Background/Objectives: Conversations about end-of-life care or advance care planning are often difficult and emotionally challenging to initiate. Tailoring messages to the specific audiences can make these sensitive discussions more manageable and effective. The Evidence-based Model for the Transfer and Exchange of Research Knowledge (EMTReK), compromising six core components (message, stakeholders, processes, context, facilitation, and evaluation) offers a structured framework for research dissemination and knowledge transfer in palliative and long-term care settings. Knowledge translation bridges research and practice, with its effectiveness depending on stakeholder engagement, tailored communication, and systematic application of evidence in policy and practice. This study explores stakeholder perspectives on a dementia care intervention, using EMTReK as an analytical framework to examine how knowledge transfer and exchange (KTE) actions were implemented across long-term care settings. Methods: A qualitative analysis was conducted on primary data comprising case narratives from multinational research groups involved in the "Caregiver Decision Support" (mySupport) study (2019-2023). Teams from Canada, the Czech Republic, Ireland, Italy, the Netherlands, and the United Kingdom evaluated the mySupport intervention through interviews, with analysis guided by components of the EMTReK model. Results: Facilitated Family Care Conferences were found to be effective mechanisms for supporting knowledge transfer and intervention uptake in dementia care across nursing homes in Europe and Canada. Despite challenges posed by the COVID-19 pandemic, Family Care Conferences adapted through stakeholder engagement, interactive learning, and innovative communication methods. Using EMTReK as an analytical framework, the research team identified key elements that contributed to successful implementation, including the importance of flexibility to accommodate local contexts. Conclusions: The transnational application of the EMTReK model for advance care planning in long-term dementia care highlights the importance of tailored, culturally relevant knowledge translation strategies, which, despite challenges from the COVID-19 pandemic, were successfully implemented through local adaptations and diverse dissemination methods, emphasising the need for further research on their impact on resident and family outcomes.

Palliative care is essential for enhancing the quality of life of individuals with life-limiting illnesses. This scoping review investigates the educational and training requirements of healthcare professionals who provide effective, person-centred palliative care to nursing home residents with advanced dementia, a population that presents complex physical and behavioural challenges. Our scoping review aims to identify and evaluate existing studies on palliative care education and training interventions for dementia in nursing homes. We focus on various aspects, including the types of interventions and their delivery formats, content, acceptability, effectiveness, outcome measures, evaluation methods, and intended learning outcomes. The goal is to inform the development of comprehensive global curricula for healthcare professionals and caregivers. Guided by the JBI methodology and the PRISMA-ScR checklist, we conducted a thorough literature search across multiple databases, including CINAHL, Medline, and ERIC, as well as grey literature sources. Using the population, concept, and context (PCC) framework, we included 27 relevant studies. Our findings indicate a significant gap in effective education and training frameworks. Many interventions lack consistency, scalability, and culturally tailored approaches necessary for meeting the intricate care needs of residents with advanced dementia. This review highlights various educational initiatives mainly directed at nursing home staff, with fewer resources available for families. It underscores the urgent need for training programs designed to address the complex, person-centred care demands of advanced dementia, providing critical insights into effective delivery methods amidst limited staff resources.

Abstract Background Despite the known benefits of exclusive breastfeeding, global rates remain below recommended targets, with Ireland having one of the lowest rates in the world. This study explores the efficacy of Participatory Action Research (PAR) and Work-Based Learning Groups (WBLGs) to enhance breastfeeding practices within Irish healthcare settings from the perspective of WBLG participants and facilitators. Methods Employing a PAR approach, interdisciplinary healthcare professionals across maternity, primary, and community care settings (n = 94) participated in monthly WBLGs facilitated by three research and practice experts. These sessions, conducted over nine months (November 2021 – July 2022), focused on critical reflective and experiential learning to identify and understand existing breastfeeding culture and practices. Data were collected through participant feedback, facilitator notes, and reflective exercises, with analysis centered on participant engagement and the effectiveness of WBLGs. This approach facilitated a comprehensive understanding of breastfeeding support challenges and opportunities, leading to the development of actionable themes and strategies for practice improvement. Results Data analysis from WBLG participants led to the identification of five key themes: Empowerment, Ethos, Journey, Vision, and Personal Experience. These themes shaped the participants’ meta-narrative, emphasising a journey of knowledge-building and empowerment for breastfeeding women and supporting staff, underlining the importance of teamwork and multidisciplinary approaches. The project team’s evaluation highlighted four additional themes: Building Momentum, Balancing, Space Matters, and Being Present. These themes reflect the dynamics of the PAR process, highlighting the significance of creating a conducive environment for discussion, ensuring diverse engagement, and maintaining energy and focus to foster meaningful practice changes in breastfeeding support. Conclusion This study highlights the potential of WBLGs and PAR to enhance the understanding and approach of healthcare professionals towards breastfeeding support. By fostering reflective and collaborative learning environments, the study has contributed to a deeper understanding of the challenges in breastfeeding support and identified key areas for improvement. The methodologies and themes identified hold promise to inform future practice and policy development in maternal and child health.

