AGE Research

Guiding Principles behind AGE research
Develop programs and resources that are:
→ Consumer driven
→ Clinically relevant
→ Evidence-based
→ Designed using adult-learning principles
→ Effective and sustainable (AGE Research and Evaluation Service)

GPA is based on the PARIHS Framework for implementing research into practice.

Research Update on the PARIHS Framework! A new article by Harvey and Kitson was published in 2016. “PARIHS revisited: from heuristic to integrated framework for the successful implementation of knowledge into practice.” March 2016. Access article here

Our main product, Gentle Persuasive Approaches (GPA®) in Dementia Care is based on the PARIHS FRAMEWORK (A Framework for Guiding the Implementation of Evidence-based Practice, Jo Rycroft-Malone, PhD, MSc, BSc (Hons), RN, 2004, retrieve full paper at link above) which states that practice change requires:

→ Quality evidence
→ Receptive workplace culture
→ Transformational facilitation

GPA is grounded in Bandura’s Theory of Self Efficacy

GPA is grounded in Bandura’s Theory of Self Efficacy (Bandura, Albert, 1977, retrieve abstract at link above), whose theoretical framework presents that:

→ High self-efficacy care providers can self-regulate appropriate practice goals and cope with practice change

→ More confident care providers are more likely to use person-centred behaviour strategies

EDUCATION THAT IS EFFECTIVE, SUSTAINABLE & EMBRACES RELEVANT CHANGE

It’s not enough to create and implement dementia care programs and curriculums even when based on evidence and best practice. Evaluating implementation in context, across settings and over time is crucial. It ensures effectiveness and sustainability and embraces relevant new evidence-based findings. At AGE, we are committed to gathering quality empirical evidence. As you will see, we are busy …

Now in its 3rd Edition, our Gentle Persuasive Approaches (GPA®) in Dementia Care education curriculum for care providers is a series of four living modules that are refined at regular intervals based on our findings through the AGE Research and Evaluation service.

Our robust social framework guides our processes and our progress:

COLLABORATION

We enjoy strong working relationships with 7 large external academic and clinical partners and/or external sponsors. As you will see from our research, we work collaboratively with healthcare professionals who are as committed as AGE is to a person-centred approach in enhancing the care of older adults. We thank all of our colleagues for their commitment.

INNOVATION

We are a leading innovator in educational services to enhance the care of older adults.

Over the past year …

We have adapted our traditional GPA Basics Education (7.5-hour) in-house curriculum for a 2-3-hour online learning format known as GPA® eLearning.

  • We have already delivered this online e-format to over 750 first year nursing
    students and 55 Emergency Department staff. This represents a savings of 4025 hours in face-to-face training.

NOTE! We have just completed an extensive research evaluation of  GPA eLearning with students at Ryerson University and McMaster University. Watch for details on our findings, coming soon!

PROMOTING A CULTURE OF SAFETY

The CHORD GPA Evaluation Project

GPA addresses the concerns expressed by [healthcare] staff for specialized training and the knowledge and skills to manage NDB with more dignity and compassion and in a person-centred fashion …

Schindel Martin, L., Gillies, L., Coker, E., Pizzacalla, A., Montemuro, M., Suva, G., McLelland, V., (2016). An education intervention to enhance staff self-efficacy to provide dementia care in an acute care hospital in Canada: A non-randomized controlled study. American Journal of Alzheimer’s Disease and Other Dementias, 31(8), 664-677.

Conclusion:

“Care providers who are employed in acute hospital settings are facing a growing number of older patients with dementia who are admitted for diagnosis and treatment of serious illnesses. These care providers are often unprepared to work with this population of patients and thus are at risk for work-related stress and burden. A dementia-specific EI, GPA, was successful in introducing specialized training for multidisciplinary staff employed in an acute care hospital in Ontario, Canada. This study determined that GPA addressed the concerns expressed by staff and provided the needed knowledge and skills to manage NDB with more dignity and compassion and in a person-centered fashion that supports the organization’s obligation to provide an excellent patient experience for the community they serve.”

