Allison Cammer1, Debra Morgan2, Norma Stewart3, Katherine McGilton4, Jo Rycroft-Malone5, Sue Dopson6, Carole Estabrooks7. 1. Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, Canada. allison.cammer@usask.ca. 2. Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, Canada. 3. College of Nursing, University of Saskatchewan, Saskatoon, Canada. 4. Toronto Rehabilitation Institute-UHN, Toronto, Ontario, Canada. 5. School of Healthcare Sciences, Bangor University, Gwynedd, UK. 6. Said Business School, University of Oxford, UK. 7. Faculty of Nursing, University of Alberta, Canada.
Abstract
PURPOSE: Context is increasingly recognized as a key factor to be considered when addressing healthcare practice. This study describes features of context as they pertain to knowledge use in long-term care (LTC). DESIGN AND METHODS: As one component of the research program Translating Research in Elder Care, an in-depth qualitative case study was conducted to examine the research question "How does organizational context mediate the use of knowledge in practice in long-term care facilities?" A representative facility was chosen from the province of Saskatchewan, Canada. Data included document review, direct observation of daily care practices, and interviews with direct care, allied provider, and administrative staff. RESULTS: The Hidden Complexity of Long-Term Care model consists of 8 categories that enmesh to create a context within which knowledge exchange and best practice are executed. These categories range from the most easily identifiable to the least observable: physical environment, resources, ambiguity, flux, relationships, and philosophies. Two categories (experience and confidence, leadership and mentoring) mediate the impact of other contextual factors. Inappropriate physical environments, inadequate resources, ambiguous situations, continual change, multiple relationships, and contradictory philosophies make for a complicated context that impacts care provision. IMPLICATIONS: A hidden complexity underlays healthcare practices in LTC and each care provider must negotiate this complexity when providing care. Attending to this complexity in which care decisions are made will lead to improvements in knowledge exchange mechanisms and best practice uptake in LTC settings.
PURPOSE: Context is increasingly recognized as a key factor to be considered when addressing healthcare practice. This study describes features of context as they pertain to knowledge use in long-term care (LTC). DESIGN AND METHODS: As one component of the research program Translating Research in Elder Care, an in-depth qualitative case study was conducted to examine the research question "How does organizational context mediate the use of knowledge in practice in long-term care facilities?" A representative facility was chosen from the province of Saskatchewan, Canada. Data included document review, direct observation of daily care practices, and interviews with direct care, allied provider, and administrative staff. RESULTS: The Hidden Complexity of Long-Term Care model consists of 8 categories that enmesh to create a context within which knowledge exchange and best practice are executed. These categories range from the most easily identifiable to the least observable: physical environment, resources, ambiguity, flux, relationships, and philosophies. Two categories (experience and confidence, leadership and mentoring) mediate the impact of other contextual factors. Inappropriate physical environments, inadequate resources, ambiguous situations, continual change, multiple relationships, and contradictory philosophies make for a complicated context that impacts care provision. IMPLICATIONS: A hidden complexity underlays healthcare practices in LTC and each care provider must negotiate this complexity when providing care. Attending to this complexity in which care decisions are made will lead to improvements in knowledge exchange mechanisms and best practice uptake in LTC settings.
Authors: Anna R Gagliardi; Fiona Webster; Melissa C Brouwers; Nancy N Baxter; Antonio Finelli; Steven Gallinger Journal: BMC Health Serv Res Date: 2014-11-19 Impact factor: 2.655
Authors: Jo Rycroft-Malone; Christopher R Burton; Joyce Wilkinson; Gill Harvey; Brendan McCormack; Richard Baker; Sue Dopson; Ian D Graham; Sophie Staniszewska; Carl Thompson; Steven Ariss; Lucy Melville-Richards; Lynne Williams Journal: Implement Sci Date: 2016-02-09 Impact factor: 7.327
Authors: Lisa A Cranley; Greta G Cummings; Joanne Profetto-McGrath; Ferenc Toth; Carole A Estabrooks Journal: BMJ Open Date: 2017-08-11 Impact factor: 2.692
Authors: Denise Cloutier; Kelli I Stajduhar; Della Roberts; Carren Dujela; Kaitlyn Roland Journal: BMC Health Serv Res Date: 2021-06-28 Impact factor: 2.655