The recent COVID-19 pandemic exacerbated pre-existing stressful conditions in health care, further elevating the risk of negative health outcomes for nurses and particularly nurse leaders. The aim of this pilot project was to assess the efficacy of mindfulness practices in attenuating nurse leaders’ perceived stress levels. There is a lack of evidence regarding the outcomes of stress reduction programs aimed at health care staff, especially for nurse leaders within the clinical setting. Mindfulness has been shown to have a significant positive effect on attenuating stress in a wide variety of populations. This study used a prospective longitudinal design with a volunteer nurse leader group comparing self-reported perceived stress levels before and after a brief mindfulness intervention. Results indicated a significant reduction in perceived stress among volunteer nurse leader participants postintervention. Further investigation is needed in a variety of settings to more fully understand and evaluate the potential impact of introducing mindfulness practices to support nurse leaders in hospital or clinical settings.

BACKGROUND:Dementia affects a large proportion of society and places a significant burden on older people and healthcare systems internationally. Managing symptoms at the end of life for people with dementia is complex. Participatory action research can offer an approach that helps to encourage implementation of evidence-based practices in long-term care settings.METHODS:Three evidence-based guidance documents (pain assessment and management, medication management, nutrition and hydration management) were introduced in three long-term care settings for older people. Data generated from work-based learning groups were analysed using a critical hermeneutic approach to explore the use of participatory action research to support the implementation of guidance documents in these settings.RESULTS:Engagement and Facilitation emerged as key factors which both enabled and hindered the PAR processes at each study site.CONCLUSIONS:This study adds to the body of knowledge that emphasises the value of participatory action research in enabling practice change. It further identifies key practice development approaches that are necessary to enable a PAR approach to occur in care settings for older people with dementia. The study highlights the need to ensure that dedicated attention is paid to strategies that facilitate key transformations in clinical practice.

Public health responses to COVID-19 in long-term residential care facilities (LTRCFs) have restricted family engagement with residents. These restrictions impact on quality of care and the psychosocial and emotional well-being of family caregivers. Following a national cross-sectional web-based survey, respondents were invited to provide personal reflections on visitor restrictions. This study aims to describe the consequences of these restrictions for individuals living in LTRCF and their families during the first wave of the COVID-19 pandemic. Data from open-ended questions contained within the survey were analyzed using Braun and Clarke's (2006) method of thematic analysis. Four themes were identified: 1. Altered Communication and Connection; 2. Emotional and Psychological Impact; 3. Protecting and Caring Role of Staff; 4. Family Role. Throughout the narrative accounts, it is evident that the visitor restrictions impacted on the emotional and mental well-being of families. Some respondents expressed frustration that they could not assist staff in essential care provision, reducing meaning and purpose in their own lives. COVID-19 LTRCF visitor restrictions made little distinction between those providing essential personal care and those who visit for social reasons. A partnership approach to care provision is important and should encompass strategies to maintain the psychosocial and emotional well-being of families and their relatives during times of self-isolating or restrictive measures.

Five members of the Post-doctoral International Community of Practice (a subgroup of the Person-centred Practice Research International Community of Practice, of which Jan was formerly the director) came together to agree a process through which we could co-create a poem in memory of Jan. Each of us had developed a relationship with Jan through our doctoral studies, but also through working with her in our organisations and through this journal. These relationships with Jan were unique to each individual but significant for us all. Individually, we each selected Evoke cards (evokecards.com) that spoke to us about our memories and relationship with Jan. Using the cards, we then recorded a video story, sharing our cards and why we had chosen them. We uploaded the stories to an online database so they could be viewed by us all. While looking at the pictures and listening to the stories, we made notes about what was significant for us within the stories. Subsequently, we met virtually to synthesise the collective themes.

