Search

Objectives: Our study aimed to describe “how” and “why” the person-centered care (PCC) approach was applied within a long-term care (LTC) community to manage responsive behaviors (RBs) in individuals with major neurocognitive disorders.Methods: A descriptive holistic single case study design was employed in the context of an LTC community in Quebec, using semi-structured interviews and non-participatory observations of experienced care providers working with clients with RBs, photographing the physical environ-ment, and accessing documents available on the LTC community’s public website. A thematic content analysis was used for data analysis.Results: The findings generated insight into the importance of considering multiple components of the LTC community to apply the PCC approach for managing RBs, including a) creating a homelike environment, b) developing a therapeutic relationship with clients, c) engaging clients in mean-ingful activities, and d) empowering care providers by offering essential resources.Conclusions: Applying and implementing the PCC approach within an LTC community to manage clients’ RBs is a long-term multi-dimensional process that requires a solid foundation.Clinical implications: These findings highlight the importance of considering multiple factors relevant to persons, environments, and meaningful activities to apply the PCC approach within LTC communities to manage RBs.

Knowledge syntheses, such as systematic reviews, scoping reviews, and realist reviews, are crucial tools to guide nursing practice, policy, and research. However, conducting high-quality knowledge syntheses is a complex and time-consuming endeavor. It is imperative for nursing students, clinicians, and researchers to be aware of key practical recommendations regarding the conduct of knowledge syntheses to improve the feasibility and efficiency of such projects.The aim of this paper was to discuss key practical recommendations for designing, planning, and conducting knowledge syntheses relevant to nursing policy, practice, and research.The recommendations discussed are based on best-practice guidance about knowledge synthesis methodology proposed by The Campbell Collaboration (Campbell systematic reviews: Policies and guidelines, 2020), Cochrane (Cochrane training, 2019), and the Joanna Briggs Institute (The Joanna Briggs Institute reviewers' manual, 2020) and on strategies used by the authors to improve the feasibility and efficiency of knowledge syntheses.This paper highlights six key practical recommendations that nursing students, clinicians, and researchers should take into account when deciding to embark on a knowledge synthesis project: (1) determining if (and why) knowledge synthesis should be conducted; (2) selecting the appropriate type of knowledge synthesis, as well as the associated methodological guidance and reporting standards; (3) developing a search strategy that balances sensitivity and specificity; (4) writing a protocol and obtaining feedback; (5) determining the resources required to conduct the different stages of the knowledge synthesis; and (6) keeping an audit trail. Fifteen common types of knowledge synthesis are presented with their definitions, relevant methodological guidance, and reporting standards.The recommendations discussed, used in conjunction with appropriate methodological guidelines, may help ensure the success of a knowledge synthesis project by providing best-practice and experience-based guidance to newcomers in the field.

Although the value of family caregivers’ involvement with relatives in long-term care (LTC) is well recognized, tensions remain regarding their role. Such tensions were exacerbated during the COVID-19 pandemic as strict public health measures restricted family access to LTC homes. Using interpretive description, we examined the impact of visitation restrictions on family caregivers’ experiences caring for a relative in LTC between March 2020 and June 2021. In-depth interviews were conducted with 14 family caregivers (five spouses and nine adult daughters) and two key themes were identified. The first theme, “seeking to maintain relational continuity,” illustrates how caregivers sought to sustain connections with residents prior to and during the pandemic. The second theme, “disrupted relational continuity,” highlights the impact of severed relational connections on caregivers’ sense of self and ongoing feelings of loss and anger. Findings call for a trauma-informed approach that recognizes the pervasiveness of trauma for family caregivers and the avoidance of re-traumatization.

Background Relatives of an older person living in a long-term care home with advanced-stage dementia must often make important and difficult decisions, including ones that impact the resident’s end-of-life. Healthcare professionals must support them in this decision-making process. The aim of this study was to propose a theory on nurses’ support of relatives who make end-of-life decisions for a resident living with dementia in a long-term care home. Method A constructivist grounded theory approach was used, with a theoretical sample of nine nurses and 10 relatives whom we met for face-to-face interviews. Three documents on end-of-life care, which were available in the study setting, were also included. The analysis was carried out using the method proposed by Charmaz. Findings The findings highlight the importance of building a strong and trusting relationship between nurses and relatives. Furthermore, exploring the refusal of palliative or end-of-life care, supporting relatives’ need to witness firsthand the condition of the person living with dementia, and education at a “good” time are useful interventions that nurses can make to support relatives’ decision-making. Conclusion Better support of relatives in end-of-life decision-making improves the well-being of relatives and older people living with dementia alike.

