29th International Nursing Research Congress
Paths to Becoming a Nurse Scholar
Claudia K Y Lai, PhD, RN, FAAN, FHKCERN, FHKCGN Honorary Professor, School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China Visiting Professor, Yangzhou University, Yangzhou, China
21 July 2018 Melbourne, Australia A Nursing Faculty Member of Today
What is expected of him/her? The Dimensions • An educator? • Teaching – To what extent as an • Research and publication educator? – Which dimension is more • A scholar? important? – How defined? • Leadership, management • A publication machine? and administration • A leader in the • Professional Services profession? • A game changer? Which dimension is the – Play important roles in most or least important? government policies?
2 The Beginning of my Journey …
My research questions as a PhD student:
• Would the production of a life story book (LSB) as an intervention lead to any changes in the quality of life (QOL- referring to social interactional domain in this study) in residents with dementia in nursing homes? • If it were useful, could its effects be sustained for six weeks after the intervention? Fig 1. Lubinski’s Social breakdown syndrome as applied to communication Fig 2. The Social Breakdown Syndrome as Evidenced by Findings from the Literature Fig 3. Merits of the LSB as an Intervention as suggested by the Literature Modified QOL
Dementing disorder Personal helplessness Susceptibility Changing communication skills
Provision of activities promoting social QOL Labeling of incompetency (Intervention)
Rediscover social & Reduction in communication abilities communication opportunities (remove excess disability)
Atrophy of Changed communication communication skills skills (Breaking of of labels) (Breaking Changed social Reduced Awareness of capabilities by of by capabilities staff Awareness engagement skills communication initiatives
Fig 4. Postulations of the Study’s Conceptual Framework Key Findings from my PhD Study
Findings & Discussion Conclusion • Enhanced social QOL is • Our current knowledge about dementing disorders may be possible through the LSB unlikely as yet to lead to intervention treatments with an impact on • Appropriate care is the onset and progression of these illnesses (Ferris & possible only through Mittleman, 1996). knowing the person • As yet, it becomes essential to • Caring is relating, which develop effective psychosocial interventions that can occurred at a deeper level promote the well-being of through the intervention those suffering from this tragic disorder. Output of my PhD Study
Awards Publications • Lai CKY, Chi I & Kayser-Jones J. Second Place • Lai CKY, Chi I & Kayser-Jones J. (2004). A in the 2003 International Psychogeriatric randomized controlled trial of a specific Association Research Awards in reminiscence approach to promote the well- Psychogeriatrics being of nursing home residents with • Lai CKY - “Adopting a Life Story Approach in dementia. International Psychogeriatrics. Caring for Older People, was selected as the 16(1), 33-49. DOI: 2004 recipient of the Research Dissemination 10.1017/S1041610204000055. in Nursing Award for Region 1, STTI • Lai CKY & Chung SF. (2008). The Chinese • Lai CKY - “Improving the Quality of Life for version of the Cohen-Mansfield Agitation Nursing Home Residents with Dementia: A Inventory. In V Lou & KW Boey (Eds.) Life Story Approach,” was selected as the Handbook of measures for the Chinese 2004 recipient of the Research Dissertation elderly (pp. 92-101). The Sau Po Center on Award for Region 1, Honor Society of Ageing, the University of Hong Kong (HKU). Nursing, Sigma Theta Tau International (STTI). Publication is in Chinese. • Recipient of the Outstanding Research • Lai CKY & Chi I. (2008). Social Engagement Postgraduate Student Award 2002-2003, the Scale. In V Lou & KW Boey (Eds.). Handbook University of Hong Kong. Awarded December of measures for the Chinese elderly. The Sau 2, 2004 for the dissertation entitled Po Center on Ageing, HKU. Publication is in “Improving the Quality of Life for Nursing Chinese Home Residents with Dementia: A Life Story Approach.” Outcomes from my PhD Work
International Collaboration Publication • Steering Group for the • Javier Olazarán, Linda Clare, Barry Reisberg, Isabel Cruz, Jordi Peña- Development of Non- Casanova, Teodoro del Ser, Bob Woods, Pharmacological Therapies Cornelia Beck, Stephanie Auer, Claudia Lai, Aimee Spector, Sam Fazio, Mary in Dementia care, Spain Mittelman, John Bond, Howard Feldman, (with a focus on Music Miia Kivipelto, Henry Brodaty, Linda Teri & Ruben Muñiz. (2010). Therapy to begin with); Nonpharmacological therapies in Sponsored by the Maria Alzheimer’s disease: A systematic review of efficacy. Dementia and Geriatric Woolf Foundation for Cognitive Disorders, 30(2), 161-178. DOI: Alzheimer’s Disease. 10.1159/000316119. My Research Program Development: A Macro Approach
For the promotion of wellbeing and quality of life of older people in diverse care settings Intellectual Care of people impairment with dementia & their families
Incontinence Restraint Instability Continence reduction & falls management
Research program addressing the 3 ‘Giants’ in the Care of Older People How do I, as a nurse and a researcher, bring changes to the healthcare environment?
