Aleksandra A. Zecevic

Safety culture in healthcare: a review of concepts, dimensions, measures and progress

Background A growing body of peer-reviewed studies demonstrate the importance of safety culture in healthcare safety improvement, but little attention has focused on developing a common set of definitions, dimensions and measures. Objectives Specific objectives of this literature review include: summarising definitions of safety culture and safety climate, identifying theories, dimensions and measures of safety culture in healthcare, and reviewing progress in improving safety culture. Methods Peer-reviewed, English-language articles published from 1980 to 2009 pertaining to safety culture in healthcare were reviewed. One hundred and thirty-nine studies were included in this review. Results Results suggest that there is disagreement among researchers as to how safety culture should be defined, as well as whether or not safety culture is intrinsically diverse from the concept of safety climate. This variance extends into the dimensions and measurement of safety culture, and interventions to influence culture change. Discussion Most studies utilise quantitative surveys to measure safety culture, and propose improvements in safety by implementing multifaceted interventions targeting several dimensions. Conversely, very few studies made their theoretical underpinnings explicit. Moving forward, a common set of definitions and dimensions will enable researchers to better share information and strategies to improve safety culture in healthcare, building momentum in this rapidly expanding field. Advancing the measurement of safety culture to include both quantitative and qualitative methods should be further explored. Using the expertise of traditional culture experts, anthropologists, more in-depth observational and longitudinal research is needed to move research in this area forward.

Pragmatism in practice: mixed methods research for physiotherapy.

The purpose of this paper is to provide an argument for the place of mixed methods research across practice settings as an effective means of supporting evidence-based practice in physiotherapy. Physiotherapy practitioners use both qualitative and quantitative methods throughout the process of patient care—from history taking, assessment, and intervention to evaluation of outcomes. Research on practice paradigms demonstrates the importance of mixing qualitative and quantitative methods to achieve ‘expert practice’ that is concerned with optimizing outcomes and incorporating patient beliefs and values. Research paradigms that relate to this model of practice would integrate qualitative and quantitative types of knowledge and inquiry, while maintaining a prioritized focus on patient outcomes. Pragmatism is an emerging research paradigm where practical consequences and the effects of concepts and behaviors are vital components of meaning and truth. This research paradigm supports the simultaneous use of qualitative and quantitative methods of inquiry to generate evidence to support best practice. This paper demonstrates that mixed methods research with a pragmatist view provides evidence that embraces and addresses the multiple practice concerns of practitioners better than either qualitative or quantitative research approaches in isolation.

Potential of Snoezelen room multisensory stimulation to improve balance in individuals with dementia: a feasibility randomized controlled trial

Objective: To investigate the influence of multisensory stimulations in a Snoezelen room on the balance of individuals with dementia. Design: Randomized controlled trial. Setting: Canadian long-term care home. Participants: Twenty-four residents (average age 86 years), in a long-term care home diagnosed with dementia, were assigned randomly to intervention and control groups. Nineteen participants completed the study. Interventions: Nine intervention group participants completed 30-minute Snoezelen room sessions twice a week for six weeks. Sessions were guided by participants’ preferences for stimulation. Interactions with tactile, visual and proprioceptive sensations were encouraged. Ten control group participants received an equal amount of volunteer visits. Main outcome measures: The Functional Reach Test, the eyes-open Sharpened Romberg and the Timed Up and Go Test with and without dual task, assessed static and dynamic balance at baseline and after the intervention. Falls frequencies were recorded six weeks before, during and after intervention. A journal was kept of observations in Snoezelen room. Results: Split-plot MANOVA analyses revealed no significant effects of unstructured Snoezelen room sessions on participants’ balance. There were no multivariate effects of time (F(4,14) = 1.13, P = 0.38) or group (F(4,14) = 0.63, P = 0.65). Group membership did not alter falls frequency. However, observations of participants’ interactions with elements of the Snoezelen room, such as imagery-induced head and eye movements, vibrating sensations and kicking activities, captured events that can be used to create specific multisensory balance-enhancing stimulations. Conclusions: Although the null hypothesis was not rejected, further investigation of a potential to influence balance in individuals with dementia through Snoezelen room intervention in long-term care homes is warranted.

