 20 PSIs and, during a second round, evaluated and prioritized the 64 PSIs using a modified RAND Appropriateness Method. The top ten ranked PSIs included clinically important concepts that had data available in a local electronic database. This included patient falls, which we investigated in our final study. In the third study, we constructed a fall risk predictive model leveraging provincial electronic medical record (EMR) and examined its reliability and validity. Overall, fall incidence rate was 1.55 (95% CI 1.36-1.76) per 1,000 patient days. The model displayed an excellent discrimination (AUC 0.82) and calibration. We propose the definition of Risk-adjusted Standardized Fall Rate (RSFR) to compared critical care performance across sites and overtime in order to test effectiveness of quality improvement strategies. RSFR demonstrates good test re-test reliability (r=0.662) and construct validity (r=0.533). The study proposed PSI for patient falls was developed from a comprehensive systematic review of the literature, structured expert panel review of candidate PSIs, and validated using a local EMR database. The main findings of this thesis support RSFR could be measured and monitored provincially or nationally to benchmark critical care safety performance.
- ItemOpen AccessExamining the Sustainability of Screening for Distress, the Sixth Vital Sign, in Two Outpatient Oncology Clinics(2013-12-23) Groff, Shannon; Holroyd-Leduc, Jayna M.; Bultz, BarryBackground: This study explored the sustainability of Screening for Distress, a program that facilitates distress management, in two cancer clinics six months post-implementation. Methods: A mixed-method cross-sectional design was utilized. To assess program sustainability and explore the barriers and facilitators of sustainability 184 charts were reviewed and sixteen semi-structured interviews were conducted. Results: 163 (88.6%) charts had completed tools and a conversation about the tool took place in 130 (79.8%) of those. 89 (54.6%) tools warranted an intervention and 68 (76.4%) of those had an intervention documented. Five themes influencing sustainability emerged: attitudes, knowledge and beliefs, outcome expectancy, implementation approach, integration with existing practices, and external factors. Conclusions: This study suggests that screening was largely sustained, possibly due to positive attitudes and outcome expectancy. However, sustainability may be enhanced by formally integrating screening with existing practices, addressing potential knowledge gaps, and ensuring engagement with all stakeholder groups.
- ItemOpen AccessMulti-disciplinary supportive end of life care in long-term care: an integrative approach to improving end of life(2021-05-22) Harasym, Patricia M.; Afzaal, Misha; Brisbin, Sarah; Sinnarajah, Aynharan; Venturato, Lorraine; Quail, Patrick; Kaasalainen, Sharon; Straus, Sharon; Sussman, Tamara; Virk, Navjot; Holroyd-Leduc, Jayna M.Abstract Background Optimal supportive end of life care for frail, older adults in long term care (LTC) homes involves symptom management, family participation, advance care plans, and organizational support. This 2-phase study aimed to combine multi-disciplinary opinions, build group consensus, and identify the top interventions needed to develop a supportive end of life care strategy for LTC. Methods A consensus-building approach was undertaken in 2 Phases. The first phase deployed modified Delphi questionnaires to address and transform diverse opinions into group consensus. The second phase explored and prioritized the interventions needed to develop a supportive end of life care strategy for LTC. Development of the Delphi questionnaire was based on findings from published results of physician perspectives of barriers and facilitators to optimal supportive end of life care in LTC, a literature search of palliative care models in LTC, and published results of patient, family and nursing perspectives of supportive end of life care in long term care. The second phase involved World Café Style workshop discussions. A multi-disciplinary purposive sample of individuals inclusive of physicians; staff, administrators, residents, family members, and content experts in palliative care, and researchers in geriatrics and gerontology participated in round one of the modified Delphi questionnaire. A second purposive sample derived from round one participants completed the second round of the modified Delphi questionnaire. A third purposive sample (including participants from the Delphi panel) then convened to identify the top priorities needed to develop a supportive end-of-life care strategy for LTC. Results 19 participants rated 75 statements on a 9-point Likert scale during the first round of the modified Delphi questionnaire. 11 participants (participation rate 58 %) completed the second round of the modified Delphi questionnaire and reached consensus on the inclusion of 71candidate statements. 35 multidisciplinary participants discussed the 71 statements remaining and prioritized the top clinical practice, communication, and policy interventions needed to develop a supportive end of life strategy for LTC. Conclusions Multi-disciplinary stakeholders identified and prioritized the top interventions needed to develop a 5-point supportive end of life care strategy for LTC.