Many people with dementia reside in long-term care, where limited staff knowledge of dementia palliative care has been identified, along with poor awareness that a palliative approach can assist in identifying unmet care needs. Evidence-based guidance in palliative care for people with dementia is available however, implementing this guidance requires staff engagement and a tailored educational approach. This pre-implementation situational analysis informed a tailored staff education intervention to support the implementation of national guidance on dementia palliative care in long term care. Using a cross-sectional study design, underpinned by the Consolidated Framework for Implementation Research, survey data were collected on site profile, staff demographics, learning needs, and readiness-to change at three residential care sites for older people in Ireland. In total, 69 staff (predominantly nurses and healthcare attendants) completed the surveys. Medication management and management of pain were the most frequently identified learning needs. Staff were confident in their ability to implement change but de-motivation and powerlessness were substantial factors as only one-third of staff were "ready for change". Staffing levels, managing risk during change and perceived reluctance in others were common barriers. These results informed an educational intervention to address the specific care context, staff learning needs and barriers to change prior to implementation.

Background The importance of providing evidence-based palliative care for people with dementia is increasingly acknowledged as important for patient outcomes. In Ireland, evidence-based guidance has been developed in order to address key features of dementia palliative care, including the management of pain, medications and hydration and nutrition. The aim of this study was to identify and explore the factors affecting the implementation of evidence-based guidance on dementia palliative care. Methods The Consolidated Framework for Implementation (CFIR) guided a mixed-method pre-post study. One guidance document pertaining to the management of pain, medication or hydration and nutrition was implemented in three long-term care facilities. Participatory action research in the form of work-based learning groups was used to implement the guidance, drawing on a situational analysis (pre-implementation). Staff questionnaires and audits were conducted pre- and post-implementation while champion interviews were also conducted post-implementation. Results Features of the guidance, the inner setting components such as readiness to change, and the process of implementation were most frequently identified as impacting implementation. Components of the outer setting, such as external policy incentives and individual characteristics, featured less commonly. Data from qualitative interviews revealed that the guidance was perceived as advantageous or complimentary to previous care provided. Within the inner setting, leadership and support from other colleagues facilitated implementation. However, limited availability of other healthcare professionals to assist with carrying out guidance actions presented a barrier in some facilities. The external facilitators of the work-based learning groups (WBLGs) were perceived as experienced and encouraged active participation and reflection on practices. Despite the challenge of releasing staff to attend the WBLGs, quantitative data demonstrated reduced staff de-motivation amongst those who did attend was noted post-implementation (pre- Mdn = 19.50 versus post- Mdn = 22.00, U = 497.00, p = 0.07). Conclusions A situational analysis informed by the CFIR framework in conjunction with a participatory action research approach helped to advance the implementation of the guidance. The progress of implementation depended on the extent to which evidence-based care was previously being implemented at each site. Post-implementation analysis using CFIR identified challenges to address in future projects such as staff cover and timing of training to facilitate attendance for staff with different working hours. Facilitators included multidisciplinary engagement with the intervention and champions at each site to support the implementation process.