BACKGROUND Dementia is one of the main public health priorities for current and future societies worldwide. Over the past years, eHealth solutions have added numerous promising solutions to enhance the health and wellness of people living with dementia-related cognitive problems, and their primary caregivers. Previous studies show that an environmental scan identifies the knowledge-to-action gap meaningfully. This paper presents the protocol of an environmental scan to monitor the currently available eHealth solutions targeting dementia and other neurocognitive disorders against selected attributes. OBJECTIVE This study aims to identify the characteristics of currently available eHealth solutions recommended for older adults with cognitive problems and their informal caregivers. To inform recommendations regarding eHealth solutions for these people, it is important to get a comprehensive view of currently available technologies and document their outcomes and conditions of success. METHODS We will perform an environmental scan of available eHealth solutions for older adults with cognitive impairment or dementia and their informal caregivers. Potential solutions will be initially identified from a previous systematic review. We will also conduct targeted searches for grey literature on Google and specialized websites covering the regions of Canada and Europe. RESULTS Technological tools will be scanned based on a preformatted extraction grid. We will assess their relevance and efficiency based on selected attributes. We will then prioritize relevant solutions based on the needs and preferences identified from a qualitative study among older adults with cognitive impairment or dementia and their informal caregivers. CONCLUSIONS This environmental scan will identify eHealth solutions that are currently available and scientifically appraised for older adults with cognitive impairment or dementia and their informal caregivers. This knowledge will inform the development of a decision support tool to assist older adults and their informal caregivers in their search for adequate eHealth solutions according to their needs and preferences, based on trustable information.

Les personnes âgees vivant avec un trouble neurocognitif majeur ont souvent des difficultes a communiquer. Ainsi, elles peuvent presenter des comportements reactifs, par exemple des comportements vocaux ou agressifs, qui sont des manifestations d’un mal-etre. Ces comportements amenent des consequences pour ces personnes, ainsi que pour leurs proches et soignants. Cet article discute de l’approche centree sur les relations pour ameliorer l’experience de chacune de ces personnes en suscitant une reflexion sur ce qui nous unit. Puis, les principes de cette approche centree sur les relations sont exposes en s’appuyant sur les besoins uniques de chacun, la reciprocite de leurs relations, ainsi que leurs aspirations communes. L’application de ces principes aupres des personnes âgees vivant avec un trouble neurocognitif, qui manifestent des comportements reactifs, se reflete par l’adoption d’un langage coherent, par l’identification des sens des comportements et d’actions personnalisees, ainsi que par l’etablissement d’un partenariat de soins. Un exemple d’une demarche integrant cette approche est presente, ainsi que ses effets possibles. L’adoption de cette approche peut cependant presenter plusieurs defis dans les milieux de soins. Pour y faire face, des strategies d’implantation sont decrites pour favoriser l’adoption de cette approche et contribuer au bien-etre de chacun.

Introduction: Supporting independent functioning of homebound, chronically ill older adults (HOAs) is a major concern across cultures. In Thailand, actions HOAs take to remain independent and maintain their holistic (mental, physical, and spiritual) health is understudied. Therefore, we explored self-care practices used by rural Thai HOAs to maintain their independence. Methods: We used a focused ethnographic approach, recruiting HOAs, their families, and community members from a rural area in Southern Thailand. Data were analyzed using content analysis. Results: Sixteen HOAs and 23 family/community members participated. Three themes emerged: self-care to stay healthy, sharing life with family and society in a positive way, incorporating both folk and modern medicine to maintain health. Factors facilitating holistic health practices were supportive family network, Thai cultural beliefs, community strength and support, and health care services. Discussion/Conclusions: These findings may help health care professionals develop interventions supporting holistic health practices of Thai HOAs to remain independent.

Although families are increasingly seen as allies to improve delirium management and reduce its consequences, their involvement in the postcardiac surgery setting is challenging considering patients' critical state and short hospital stay. To our knowledge, no theory-based nursing intervention exists that optimally supports the involvement of families in delirium management in the context of postcardiac surgery.We aimed to develop MENTOR_D, a nursing intervention to support the involvement of families in delirium management.MENTOR_D was developed based on Sidani and Braden's (2011) intervention development framework. Narrative literature reviews paired with the clinical experience of an expert committee were used to inform these three steps: (1) develop an understanding of the problem under study; (2) define the objectives of the intervention and identify a theoretical framework for highlighting strategies to be used in the intervention; and (3) operationalize the intervention and identify its anticipated outcomes.As a result of the three steps, the MENTOR_D nursing intervention relies on a caring-mentoring relationship between a nurse and the family. The aim of MENTOR_D is to increase the presence of the family at their relative's bedside and their involvement in delirium management. MENTOR_D's content is delivered over three phases that are organised around the visits of the family at the patient's bedside. During these phases, families used their knowledge of the patient to tailor the delirium management actions. These actions include orientation and reminiscence and were aimed at diminishing anxiety and increasing sense of self-efficacy in families and diminishing delirium severity and improving recovery in patients.A deep understanding of the underlying mechanisms of an intervention is key in its success to reach the targeted goals of effectiveness in practice. This understanding can be achieved through the careful development of a theory of the intervention before the operationalisation of its components and its testing. The proposed paper presents the theory of the MENTOR_D intervention, that is, its conceptualization and proposed mechanisms of action.As delirium continues to be a major complication, this intervention is a promising solution to increase families' involvement in delirium management and highlights the support that nurses can offer to facilitate this involvement. With its use in future studies and practice, it can be further refined.