(1) Through examining the effects of intervention programs using randomized controlled trials to build up evidence.
(2) Through iterative cycles in research and through engaging stake holders in the translation of evidence into practice. Phases of Translation Research in Medical Sciences Thornicroft et al. (2011)
Phase 0 Phase 1 Phase 2 Phase 3 Phase 4 Basic Early Early Late Implementation science human clinical clinical . adoption in principle discovery trials trials trials . early implementation . persistence of implementation block Translational block Translational block Translational
T1 T2 T3
Fig. 1. Five phases and three blocks in the translational medicine continuum. A Model of Translational Research
Stages (Grady, 2010) Studies/Projects 1. Early translation – develop & test PhD work intervention 2. Late translation - test in larger clinical trials Multi-centre trials in community settings
3. Adoption into practice – disseminate Through working intervention to healthcare providers by, e.g. with NGOs guidelines, education Life Story Work for (Cognitively Intact) Seniors in the Community: Issues and Challenges (2010-2012) An example of a late translational study T0 T1 T2 Preparatory 6 weeks Stage 4-6 weeks
Control group Control group Comparison Recruitment Comparison group Same as Random Assignment group Process and consent T0 Same as T0 Intervention group Intervention group Resident data Resident data Resident data Demographics Demographics Demographics SES SES SES WIB WIB WIB RAI- ADL RAI-ADL MDS MMSE MMSE Data to Facility MMSE collect data Staff data Staff interview Staff interview
Continuous cycle until the sample size Funded by Research Grants Council, HKSAR requirement was met Life Story Work: Adoption into Practice
Year Event Trained May 2004 Workshop Series on “Improving 70 social workers and & Aug 2005 the well-being of elderly people some nurses from (Post-PhD) using the life story approach different NGOs and (Part I & II),” hosted by the Sau care settings in Hong Po Centre on Ageing, The Kong University of Hong Kong
2005 - A series of workshops for the ~ 50 social workers 2006 Evangelical Lutheran Church of and SW students HK (NGO) About “INSTABILITY” - “RESTRAINT REDUCTION” Restraint Reduction in Rehabilitation Settings (2001-2004)
Pre-phase (5M) Post-phase (5M)
Intervention Facility Facility (6M) Restraint Rate Restraint Rate
Staff Education Restraint Reduction (x12 @1hr/session in 2M) Committee (4M)
Fall Rate Fall Rate Pre-conference Ass
Post-conference Ass (2 days) Patients’ Demographics Patients’ Demographics Functional Level (BI) Functional Level (BI) Post-conference Ass (1M) Cognitive Level (MMSE) Cognitive Level (MMSE) Fall Risk (MFS) Family Education Talks Fall Risk (MFS) Family Questionnaire (4 times @30mins each) 1st Staff 2nd Staff Questionnaire Questionnaire
Funding: Competitive Earmarked Research Grant, Focus Groups Survey (x4) Hong Kong, PolyU Block Grant, & Dean’s Reserve Point Prevalence Survey (2 days) Findings from my Restraint Reduction Study
Findings Implications • There was an significant • Management support is crucial, probably increase of intermittent more crucial than staff education. restraint rates post- • Repeated cycles of education is needed intervention. for reinforcement of behavior. • Point prevalence results indicate that • There was an significant there was some room for improvement decrease of continuous in using restraint alternatives. restraint rates post- • Family education and involvement can intervention. help the health care team in boosting restraint reduction. • There was an significant • Ward case conferences is a good avenue increase in the use of for restraint reduction as they do bedside rate post- produce a high level of impact. intervention. • The efforts in restraint reduction should be multi-disciplinary. Output & Outcomes of the Restraint Reduction Study
