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Publications (23)

  • [Show abstract] [Hide abstract] ABSTRACT: . Although feasible protocols for pain assessment and management in long-term care (LTC) have been developed, these have not been implemented on a large-scale basis. Objective . To implement a program of regular pain assessment in two LTC facilities, using implementation science principles, and to evaluate the process and success of doing so. Methods . The implementation protocol included a pain assessment workshop and the establishment of a nurse Pain Champion. Quality indicators were tracked before and after implementation. Focus groups and interviews with staff were also conducted. Results . The implementation effort was successful in increasing and regularizing pain assessments. This was sustained during the follow-up period. Staff members reported enthusiasm about the protocol at baseline and positive results following its implementation. Despite the success in increasing assessments, we did not identify changes in the percentages of patients reported as having moderate-to-severe pain. Discussion . It is our hope that our feasibility demonstration will encourage more facilities to improve their pain assessment/management practices. Conclusions . It is feasible to implement regular and systematic pain assessment in LTC. Future research should focus on ensuring effective clinical practices in response to assessment results, and determination of longer-term sustainability.
    Article · Mar 2016 · Pain research & management: the journal of the Canadian Pain Society = journal de la societe canadienne pour le traitement de la douleur
  • [Show abstract] [Hide abstract] ABSTRACT: Purpose: The purpose of this study was to determine whether providing fall risk information to long-term care (LTC) nurses affects restraint use, activities of daily living (ADL), falls, and nurse fears about patient falls. Methods: One-hundred and fifty LTC residents were randomized to a fall risk assessment intervention or care-as-usual group. Hypotheses were tested using analyses of variance and path analyses. Results: Restraint use was associated with lower ADL scores. In the intervention group, there ceased to be significant relationships between nurse fears about falls and patient falls (after controlling for actual patient risk; post-intervention, nurse fears about falls were based on realistic appraisals), and between fears and restraints (i.e. unjustified nurse fears became less likely to lead to unjustified restraint use). No group differences in falls were identified. Conclusion: Despite a lack of group differences in falls, results show initial promise in potentially impacting resident care. Increasing intervention intensity may lead to fall reductions in future research. Implications for Rehabilitation Given the high prevalence rates of falls in LTC and associated injuries, prevention programs are important. Nurse fears about patient falls may impact upon restraint use which, when excessive, can interfere with the patient's ability to perform ADL. Excessive restraint use, due to unjustified nurse fears, could also lead to falls. Providing accurate, concise information to nursing staff about patient fall risk may aid in reducing the association between unjustified nurse fears and the resulting restraint use that can have potential negative consequences.
    Article · Oct 2015 · Disability and Rehabilitation
    [Show abstract] [Hide abstract] ABSTRACT: Behaviours of concern ( e.g. aggression) are often present in residents of long-term care (LTC) facilities diagnosed with dementia and may impact quality of life. Prior uncontrolled research has shown that an intervention involving sharing resident life histories may be effective in reducing aggressive behaviours and improving quality of life, perhaps by increasing staff empathy. We used a randomised controlled design, involving a considerably larger sample than previous investigations. We also examined staff perceptions of LTC resident personhood in relation to aggressive behaviour. Seventy-three residents were randomised to either a life history intervention (N = 38) or a control condition (N = 35). Ninety-nine nurses and care aides answered questionnaires about their own attitudes and the residents' behaviours and quality of life at baseline, post-intervention and at follow-up. Results of mixed-effects modelling indicated significant differences between groups in personhood perception and resident quality of life. Personhood perception mediated the relationship between the intervention and improved quality of life. We identified significant negative correlations between resident cognitive impairment and staff perceptions of resident personhood. Qualitative findings suggested that staff primarily changed their verbal interactions with residents following the intervention, which may be particularly helpful for residents with the most severe dementia. Our results indicate that LTC residents benefit when life histories are constructed with their families and shared with nursing staff.