Download Full Evaluation Report

Open Access Link to report

Spotlight on Clinical Care in the Journal of Nursing Administration for Individuals

Sustainability of an innovation to support and respond to persons with behaviours related to dementia and delirium.

Gillies, L., Coker E., Montemuro, M., Pizzacalla A. Journal of Nursing Administration, 45(2): 70-73, February 2015.

Abstract:

Gentle Persuasive Approaches (GPA) in Dementia Care, a program designed for staff caring for patients in long-term care who exhibit challenging behaviours, was implemented and has been sustained in an acute care setting. Outcomes include fewer codes indicating violent situations, a reduction in physical restraint and sitter use, and fewer reports of safety incidents involving agitated patients. In this article, we describe the innovation (GPA) and the strategies used to sustain its successful implementation.

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Gentle Persuasive Approaches (GPA®) in Dementia Care Implementation has resulted in a trend toward reduction of physical restraints and workplace violence:

Speziale, J., Black, E., Coatsworth-Puspoky, R., Ross, T., & O’Regan, T. (2009, March). Moving Forward: Evaluating a Curriculum for Managing Responsive Behaviours in a Geriatric Psychiatry Inpatient Population. The Gerontologist, 49(4), 570-576.

Abstract
Purpose: The Gentle Persuasive Approaches (GPA) curriculum was developed as an adjunct to other educational initiatives that were part of Ontario, Canada’s Alzheimer Strategy. GPA emphasizes that an individual’s unique personal history has a direct application to the interpretation of and response to their behavior. It incorporates strategies into geriatric patient care to assist staff to respond effectively to verbal and physical expressions of need.

Design and Methods: A pre- and post-intervention approach was used to evaluate the effectiveness of GPA: (a) Staff Satisfaction Surveys immediately after GPA training and after 3 months, (b) risk event profiling to monitor aggressive behavior rates, (c) occupational health and safety records pre- and post-GPA training, and (d) Residential Assessment Instrument–Mental Health indicators pre- and post-GPA training.

Results: Surveys revealed that GPA training significantly improved staff’s response to challenging behaviors, understanding of how brain changes impact behavior, and learning strategies to respond to challenging behaviors. Specific body containment techniques were less employed on geriatric patients who experience responsive behaviors. Pre- and postphysical aggression rates declined over the
6-month period following GPA training. The training did not appear to impact occupational injury rates.

Implications: GPA appears to be a useful and positive approach for providing care to an inpatient geriatric psychiatry population. Specific body containment techniques may be less useful when employed with patients who have responsive behaviors. The program evaluation suggests that application of the GPA curriculum may be extended to patients with diagnoses other than dementia.

Learn More
gerontologist.oxfordjournals.org/content/49/4/570.long

Gentle Persuasive Approaches (GPA®) teaches staff to respond effectively to cognitively impaired residents who display self-protective behaviours: 

Schindel Martin, L., Morden, P., Cetinski, G., Lasky, N., McDowell, C., & Roberts, J. (2003, September). Teaching staff to respond effectively to cognitively impaired residents who display self-protective behaviours. American Journal of Alzheimer’s Disease and Other Dementias, 18(5), 273-281. 

Conclusion:

“Six weeks after receiving training on care for persons with emotional and physical agitation, staff in a long-term care facility demonstrated increased knowledge and higher skill in response techniques than staff not trained. Although the self-reported confidence improved more for the experimental group, there was not a statistically significant difference. Longer follow-up and a larger sample are required to determine the effect of training on staff confidence. Analysis of qualitative data (focus groups and participant observation field notes) suggests an organizational culture of tolerance and respect for residents who display physical behaviors. The formal training program did much to relieve concerns about handling residents in ways feared to be inappropriate and unsafe. Training also gave staff new skills that made them feel more prepared to handle physical displays, while at the same time affirming the importance of good verbal communication skills. Staff thought they would become more confident over time as the opportunity to apply techniques in clinical practice arises.”