Two of the most salient problems in nursing homes are the responsive behaviours and falls of older people living with Alzheimer’s disease and related disorders. Intelligent videomonitoring and mobile applications are potential technologies that may help prevent and manage these problems. However, evidence for the needs for technologies in nursing homes is scarce. This study aimed to explore the perceptions and needs of care managers, and of formal and family caregivers in nursing homes regarding these potential technologies. With an exploratory qualitative design based on Rogers’ diffusion of innovation theory, individual interviews and a content analysis were conducted. Results show that the potential users of these technologies consider them relevant in nursing homes. The characteristics that would make these technologies useful in nursing homes are described. These results could be used to develop useful technologies to improve the quality of clinical practice in nursing homes.

Background and Objectives e-Health solutions are an innovative approach to support aging with cognitive impairment. Because technology is developing at a fast pace, the aim of this review was to present an overview of the research regarding the effectiveness of these solutions. Moreover, the availability of these solutions was examined. Research Design and Methods Systematic searches were conducted in 7 databases. Full texts of potentially relevant references were assessed by 2 reviewers, and discrepancies were solved through discussion. Data on study characteristics, technology type, application domain, availability, outcomes, and effects were extracted. A categorization exercise and narrative synthesis were conducted. Results In total, 72 studies describing 70 e-Health solutions were identified. The majority of solutions comprised cognitive training for older adults, followed by educational and supportive web platforms for caregivers. Outcomes included mainly measures of cognition, psychosocial functioning, caregiving processes, caregiver–care receiver relationship, and activities of daily living. Positive effects of cognitive training technologies were observed on cognitive functioning of older adults, as well as those of supportive web platforms on behavioral and psychological symptoms of dementia and caregiver self-efficacy. The effects of these solutions on depression in both target groups were inconclusive. The methodological quality of the studies was moderate to good. However, some important limitations were observed. Discussion and Implications The review identified cognitive training solutions and supportive web platforms as the most effective on a limited number of outcomes. Although other solutions seem promising, further research has to overcome methodological issues. Furthermore, solutions for leisure and reminiscence and outcomes specifically related to independent living deserve more attention.

Evaluate a web-based tailored nursing intervention, TAVIE en m@rche, on increasing daily steps after an acute coronary syndrome.Parallel two-group multicentre randomized trial.An experimental group receiving TAVIE en m@rche, was compared to a control group receiving hyperlinks to public websites. Acute coronary syndrome patients who were insufficiently active were recruited from three coronary care units. Daily steps at 12 weeks were the primary outcome. Secondary outcomes included self-reported walking and moderate to vigorous physical activity (MVPA). Exploratory outcomes were angina frequency, emergency department visits, hospitalizations and secondary prevention programme attendance.Primary data were analysed for 39 participants. No significant effects were found. At 12 weeks 275.9 more daily steps and 1,464.3 more energy expenditure in MVPA were found in the experimental group relative to the control. No effects were found for angina frequency, emergency department visits, hospitalizations and secondary prevention programme attendance.The lack of effect on our primary result may be explained by the intervention goal that was mismatched to the needs of our mostly sufficiently active sample at randomization, resulting in no meaningful change in daily steps. Although the non-significantly greater increase in self-reported MVPA may represent gains in health among the participants that accessed TAVIE en m@rche, this result should be interpreted with caution.From 40%-60% of acute coronary syndrome patients self-report insufficient levels of physical activity. No effect was found on the primary outcome of daily steps. Although not significant, a greater increase in MVPA was found at 12 weeks. The primary outcome can be explained by most of the sample having attained the physical activity recommendation at randomization. Caution in interpreting the non-significant increase in MVPA is warranted due to attrition bias and statistical uncertainty. Future directions may consider the timing of randomization in relation to meeting the needs of insufficiently active acute coronary syndrome patients.目的: 评估基于网络的定制护理干预(TAVIE en m@rche)对于急性冠脉综合征后增加每日行走步数的作用。 设计: 平行的两组多中心随机研究 方法: 对比接受TAVIE en m @ rche的实验组与接收公共网站超链接的对照组。我们从三个冠心病重症监护病房招募了活动不足的急性冠状动脉综合征患者。研究主要结果是12周的每日步数。次要结果包括患者自己报告的行走和中等强度到高强度的身体活动(MVPA)。探索性结果为心绞痛发作频率、急诊就诊、住院和二级预防方案出现次数。 结果: 我们分析了39名参与者的原始数据,没有发现显著影响。在十二周中,相比于对照组,实验组的中等强度到高强度的身体活动中,每日步数增加了275.9步,并且增加了1464.3的能量消耗。心绞痛发作频率、急诊就诊、住院和二级预防方案出现次数没有受到影响。 结论: 没有对主要结果产生影响的原因可能是干预目标与随机分配的多数活动充分的样本需求不匹配,导致每日步数没有出现有意义的变化。尽管患者自己报告的中等强度到高强度的身体活动并没有显著地大幅增长,这可能意味着访问TAVIE en m@rche的参与者健康状况有所改善,但是对于这一结果,应当谨慎解释。 影响: 40%至60%的急性冠状动脉综合征患者自己报告的身体活动不足。每日步行没有对主要结果产生影响。尽管不显著,但在十二周中,每日中等强度到高强度的身体活动有所增长。出现这样的主要结果的原因是,大多数样本在随机分组时已经得到了活动身体的建议。由于损耗性偏差和统计不确定性,对这一非显著增长,应当谨慎解释。今后的研究方向可能会考虑随机化的时间,以满足缺少身体活动的急性冠状动脉综合征患者的需求。.