    Article · Aug 2015 · Ageing and Society
  • [Show abstract] [Hide abstract] ABSTRACT: AimTo study resilience among long-term care (LTC) nurses and its relationship to organisational empowerment, self-reported quality of care, perceptions of resident personhood (i.e. viewing another person as a person, implying respect) and absenteeism.Background Although resilience has been examined among nurses, it has not been studied in LTC nurses where resident rates of dementia are high, and nurses may experience stress affecting care and the way residents are perceived.MethodA sample of one hundred and thirty LTC nurses from across North America completed a series of questionnaires.ResultsResilient nurses were more likely to report higher quality of care and to view residents as having higher personhood status (despite deteriorating cognitive function). Resilience was not predictive of absenteeism. Organisational empowerment did not add to the predictive power of resilience.Conclusions Resilience is of importance in LTC nursing research and future studies could examine this construct in relation to objectively measured resident outcomes.Implications for nursing managementOur findings suggest that interventions to improve LTC staff resilience would be important to pursue and that consideration should be given to resilience in optimizing the match between potential staff members and LTC positions.
    Article · Jun 2015 · Journal of Nursing Management
  • [Show abstract] [Hide abstract] ABSTRACT: Although emotion regulation (ER) modulates the pain experience, inconsistencies have been identified regarding the impact of specific regulation strategies on pain. Our goal was to examine the effects of emotion suppression and cognitive reappraisal on automatic (i.e., nonverbal) and cognitively mediated (i.e., verbal) pain expressions. Non-clinical participants were randomized into either a suppression (n = 58), reappraisal (n = 51), or monitoring-control (n = 42) condition. Upon arrival to the laboratory, participants completed the Emotion Regulation Questionnaire (ERQ), to quantify self-reported suppression and reappraisal tendencies. Subsequently, they completed a thermal pain threshold and tolerance task. They were then provided with instructions to use, depending on their experimental condition, suppression, reappraisal or monitoring strategies. Afterwards, they were exposed to experimentally-induced pain. Self-report measures of pain, anxiety, and tension were administered and facial expressions, heart rate, and galvanic skin response were recorded. The Facial Action Coding System was used to quantify general and pain-related facial activity (i.e., consistent with prior research, we defined facial actions that occurred during at least 5% of pain stimulation periods as "pain-related actions"). Reappraisal- and suppression-induction led to reductions in nonverbal and verbal indices of pain. Moreover, self-reported tendencies to use suppression and reappraisal (as measured by the ERQ) did not interact with experimental condition in the determination of participants' responses. Results suggest that consciously applying ER strategies during a painful task can moderate both cognitively mediated (e.g., verbal) and automatic (e.g., facial activity) expressions of pain.
    Article · Feb 2015 · Pain
  • Nicole E Pugh · Heather D Hadjistavropoulos · Amy J D Hampton · [...] · Jaime Williams
    [Show abstract] [Hide abstract] ABSTRACT: Postpartum depression (PPD) afflicts up to 15 % of women following childbirth and negatively impacts both mother and child. Therapist-assisted internet cognitive behavior therapy (TAICBT) is a promising intervention for the treatment of PPD; however, women's perceptions of TAICBT have not been examined. Responses to 10 open-ended questions from 24 women who received TAICBT for PPD were thematically analyzed. The majority of women expressed that the TAICBT program afforded flexibility, accessibility, and convenience, as well as anonymity and privacy. Some participants described the program as helping them take a step in the right direction and enhance their self-awareness and parenting skills. Participants also described having the internet therapist individualize their treatment. Challenges related to the TAICBT program were also identified by a minority of participants including managing time to log onto the program, the fast pace, completion of homework around childcare duties, and challenges of not having a face-to-face therapist. Participants also made suggestions for future programming. The large majority of participants consistently described their internet therapist favorably; however, challenges related to the internet therapy were also identified. Results should be integrated in the development of future programming.