- ItemOpen AccessOptimizing Advance Care Planning in the Acute Cardiac Care Setting: A combined quality improvement and knowledge translation approach.(2019-03-17) Shaw, Marta; Holroyd-Leduc, Jayna M.; Simon, Jessica E.; White, Deborah Elizabeth; Flemons, William Ward; Grant, Jeff AndrewAdvance care planning (ACP) is a process by which patients are able to prepare for future in-the-moment medical decision-making and share their values, wishes and preferences. ACP is important as patients are often not well informed about life-sustaining treatments, they can endure more invasive care at end of life than they would want, and they spend more time in hospital than they prefer. Despite known benefits of ACP and recognition of its importance, its integration into regular clinical workflow remains limited. We conducted three studies to examine and address the problem of integrating ACP process into clinical workflow. The first study utilized qualitative methods to characterize ACP process across clinical contexts. In the second study, we utilized an integrated knowledge translation approach to design and implement a multifaceted intervention to routinize ACP process in one hospital unit. We assessed outcomes using an interrupted time series design, and collected data for thirty-two weeks; before, during and after the intervention period. In our third study, we utilized multiple methods to conduct a process evaluation to better understand the effectiveness of our ACP intervention implementation procedure. From our first study, we found that there was significant variability of ACP process both across and within clinical contexts. Segmented regression analysis from our ACP intervention, showed an increase in the proportion of patients to be discharged with a prepared green sleeve, containing their ACP documentation. No significant change was measured for the remaining process and outcome measures. The process evaluation indicated that limitations in the engagement of physicians may have constrained the impact of the intervention. Future opportunities have already begun to address implementation challenges of this work and are using tailored and targeted approaches to improve the reach of intervention components. This program of study comprised of an effort to improve the integration of ACP process into clinical workflow using an iKT approach. Process evaluation helped to provide a deeper understanding of the implementation process. Future research can help to address implementation challenges of this study by focusing on tailored engagement of knowledge users and a strengthening of skill and team building.
- ItemOpen AccessA pragmatic study exploring the prevention of delirium among hospitalized older hip fracture patients: Applying evidence to routine clinical practice using clinical decision support(BioMed Central, 2010-10-22) Holroyd-Leduc, Jayna M.; Abelseth, Greg A.; Khandwala, Farah; Silvius, James L.; Hogan, David B.; Schmaltz, Heidi N.; Frank, Cyril B.; Straus, Sharon E
- ItemOpen AccessPrioritization of indicators of the quality of care provided to older adults with frailty by key stakeholders from five canadian provinces(2022-02-23) Giguere, Anik; Holroyd-Leduc, Jayna M.; Straus, Sharon E.; Urquhart, Robin; Turcotte, Véronique; Durand, Pierre J.; Turgeon, AlexisAbstract Background To meet the needs of older adults with frailty better, it is essential to understand which aspects of care are important from their perspective. We therefore sought to assess the importance of a set of quality indicators (QI) for monitoring outcomes in this population. Methods In this mixed-method study, key stakeholders completed a survey on the importance of 36 QIs, and then explained their ratings in a semi-structured interview. Stakeholders included older adults with frailty and their caregivers, healthcare providers (HCPs), and healthcare administrators or policy/decision makers (DMs). We conducted descriptive statistical analyses of quantitative variables, and deductive thematic qualitative analyses of interview transcripts. Results The 42 participants (8 older adults, 18 HCPs, and 16 DMs) rated six QIs as more important: increasing the patients’ quality of life; increasing healthcare staff skills; decreasing patients’ symptoms; decreasing family caregiver burden; increasing patients’ satisfaction with care; and increasing family doctor continuity of care. Conclusions Key stakeholders prioritized QIs that focus on outcomes targeted to patients and caregivers, whereas the current healthcare systems generally focus on processes of care. Quality improvement initiatives should therefore take better account of aspects of care that are important for older adults with frailty, such as having a chance to express their individual goals of care, receiving quality communications from HCPs, or monitoring symptoms that they might not spontaneously describe. Our results point to the need for patient-centred care that is oriented toward quality of life for older adults with frailty.