Managing Agitation Using Nonpharmacological Interventions for Seniors With Dementia

Approximately 36 million people have Alzheimer’s disease worldwide, and many experience behavioral issues such as agitation. The purpose of this study was to investigate the perceptions of long-term care (LTC) staff regarding the current use of nonpharmacological interventions (NPIs) for reducing agitation in seniors with dementia and to identify facilitators and barriers that guide NPI implementation. Qualitative methods were used to gather data from interviews and focus groups. A total of 44 staff from 5 LTC facilities participated. Findings showed that both medications and NPIs are used for the management of agitation. The use of NPIs was facilitated by consistency in staffing, and the ability of all the staff members to implement them. Common barriers to NPI use included the perceived lack of time, low staff-to-resident ratios, and the unpredictable and short-lasting effectiveness of NPIs. This study offers insight into perceived factors that influence implementation of NPIs and the perceived effectiveness of NPIs.

Seniors Falls Investigative Methodology (SFIM): A Systems Approach to the Study of Falls in Seniors

La recherche actuelle portant sur les chutes chez les aînés manque d’analyse approfondie sur des questions telles les facteurs humains et l’erreur humaine. Un savoir plus élargi est nécessaire afin de comprendre pourquoi les personnes âgées sont exposées à des chutes. Le but de cette étude est d’illustrer la possibilité d’adapter la Méthodologie intégrée d’enquête sur la sécurité (MIES), utilisée dans l’investigation des accidents dans les domaines de l’industrie et des transports, à l’étude des chutes chez les aînés. La version adaptée de cette méthodologie — Méthodologie d’enquête sur les chutes chez les aînés (MECA) utilise une approche systémique afin de mener l’investigation au-delà des causes immédiates d’un incident, pour révéler les conditions et les actions dangereuses qui contribuent à des résultats cliniques défavorables. Une étude de cas est utilisée comme exemple pour décrire de manière détaillée les six phases du processus d’investigation. La MECA offre la possibilité de: identifier les manquements à la sécurité; utiliser les connaissances actuelles en matière de chutes; établir et standardiser un système d’échange de données; focaliser la perspective sur le système et non pas sur la victime des chutes à répétition; guider le processus de prévention ciblée An in-depth understanding of human factors and human error is lacking in current research on seniors’ falls. Additional knowledge is needed to understand why seniors are falling. The purpose of this article is to describe the adapting of the Integrated Safety Investigation Methodology (ISIM) (used for investigating transportation and industrial accidents) to studying seniors’ falls. An adapted version—the Seniors Falls Investigative Methodology (SFIM)—uses a systems approach to take an investigation beyond the immediate cause of an incident and reveal unsafe acts and deeply imbedded unsafe conditions that contribute to adverse outcomes. An example case study is used to describe six phases of the investigative process in detail. The SFIM has the potential to identify safety deficiencies; utilize existing knowledge about falls; establish a standardized reporting system; shift focus from the faller to the system; and guide targeted prevention.

Toe-out, lateral trunk lean, and pelvic obliquity during prolonged walking in patients with medial compartment knee osteoarthritis and healthy controls

To compare the time‐varying behavior of maximum toe‐out angle, lateral trunk lean (over the stance leg), and pelvic obliquity (rise and drop on the swing leg) during prolonged walking in participants with and without medial compartment knee osteoarthritis (OA), and to explore correlations between these gait characteristics and pain.

Mobility and cognition in seniors. Report from the 2008 Institute of Aging (CIHR) Mobility and Cognition Workshop

Background The annual Scientific Meeting of the Canadian Association on Gerontology was held on October 24 and 25, 2008 in London, Ontario. Prior to the annual meeting, mobility and cognition experts met on October 23, 2008 to engage in a pre-conference workshop. Methods Discussions during the workshop addressed novel areas of research and knowledge and research gaps pertaining to the interaction between mobility and cognition in seniors. Results Workshop presenters moved from the neuromuscular, biomechanics, and neurology of gait impairments, and falls through the role of cognition and mood on mobility regulation to the whole person in the environment. Research gaps were identified. Conclusions Despite a consensus that mobility and cognition are increasingly correlated as people age, several gaps in our understanding of mechanisms and how to assess the interaction were recognized. The gaps originally identified in 2008 are still pertinent today. Common and standardized assessments for “mobility and cognition” are still not in place in current practice. Interventions that target mobility and cognitive decline as a single entity are still lacking.

Influenza vaccinations: older adults' decision-making process.