Objectives This qualitative descriptive study aims to explore the meanings of holistic health in the southern Thai culture experienced by homebound older people. Background The ageing society necessitates many services to meet the holistic needs of older people. Homebound older people are commonly an understudied population who may view their holistic health and well-being differently from others. Due to geographical differences and local Thai cultural context, exploring the holistic health in the southern Thai culture would help promote a healthy lifestyle and improve their health outcomes. Methods Based on purposeful sampling, 16 key informants who were homebound older people (ages ≥ 60 years old) living at home in a rural southern Thai community were participated in semi-structured interviews. Informants consisted of six males and ten females who were Buddhist and married. Their ages ranged from 79 to 99, including nine homebound older people who lived in a couple, and seven widows and widowers. Eight had completed the primary school, and others were uneducated. The data were analysed with a content analysis. Results Most of the informants had chronic diseases. In a broad main theme, the informants described the holistic health in local context as 'Bai Lod; which means being alive with positive, active and independent functioning. This theme included three sub-themes: self-supporting or taking care of themselves, having the ability to control their health conditions and being proud as a healthy older adult. The older people described self-supporting as the ability to perform their activities of daily living, take care of their own health and work independently (active living). Having the ability to control their health conditions meant functioning well physically, although being frail, by maintaining their health through self-management, and having a good mental health during such a life-changing situation. Older people valued the ability to live by themselves without being a burden to their family. They felt happy with their life. Conclusion Holistic health was described as being positive and active at home, and influenced by beliefs and values related to good physical function, mental health and spiritual activities. These findings could help healthcare professionals better understand older people' health, well-being and cultural care in order to develop alternative strategies to maintain, enhance and support an active life for homebound older people.

Background Healthy aging (HA) is a contemporary challenge for population health worldwide. Electronic health (e-Health) interventions have the potential to support empowerment and education of adults aged 50 and over. Objectives To summarize evidence on the effectiveness of e-Health interventions on HA and explore how specific e-Health interventions and their characteristics effectively impact HA. Methods A systematic review was conducted based on the Cochrane Collaboration methods including any experimental study design published in French, Dutch, Spanish, and English from 2000 to 2018. Results Fourteen studies comparing various e-Health interventions to multiple components controls were included. The target population, type of interventions, and outcomes measured were very heterogeneous across studies; thus, a meta-analysis was not possible. However, effect estimates indicate that e-Health interventions could improve physical activity. Positive effects were also found for other healthy behaviors (e.g., healthy eating), psychological outcomes (e.g., memory), and clinical parameters (e.g., blood pressure). Given the low certainty of the evidence related to most outcomes, these results should be interpreted cautiously. Conclusions This systematic review found limited evidence supporting the effectiveness of e-Health interventions, although the majority of studies show positive effects of these interventions for improving physical activity in older adults. Thus, better quality evidence is needed regarding the effects of e-Health on the physiological, psychological, and social dimensions of HA. Systematic review registration The review protocol was registered in PROSPERO (registration number: CRD42016033163)

Few studies have been conducted on strategies to promote the implementation of complex interventions in nursing homes (NHs). This article presents a pilot study intended to assess the strategies that would enable the optimal implementation of a complex intervention approach in NHs based on the meanings of screams of older people living with Alzheimer’s disease. An action research approach was used with 19 formal and family caregivers from five NHs. Focus groups and individual interviews were held to assess different implementation strategies. A number of challenges were identified, as were strategies to overcome them. These latter included interactive training, intervention design, and external support. This study shows the feasibility of implementing a complex intervention to optimize older people’s well-being. The article shares strategies that may promote the implementation of these types of interventions in NHs.

Resume Les infirmieres et les proches aidants ont un role significatif dans la mise en place des mesures de prevention du delirium. Une communication efficace entre ces groupes de personnes est essentielle. Une etude de cas multiples a permis de comprendre en profondeur la communication entre les infirmieres et les proches aidants de personnes âgees hospitalisees sur une unite de chirurgie cardiaque et a risque de delirium. La communication circulaire telle que decrite par Wright et Leahey (2014) a servi de cadre de reference pour cette etude. En plus de la reponse a leurs besoins, du respect, de l’ouverture et de l’humanisme dans les soins offerts a la personne âgee, les resultats mettent en evidence que la presence des proches aidants aupres de la personne âgee et leur confiance dans les soins infirmiers, pouvant etre alteree par leurs experiences anterieures d’hospitalisation, influencent leur communication avec les infirmieres. Les infirmieres sont encouragees a communiquer efficacement avec tous les types de proches aidants de personnes âgees hospitalisees afin d’ameliorer la qualite et la securite des soins offerts.