    Article · Aug 2014 · Archives of Women s Mental Health
  • [Show abstract] [Hide abstract] ABSTRACT: Our goal was to develop and validate, based on theoretical and empirical knowledge, the Pain Assessment Checklist for Seniors with Limited Ability to Communicate (PACSLAC-II), a shorter tool that would improve on the PACSLAC, while addressing limitations of the original version. The PACSLAC was revised based on the relevant clinical and theoretical literature. Psychometric properties and clinical utility of the resulting 31-item PACSLAC-II were examined. Specifically, the PACSLAC-II was used to assess pain based on video footage of long-term care (LTC) residents with dementia undergoing painful procedures as part of routine care. Its ability to discriminate pain from non-pain related states was compared to that of pre-existing pain assessment tools using archival data. A second phase involved the use of the PACSLAC and PACSLAC-II by LTC staff in order to solicit feedback from health care providers. Mixed methods analysis of this feedback was conducted. The PACSLAC-II demonstrated satisfactory reliability, excellent validity, and ability to differentiate between pain and non-pain states. The PACSLAC-II also accounted for unique variance in differentiating between pain and non-pain states, even after controlling for the pre-existing tools combined, including the PACSLAC. The PACSLAC-II was also preferred by many LTC nurses and care aides, due to its length and condensed nature, which was thought to facilitate documentation and greater efficiency in pain management. Findings indicate that the empirical and theoretically-driven revisions to the PACSLAC led to improved ability to differentiate between pain and non-pain states, while retaining its clinical utility.
    Article · Nov 2013 · The Clinical journal of pain
  • [Show abstract] [Hide abstract] ABSTRACT: An ongoing concern in long-term care (LTC) is that pain problems are often not identified correctly. There is also evidence that behavioral disturbance due to pain is misattributed to psychiatric conditions and consequently frequently treated with psychotropic rather than analgesic medication. This can result in unnecessary polypharmacy and ineffective pain management. In a previous study, implementation of a pain assessment protocol resulted in changes in administration of pro re nata (PRN) medications and positive outcomes. However, there were no changes in regularly scheduled medications suggesting that assessment results were either not communicated to the prescribing physicians or not taken into account. The goal of this study was to determine whether a pain assessment protocol, augmented with communication of the assessment results to the residents' physicians, affects prescriptions of analgesic and psychotropic medication. Psychotropic medication reduction would help address the problem of polypharmacy frequently seen in LTC facilities. PRN medications were also examined. This investigation involved a two group design (control vs. assessment). A mixed methods analysis included both quantitative and qualitative procedures. At the end of the study, residents in the pain assessment group were administered fewer psychotropic medications than patients in the control group, helping address the problem of polypharmacy. Pain levels were comparable between the groups. Health care staff indicated that the protocol resulted in more careful evaluation of residents' pain and greater appropriateness of prescriptions including reductions in polypharmacy.
    Article · Oct 2013 · Pain management nursing: official journal of the American Society of Pain Management Nurses
  • [Show abstract] [Hide abstract] ABSTRACT: Introduction: Inadequacies in pain assessment and management in long-term care have been well documented. Insufficient pain education and inaccurate beliefs about the nature of pain and aging have been identified as possible contributors. The present study addresses the need for improved, efficient and feasible continuing pain education through the use of an assessment training video. Methods: A total of 148 long-term care staff viewed and evaluated the training video. Knowledge changes and pain beliefs were assessed postvideo and at a four-week follow-up. Beliefs about pain, as well as pain and aging, were also examined using multivariate procedures to determine whether these variables influenced participants' evaluation of the video. Focus groups were also conducted, and transcripts were analyzed using thematic content analysis. Results: Pain assessment knowledge improved postvideo and at the four-week follow-up. Participants positively evaluated the content and quality of the video. Individuals who held stronger beliefs (at baseline) about the organic nature of pain provided more positive evaluations. Barriers to implementation of practices in the video identified by the focus groups (and qualitative analysis) included time, workload and resistance to change. Facilitators to implementation included continued management support and observing the benefits to implementation. Discussion: The present study provides support for the use of video training. However, based on the focus group results, top-down implementation approaches with ongoing management involvement throughout the implementation process may be needed to achieve sustained changes in pain assessment practices. A model useful for sustained implementation was proposed and discussed, and is hoped to facilitate future research.