- ItemEmbargoRisk Factors for Dementia Development, Frailty, and Mortality in Older Adults with Epilepsy: A Population-Based Analysis(2020-08-28) Subota, Ann Ana; Holroyd-Leduc, Jayna M.; Jetté, Nathalie J.; Josephson, Colin Bruce; McMillan, Jacqueline M.As the global population ages, more individuals will develop and live with epilepsy and dementia. Previous literature suggests older adults with epilepsy are more likely to develop dementia, yet little is understood about the impact of dementia and frailty in older adults with epilepsy. This thesis aimed to address these knowledge gaps by examining the risk factors for incident dementia development and the role of dementia and frailty on mortality in older adults with incident epilepsy. A cohort of 1048 older adults with incident epilepsy aged 65 years or older were identified using a large population-based primary care dataset from the United Kingdom. The odds of having dementia were 7.39 [95% CI 5.21-10.50] times higher in older adults with incident epilepsy compared to older adults without epilepsy (p-value < 0.001). In the final multivariable logistic model, only the Charlson comorbidity index score at baseline incident epilepsy diagnosis was significantly associated with an increased odds of incident dementia [OR: 1.34, 95% CI 1.14-1.56, p-value < 0.001]. In a multivariate Cox model, age [HR: 1.06, 95% CI 1.02-1.11, p-value < 0.002], baseline dementia [HR: 2.68, 95% CI 1.66-4.33, p-value < 0.001] and baseline e-frailty index score [HR: 7.64, 95% CI 1.21-48.19, p-value = 0.030] were significantly associated with a higher hazard of death among older adults with incident epilepsy. The presence of dementia and the degree of frailty experienced both significantly increase the hazard of death in older adults with incident epilepsy. e-Frailty index scores could be utilized more widely in epilepsy clinics in all older adults with epilepsy to identify individuals who may be at greater risk of dying; additional supports and interventions could be provided to reduce mortality in older adults with epilepsy.
- ItemOpen AccessThe Seamless Transfer-of-Care Protocol: a randomized controlled trial assessing the efficacy of an electronic transfer-of-care communication tool(BioMed Central, 2012-11-21) Okoniewska, Barbara M.; Santana, Maria J.; Holroyd-Leduc, Jayna M.; Flemons, W. Ward; O'Beirne, Maeve; White, Deborah; Clement, Fiona M.; Forster, Alan; Ghali, William A.
- ItemOpen AccessSelection of Peritoneal Dialysis Among Older Eligible Patients with End-Stage Renal Disease(2016) Wong, Ben; Holroyd-Leduc, Jayna M.; Quinn, Rob; Ravani, Pietro; Venturato, LorraineThis study seeks to explore potential patient and care provider barriers that may explain why older patients with end-stage renal disease (ESRD) are less likely to choose peritoneal dialysis (PD). A mixed methods approach was used: survival analysis was performed on administrative data of patients deemed eligible for both PD and hemodialysis (HD); semi-structured interviews were also conducted with older patients. We found PD and HD are associated with similar survival in incident dialysis patients regardless of patient’s age, and the effect of modality on survival did not vary with follow-up time. Selection of a particular dialysis modality is highly personal and is driven by patient preference for the convenience and maintenance of a normal life provided by PD versus the heightened sense of security afforded by in-centre HD. Addressing these issues when counselling about dialysis choice may help increase PD uptake among older ESRD patients.
- ItemOpen AccessSub-Saharan African immigrant Cardiovascular Disease and risk factor control: Facilitators and Barriers in the use of or in accessing chronic disease management services in the Calgary municipal area(2014-09-30) Anokye, Emmanuel; Holroyd-Leduc, Jayna M.The objective of this study was to explore facilitators and barriers to chronic disease management programs and resources among Calgarian sub-Saharan African (SSA) immigrants with cardiovascular disease (CVD)/ related risk factors (i.e. hypertension, diabetes, and hypercholesterolemia). Utilizing mixed methods design, descriptive statistics from a survey assessing CVD management practices and service use was collected, among a sample of adult SSA immigrants in Calgary. Participants with related risk factors were selected for interviews on barriers to self-health management. Participants with CVD-related conditions accessed health care services through primary access points; mostly family doctors (n=68, 88.31%). Participants over 40 years with CVD-related conditions reported highest management difficulties (n=26, 25.49%). Thematic analysis showed, low morbidity and good healthcare provider relationships, were facilitators to successful CVD-related disease management; whereas, high morbidity and work stress were barriers. Differences in age and morbidity appear to influence CVD testing and health management styles for this sample.