Background: COVID-19 has disproportionately affected older people. Visiting restrictions introduced since the start of the pandemic in residential care facilities (RCFs) may impact negatively on visitors including close family, friends, and guardians. We examined the effects of COVID-19 visiting restrictions on measures of perceived loneliness, well-being, and carer quality of life (QoL) amongst visitors of residents with and without cognitive impairment (CI) in Irish RCFs.Methods: We created a cross-sectional online survey. Loneliness was measured with the UCLA brief loneliness scale, psychological well-being with the WHO-5 Well-being Index and carer QoL with the Adult Carer QoL Questionnaire (support for caring subscale). Satisfaction with care (“increased/same” and “decreased”) was measured. A history of CI was reported by respondents. Sampling was by convenience with the link circulated through university mail lists and targeted social media accounts for 2 weeks in June 2020.Results: In all, 225 responses were included of which 202 noted whether residents had reported CI. Most of the 202 identified themselves as immediate family (91%) and as female (82%). The majority (67%) were aged between 45 and 64 years. Most (80%) reported that their resident had CI. Approximately one-third indicated reduced satisfaction (27%) or that restrictions had impaired communication with nursing home staff (38%). Median loneliness scores were 4/9, well-being scores 60/100 and carer QoL scores 10/15. Visitors of those with CI reported significantly lower well-being (p = 0.006) but no difference in loneliness (p = 0.114) or QoL (p = 0.305). Reported CI (p = 0.04) remained an independent predictors of lower WHO-5 scores, after adjusting for age, sex, RCF location, and dementia stage (advanced), satisfaction with care (reduced), and perception of staff support measured on the Adult Carer QoL Questionnaire.Conclusion: This survey suggests that many RCF visitors experienced low psychosocial and emotional well-being during the COVID-19 lockdown. Visitors of residents with CI report significantly poorer well-being as measured by the WHO-5 than those without. Additional research is required to understand the importance of disrupted caregiving roles resulting from visiting restrictions on well-being, particularly on visitors of residents with CI and how RCFs and their staff can support visitors to mitigate these.

This document is the author deposited version. You are advised to consult the publisher's version if you wish to cite from it. Published version GIRLING, Carla, HIND, Daniel, ARDEN, Madelynne A and WILDMAN, Martin J (2019). Developing an implementation strategy for the use of objective adherence data in routine clinical practice: a case study in cystic fibrosis clinics (abstract only). Implementation Science, 14 (Supp2).

Abstract Background Over one third of people with dementia in Ireland reside in Long Term Care (LTC) settings. Dementia palliative care is complex; healthcare staff in LTC settings have requested specific guidance to support practice. This participatory action research project will introduce national evidence-based guidance documents relating to pain, hydration/nutrition, and medication management, into three LTC settings in Munster, using a tailored Work-based Learning approach, informed by a baseline multi-modal situational analysis. Methods Site and staff data were collected using a site profile tool; staff demographic and learning needs surveys; and the ‘VOCALISE’ readiness-to-change survey, in the three sites. Results Within the sites, 42-88% of residents had probable/definite dementia. Multidisciplinary input varied considerably between sites. In total, 69 staff (predominantly nurses and healthcare attendants) completed learning needs surveys. Many reported prior dementia education (range 53-76% across sites). This was twice as often on hydration/nutrition and medication topics than pain. Reflecting this, staff in all sites identified knowledge deficits, but particularly in pain identification, assessment and management. Other learning needs included supporting and communicating with families; resident care planning and advance care planning; and resident ‘comfort’. Of 58 staff with completed VOCALISE data, 33% were rated as ‘ready to change’, 14% ‘not’, and the remainder ambivalent. Interestingly, staff had high confidence in the ability of change to happen, but low motivation scores; and overall ambivalence towards their own power to make change happen. Some barriers were site-specific, but overall, staffing levels, managing risk during change and perceived reluctance in others were common barriers to change, as was the possibility that patient wishes hadn’t informed the change process. Conclusion Our baseline data highlights that education and change implementation needs to be tailored to the recipient site, recognising site-specific barriers to change. We will now use this data in our Work-based Learning intervention.

P1 What makes innovations both ‘stick’ and ‘spread’? A multidisciplinary systematic review to understand implementation depth and scale-up of innovations in healthcare Alexandra Ziemann, Yaru Chen, Yiannis Kyratsis, Charitini Stavropoulou, Harry Scarbrough Centre for Healthcare Innovation Research (CHIR), City, University of London, London, United Kingdom; 2 VU Amsterdam, Amsterdam 1081 HV, Netherlands; School of Health Sciences, City, University of London, London, United Kingdom; CASS Business School, City, University of London, London, United Kingdom Implementation Science 2019, 14(Suppl 2):P1

