Purpose

This study explored whether perceptions of evidence or organizational context were associated with the use of external memory aids with residents with dementia in skilled nursing facilities (SNFs).

Method

A survey design, supplemented by a small sample of exploratory interviews, was completed within the Promoting Action on Research Implementation in Health Services framework. Ninety-six speech-language pathologists (SLPs) and 68 facility rehabilitation directors (FRDs) completed the Organizational Readiness to Change Assessment (Helfrich, Li, Sharp, & Sales, 2009) in relationship to the use of external memory aids. Five SLPs completed an interview exploring perceptions of evidence and context in relationship to memory aid use.

Results

SLPs and FRDs had favorable perceptions of evidence supporting memory aids. FRDs perceived the organizational context of the SNF more favorably than SLPs. SLP participants used external memory aids in the past 6 months in 45.89% of cases of residents with dementia. For SLP participants, a 26% (p < .05) increase of external memory aid use was associated with every 1-unit change in favor of the evidence. Interview data revealed barriers to external memory aid implementation.

Conclusions

Part of evidence-based practice implementation may be influenced by clinician perceptions. Efforts to increase implementation of external memory aids in SNFs should address these clinician perceptions.

References

  • Aarons, G. A., Glisson, C., Green, P. D., Hoagwood, K., Kelleher, K. J., & Landsverk, J. A. (2012). The organizational social context of mental health services and clinician attitudes toward evidence-based practice: A United States national study.Implementation Science, 7, 56.
  • Andrews-Salvia, M., Roy, N., & Cameron, R. M. (2003). Evaluating the effect of memory books for individuals with severe dementia.Journal of Medical Speech-Language Pathology, 11, 51–59.
  • Bayley, M. T., Hurdowar, A., Richards, C. L., Korner-Bitensky, N., Wood-Dauphinee, S., Eng, J. J., … Graham, I. D. (2012). Barriers to implementation of stroke rehabilitation evidence: Findings from a multi-site pilot project.Disability and Rehabilitation, 34, 1633–1638.
  • Bourgeois, M. S. (1992). Evaluating memory wallets in conversations with persons with dementia.Journal of Speech and Hearing Research, 35, 1344–1357.
  • Bourgeois, M. S. (1993). Effects of memory aids on the dyadic conversations of individuals with dementia.Journal of Applied Behavior Analysis, 26, 77–87.
  • Bourgeois, M. S. (2007). Memory books and other graphic cueing systems: Practical communication and memory aids for adults with dementia. Baltimore, MD: Health Professions Press.
  • Bourgeois, M. S., Burgio, L. D., Shulz, R., Beach, S., & Palmer, B. (1997). Modifying repetitive verbalizations of community-dwelling residents with AD.The Gerontologist, 37, 30–39.
  • Bourgeois, M. S., Dijkstra, K., Burgio, L., & Allen-Burge, R. (2001). Memory aids as an augmentative and alternative communication strategy for nursing home residents with dementia.Augmentative and Alternative Communication, 17, 196–210.
  • Bourgeois, M. S., & Hickey, E. M. (2009). Dementia from diagnosis to management: A functional approach. New York, NY: Psychology Press.
  • Brisebois, A., & Doyon, O. (2010). Applying the PARIHS model of evidence-based practice to implement a systematic evaluation of delirium in a cardiac surgery intensive care unit: Impact on delay of treatment and nurses' knowledge.European Journal of Cardiovascular Nursing, 9(1), S5.
  • Brown, D., & McCormack, B. (2005). Developing postoperative pain management: Utilising the Promoting Action on Research Implementation in Health Services (PARIHS) framework.Worldviews of Evidence-Based Nursing, 2, 131–141.
  • Burgio, L. D., Allen-Burge, R., Roth, D. L., Bourgeois, M. S., Dijkstra, K., Gerstle, J., … Bankester, L. (2001). Come talk with me: Improving communication between nursing assistants and nursing home residents during care routines.The Gerontologist, 41, 449–460.
  • Burke, J. P., & Gitlin, L. N. (2012). How do we change practice when we have the evidence?.American Journal of Occupational Therapy, 66, e85–e88.
  • Buron, B. (2008). Levels of personhood: A model for dementia care.Geriatric Nursing, 29, 324–332.
  • Eagan, M., Berube, D., Rancine, G., Leonard, C., & Rochon, E. (2010). Methods to enhance communication between individuals with Alzheimer's disease and their caregivers: A systematic review.International Journal of Alzheimer's Disease, 1–12. Retrieved from http://dx.doi.org/10.4061/2010/906818
  • Elliot, E. J. (2004). Evidence-based speech pathology: Barriers and benefits.International Journal of Speech-Language Pathology, 6, 127–130.
  • Estabrooks, C. A., Squires, J. E., Cummings, G. G., Teare, G. F., & Norton, P. G. (2009). Study protocol for the Translating Research in Elder Care (TREC): Building context—An organizational monitoring program in long-term care project (project one).Implementation Science, 4, 52.
