Greta G Cummings

• PhD RN FCAHS FAAN FCAN
• Head of Faculty at University of Alberta

Background/Objectives Transitions to and from Emergency Departments (EDs) can be detrimental to long‐term care (LTC) residents and burden the healthcare system. While reducing avoidable transfers is imperative, various terms are used interchangeably including inappropriate, preventable, or unnecessary transitions. Our study objectives were to devel...

Background Context (work environment) plays a crucial role in implementing evidence-based best practices within health care settings. Context is multi-faceted and its complex relationship with best practice use by care aides in long-term care (LTC) homes are understudied. This study used an innovative approach to investigate how context elements in...

Aims To understand factors influencing nurse manager retention or intention to leave, develop a preliminary theoretical model and identify strategies and interventions for workforce planning. Design Systematic review update of literature with integrated design of mixed research synthesis. Methods We included peer‐reviewed articles examining facto...

Introduction Decisions about nurse staffing models are a concern for health systems globally due to workforce retention and well-being challenges. Nurse staffing models range from all Registered Nurse workforce to a mix of differentially educated nurses and aides (regulated and unregulated), such as Licensed Practical or Vocational Nurses and Healt...

Background and Objectives Organizational context is thought to influence whether care aides feel empowered, but we lack empirical evidence in the nursing home sector. Our objective was to examine the association of features of nursing homes’ unit organizational context with care aides’ psychological empowerment. Research Design and Methods This cr...

Background Understanding antecedents and consequences of incivility across higher education is necessary to create and implement strategies that prevent and slow uncivil behaviors. Purpose To identify the nature, extent, and range of research related to antecedents and consequences of incivility in higher education. Objectives 1) To identify disc...

Background and Objectives Older adults residing in residential aged care facilities (RACFs) often experience sub-standard transitions to emergency departments (EDs) through rationed and delayed ED care. We aimed to identify research describing interventions to improve transitions from RACFs to EDs. Research Design and Methods In our scoping review...

Background Overcrowding and long wait times in the emergency department (ED) have resulted in decreased patient satisfaction and quality of care. One of the solutions proposed to address wait times is the introduction of the nurse practitioner (NP) role in the ED. We present a systematic mixed studies review protocol that aims to gather and analyze...

Aim To examine trends in quality of work life and health outcomes of managers in nursing homes in Western Canada pre-pandemic. Methods A repeated cross-sectional descriptive study using data collected in 2014–2015, 2017 and 2019–2020, in the Translating Research in Elder Care Programme. Self-reported measures of demographics, physical/mental healt...

Background Pain is highly burdensome, affecting over 30% of long-term care (LTC) residents. Pain significantly reduces residents’ health-related quality of life (HRQoL), limits their ability to perform activities of daily living (ADLs), restricts their social activities, and can lead to hopelessness, depression, and unnecessary healthcare costs. Al...

The organizational context in nursing homes is associated with quality of care and residents’ quality of life. Our objective was to examine nursing home staff perceptions of unit organizational context. We conducted a secondary analysis of cross-sectional data. Participants were 3765 unregulated (health care aides (HCAs)) and 1130 regulated staff (...

Objective: To identify sociodemographic, health condition, and organizational/process factors associated with pressure injury (PI) incidence during older adults' emergency transitions from long-term care (LTC) to the ED. Methods: Emergency transitions were tracked for older adults within included LTC facilities to participating EDs in two urban...

While burnout among health care workers has been well studied, little is known about the extent to which burnout among health care workers impacts the outcomes of their care recipients. To test this, we used a multi-year (2014–2020) survey of care aides working in approximately 90 nursing homes (NHs); the survey focused on work–life measures, inclu...

Background Emotional support is key to improve older adults’ subjective health, and psychological, social and emotional well-being. However, many older adults living in the community lack emotional support, increasing the risk for loneliness, depression, anxiety, potentially avoidable healthcare use and costs, and premature death. Multiple intersec...