- ItemOpen AccessUnderstanding How to Care about Indifference: A Multistep Approach to Apathy in Parkinson’s Disease(2018-06-08) Mele, Bria; Holroyd-Leduc, Jayna M.; Goodarzi, Zahra S.; Hanson, Heather; Pringsheim, Tamara M.; Ismail, ZahinoorBackground: Apathy is a complex and heterogeneous symptom in Parkinson’s disease (PD). It is present in 17 – 70% of persons with PD. Limited information is available on how to define, diagnose, and subsequently manage apathy in PD. Objectives: To firstly synthesize all available knowledge on apathy in PD to assess what is currently known and where gaps exist. Secondly, we aimed to assess barriers and facilitators to the use of this knowledge clinically. Methods: A scoping review based on literature from six databases and extensive grey literature search was completed, examining the diagnosis, treatment, and management of apathy in PD. In focus groups and interviews with stakeholders, we assessed barriers and facilitators to the use of this knowledge. Results: A large body of literature exists on apathy in PD, however key gaps limit the use of knowledge. Gaps include the lack of an accepted apathy definition and limited treatment options. Health care practitioners feel limited in their ability to diagnose apathy without validated screening–tools. Patients and caregivers identified awareness of apathy and planning their days as key facilitators to diagnosis and management. Conclusions: Our findings highlight the importance of developing a broad understanding of available literature and the associated gaps, and the key role that stakeholders play in identifying where further research is required most. Our findings will aid in future research directed at the development of an apathy definition and management focused on non-pharmacological interventions.
- ItemOpen AccessUnderstanding the Barriers to Guideline Use for Depression & Anxiety in Patients with Parkinson's Disease and Dementia.(2016) Goodarzi, Zahra; Holroyd-Leduc, Jayna M.; Hanson, Heather; Jette, Nathalie; Patten, Scott; Pringsheim, TamaraBackground: Depression or anxiety are under-diagnosed and under-treated in those with dementia or Parkinson’s disease (PD). Objectives: The objectives of this thesis were to first understand what high quality guideline recommendations exist for depression or anxiety in dementia or PD. Secondly to explore the barriers and facilitators to implementing these guidelines. Methods: A systematic review of guidelines was completed, following the PRISMA statement and using the AGREE II tool to assess quality. In focus groups with stakeholders, we assessed the barriers and facilitators to guideline use and implementation. Results: Guideline quality scores were lowest for stakeholder involvement, applicability, and editorial independence. Major barriers to use included a lack of evidence, lack of applicability to the practice population, impractical or out of date recommendations. Conclusions: There are guideline recommendations for depression or anxiety in dementia and PD. However, practitioners have difficulty with implementation due to a lack of evidence and applicability.
- ItemOpen AccessUnderstanding the Relationship Between Health Technology Reassessment and Knowledge Translation(2020-10-18) Esmail, Rosmin; Clement, Fiona M.; Hanson, Heather M.; Holroyd-Leduc, Jayna M.; Niven, Daniel J.Until now, it was not well understood how the field of Knowledge Translation (KT) would be applicable to Health Technology Reassessment (HTR). This thesis reports on three studies to determine how KT approaches are used to translate HTR outputs to achieve the desired outcomes. The first study was a scoping review of full-spectrum (phases of planning/design, evaluation, implementation, sustainability/scalability) KT Theories, Models, Frameworks (KT TMFs). Thirty-six KT TMFs were identified and categorized according to five approaches: process models, determinant frameworks, classic theories, implementation theories, and evaluation frameworks. It provided a starting point for the selection of KT TMFs for HTR. The second study employed a modified Delphi process and expert survey to review the 36 full-spectrum KT TMFs and determined which may be suitable for HTR. The three-round modified Delphi process resulted in 16 KT TMFs. Twenty-two international experts (11 KT and 11 HTR) were surveyed. None of the 16 KT TMFs reached ≥ 70% agreement when ratings of “yes” were considered. However when ratings of “yes” and “partially yes” were combined, the Consolidated Framework for Implementation Research (CFIR) was considered the most suitable by both KT and HTR experts (86%). One additional KT TMF was selected by KT experts: the Knowledge-to-Action framework. HTR experts selected two additional KT TMFs: the co-KT framework and the Plan-Do-Study-Act cycle. The third study involved 13 one-to-one semi-structured interviews on characteristics of KT TMFs that were important to consider for the HTR outputs of decreased use or de-adoption of a technology. Four foundational principles, three levers of change, and five steps for knowledge to action emerged as KT TMF traits for HTR. From the KT TMFs that were mapped onto the characteristics, CFIR had the most characteristics (11/12) missing only the ability to map to the micro, meso, macro levels. This is the first body of work that examines the relationship between HTR and KT. The findings offer guidance to users on the application of KT TMFs to the HTR process and implementation of its outputs. Practical use of these KT TMFs to the HTR process will provide further advancement in this area.