Publications International Collaboration • Suen LKP, Lai CKY, Wong TKS, Chow SKY, • Bleijlevens et al. (2010-2013): Kong SKF, Ho JYL, Kong TK, Leung JSC & Wong IYC. (2006). Use of physical Dephi study on a renewed restraints in rehabilitation settings: staff definition of physical restraint knowledge, attitudes and predictors. • Publication: Journal of Advanced Nursing, 55(1), 20-28. – Bleijlevens MHC, Wagner LM, Capezuti EA, et DOI: 10.1111/j.1365-2648.2006.03883.x al. on behalf of the International Physical • Lai CKY & Wong IYC. (2008). Families’ Restraint Workgroup (Lai CKY, a member of perspectives on the use of physical the Workgroup). (2016). Physical restraints: restraints. Contemporary Nurse, 27(2), consensus of a research definition using a 177-184. DOI: modified Delphi Technique. JAGS, 64(11), 10.5172/conu.2008.27.2.177. 2307-2310. • Lai CKY, Chow SKY, Suen LKP, & Wong IYC. Local with interRAI Hong Kong (2011). The effect of a restraint reduction program on physical restraint rates in • Publication rehabilitation settings in Hong Kong. – Lam K, Kwan J, Kwan CW, Chong AML, Lai CKY, Lou VWQ, Leung AYM, Liu JYW, Xue B, & Chi, I. Rehabilitation Research and Practice, Vol (2017). Factors Associated with the Trend of 2011, Article ID 284604, 9 pages. doi: Physical and Chemical Restraint Use among 10.1155/2011/284604. Long-term Care Facility Residents in Hong Kong: Data from an 11-year observational study. Journal of the American Medical Directors’ Association, 18(12), 1043-1048. DOI: 10.1016/j.jamda.2017.06.018. Other Works related to Restraint Reduction
Li Wing On & Lai (2009). The use of physical restraint in acute medical setting: A case study on the perspectives and practices among health care professionals Findings: Conclusion: • Physical restraints were used • Limited collaboration among unnecessarily >60% of the time various disciplines in restraint • Limited involvement in restraint use use among medical staff and • Patient management was allied health professionals; mostly mainly disease-focused only the nurse was involved • Quality of psychosocial care • Inadequate monitoring and was poor documentation while patients • Promote multidisciplinary were put on restraints awareness and restraint • Patient were observed to exhibit assessment and reduction behavior of apathy and efforts should be able to helplessness produce results Use of physical restraint : a traditional nursing practice revisited within an action research framework - Results (Dr. Maria Chui, 2010 )
Trunk & Limb Restraint - Female Ward Trunk Restraint Limb Restraint
35% 30% Prevalence rate of trunk 25% 20% and limb restraint – 15%
10% Female participating ward
5%
0% Pre- Jan- Feb- Mar- Apr- May- Jun- Jul-07 Aug- Sep- Oct- Nov- Dec- Jan- Feb- Mar- Apr- May- Jun- study 07 07 07 07 07 07 07 07 07 07 07 08 08 08 08 08 08
Prevalence rate of trunk and limb restraint – Male participating ward
