The Influence of Organizational Context on Best Practice Use by Care Aides in Residential Long-Term Care Settings

Abstract

Our study suggests that context plays an important role in care aides' use of best practices in nursing homes. Individual characteristics played a more prominent role than contextual factors in predicting conceptual use of best practices.

The role of organizational context in moderating the effect of research use on pain outcomes in hospitalized children: a cross sectional study

“…A few (e.g., culture, social capital, structural and electronic resources, and slack time) were significant across the relationship between both IRU and CRU and pain outcomes. Squires et al [13] reported that there were more elements of organizational context that predicted CRU ( n  = 6) versus IRU ( n  = 1) while Estabrooks et al [15] found almost queal numbers of ACT elementat influenced IRU ( n  = 4) versus CRU ( n  = 3) Some elements of organizational context (e.g., culture, social capital, structural and electronic resources, and slack time) appear to operate in similar ways for both IRU and CRU in relation to the caregiver process or best practice outcomes (e.g. pain assessment using a valid measure).…”

“…IRU (i.e., direct use of research) was measured using one item on a five point scale where 1 = never use and 5 = almost always use [15]. The IRU item has been shown to be acceptable to respondents [16].…”

“…The proportion of nurses possessing a baccalaureate degree or higher and unit culture significantly predicted nurses’ instrumental research use (IRU) (i.e., direct use of research; when evidence is translated to a format such as a guideline or protocol and used for making decisions about patient care) while leadership, culture, evaluation (feedback of patient data to the unit), formal interactions, informal interactions, organizational slack [availability of resources (i.e., space, staff, time) which allow the unit to adapt successfully to internal or external pressures for change] (space), and unit specialty predicted conceptual research use (CRU) (i.e., indirect use of research; that enlightens or informs the user’s attitudes or beliefs about research, but may not result in clinical practice changes [13, 14]). Estabrooks et al [15] reported that social capital, organizational slack (staffing and time), the number of informal interactions and unit type were significant predictors of IRU by care aides to residents in Canadian nursing homes. Significant predictors of CRU included evaluation, structural resources and organizational slack (time).…”

Factor Structure, Reliability and Measurement Invariance of the Alberta Context Tool and the Conceptual Research Utilization Scale, for German Residential Long Term Care

“…Using hierarchical linear models, the authors also demonstrated that the ACT pediatric acute care (Estabrooks et al, 2011c) and the ACT LTC (Estabrooks et al, 2011a) were able to discriminate between different care units. Most recent evidence based on multi-level models suggests that the ACT concepts are significant predictors of research utilization (Squires et al, 2013a; Estabrooks et al, 2015b) as well as resident outcomes (Estabrooks et al, 2015a; relation to other variables validity evidence).…”

“…The Canadian research team was able to demonstrate that more favorable organizational context as assessed by the ACT is positively associated with staff outcomes such as use of best practice (Estabrooks et al, 2015b), lower burnout (Estabrooks et al, 2012), and a better trajectory of resident symptom burden in the last 12 months of life (Estabrooks et al, 2015a). Comparable German research tools were unavailable, therefore we translated the Canadian tools into German, adapted them to the context of German LTC settings, and studied their psychometric properties.…”