    Article · Aug 2013
  • [Show abstract] [Hide abstract] ABSTRACT: Interest in person-centred dementia care has flourished in the last two decades. Despite growing interest in the development and implementation of person-centred approaches to dementia care, important empirical questions remain. For instance, although Kitwood (1997) emphasized that personhood, a status extended by others, is at the heart of person-centred care, to our knowledge, no one has demonstrated empirically that beliefs about patient status influence how care is provided. The purpose of this series of three studies was to operationalize Kitwood's definition of personhood in order to test this hypothesis. To operationalize Kitwood's definition of personhood, we generated items to create the Personhood in Dementia Questionnaire (PDQ; Study 1). We then completed preliminary tests of the PDQ's convergent and discriminant validity (Study 2). Finally, we examined the PDQ's relationships with other constructs such as burnout and job satisfaction, and we used linear regression to test the hypothesis that health providers' beliefs about personhood influence intended approaches to dementia care (Study 3). In Study 1, we generated a pool of 64 potential questionnaire items. In Study 2, a 20-item version of the PDQ demonstrated good internal consistency, resistance to socially desirable responding, and evidence of convergent and discriminant validity. In Study 3, PDQ scores accounted for a significant proportion of variance in health providers' intended approaches to dementia care, including pain management. PDQ scores were not related to job satisfaction or to most aspects of burnout. These results provide the first direct empirical evidence of Kitwood's (1997) theory that beliefs about patient personhood have the potential to influence health providers' care decisions, including decisions about pain management.
    Article · Aug 2013
  • Omeed O Ghandehari · Thomas Hadjistavropoulos · Jaime Williams · [...] · Lisa M Lix
    [Show abstract] [Hide abstract] ABSTRACT: The underassessment and undertreatment of pain in residents of long-term care (LTC) facilities has been well documented. Gaps in staff knowledge and inaccurate beliefs have been identified as contributors. To investigate the effectiveness of an expert-based continuing education program in pain assessment⁄management for LTC staff. Participants included 131 LTC staff members who were randomly assigned to either an interactive pain education (PE) program, which addressed gaps in knowledge such as medication management, or an interactive control program consisting of general dementia education without a specific clinical focus. Participants attended three sessions, each lasting 3 h, and completed measures of pain-related knowledge and attitudes⁄beliefs before, immediately after and two weeks following the program. Focus groups were conducted with a subset of participants to gauge perception of the training program and barriers to implementing pain-related strategies. Analysis using ANOVA revealed that PE participants demonstrated larger gains compared with control participants with regard to pain knowledge and pain beliefs. Barriers to implementing pain-related strategies certainly exist. Nonetheless, qualitative analyses demonstrated that PE participants reported that they overcame many of these barriers and used pain management strategies four times more frequently than control participants. Contrary to previous research, the present study found that the interactive PE program was effective in changing pain beliefs and improving knowledge. Continuing PE in LTC has the potential to address knowledge gaps among front-line LTC providers.