Le but de cette étude était d’explorer les influences auto-évaluatives parmi les personnes plus âgées en décidant de prendre ou non le vaccin contre la grippe saisonnière. Trente-et-un receveurs et six non-receveurs (âgés de 67–91 ans) ont participé à six groupes de discussion à London, Ontario. Les réunions des groupes de discussion ont duré environ 60 minutes, ont été enregistrées sur bande audio-magnetique et transcrites mot à mot. Les principaux animateurs de la prise du vaccin étaient les recommandations et la confiance dans les professionnels de la santé, et la croyance en l’efficacité du vaccin. Les principaux obstacles étaient la peur des réactions indésirables et la croyance en la capacité de résistance des personnes âgées. L’Agence de la santé publique du Canada et les membres de professions paramédicales devraient sensibiliser les personnes âgées à un diagnostic précis des symptômes de la grippe, l’efficacité des vaccins et les populations qui sont à risque de contracter la grippe. L’accent devrait être mis sur la correction des idées fausses au sujet des effets indésirables. The purpose of this study was to explore the self-perceived influences among older adults in deciding whether to take or not take the seasonal influenza vaccine. Thirty-one receivers and six non-receivers (aged 67–91) participated in six focus groups in London, Ontario. The focus group meetings lasted approximately 60 minutes, were digitally audio-recorded, and transcribed verbatim. Inductive content analysis was performed to analyse the transcripts. The major facilitators of taking the vaccine were recommendations by, and trust in, health professionals, and a belief in vaccine efficacy. The major barriers were a fear of adverse reactions and the belief in resilience of an older adult. The Canadian Public Health Agency and allied health professionals should educate older adults in accurate influenza symptoms, vaccine efficacy, and populations at risk for contracting influenza. Focus should be given on correcting misconceptions about adverse events.

Effectiveness of balance exercises in the acute post-operative phase following total hip and knee arthroplasty: a randomized clinical trial

Objectives: To determine the effectiveness of balance exercises in the acute post-operative phase following total hip arthroplasty or total knee arthroplasty. Methods: Patients who had total hip arthroplasty (n = 30) or total knee arthroplasty (n = 33) were seen in their residence 1–2 times per week for 5 weeks. At the first post-operative home visit, patients were randomly assigned to either typical (TE, n = 33) or typical plus balance (TE + B, n = 30) exercise groups. The TE group completed seven typical surgery-specific joint range-of-motion and muscle strengthening exercises, while the TE + B group completed the typical exercises plus three balance exercises. Patients were assessed before and 5 weeks after administering the rehabilitation program using four outcome measures: (1) the Berg Balance Scale, (2) the Timed Up and Go test, (3) the Western Ontario McMaster Universities Osteoarthritis Index, and (4) the Activities-specific Balance Confidence Scale. Results: Post-intervention scores for all four outcome measures were significantly improved (p < 0.01) over baseline scores. Patients who participated in the TE + B group demonstrated significantly greater improvement on the Berg Balance Scale and the Timed Up and Go tests (p < 0.01). Conclusion: Balance exercises added to a typical rehabilitation program resulted in significantly greater improvements in balance and functional mobility compared to typical exercises alone.

Time-varying behaviour, test-retest reliability and concurrent validity of lateral trunk lean and toe-out angles during prolonged treadmill walking.

Lateral trunk lean over the stance limb and toeing-out are potential adaptive gait mechanisms that reduce knee joint loading. The purpose of the present study was to evaluate the time-varying behaviour, the test-retest reliability and the concurrent validity of lateral trunk lean angle and toe-out angle during prolonged walking in healthy adults. Twenty healthy volunteers (51±8 years, 12 females) completed two test sessions at least 24h apart but within the same week. For each participant, at each session, three-dimensional gait kinematics were assessed intermittently during 60min of treadmill walking. Additionally, over-ground three-dimensional gait analysis was performed immediately before and after the treadmill walking. Maximum lateral trunk lean angle and maximum toe-out angle did not change over time (p>0.05), were consistent from day to day (test-retest reliability: ICC=0.61-0.72 and 0.90-0.95, respectively) and were consistent with over-ground measures (concurrent validity: ICC=0.88 and 0.92, respectively). These findings suggest that lateral trunk lean angle and toe-out angle are consistent during prolonged walking and that these measures are reliable and valid for use in studying adaptive gait mechanisms.