P1 What makes innovations both ‘stick’ and ‘spread’? A multidisciplinary systematic review to understand implementation depth and scale-up of innovations in healthcare Alexandra Ziemann, Yaru Chen, Yiannis Kyratsis, Charitini Stavropoulou, Harry Scarbrough Centre for Healthcare Innovation Research (CHIR), City, University of London, London, United Kingdom; 2 VU Amsterdam, Amsterdam 1081 HV, Netherlands; School of Health Sciences, City, University of London, London, United Kingdom; CASS Business School, City, University of London, London, United Kingdom Implementation Science 2019, 14(Suppl 2):P1

and practitioners define and explore issues that arise in their work. It can be used to critically examine things that are going badly, or to look at things that are going well and to see how that happened and what can be done to continue the trend. Aims: This article is a critical reflection of my experience of using reflection during my doctoral studies. It focuses on reflection using creative methods, for highlighting challenges and discovering identity and context. Implications for practice: The process of reflection can highlight challenges and approaches needed when implementing a change initiative Using creative methods of reflection can open up (unlock) new ways of knowing, encourage a more in-depth exploration of experiences and promote dialogue

Chapter 10 Giving Voice to 'Hard To Reach Groups' in Healthcare Research A Narrative Approach Catherine Buckley, Catherine BuckleySearch for more papers by this author Catherine Buckley, Catherine BuckleySearch for more papers by this author Book Editor(s):Brendan McCormack, Brendan McCormack Queen Margaret University, Edinburgh, Scotland, UKSearch for more papers by this authorSandra van Dulmen, Sandra van Dulmen NIVEL (Netherlands Institute for Health Services Research), Utrecht and Radboud University Medical Centre, Nijmegen, The NetherlandsSearch for more papers by this authorHilde Eide, Hilde Eide University College of Southeast Norway, Drammen, NorwaySearch for more papers by this authorKirsti Skovdahl, Kirsti Skovdahl University College of Southeast Norway, Drammen, NorwaySearch for more papers by this authorTom Eide, Tom Eide University College of Southeast Norway, Drammen, NorwaySearch for more papers by this author First published: 08 August 2017 https://doi.org/10.1002/9781119099635.ch10 AboutPDFPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShareShare a linkShare onFacebookTwitterLinked InRedditWechat Summary This chapter focuses on the development, implementation and evaluation of a methodological framework for a narrative-based approach to practice development and person-centred care in residential aged care settings. The framework was implemented in practice using an action research (AR) approach, with work-based learning groups. The framework confirmed the identity and voices of older people by taking account of their biography. However, three key areas emerged that warranted further conceptualisation. These were: how staff and residents responded to change (narrative being), development of shared understandings (narrative knowing) and intentional action (narrative doing). Combining person-centred care and narrative can potentially enable a more comprehensive approach to the development of an effective workplace culture where the communication qualities of narrative such as active listening, open questioning, and exploration are combined with the principles of engagement, enlightenment and emancipation to promote person-centredness and ensure the voice of the vulnerable older person is heard. Person-Centred Healthcare Research RelatedInformation

AIMS AND OBJECTIVES:To evaluate the effects of the implementation of a methodological framework for a narrative-based approach to practice development and person-centred care in residential aged care settings.BACKGROUND:Care in long-term residential settings for older people is moving away from the biomedical approach and adopting a more person-centred one. Narrative can help shape the way care is planned and organised. The provision of person-centred care that is holistic and that takes account of resident's beliefs and values can be enhanced by incorporating narrative approaches to care within a practice development framework.DESIGN:The chosen methodology was participatory action research.METHODS:Between 2010-2014, a methodological framework of narrative practice was implemented in two residential care settings, comprising 37 residents and 38 staff, using an action research approach. Three action cycles: (i) narrative practice and culture identification, (ii) developing narrative practice and (iii) working in a storied way emerged during the implementation.RESULTS:Key outcomes emerged in relation to the findings. These were based on narrative being, knowing and doing and centred around the key outcomes of (i) how people responded to change (narrative being), (ii) the development of shared understandings (narrative knowing) and (iii) intentional action (narrative doing).CONCLUSION:The implementation of a framework of narrative practice demonstrated that how people respond to change, the development of shared understandings and intentional action were interrelated and interlinked. It illustrated the importance of ensuring that practice context is taken account of in the implementation of action research and the importance of ensuring that narrative being, knowing and doing are clear and understandable for change to occur.RELEVANCE TO CLINICAL PRACTICE:Implementation of a narrative approach to care can develop new ways of working that value biography and promote the development of a co-constructed plan of care.