The association of organizational context with quality of care in nursing homes is not well understood at the clinical microsystem (care unit) level. This cross-sectional study examined the associations of unit-level context with 10 unit-level quality indicators derived from the Minimum Data Set 2.0. Study settings comprised 262 care units within 9...

Background: Potentially avoidable emergency department transfers (PAEDTs) and hospitalizations (PAHs) from long-term care (LTC) homes are two key quality improvement metrics. We aimed to: 1) Measure proportions of PAEDTs and PAHs in a Quebec sample; and 2) Compare them with those reported for the rest of Canada. Methods: We conducted a repeated...

Nursing homes were profoundly affected by the COVID-19 pandemic, influencing work outcomes of care aides who provide the most direct care. We compared care aides' quality of work life by conducting a repeated cross-sectional analysis of data collected in February 2020 and December 2021 from a stratified random sample of urban nursing homes in two C...

Background: Inadequate pain management persists in nursing homes. Nursing assistants provide the most direct care in nursing homes, and significantly improving the quality of care requires their adoption of best care practices informed by the best available evidence. We assessed the association between nursing assistants' use of best practices and...

Background: Prior to the pandemic, every day approximately 28 long term care (LTC) residents were transferred to an emergency department (ED) in Alberta. This was placing increasing strain on healthcare resources and potentially negatively impacting the health and wellness of residents (e.g., exposure to iatrogenic harms). Many residents’ condition...

Objectives: Quality of life (QoL) of nursing home (NH) residents is critical, yet understudied, particularly during the COVID-19 pandemic. Our objective was to examine whether COVID-19 outbreaks, lack of access to geriatric professionals, and care aide burnout were associated with NH residents' QoL. Design: Cross-sectional study (July to Decembe...

Background: The complex nature of leadership in nursing and healthcare requires a vast skill set. Leadership self-efficacy (LSE) has emerged as an important concept to support leadership development in the nursing literature. An analysis of LSE can clarify and inform strategies for leadership development among nurses. Objective: To clarify the c...

Aim To examine the influence of hospital culture and authentic leadership on the effects of quality improvement practices on patient satisfaction. Background Nurses in formal leadership roles shape and are shaped by organizational culture to achieve high performance standards to influence quality of care. Design Using structural equation modellin...

Background: Professional nursing associations across jurisdictions engaged in significant policy advocacy during the COVID-19 pandemic to support nurses, the public and health systems. While professional nursing associations have a long history of engaging in policy advocacy, scholars have rarely critically examined this important function. Purpos...

Objective: To develop a taxonomy of interventions aimed at reducing emergency department (ED) transfers and/or hospitalizations from long-term care (LTC) homes. Design: A systematic scoping review. Setting and participants: Permanent LTC home residents. Methods: Experimental and comparative observational studies were searched in MEDLINE, CIN...

Background Documentation during resident transitions from long-term care (LTC) to the emergency department (ED) can be inconsistent, leading to inappropriate care. Inconsistent documentation can lead to undertreatment, inefficiencies and adverse patient outcomes. Many individuals residing in LTC have some form of cognitive impairment and may not be...

Aims To determine what extent are workplace empowerment, New Graduate Nurses’ (NGN) perceptions of nurse leaders, trust in management, and areas of worklife predict coworker incivility experiences? Background NGNs’ perceptions of nursing leaderships’ control over workload contribute to coworker incivility experiences were tested. The relationship...

Background The number of research publications reporting the use of the Promoting Action on Research Implementation in Health Services (PARIHS) framework and the integrated PARIHS (i-PARIHS) framework has grown steadily. We asked how the last decade of implementation research, predicated on the (i-)PARIHS framework (referring to the PARIHS or i-PAR...

Objective: To evaluate changes in mental health and well-being (eg, quality of work life, health, intention to leave) among nursing home managers from a February 2020 prepandemic baseline to December 2021 in Alberta, Canada. Design: Repeated cross-sectional survey. Setting and participants: A random sample of nursing homes (n = 35) in urban ar...