Background As many delirium manifestations (e.g., hallucinations or fears) are linked to patients' experiences and personality traits, it is suggested that interventions should be tailored to optimize its management. The inclusion of family members, as part of an intervention, has recently emerged as a solution to developing individualised patient care, but has never been assessed in post-cardiac surgery intensive care unit where almost half of patients will present with delirium. Aims To assess the feasibility, acceptability and preliminary efficacy of an nursing intervention involving family caregivers (FC) in delirium management following cardiac surgery. Design A randomized pilot study. Methods A total of 30 patient/FC dyads were recruited and randomized to usual care (n = 14) or intervention (n = 16). The intervention was based on the Human Caring Theory, a mentoring model, and sources informing self-efficacy. It comprised seven planned encounters spread over 3 days between an intervention nurse and the FC, each including a 30-min visit at the patient's bedside. During this bedside visit, the FC used delirium management strategies, e.g. reorient the person with delirium. The primary indicator of acceptability was to obtain consent from 75% of approached FCs. The preliminary effect of the intervention on patient outcomes was assessed on (1) delirium severity using the Delirium Index, (2) occurrence of complications, such as falls, (3) length of postoperative hospital stay and (4) psycho-functional recovery using the Sickness Impact Profile. The preliminary effect on FC outcomes was assessed on FC anxiety and self-efficacy. Data were analysed using descriptive statistics, ANCOVAs and logistic regressions. Results The primary indicator of obtaining consent from FC was achieved (77%). Of the 14 dyads, thirteen (93%) dyads received all seven encounters planned in the experimental intervention. Intervention group patients presented better psycho-functional recovery scores when compared with control group patients (p = 0·01). Mean delirium severity scores showed similar trajectories on days 1, 2 and 3 in both groups. Conclusion The mentoring intervention was acceptable and feasible and shows promising results in improving patients and FC outcomes. Relevance to clinical practice Nurses should involve, if willing, FC to participate in activities that optimise patient well-being FC to use recognized delirium management strategies like reorientation and reassurance.

Aim To explore the conditions that may influence the implementation of an interactive mobile application (app) and an intelligent videomonitoring system (IVS) in nursing homes (NHs) and the ethical challenges of their use. Background There is a lack of knowledge about implementing technologies in NHs and the ethical challenges that might arise. In past studies, nursing care teams expressed the need for technologies offering clinical support. Technologies like an IVS and an app could prove useful in NHs to prevent and manage falls and responsive behaviours. Design An exploratory qualitative study was conducted with care managers, family caregivers and formal caregivers in five NHs. Methods Each participant was shown a presentation of a potential app and a short video on an IVS. It was followed by an individual semi-structured interview. A conventional content analysis was performed. Findings Potential users found it would be possible to implement these technologies in NHs even if resistance could be expected. To facilitate adoption and achieve clinical benefits, the implementation of technologies should be pilot-tested, and coaching activities should be planned. Ethical risks were considered already present in NHs even without technologies, for example, risks to privacy. Strategies were proposed, for instance, to adapt the code of ethics and procedures. Some potential prejudices about the interest and abilities of older staff, nurses' aides, and family caregivers to use technology were identified. Conclusions Through rigorous and ethical implementation, technologies supporting clinical care processes could benefit older people living in NHs, as well as their relatives and the staff. Implications for practice Various strategies are proposed to successfully implement technologies. Effort should be made to avoid prejudices during implementation, and procedures should be adapted to mitigate possible ethical challenges.

Background Physically aggressive behaviors are very common among older people living with cognitive impairment. These behaviors may have significant consequences for family and formal caregivers, as well as for the other people in the older people’s environment, and are also a frequent cause of institutionalization. Two relevant systematic reviews have been published on the subject but do not specifically target physically aggressive behaviors or only focus on care in nursing homes. Moreover, they do not address the causes, associated factors, and consequences of these behaviors, even though these should indeed be considered when developing interventions. Thus, the purpose of this scoping review is to map the state of knowledge on these physically aggressive behaviors with a view to developing personalized interventions. Offering a humanist and relational perspective by which these behaviors may be examined, the Senses Framework will guide this review. Methods The scoping review method of Levac, Colquhoun, and O’Brien will be used. Several databases (e.g., CINAHL, PubMed, PsycINFO, SCOPUS, Grey Literature Report, clinical trials registries) will be searched for literature published in the past 15 years, using a combination of keywords and descriptors. Other data sources will be used to identify non-indexed literature or unpublished results (e.g., articles references, journal tables of content, contact with key authors). The literature will be selected regardless of setting, if it concerns older people, aged 65, or older with cognitive impairment who present physically aggressive behaviors. Data will be extracted systematically by the research team. A quality assessment of the literature will be done to consider this aspect in the data synthesis. A content analysis will be used to synthesize the results. Discussion No scoping review has been found on the physically aggressive behaviors of older people living with cognitive impairment in various settings. The results of this review will identify needs for further research and for clinical and training development on this problem from a humanist standpoint. Systematic review registration Currently, it is not possible to register a systematic scoping review protocol (e.g., PROSPERO). Electronic supplementary material The online version of this article (10.1186/s13643-019-1091-8) contains supplementary material, which is available to authorized users.