    Article · Mar 2013 · Pain research & management: the journal of the Canadian Pain Society = journal de la societe canadienne pour le traitement de la douleur
  • Jaime Williams · Thomas Hadjistavropoulos · Omeed O. Ghandehari · [...] · Lisa Lix
    [Show abstract] [Hide abstract] ABSTRACT: Person-centred approaches in long-term care focus on providing holistic care to residents in order to improve quality of life, enhance resident wellbeing and autonomy, and mitigate behavioural and/or other symptoms. The results of research on person-centred approaches to care are mixed, with very few high-quality empirical studies examining resident outcomes specifically. The purpose of this investigation was to examine a person-centred care programme implemented in three Canadian long-term care facilities to determine its effect on resident outcomes, approach to care and maintenance of the programme three years after implementation. Using the Resident Assessment Instrument Minimum Data Set (RAI-MDS) scale scores and quality indicators, we retrospectively examined resident outcomes before, after and six months following the initiation of the programme using three additional facilities as control. We did not find any effects on resident outcomes. Focus group interviews with facility staff revealed no systematic differences between the programme and control facilities in their approach to care. All facilities supported aspects of a person-centred philosophy. Focus group interview data from the programme facilities indicated partial maintenance in two facilities and more complete maintenance in one facility. Although staff members supported the programme, implementation and maintenance proved difficult and effectiveness on resident outcomes was not indicated in this research. Additional controlled studies are needed.
    Article · Mar 2013 · Ageing and Society
  • [Show abstract] [Hide abstract] ABSTRACT: The principles in the Canadian Code of Ethics for Psychologists (CCEP; Canadian Psychological Association, 2000) are ranked in order of importance. Although there is some support for the ranking, it is unclear whether its utilization leads to more ethical decision making. We investigated whether medical residents and undergraduate students who were given information about the ranking would provide more ethical (i.e., in accordance with the CCEP) and consistent responses to dilemmas and would be more confident in their decisions than participants not provided with ranking information. Forty-seven medical residents and 45 students were taught about the CCEP principles. Half of the participants were provided with information about the ranked order. Participants responded to 6 vignettes describing ethical dilemmas with courses of action, by rating whether the course of action was ethical and providing a by rationale. Participants, who knew about the ranking, provided ratings that were more consistent with the CCEP although the pattern varied across vignettes. Moreover, participants in the ranked condition made decisions faster than participants in the unranked condition. We found no evidence that participants were more likely to agree with each other when familiar with the CCEP hierarchy. Finally, students in the ranked condition were less confident than students in the unranked condition whereas ranking did not affect the residents' confidence. Thematic analysis of participants' rationales revealed that, among those who responded inconsistently with the CCEP, some had misunderstood the ethical principles, misinterpreted the relative vulnerability of the parties depicted in the vignettes, and/or provided rationales that were consistent with the code whereas their ratings were not. Specific contextual factors that affected decision making are discussed as are the implications of these findings for the CCEP.
    Article · Aug 2012
  • [Show abstract] [Hide abstract] ABSTRACT: Although falls often result in serious injury among seniors residing in long-term care (LTC), there is a paucity of research about LTC staff perceptions about falls. Our purpose was to elicit opinions of LTC staff about falls and fall prevention given 'least restraint' policies. We also aimed to identify obstacles for optimal falls prevention. Data were collected from administrators and a wide variety clinical staff (N = 98; 7 LTC facilities) using 11 focus groups and 28 interviews. Questions were asked about clinical practices related to falls. We employed thematic analysis to ascertain primary and secondary themes within the data. Participants viewed falls as a major challenge. They expressed concerns about their ability to control falls and manage consequences. Participants were conflicted about the role of restraints in falls management. Although they acknowledged beneficial effects of least restraint in terms of resident independence and increased activity, they also noted that in some instances, restraints may prevent falls, especially when individuals with dementia are considered. Participants were highly attentive to issues surrounding falls. However, many were unaware of clinically important findings from relevant research and misperceived fall-related (restraint) policies. Physical therapists have a role to play in education initiatives targeting these areas.
    Article · Mar 2011 · Disability and Rehabilitation
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    [Show abstract] [Hide abstract] ABSTRACT: Improving the quality of life for long-term care (LTC) residents is of vital importance. Researchers need to involve LTC staff in planning and implementing interventions to maximize the likelihood of success. The purposes of this study were to (a) identify barriers and facilitators of LTC homes' readiness to implement evidence-based interventions, and (b) develop strategies to facilitate their implementation. A mixed methods design was used, primarily driven by the qualitative method and supplemented by two smaller, embedded quantitative components. Data were collected from health care providers and administrators using 13 focus groups, 26 interviews, and two surveys. Findings revealed that participants appreciated being involved at early stages of the project, but receptiveness to implementing innovations was influenced by study characteristics and demands within their respective practice environment. Engaging staff at the planning stage facilitated effective communication and helped strategize implementation within the constraints of the system.
