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Comparing Lay and Professional Perspectives 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
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