Aims To explore the nuances of theory utilization in qualitative methodologies, discuss the different relationships that applied qualitative methodologies have with theory and use the foundational underpinnings of interpretive description to challenge strongly entrenched ideas of theory that have extended into applied qualitative nursing research....

Introduction: At the moment, it is unknown where optimal safe nurse staffing levels are located. Park’s Optimized Nurse Staffing (Sweet Spot) Estimation Theory may help pinpoint the optimal safe staffing levels maximizing quality of care outcomes relative to cost in home health nursing. However, theory testing is necessary to determine testability...

Background Caring for the well-being of older adults is one of the greatest challenges in modern societies. Improving the quality of care and life for older adults and the work lives of their care providers calls for effective knowledge translation of evidence-based best practices. Objective This study’s purpose is to contribute to knowledge trans...

Background and objectives: Older adults (≥65 years) are living longer with complex health needs and wish to remain at home as their care needs change. We aimed to determine which factors influence older persons' transitions from home living to facility-based care (FBC) settings such as long-term care facilities or assisted living. Research design...

Objective: This paper aims to spur thought-provoking practical debates on current nurse workforce staffing and scheduling systems in relation to a critical review of Ang and colleagues’ (2018) article entitled “Nurse workforce scheduling in the emergency department: A sequential decision support system considering multiple objectives.” Design: Disc...

Background and objectives: Frailty has been investigated for decades with a proliferation of frailty instruments attributed to many existing conceptual models and operational criteria. The purpose of this systematic review was to understand how instruments were developed to assess frailty in community dwelling older adults. Research design and me...

Aim To explore how an ecological approach be used to explore relationships among workplace empowerment, authentic leadership, trust in management, areas of work life and co‐worker incivility experiences of new graduate nurses. Design Key concepts related to new graduate nurses' incivility experience informed the research question building on the f...

Background: Long-term care (LTC) residents frequently experience transitions in the location of more advanced care delivery, including receiving emergency department (ED) care. In this proof-of-concept study, we aimed to determine if we could identify measures in quality of care across transitions from LTC to the ED, via emergency medical services...

In the Dutch nursing context, work remains in strengthening the voice of nurses serving as frontline health care providers and board members alike. Conceptual clarity of Public Opinion Leadership (POL) in nursing practice is needed to provide attributes, antecedents and consequences for nurses and nurse leaders so they can contribute in the public...

Policy advocacy is a fundamental component of nursing's social mandate. While it has become a core function of nursing organizations across the globe, the discourse around advocacy has focused largely on the responsibilities and accountabilities of individual nurses, with little attention to the policy advocacy work undertaken by nursing organizati...

Background: At the moment, it is unknown where optimal safe nurse staffing levels are located. Park's Optimized Nurse Staffing (Sweet Spot) Estimation Theory may help pinpoint the optimal safe staffing levels to maximize quality of care outcomes relative to cost in home health nursing. However, theory testing is necessary to verify testability and...

Objective: This paper aims to spur thought-provoking practical debates on current nurse workforce staffing and scheduling systems in relation to a critical review of Ang and colleagues' (2018) article entitled “Nurse workforce scheduling in the emergency department: A sequential decision support system considering multiple objectives.” Design: Disc...

Conclusion Systematically encouraging and supporting care aides to voice suggestions for improvement could be an important component of a future multi-component intervention tailored to improve pain in nursing home residents. Background • One in three nursing home (NH) residents in Canada suffer from daily pain. 1 • NH context (work environment) 2...

OBJECTIVES: Long term care (LTC) facilities are essential in the provision of daily care needs for older adults experiencing frailty. In times of acute medical distress, LTC residents may require transfer to emergency departments (ED). However, many transfers from the LTC to ED may not be required and residents could instead be treated within LTC u...