Kwok T, Bai X, Chui MY, Lai CK, Ho DW, Ho FK, Woo J. (2012). Effect of Physical Restraint Reduction on Older Patients’ Hospital Length of Stay. Journal of the American Medical Directors Association, 13(7), 645-650. DOI: 10.1016/j.jamda.2012.05.019 Most Recent Work Related to “INSTABILITY” On Fall Prevention & Management On Restraint and Falls (PI: Dr Justina Liu) • Lai et al. (2015-2016, funded • Liu JYW, Lai CKY & Hill K. “The by the Yuen Yuen Institute Effects of a Simplified 10-step Tai- Social Services Department): A chi Programme on the Motor study to review clinical Performance and Fall Prevention of Community-dwelling Older People practice issues of the aged with Dementia (PWD): a Pilot homes of the Yuen Yuen Cluster RCT Study” Institute to enhance quality • Publications: residential care. – Liu JYW, Kwan RYC, Lai CKY & Hill K. (2018). A Publication: simplified 10-step Tai-chi programme for • people with dementia to improve their motor – Kor PPK, Kwan YRC, Liu JYW, & Lai performance: a feasibility study. Clinical CKY (2018). Knowledge, practice and Rehabilitation, Provisional acceptance for attitude of nursing home staff toward publication. the use of physical restraint: Are – Yoon GHJ, Kwan RYC, Liu JYW, Lai CKY. there changes over time? Journal of (2018). Fall prevention in nursing homes: Nursing Scholarship. Accepted April local and international practices and 20, 2018. policies. Asian Journal of Gerontology and Geriatrics. Accepted for publication. In press. On ‘CONTINENCE MANAGEMENT’ On ‘INCONTINENCE’ – A Translational Research on Prompted Voiding
Funded by the Hong Kong Jockey Club Charities Trust (2011-2013)
Continue after study?
2nd 3-months post- 6-months Post- 1st baseline baseline intervention intervention measures measures measures measures
Pre-test 6-month PV Program Post-test staff Staff Passed staff interviews training interviews
Quality monitoring & surveillance system
Aim: To examine the long-term effect of PV in managing UI among NH residents
Lai CKY & Wan XJ (2017). Using prompted voiding to manage urinary incontinence in residential care settings: Can it be sustained? Journal of the American Medical Directors Association, 18(6), 509-514. This study provided some answers to translational research. The literature suggested Our study found ...... … Education corrected To test the effect of concepts & changed empowerment attitude & perception approaches Besides theory & practice, To identify effective assessment to assure strategies for staff clinical competency was training important To identify unique Understanding the barriers and effective barriers would help to strategies modify the intervention Roe et al., 2004 Empowerment Through Staff Training
100 In-service classes and In-service class 90 hands-on training & hands-on 80 training • Interactive lectures 70 (knowledge about UI, UI In-service class 60 care, PV) 50 • Demonstration by role plays 40
• Discussions to clarify Number of staff 30 concept 20 • On-site (bedside) skill 10 training and supervision 0 • Ascertaining learnt skills using a checklist Results in the Longer Term: Continuation of PV Programme in the Study Sites
Continued
D E C
Planning To implement the B program after renovation Discontinued Nurse-in-charge A resigned On ‘INTELLECTUAL IMPAIRMENT’ Music-with-Movement (MWM) Intervention for People with Dementia & Their Families in the Community
An RCT funded by the Ho Cheung Shuk Yuen Charitable Foundation (2014-2016)
A Train-the-Trainer approach is adopted to develop capacity for both healthcare staff and family caregivers.