Background Following major organizations' recommendations, healthcare professionals' education has been reformed in the last decade into competency-based education (CBE) to better prepare them with core competencies. This change was intended to prepare new graduates for the reality of health systems and future challenges. Few studies have focused on how new graduate nurses (NGNs) from these reformed programs use the competencies they have developed. Objective To describe the competencies of NGNs from a Canadian competency-based baccalaureate program, as perceived by various actors in acute-care settings. Methods A focused ethnography was conducted on three acute-care wards of an academic hospital. Participants (n = 19) from four subgroups (NGNs, preceptors, clinical nurse specialists, and nurse managers) participated in individual semi-structured interviews or focus groups. Data were also collected through observation and fieldnotes; an ethnographic analysis framework was used. Results Three themes were identified to describe the deployment of NGNs' competencies: NGNs' appropriation of their new role, fragmentation of practice into tasks, and development of practice; NGNs' collaboration within the interprofessional team, management of the dyad with licensed practical nurses, and ability to integrate patients and families into the team; and NGNs' scientific practice, increased scientific curiosity, and use of credible sources. Analysis of these themes' elements in light of the competency framework of the program showed that NGNs deploy seven of the eight competencies developed during their training. Conclusion This study's results can be applied by nursing educators and hospital decision makers to ensure NGNs are able to use their competencies and to smoothen the transition period between the academic and clinical settings.

BACKGROUND The public’s understanding of science can be influential in a wide range of areas related to public health, including policy making and self-care. Through the digital and social media ecosystem, health scientists play a growing role in public science communication (SC). OBJECTIVE This review aimed to (1) synthesize the literature on SC initiated by health scientists targeting the public in the digital and social media ecosystem and (2) describe the SC strategies and communication channels used. METHODS This scoping review was based on the Joanna Briggs Institute Methodological Framework. A systematic search was performed in 6 databases (January 2000 to April 2018). Title and abstract screening, full-text review, data charting, and critical appraisal were performed independently by two review authors. Data regarding included studies and communication channels were synthesized descriptively. A typology of SC strategies was developed using a qualitative and inductive method of data synthesis. RESULTS Among 960 unique publications identified, 18 met inclusion criteria. A third of publications scored good quality (6/18, 33%), half scored moderate quality (9/18, 50%), and less than a fifth scored low quality (3/18, 16%). Overall, 75 SC strategies used by health scientists were identified. These were grouped into 9 types: content, credibility, engagement, intention, linguistics, planification, presentation, social exchange, and statistics. A total of 5 types of communication channels were identified: social networking platforms (eg, Twitter), content-sharing platforms (eg, YouTube), digital research communities (eg, ResearchGate), personal blogs and websites (eg, WordPress), and social news aggregation and discussion platforms (eg, Reddit). CONCLUSIONS Evidence suggests that multiple types of SC strategies and communication channels are used by health scientists concurrently. Few empirical studies have been conducted on SC by health scientists in the digital and social media ecosystem. Future studies should examine the appropriateness and effectiveness of SC strategies for improving public health–related outcomes and identify the barriers, facilitators, and ethical considerations inherent to the involvement of health scientists in the digital and social media ecosystem.

Worldwide, the proportion of older adults (60+) is growing very fast, increasing the prevalence of cognitive disorders such as Mild Cognitive Impairment and dementia. Recent literature shows a clear preference of older adults towards Aging in Place (AIP). In order to realize AIP in cognitively impaired older adults, appropriate measurements regarding safety and practical feasibility need to be taken. In answer to this issue, various e-Health solutions have been developed in the last decade, targeting support of memory, social contact, daily activities and personal safety. Much attention has also been given to solutions for caregivers of cognitively impaired older adults. Since the field of e-Health research is expanding at fast pace, implementing effective e-Health solutions based on research evidence constitutes a challenge. Therefore, this systematic review aims to review recent study findings in the field of e-Health research regarding community-dwelling cognitively impaired older adults and their informal caregivers. We also consider potential adverse effects of adoption of these solutions. An initial search led to 12999 potentially relevant citations. First-level title-screening of citations was completed in January 2019. Third-level full-text screening is targeted for April 2019. If possible, effect sizes for each type of e-Health intervention will be calculated.

Objective The goal of this review is to analyse articles on the experience of surrogates who find themselves making end-of-life decisions for a relative with a major neurocognitive disorder in a nursing home. Design An integrative review of the literature based on Whittemore and Knafl's method. Data sources This review used the CINAHL, PubMed, PsycInfo, Embase and Web of Science databases. A complementary search was also conducted via citation pearl searching, and the reference lists from the selected articles were manually verified. Review method The quality of the selected articles was assessed using the Crow Critical Appraisal Tool, and the data were extracted systematically and were then organised according to Mishel's uncertainty in illness theory. The data that did not correspond to any concept of the theory were excluded at this stage. Analysis was conducted using the method put forward by Miles, Huberman and Saldana. Results A total of 18 articles were selected: 11 qualitative, 5 quantitative and 1 using a mixed method, as well as 1 ethical argument. The subjects arising from the analysis of the articles were the types of decisions made, the support available for the surrogates, the role and involvement of the surrogates in the process and the factors that influence the decisions. Conclusion The results of this integrative review stimulate reflection on the needs of family members involved in making decisions, as well as on the nursing practice and research. Published literature is mainly from North America, and thus, more research is needed to better understand the impact of cultural and ethnic differences in the process, which was poorly covered by the existing literature. Also, exploring nurses' involvement in supporting surrogates may eventually better equip nurses for their interventions with surrogates. Implications for practice Describing the illness progression and the signification of palliative care to the resident with a NCD and their surrogate decision makers, as well as discussing end-of-life care preferences as early as possible are all nursing interventions that could potentially enhance surrogates' end-of-life decision-making process.

