Nora Jacobson

The relationship between staffing and quality in long-term care facilities: exploring the views of nurse aides.

Research on staffing and quality of care in long-term care facilities confirms that adequate staffing levels are important to ensuring quality but few studies have examined how the two are linked. The research reported in this article used participant observation and indepth interviewing to explore how nurse aides (NAs) understand the link between staffing and quality. The findings show that NAs deem their relationships with residents to be the central determinant of quality of care as well as an important outcome in itself. Adequate staffing is essential to allowing NAs to nurture these relationships.

Organizational Factors that Influence University-Based Researchers’ Engagement in Knowledge Transfer Activities

Knowledge transfer has become a priority for universities and other publicly funded research institutions. However, researchers working in these settings report certain structural barriers to engaging in knowledge translation activities. This article describes these barriers, situating them in the disjunction between current expectations and the historical tradition of disciplinary authority in academia. The authors review some of the organizational solutions that have been proposed to address this disjunction. This analysis of barriers and solutions suggests that five domains of organizational policy and practice—promotion and tenure, resources and funding, structures, knowledge transfer orientation, and documentation—may be critical to promoting researchers’engagement in knowledge transfer.

Reciprocity: An ethic for community-based participatory action research

Ethical issues have been of ongoing interest in discussions of community-based participatory action research (CBPAR). In this article we suggest that the notion of reciprocity — defined as an ongoi...Ethical issues have been of ongoing interest in discussions of community-based participatory action research (CBPAR). In this article we suggest that the notion of reciprocity — defined as an ongoing process of exchange with the aim of establishing and maintaining equality between parties — can provide a guide to the ethical practice of CBPAR. Through sharing our experiences with a CBPAR project focused on mental health services and supports in several cultural-linguistic immigrant communities in Ontario, Canada, we provide insights into our attempts at establishing reciprocal relationships with community members collaborating in the research study and discuss how these relationships contributed to ethical practice. We examine the successes and challenges with specific attention to issues of power and gain for the researched community. We begin with a discussion of the concept of reciprocity, followed by a description of how it was put into practice in our project, and, finally, conclude with suggestions for how an ethic of reciprocity might contribute to other CBPAR projects.

Dignity Violation in Health Care

In this grounded theory analysis I sought to understand dignity violation in health care and to explore the context in which such violations take place. I found that dignity violation in health care occurs through processes of rudeness, indifference, condescension, dismissal, disregard, dependence, intrusion, objectification, restriction, labeling, contempt, discrimination, revulsion, deprivation, assault, and abjection. The conditions that promote these processes reside in the positions of the actors involved; in the asymmetrical relationships between the actors; in the health care setting itself, which is characterized by multiple tensions—including those between needs and resources, crisis and routine, experience and expertise, and rhetoric and reality; and in the embeddedness of health care in a broader social order of inequality. These findings suggest several interventions that might mitigate dignity violation in health care.

Linkage and exchange at the organizational level: a model of collaboration between research and policy

This paper describes an organization-level initiative designed to promote linkage and exchange between a research unit and the mental health policy branch of Ontarios provincial government. Using a framework that conceptualizes four tiers – inter-organizational relationship, interactive research projects, dissemination and policy formation – in the application of linkage and exchange to the research and policy development processes, we present an example in order to explore the issues that arise in each tier. We conclude that while such initiatives enhance the relevance of research in the policy development process, they also present challenges that must be recognized and managed.

Developing Theory From Complexity: Reflections on a Collaborative Mixed Method Participatory Action Research Study

Research studies are increasingly complex: They draw on multiple methods to gather data, generate both qualitative and quantitative data, and frequently represent the perspectives of more than one stakeholder. The teams that generate them are increasingly multidisciplinary. A commitment to engaging community members in the research process often adds a further layer of complexity. How to approach a synthesizing analysis of these multiple and varied data sources with a large research team requires considerable reflection and dialogue. In this article, we outline the strategies used by one multidisciplinary team committed to a participatory action research (PAR) approach and engaged in a mixed method program of research to synthesize the findings from four subprojects into a conceptual framework that could guide practice in community mental health organizations. We also summarize factors that hold promise for increasing productivity when managing complex research projects.

Social Epistemology: Theory for the “Fourth Wave” of Knowledge Transfer and Exchange Research

Knowledge transfer and exchange has become an increasingly important practice in the arena of publicly funded health and social research. Throughout its history, investigators have used a variety of borrowed theories to explore and explain the determinants, processes, and results of knowledge transfer. As the context in which knowledge transfer takes place has changed, so too has the theory used to explore and explain the process. This article reviews the role of theory in knowledge transfer and exchange research and proposes a novel source for potentially useful new theory in the current context: social epistemology.

Improving Primary Care for Persons with Disabilities: The nature of expertise

It has been well documented that persons with disabilities (PWDs) have a more vulnerable health status than persons without disabilities; yet, they often receive inadequate primary care within the US health care system. This study explores how PWDs think about the health care they receive, particularly how primary care providers facilitate or hinder quality care for PWDs. The findings from this study expand the concept of expertise in health care, suggesting it goes well beyond technical competence of health care providers. For PWDs, expertise is multi-dimensional, not solely the domain of providers and includes having knowledge and using that knowledge within the context of the provider-patient relationship. PWDs identified three distinct areas of expertise: medical/technical, medical/biographical, and systems. Expertise can be brought to health care encounters by both PWDs and providers, and it can be developed through collaboration during interactions between providers and PWDs.

Defining recovery: an interactionist analysis of mental health policy development, Wisconsin 1996-1999.

The author examines how, as part of a reform of Wisconsins public mental health system, a workgroup of system stakeholders defined and operationalized the concept of recovery. Based on participant observation, document analysis, and interviews, with an analytic framework drawn from symbolic interactionism, the author finds that although individual members held a range of definitions of recovery, the workgroup was able to reach consensus in its policy recommendations through processual means and by tacitly agreeing on a set of overarching values that were flexible enough to accommodate many definitions.

Sustaining Culture Change: Experiences in the Green House Model

OBJECTIVE To describe conditions that influence how Green House (GH) organizations are sustaining culture change principles and practices in a sample of GH skilled nursing homes. DATA SOURCES/STUDY SETTING Primary data were collected at 11 skilled nursing GH organizations from 2012 to 2014. These organizations have adopted the comprehensive and prescriptive GH model of culture change. STUDY DESIGN To develop an understanding of sustainability from the perspective of staff who are immersed in GH daily work, grounded theory qualitative methods were used. DATA COLLECTION METHODS Data were collected using semi-structured interviews with 166 staff and observation of house meetings and daily operations. Data were analyzed using grounded dimensional analysis. PRINCIPAL FINDINGS Organizations varied in their ability to sustain GH principles and practices. An organizations approach to problem solving was central to sustaining the model. Key conditions influenced reinforcement or erosion of GH principles and practices. CONCLUSIONS Reinforcing the GH model requires a highly skilled team of staff with the ability to frequently and collaboratively solve both mundane and complex problems in ways that are consistent with the GH model. This raises questions about the type of human resources practices and policy supports that could assist organizations in sustaining culture change.