Objective To identify the barriers and strategies perceived by orthodontists when obtaining consent from their adult patients concerning patients’ comprehension or recollection of treatment information. Settings and Sample Population The sample comprised 12 orthodontists working in 8 different cities in Alberta, Canada. Methods An exploratory inve...

A better way to care for Long Term Care residents (LTC) in times of medical urgency: improving acute care for LTC residents. Leanna Wyer, Shawna Reid, Abraham Munene, Eddy Lang, Vivian Ewa, Heather Hair, Greta Cummings, Patrick McLane, Eldon Spackman, Peter Faris, Dominic Alaazi, Marian George, Jayna Holroyd-Leduc Background: Many LTC residents are...

The objective of this study was to determine the association between biases related to attrition, missing data, and the use of intention to treat and changes in effect size estimates in physical therapy randomized trials. A meta-epidemiological study was conducted. A random sample of randomized controlled trials included in meta-analyses in the phy...

Introduction Health care aides (personal support workers and nursing assistants) provide ~80%–90% of direct care to residents in nursing homes; it is therefore important to understand whether supervision of health care aides affects quality of care. We sought to determine whether health care aide reporting practices are associated with resident out...

Objectives People are living longer with complex health needs and wish to remain in their homes as their care needs change. We examined which client factors (sociodemographic, health service use, health, and function) influenced older persons’ (≥65 years) time to transition from home living to assisted living (AL) or long-term care (LTC) facilities...

We identified quality indicators (QIs) for care during transitions of older persons (≥ 65 years of age). Through systematic literature review, we catalogued QIs related to older persons’ transitions in care among continuing care settings and between continuing care and acute care settings and back. Through two Delphi survey rounds, experts ranked r...

Transitions for older persons from long-term care (LTC) to the emergency department (ED) and back, can result in adverse events. Effective communication among care settings is required to ensure continuity of care. We implemented a standardized form for improving consistency of documentation during LTC to ED transitions of residents 65 years of age...

Background In this meta-epidemiological study, we aimed to examine associations between treatment effect size estimates and sponsorship bias in oral health randomized clinical trials. Methods We selected oral health related meta-analyses that included a minimum of five randomized controlled trials. We extracted data, in duplicate, related to influ...

Aims To describe strategies nursing leaders use to promote evidence‐based practice implementation at point‐of‐care using data from health systems in Australia, Canada, England and Sweden. Design A descriptive, exploratory case‐study design based on individual interviews using deductive and inductive thematic analysis and interpretation. Methods F...

Background Front-line nurse managers provide direct oversight of healthcare delivery to ensure organizational expectations are enacted to achieve optimal patient and staff outcomes. Ensuring the job satisfaction of front-line nurse managers is key to retaining these individuals in their integral roles. Understanding factors influencing job satisfac...

This cross-sectional study describes care aides’ characteristics and quality of work life in Western Canadian nursing homes.

Background Nursing leadership plays a vital role in shaping outcomes for healthcare organizations, personnel and patients. With much of the leadership workforce set to retire in the near future, identifying factors that positively contribute to the development of leadership in nurses is of utmost importance. Objectives To identify determining fact...

Residents of long-term care (LTC) whose deaths are imminent are likely to trigger a transfer to the emergency department (ED), which may not be appropriate. Using data from an observational study, we employed structural equation modeling to examine relationships among organizational and resident variables and death during transitions between LTC an...

Objective: To investigate relationships among flexible and hierarchical organizational cultures, quality improvement domains, and authentic leadership competencies in Canadian healthcare facilities. Method: Observational cross-sectional study conducted in Alberta, Canada. Nurse managers (n=226) completed a survey including validated measures of or...

Background: Effective communication among interdisciplinary healthcare teams is essential for quality healthcare, especially in nursing homes (NHs). Care aides provide most direct care in NHs, yet are rarely included in formal communications about resident care (e.g., change of shift reports, family conferences). Audit and feedback is a potentiall...