Aim To explore the influence of an acute care setting on competency deployment of new graduate nurses (NGNs) from a competency-based undergraduate programme. Background In the last 15 years, nursing education has shifted to competency-based education (CBE). Few studies have focused on how NGNs from these reformed programmes use the competencies they have developed. To be paradigmatically coherent with the nature of a competence, studies should also examine how context influences nursing practice and competency deployment. Design A focused ethnography of three acute care units from one academic hospital in Canada. Methods Purposive and snowball sampling strategies were used to recruit 19 participants: NGNs (n = 4), nurse preceptors (n = 2), clinical nurse specialists (n = 9) and nurse managers (n = 4). Data were collected through individual interviews, focus groups, observation and documentation. Data were analysed according to Roper and Shapira (Ethnography in nursing research. Thousand Oaks, CA: Sage Publications, 2000) ethnographic nursing analysis framework. Results Organisational and individual factors were identified as influencing NGNs' competency deployment. Organisational factors are orientation, stability, workload and the scientific culture of the unit. Personal factors have been linked to groups of professionals: for NGNs, personality and clinical placements during their initial education; for nurses working with NGNs, to be role models, to promote integration and to denounce bullying; and for other health professionals, to recognise nursing expertise. Conclusion One way to smooth the transition from academic to clinical settings for NGNs is by offering transition or orientation programmes that will provide them with stability and a reduced workload, allowing them to progressively deploy their competencies. Relevance to clinical practice Organisational and individual factors influence how new graduate nurses deploy their competencies. Clinical educators and nurse managers can help new nurses by acting on these factors. This study conforms to the COREQ Research Reporting Guidelines for qualitative studies.

Qualitative research should strive for knowledge translation toward the goal of closing the gap between knowledge and practice. However, it is often a challenge in nursing to identify knowledge translation strategies able to illustrate the usefulness of qualitative results in any given context. This article defines storytelling and uses pragmatism to examine storytelling as a strategy to promote the knowledge translation of qualitative results. Pragmatism posits that usefulness is defined by the people affected by the problem and that usefulness is promoted by modalities, like storytelling, that increase sensitivity to an experience. Indeed, stories have the power to give meaning to human behaviors and to trigger emotions, and in doing so bring many advantages. For example, by contextualizing research results and appealing to both the reason and the emotions of audiences, storytelling can help us grasp the usefulness of these research results. Various strategies exist to create stories that will produce an emotional experience capable of influencing readers' or listeners' actions. To illustrate the potential of storytelling as a knowledge translation strategy in health care, we will use our story of discovering this strategy during a qualitative study in a nursing home as an example.

IntroductionThe optimisation of health science communication (HSC) between researchers and the public is crucial. In the last decade, the rise of the digital and social media ecosystem allowed for the disintermediation of HSC. Disintermediation refers to the public’s direct access to information from researchers about health science-related topics through the digital and social media ecosystem, a process that would otherwise require a human mediator, such as a journalist. Therefore, the primary aim of this scoping review is to describe the nature and the extent of the literature regarding HSC strategies involving disintermediation used by researchers with the public in the digital and social media ecosystem. The secondary aim is to describe the HSC strategies used by researchers, and the communication channels associated with these strategies.Methods and analysisWe will conduct a scoping review based on the Joanna Briggs Institute’s methodology and perform a systematic search of six bibliographical databases (CINAHL, EMBASE, IBSS, PubMed, Sociological Abstracts and Web of Science), four trial registries and relevant sources of grey literature. Relevant journals and reference lists of included records will be hand-searched. Data will be managed using the EndNote software and the Rayyan web application. Two review team members will perform independently the screening process as well as the full-text assessment of included records. Descriptive data will be synthesised in a tabular format. Data regarding the nature and the extent of the literature, the HSC strategies and the associated communication channels will be presented narratively.Ethics and disseminationThis review does not require institutional review board approval as we will use only collected and published data. Results will allow the mapping of the literature about HSC between researchers and the public in the digital and social media ecosystem, and will be published in a peer-reviewed journal.

La comprehension des comportements humains est au cœur de la discipline infirmiere. Le developpement de connaissances sur ces comportements est primordial pour guider la pratique infirmiere, tant dans le domaine clinique, que pour la formation en soins infirmiers ou la gestion des soins infirmiers. Dans ce contexte, l’ethnographie est souvent meconnue comme methode de recherche visant a mieux comprendre les comportements dans leur environnement socioculturel. Cet article a pour but de presenter les principes qui guident cette methode qualitative et son application pour la recherche infirmiere. Dans un premier temps, la methode ethnographique et certaines de ses variantes seront decrites. Le deroulement d’une etude ethnographique sera par la suite expose. Finalement, des exemples d’etudes ethnographiques en science infirmiere seront presentes. Cet article offre des bases pour l’elaboration de protocoles de recherche utilisant l’ethnographie pour l’avancement des connaissances infirmieres, de meme que pour une meilleure utilisation des resultats issus d’etudes ethnographiques pour ameliorer les pratiques de soins.