  • Fixsen, D. L., Naoom, S. F., Blasé, K. A., Friedman, R. M., & Wallace, F. (2005). Implementation research: A synthesis of the literature (FMHI Publication No. 231). Tampa: University of South Florida, Louis de la Parte Florida Mental Health Institute, and the National Implementation Research Network.
  • Gitlin, L. N., Jacobs, M., & Earland, T. V. (2010). Translation of a dementia caregiver intervention for delivery in homecare as a reimbursable Medicare service: Outcomes and lessons learned.The Gerontologist, 50, 847–854.
  • Green, L. W., Ottoson, J. M., García, C., & Hiatt, R. A. (2009). Diffusion theory and knowledge dissemination, utilization, and integration in public health.Annual Review of Public Health, 30, 151–174.
  • Hagedorn, H. J., & Heideman, P. W. (2010). The relationship between baseline Organizational Readiness to Change Assessment subscale scores and implementation of hepatitis prevention services in substance use disorders treatments: A case study.Implementation Science, 5, 46.
  • Helfrich, C. D., Damschroder, L. J., Hagedorn, H. J., Daggett, G. S., Sahay, A., Ritchie, M., … Stetler, C. B. (2010). A critical synthesis of the literature on the promoting action on research implementation in health services (PARIHS) framework.Implementation Science, 5, 82.
  • Helfrich, C. D., Li, Y. F., Sharp, N. D., & Sales, A. E. (2009). Organizational Readiness to Change Assessment (ORCA): Development of an instrument based on the Promoting Action on Research in Health Services (PARIHS) framework.Implementation Science, 4, 38.
  • Hoerster, L., Hickey, E. M., & Bourgeois, M. S. (2001). Effects of memory aids on conversations between nursing home residents with dementia and nursing assistants.Neuropsychological Rehabilitation, 11, 399–427.
  • Kagan, A., Simmons-Mackie, N., Gibson, J. B., Conklin, J., & Elman, R. (2010). Closing the evidence, research, and practice loop: Examples of knowledge transfer and exchange from the field of aphasia.Aphasiology, 24, 535–548.
  • Kitson, A., Harvey, G., & McCormack, B. (1998). Enabling the implementation of evidence-based practice: A conceptual framework.Qualitative Research in Health Care, 7, 149–158.
  • Kitson, A. L., Rycroft-Malone, J., Harvey, G., McCormack, B., Seers, K., & Titchen, A. (2008). Evaluating the successful implementation of evidence into practice using the PARIHS framework: Theoretical and practical challenges.Implementation Science, 3, 1.
  • McCurtin, A., & Roddam, H. (2012). Evidence-based practice: SLTs under siege or opportunity for growth? The use and nature of research evidence in the profession.International Journal of Language & Communication Disorders, 47, 11–26.
  • Mullen, R. (2005). Survey tests members' understanding of evidence-based practice.ASHA Leader, November 8.
  • Nelson, T. D., Steele, R. G., & Mize, J. A. (2006). Practitioner attitudes toward evidence-based practice: Themes and challenges.Administration and Policy in Mental Health and Mental Health Services Research, 33, 398–409.
  • O'Connor, S., & Pettigrew, C. (2009). The barriers perceived to prevent the successful implementation of evidence-based practice by speech and language therapists.International Journal of Language & Communication Disorders, 44, 1018–1035.
  • Patton, M. (2002). Qualitative research and evaluation methods (3rd ed.). Thousand Oaks, CA: Sage.
  • Pollock, A. S., Legg, L., Langhorne, P., & Sellars, C. (2000). Barriers to achieving evidence-based stroke rehabilitation.Clinical Rehabilitation, 14, 611–617.
  • Powell, B. J., McMillen, J. C., Proctor, E. K., Carpenter, R. C., Griffey, R. T., Bunger, J. C., … York, J. L. (2012). A compilation of strategies for implementing clinical innovations in health and mental health.Medical Care Research and Review, 69, 123–157.
  • Rycroft-Malone, J. (2004). The PARIHS framework: A framework for guiding the implementation of evidence-based practice.Journal of Nursing Care Quality, 19, 297–304.
  • Shewhart, A. (1931). Economic control of quality of manufactured product. New York, NY: D. Van Nostrand.
  • Sohlberg, M. M., Kennedy, M., Avery, J., Coelho, C., Turkstra, L., Ylvisaker, M., & Yorkston, K. (2007). Evidence-based practice for the use of external aids as a memory compensation technique.Journal of Medical Speech Language Pathology, 15, xv–li.
  • Stetler, C. B., Damschroder, L. J., Helfrich, C. D., & Hagedorn, H. J. (2011). A guide for applying a revised version of the PARIHS framework for implementation.Implementation Science, 6, 99.
  • Vallino-Napoli, L. D., & Reilly, S. (2004). Evidence-based health care: A survey of speech pathology practice.International Journal of Speech-Language Pathology, 6, 107–112.
  • Varkey, P., Reller, M. K., & Resar, R. K. (2007). Basics of quality improvement in health care.Mayo Clinic Proceedings, 82, 735–739.
  • Zipoli, R. P., & Kennedy, M. (2005). Evidence-based practice among speech-language pathologists: Attitudes, utilization, and barriers.American Journal of Speech-Language Pathology, 14, 208–220.

Additional Resources