    Full-text Article · Dec 2010 · Qualitative Health Research
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    [Show abstract] [Hide abstract] ABSTRACT: Within any organization (e.g. a hospital or clinic) the perception of the way things operate may vary dramatically as a function of one's location in the organizational hierarchy as well as one's professional discipline. Interorganizational variability depends on organizational coherence, safety, and stability. In this four-nation (Canada, Ireland, Australia, and Korea) qualitative study of 42 nurses, we explored their perception of how ethical decisions are made, the nurses' hospital role, and the extent to which their voices were heard. These nurses suggested that their voices were silenced (often voluntarily) or were not expressed in terms of ethical decision making. Finally, they perceived that their approach to ethical decision making differed from physicians.
    Full-text Article · Nov 2009 · Nursing Ethics
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    Thomas Hadjistavropoulos · Keela Herr · Dennis C Turk · [...] · Jaime Williams
    [Show abstract] [Hide abstract] ABSTRACT: This paper represents an expert-based consensus statement on pain assessment among older adults. It is intended to provide recommendations that will be useful for both researchers and clinicians. Contributors were identified based on literature prominence and with the aim of achieving a broad representation of disciplines. Recommendations are provided regarding the physical examination and the assessment of pain using self-report and observational methods (suitable for seniors with dementia). In addition, recommendations are provided regarding the assessment of the physical and emotional functioning of older adults experiencing pain. The literature underlying the consensus recommendations is reviewed. Multiple revisions led to final reviews of 2 complete drafts before consensus was reached.
    Full-text Article · Feb 2007 · Clinical Journal of Pain
  • [Show abstract] [Hide abstract] ABSTRACT: Although psychological and pharmacological treatment approaches for Body Dysmorphic Disorder have been evaluated, the relative effectiveness of these two types of interventions has not been examined. We conducted a meta-analysis of randomized clinical trials and case series studies involving psychological (i.e., behavioural, cognitive-behavioural, cognitive) or medication therapies. Our findings support the effectiveness of both types of therapy, but suggest that cognitive-behavioural treatment may be the most useful. These findings require cross-validation through large-scale clinical trials.
    Article · Feb 2006 · Behaviour Research and Therapy
  • Jaime Williams · William Smythe · Thomas Hadjistavropoulos · [...] · Ronald Martin
    [Show abstract] [Hide abstract] ABSTRACT: We examined the content of Canadian hospital mission statements using thematic content analysis. The mission statements that we studied varied in terms of both content and length. Although there was some content related to goals designed to ensure organizational visibility, survival, and competitiveness, the domain of values predominated over our entire coding structure. The primary value-related theme that emerged concerned the importance of patient care.
    Article · Oct 2005 · Health care management review
  • Ronald Martin · Jaime Williams · Thomas Hadjistavropoulos · [...] · Michael MacLean
    [Show abstract] [Hide abstract] ABSTRACT: The literature suggests that pain in the elderly, especially among seniors with dementia, is under-assessed and under-treated. This qualitative study solicited the perspectives of seniors, front-line nursing staff, nursing-home administrators, and informal caregivers of seniors with dementia on the current status of pain assessment and management. The views of these participants complement the research findings reported in the literature. While some of their explanations and potential solutions concerning under-treatment of pain in seniors echo views that have been presented in the literature, the participants also pointed to factors and avenues that have been given less formal consideration (e.g., systemic barriers to effective assessment and treatment of pain). They also highlighted the need for pain-control strategies beyond medication. The implications of these findings are discussed.
    Article · Jul 2005 · The Canadian journal of nursing research = Revue canadienne de recherche en sciences infirmières