The goal of this mixed method study was to describe the psychosocial profile of HIV-infected persons identified as long-term nonprogressors (LTNP), and their experiences of nonprogression. Data were collected from 24 participants with a mean age of 48 years and a mean duration of infection of 14 years. Results show rather moderate levels of anxiety and depression symptoms and a modest mean score of social support. Participants adapted by using acceptance, positive restructuring, and active coping strategies. Seven themes marked the experience: (a) reacting to announcement and dealing with diagnosis, (b) valuing interpersonal relations and well-being, (c) making changes in life, (d) coping with stress, (e) dealing with health care, (f) beliefs about reasons for nonprogression, and (g) living positively while dreading progression. The findings enrich a field of knowledge that has had little attention so far and shed light on the psychosocial profile of LTNP and their experiences of nonprogression.

Two of the most frequent problems in long-term care facilities (LTC) are behavioral symptoms and falls of older people living with Alzheimer’s disease or associated disorders. Intelligent videomonitoring and mobile application are potential gerontechnologies to help manage these problems. However, evidence about the needs for technologies in LTC is scarce. The goal of this study was to explore the perceptions and needs of managers, formal and family caregivers in LTC regarding these technologies, as well as the conditions and ethical challenges that could influence their use. Individual interviews and a content analysis were conducted. Results show the relevance of these technologies in LTC and the characteristics that make them useful. Based on these results, technologies could be developed to improve the quality of clinical practice in LTC.

Background: Despite the health benefits of increasing physical activity in the secondary prevention of acute coronary syndrome (ACS), up to 60% of ACS patients are insufficiently active. Evidence supporting the effect of Web-based interventions on increasing physical activity outcomes in ACS patients is growing. However, randomized controlled trials (RCTs) using Web-based technologies that measured objective physical activity outcomes are sparse. Objective: Our aim is to evaluate in insufficiently active ACS patients, the effect of a fully automated, Web-based tailored nursing intervention (TAVIE en m@rche) on increasing steps per day. Methods: A parallel two-group multicenter RCT (target N=148) is being conducted in four major teaching hospitals in Montreal, Canada. An experimental group receiving the 4-week TAVIE en m@rche intervention plus a brief “booster” at 8 weeks, is compared with the control group receiving hyperlinks to publicly available websites. TAVIE en m@rche is based on the Strengths-Based Nursing Care orientation to nursing practice and the Self-Determination Theory of human motivation. The intervention is centered on videos of a nurse who delivers the content tailored to baseline levels of self-reported autonomous motivation, perceived competence, and walking behavior. Participants are recruited in hospital and are eligible if they report access to a computer and report less than recommended physical activity levels 6 months before hospitalization. Most outcome data are collected online at baseline, and 5 and 12 weeks postrandomization. The primary outcome is change in accelerometer-measured steps per day between randomization and 12 weeks. The secondary outcomes include change in steps per day between randomization and 5 weeks, and change in self-reported energy expenditure for walking and moderate to vigorous physical activity between randomization, and 5 and 12 weeks. Theoretical outcomes are the mediating role of self-reported perceived autonomy support, autonomous and controlled motivations, perceived competence, and barrier self-efficacy on steps per day. Clinical outcomes are quality of life, smoking, medication adherence, secondary prevention program attendance, health care utilization, and angina frequency. The potential moderating role of sex will also be explored. Analysis of covariance models will be used with covariates such as sex, age, fatigue, and depression symptoms. Allocation sequence is concealed, and blinding will be implemented during data analysis. Results: Recruitment started March 30, 2016. Data analysis is planned for November 2017. Conclusions: Finding alternative interventions aimed at increasing the adoption of health behavior changes such as physical activity in the secondary prevention of ACS is clearly needed. Our RCT is expected to help support the potential efficacy of a fully automated, Web-based tailored nursing intervention on the objective outcome of steps per day in an ACS population. If this RCT is successful, and after its implementation as part of usual care, TAVIE en m@rche could help improve the health of ACS patients at large. Trial Registration: ClinicalTrials.gov NCT02617641; https://clinicaltrials.gov/ct2/show/NCT02617641 (Archived by WebCite at http://www.webcitation.org/6pNNGndRa) [JMIR Res Protoc 2017;6(4):e64]

Population aging represents a major challenge as the proportion of people aged over 65 years worldwide is expected to reach 2 billion by 2050. This has profound implications for the planning and delivery of health and social care. The knowledge we want to disseminate come from a systematic review on e-health interventions for healthy aging (HA). This project arises from a research collaboration putting together complementary expertise in information and communication technology and aging. The overarching goal of this project is to ensure rapid translation of scientific evidence on effective e-health interventions promoting HA in order to accelerate their implementation for the benefit of older adults and their caregivers. Various knowledge translation strategies will be developed and implemented with knowledge users.