Aim: To identify predictors of toxic leadership behaviour in nurse managers. Background: Toxic leadership is becoming increasingly prevalent in nursing; however, the literature provides very limited evidence of the different factors that promote toxic leadership behaviour in nurse managers. Methods: A descriptive, cross-sectional design was used....

Purpose: To analyze the leadership network structure among nursing leaders in Spain identified through the Grupo40Enfermeras y Universidad event. Methods: A descriptive cross-sectional study using social network analysis was used. Study sample consisted of 210 individuals, of whom 119 received nominations as referents. Structural analysis of the ne...

Background The concept of prefrailty lacks clarity. Often, prefrailty is defined in relation to frailty and less often as a distinct concept. Theoretical evidence for prefrailty is minimal unlike frailty, which has been examined for decades although consensus about how to measure frailty has not been achieved. Objective The aim of this study was t...

Aim: This paper describes the development and testing of the psychometric property of the Toxic Leadership Behaviors of Nurse Managers Scale (ToxBH-NM). Background: Toxic leadership is growing increasingly pervasive in the field of nursing. However, the current literature lacks comprehensive attempts to explain how toxic leadership disrupts work...

Background: Sponsorship bias could affect research results to inform decision makers when using the results of these trials. The extent to which sponsorship bias affect results in the field of physical therapy has been unexplored in the literature. Therefore, the main aim of this study was to evaluate the influence of sponsorship bias on the treat...

Background Effective communication among interdisciplinary healthcare teams is essential for quality healthcare, especially in nursing homes (NHs). Care aides provide most direct care in NHs, yet are rarely included in formal communications about resident care (e.g., change of shift reports, family conferences). Audit and feedback is a potentially...

Background: Effective communication among interdisciplinary healthcare teams is essential for quality healthcare, especially in nursing homes (NHs). Care aides provide most direct care in NHs, yet are rarely included in formal communications about resident care (e.g., change of shift reports, family conferences). Audit and feedback is a potentially...

Kislov and colleagues draw on multiple qualitative case studies of evidence-based nursing conducted in Sweden, Canada, Australia and the UK to describe the chain of codified knowledge which reflects the institutionalisation of evidence-based practice as organisational “business as usual”. This chain is dominated by performance standards, policies a...

Emergency transfers of seniors in long-term care facilities (LTCF) aged >65 to hospital emergency departments (ED) are common and carry with them risks that can lead to less-than-optimal quality of care and quality of life. Pressure ulcers are one such risk. We used data from the Older Persons Transitions in Care (OPTIC; N=637) study, conducted in...

Studies examining risk of death during acute care transitions have highlighted potential predictors of death during transition. However, they have not closely examined the relationships and directional effects of organizational context, care processes, resident demographics and health conditions on death during transition. By employing structural e...

A population's health is dependent on the availability of skilled health professionals. We know little about retirement decision-making among publicly employed Canadian registered nurses (RNs) and allied health professionals (AHPs). We identified and compared factors reported to influence early versus 65+ retirement decisions among RNs (n = 794) an...

NTRODUCTION: Availability of health professionals is fundamental to a population’s health. Despite shortages, we know little about retirement decision-making among publicly-employed, Canadian Registered Nurses (RNs) and allied health professionals (AHPs). Limited data on RN/AHP “supply” inhibits the effectiveness of health workforce planning. OBJEC...

Aim: To identify demographic-, individual-, and organizational-level predictors of job satisfaction among managers in residential long-term care (LTC) facilities. Background: Job satisfaction predicts turnover among managers in LTC settings. However, factors affecting job satisfaction among LTC facility managers remain poorly understood. Method...

Background: Early retirement (before age 65) is the norm among registered nurses (RNs) and allied health professionals (AHPs) employed in Canada's public system. As a country whose population is rapidly aging, it is in Canada's best interest to try and extend the work lives of RNs and AHPs. Objectives: (1) To test the predictive validity of our...