Music Caregiver Intervention Education
PWeD: PWeD: ↓Anxiety Caregiver: Well-being ↑ Sleep Quality Well-being
Lai CKY, et al. (2016). Interdisciplinary Collaboration in the use of a Music-with-Movement Intervention to Promote the Wellbeing of People with Dementia and Their Families. Nursing and Health Sciences, (18)1, 79-84. The Study on MWM – A Sustainable Implementation Design
Music therapist Trains Deliver the Intervention Project People Family Staff with caregivers dementia Train
People Family with caregivers Formal caregivers: dementia Project frontline & Beyond the the Beyond management staff 31 Output of the MWM Study
Performance Achievement Future • E-book • 95 participating dyads • The Foundation • 125 sessions of • 10 NGOs (16 service indicated interest to training centres) support the next • 5 public education • 86 staff members phase of the project - events trained for further dissemination of the • 6 professional training • 800 seniors benefited research protocol & knowledge (beyond the project) • Provide consultancy dissemination events • 1200 members of the services to • 3 publications public became aware collaborating partners • Attracted international attention – visited by Korean team
32 The Study on using MWM using a Dyadic Approach
Award Publications
Recipient of a Merit Award . Lai CKY, Lai DLL, Ho JSC, Wong KKY & Cheung DSK from the PolyU Distinguished (2016). Interdisciplinary Collaboration in the use of Knowledge Transfer a Music-with-Movement Intervention to Promote the Wellbeing of People with Dementia and Their Excellence Awards for 2017 Families: Development of an Evidence-based held once every 5 years in the Intervention Protocol. Nursing and Health Sciences, category of Community (18)1, 79-84. Article first published online: 10 SEP Excellence. 2015. DOI: 10.1111/nhs.12238 . Lai DLL & Lai CKY (2015). A case study on a home- based caregiver-delivered music with movement intervention for people with early dementia. Manuscript submitted to SAGE Open Medical Case Report. Revision submitted. . Lai DLL, Cheung DSK & Lai CKY (2017). Knowledge translation of a music-with-movement intervention to caregivers of people with dementia. Manuscript in revision. 2nd Round (2018-2020) of the MWM Project by the Funder Aim To work with community organizations to improve the psychosocial wellbeing of the dyads through further promotion of the evidence-based MWM intervention model and protocol New Develop contractual agreement with collaborating NGOs on elements 1. structuring a system for capacity building of the centre staff 2. developing the means to sustain the interest and capacity of families Build up a mobile voluntary support team to support the caregivers to adopt and sustain the intervention Ultimate Create a supportive culture for people with dementia (PWD) goals and their families Develop further evidence on the effect of the intervention About Creating a Track Record in Securing Grants Requisites
1. To conduct good research 2. To maintain progress and deliver committed deliverables in the agreed timeframe 3. To report completed research 4. To try and retry, and yet again retry to secure funding About Creating a Track Record in Securing Grants Requisites Looking at My Track Record . Life Story Work research -> 1. To conduct good research . Wandering -> 2. To maintain progress and . Online Resources for Dementia deliver committed Care -> deliverables in the agreed . Work on restraint reduction timeframe . Model Nursing Home > will secure 3rd grant from the Yuen Yuen 3. To report completed Institute (NGO) research Timeline . Music-with-movement > been nd 4. To try and retry, and yet invited to continue with 2 phase of the study (Charitable again retry to secure Foundation) funding . Pok Oi Hospital (NGO) > will secure 2nd grant The Track Record
. Life Story Work research > . Wandering > . Online Resources for Dementia Care > . Work on restraint reduction . Model Nursing Home > will secure 3rd grant from the Yuen Yuen Institute (NGO) . Music-with-movement > been invited to Timeline ??? Timeline continue with 2nd phase of the study (Charitable Foundation) . Pok Oi Hospital (NGO) > will secure 2nd grant How do I progress along my journey…?
Intermediate ‘Baby’ Steps Maturing Steps • Publishing in local • Publishing in local • Publishing in journals & & international international journals with IF newsletters journals • Maintaining a certain no. • Writing for grants • Writing for larger of publications in local mainly as a grants & with journals & book chapters principal interdisciplinary • Writing for large grants investigator (PI) team members and be co-I of other professional associates’ • Reaching out to • Serving on boards grant proposals communities (NGOs & executive • Continuing my & professional committees of community service both associations) NGOs & locally and professional internationally, but becoming more selective associations The research methods that I used …
Intermediate Initial Work Current State Period • Surveys • Cohort study • Quality • Descriptive • Interventional trials improvement study explorative studies • Systematic reviews • Mixed methods • Instrument • Multi-centre design validation randomized • Implementation/ • Prospective controlled trials translational interventional trial • Set up an advanced research practice nurse clinic • Action research Quotes from Bill Gates
• “Don't compare yourself with anyone in this world...if you do so, you are insulting yourself.” Quotes from Bill Gates
• “Don't compare • “Most people yourself with anyone in overestimate what they this world...if you do so, can do in one year and you are insulting underestimate what yourself.” they can do in ten years.” Challenges in Academic Life (1) – Outstanding Performance
• There are no fast returns in scientific work, but academics are expected to produce output that has a quick impact. Challenges in Academic Life (1) – Outstanding Performance
• There are no fast • “(Annualized returns returns in scientific 1926-present)…through work, but academics 2014, the S&P 500 had are expected to an average annual produce output that return of 10.12% and has a quick impact. the 20 year average is 9.85%” (Peter Dunn Dec 31, 2014)
Source: https://petetheplanner.com/what- rate-of-return-should-you-expect-on-your- investments/ Success Rates of NIH Research Project Grants (https://nexus.od.nih.gov/all/2018/03/07/how-many-researchers-revisited-a-look-at-cumulative- investigator-funding-rates/)
The success rate is similar in Hong Kong for Research Grants Council funding.
(Source: Parks S, Manville C, Stewart K, et al. (2017) A review of the Hong Kong Research Grants Council. University Grants Council, Hong Kong SAR. Cambridge, UK, RAND Corporation.) Challenges in Academic Life (2) - Running Against the Current
• The current milieu does not favor the dissemination of negative findings in research, but science is supposedly about discovering ‘facts/truths’ about the world around us. Challenges in Academic Life (2) - Running Against the Current • The current milieu does • Franco et al. (2014, not favor the published in Science) used a dissemination of negative Time-sharing Experiments in findings in research, but the Social Sciences archive science is supposedly of ~250 peer-reviewed study proposals conducted using about discovering nationally representative ‘facts/truths’ about the samples world around us. • Only 10/48 (21%) null results were published, whereas 56/91 (62%) with significant results did Franco A, Malhotra N, Simonovits G (2014). Publication bias in the social sciences: Unlocking the file drawer. Science 345(6203):1502-5. doi: 10.1126/science.1255484 Challenges in Academic Life (3) The Value of the Work that We Do Universities focus on the development of cutting- edge knowledge, but in real life do those whom we serve always require cutting-edge knowledge?
Example 1 Example 2 • A nurse consultant in a • In some hospitals in Hong hospital in Hong Kong is Kong, patients who are not studying whether physical mobile or independent are restraints are associated asked to put on adult with falls. diapers. Such is why I took to a macro approach in the development of my research program.
For the promotion of wellbeing and quality of life of older people in diverse care settings Intellectual Care of people impairment with dementia & their families
Incontinence Restraint Instability Continence reduction & falls management
Research program addressing the 3 ‘Giants’ in the Care of Older People What Is Expected of Us by Our Universities and Presumably What Everybody Wants … Dimension Indicator(s) Educator Researcher • Papers published in peer-reviewed journals of high impact factor • Obtained patents or research awards • Successful in external competitive grants • Secured high level consultancy projects • Mentor junior faculty • Develop a critical mass studying a key and innovative area of research that likely to be of world acclaim if successful Practice Leader Policy Advocate
49 Getting There
• Takes time, at least for most people • Takes strategizing • Entails hard work, really hard work! • The pressure is relentless so we need to learn how to manage our work life in order not to be overwhelmed and be ‘consumed’ • Can be fun too; need to make it something enjoyable • Be appreciative of what you have; no one likes to give chances to people who do not like their job • Have hope! Strategize, work hard, no need to be ‘calculative’ all the time. Life unfolds in mysterious ways.
50 My Growth and Development – Closely Tied to OUR Growth & Development 2005 As a Ageing & Health Research Group 2006
51 Our Growth & Development
2007 2008
52 Our Growth & Development
2009 2010 As a Group within the Still an Ageing & Health Research Adult Nursing Division Group
53 Our Growth & Development
2011 2012 We are now a Centre!
54 We Love SN, PolyU
Mini-Retreat with Advisors & 2013 Affiliated Members Jun 3, 2014
Nov 2014: We became a member of the National Hartford Centers of Geriatric Nursing Excellence
•55 Centre of Gerontological Nursing
2015 Inaugural Conference, 2016
56 No matter what kind of scholars we want to be after considering our options,
Is the path being chosen in alignment with our aspirations and life goals?
Who we can become, can only be based upon who we are.
57 Above all …
Commitment and perseverance is the key. Thank you. Claudia Lai [email protected]
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