A Profile of Regulated Nurses Employed in Canadian Long-Term Care Facilities—CORRIGENDUM - Volume 38 Issue 2 - Janet E. Squires, Jennifer Baumbusch, Melissa Demery Varin, Ibo MacDonald, Stephanie Chamberlain, Anne-Marie Boström, Genevieve Thompson, Greta Cummings, Carole A. Estabrooks

Aim To evaluate effectiveness of specific policy and practice changes to the process of registration for internationally educated nurses. Background Little research exists to inform registration policy for internationally educated health professionals. Introduction Internationally educated nurse employment can help address nursing shortages. Regu...

Drawing on multiple qualitative case studies of evidence‐based health care conducted in Sweden, Canada, Australia, and the United Kingdom, the authors systematically explore the composition, circulation, and role of codified knowledge deployed in the organizational enactment of evidence‐based practice. The article describes the “chain of codified k...

RÉSUMÉ Le personnel infirmier autorisé (PIA) et les infirmiers auxiliaires (I aux ) fournissent le volet spécialisé des soins infirmiers dans les centres de soins de longue durée au Canada. Cependant, peu d’études se sont penchées sur cette main-d’œuvre importante. Une enquête a été réalisée chez 309 PIS et 448 I aux provenant de 91 centres pour pe...

Aim To examine predictors of Canadian new graduate nurses’ health outcomes over 1 year. Design A time‐lagged mail survey was conducted. Method New graduate nurses across Canada (N = 406) responded to a mail survey at two time points: November 2012–March 2013 (Time 1) and May–July 2014 (Time 2). Multiple linear regression (mental and overall healt...

Stigma is commonly experienced by people living with HIV/AIDS and by those providing care to HIV/AIDS patients. Few intervention studies have explored the impact of workplace policies and/or quality improvement on stigma. We examine the contribution of health care workplace policies, procedures and quality assurance initiatives, and self- and peer-...

Objective: For long-term care (LTC) residents, transfers to emergency departments (EDs) can be associated with poor health outcomes. We aimed to describe characteristics of residents transferred, factors related to decisions during transfer, care received in emergency medical services (EMS), ED settings, outcomes on return to LTC, and times of tran...

Background The approach and style of leaders is known to be an important factor influencing the translation of research evidence into nursing practice. However, questions remain as to what types of roles are most effective and the specific mechanisms through which influence is achieved. Objectives The aim of the study was to enhance understanding...

RÉSUMÉ Les aides-soignants non réglementés fournissent la majorité des soins directs dans les résidences pour personnes âgées. Nos travaux précédents ont rapporté un premier profil démographique des aides-soignants de l’ouest du Canada par le programme de recherche Translating Research in Elder Care (TREC; 2007-2022) visant les services de santé ap...

The roles and responsibilities of oncology nurses have rapidly transformed over the past century from general nurses providing bedside comfort care with few technological advances to advanced practice oncology nurses responsible for everything from performing invasive procedures to diagnostic interpretation and screening for cancer prevention. As c...

Aim To explore the organisational antecedents related to horizontal violence among nurses and the extent to which policy initiatives reduce its incidence. Background Organisational re‐engineering initiatives affect registered nurse roles, adding complexity to organisational antecedents related to horizontal violence and policy. No previous systema...

Purpose The purpose of this paper is to examine relationships between internationally educated nurses’ (IENs’) performance in a registered nurse competency assessment process and the outcomes of their nursing registration applications. Assessments of nursing practice competencies, IEN applicant characteristics and registration outcomes were explore...

Background: Early retirement (before age 65) is the norm among Registered Nurses (RNs) and allied health professionals (AHPs) employed in Canada’s public health system. As a country whose population is rapidly aging, it is in Canada’s best interest to try and extend the work lives of RNs and AHPs. Objectives: To test a previously validated model of...

Background: Scholarship cites health care managers (HCMs) as not using research evidence in their management practice. The purpose of this review was to evaluate the effectiveness of interventions to enhance HCMs use of research evidence in practice. Methods: We carried out a systematic review and focus groups to validate the review findings. We...