Learn More Read the full report

Published

Orthopaedic Nursing, 2015
Pizzacalla, A., Montemuro, M., Coker, E., Schindel-Martin, L., Gillies, L., Robinson, K., Pepper, H.,
Benner, J., Gusciora, J., (2015). Gentle Persuasive Approaches. Introducing an educational program on an orthopaedic unit for staff caring for patients with dementia and delirium. Orthopaedic Nursing,
34(2), 101–107.

The team (see above) received the Teresa Pellino Research Writers award for best paper, Gentle Persuasive Approaches. Introducing an educational program on an orthopaedic unit for staff caring for patients with dementia and delirium,” from the editors of Orthopaedic Nursing, 2016

Journal of Pastoral Care & Counselling, 2005

Ryan, E.B., Schindel Martin, L., Beaman, Amanda (2005). Communication Strategies to Promote Spiritual Well-Being among People with Dementia. Journal of Pastoral Care & Counselling, vol. 59, 1-2: pp. 43-55.

Abstract:

Declining communication skills in dementia threaten a person’s sense of self. Building on enduring capabilities, pastoral visitors can significantly enhance spiritual well-being through the use of individualized, person-centered strategies. This article outlines the primary spiritual needs of older adults with dementia and some general strategies to improve communication based on enduring abilities. Detailed examples illustrate how these personhood-centered strategies can meet spiritual needs by connecting with individuals with dementia through life stories and through helping them to participate in religious life.

Link to Abstract here

Dementia Nursing: An Overview of Best Practices at the Bedside, Dr. Lori Schindel Martin

Learn More Download

RECENT PRESENTATIONS & SUBMISSIONS

AGE believes strongly in research training for students. Special thanks to the Canadian Frailty Network for providing funding for our research summer student (denoted by “ss” in research team listings below).


Peer-Reviewed Presentations

Presented, 45th Annual Scientific and Education Meeting of the CAG, 2016
McLelland, V.C., Schindel Martin, L., Julian, P.(ss), Ryan, D., Lee, J., Cowan, D., & Wilding, L., Effects of a dementia educational intervention for emergency departments on staff knowledge, competence, and self-efficacy in providing person-centred care.
Learn More Download Poster

Julian P.(ss), Schindel Martin, L., McLelland, V.C., Ryan, D., Lee, J., Cowan, D., Wilding, L., Managing behaviours associated with dementia: Tailoring an educational intervention for emergency department staff.
Learn More Download Poster

Schindel Martin, L., Romaniuk D., Newman, K., Purdy, N., Kenmir, A., Wiesenthal, S., Verkeil, M., Hughes, M., Julian, P.(ss), McLelland V.C., Boucher, P., (Oral) Continued evaluation of an on-line dementia-specific educational intervention in a baccalaureate collaborative nursing degree program.

Recent Abstracts 

Deans’ Student Research Presentation, Ryerson University, Atrium, FCS, November 23, 2016.
Julian, P.(ss), Schindel Martin, L., Ryan, P., Lee, J., McLelland, V.C., Cowan, D., Wilding, L. Qualitative findings of an educational intervention for emergency department staff about dementia care.

Abstracts submitted and accepted, 19th Biennial Conference of the Canadian Gerontological Nursing Association (CGNA), May 2017:

Julian, P.(ss), Schindel Martin, L., McLelland V.C., Ryan, D., Lee, J., Cowan, D., Wilding, L. Bridge the gap: Participant voices support the need for any online dementia education for emergency department staff.

McLelland, V.C., Schindel Martin, L., Julian, P.(ss), Ryan, D., Lee, J., Cowan D., Wilding, L. Effects of a dementia educational intervention for emergency departments on staff knowledge, confidence, and self-efficacy in providing person-centred care.

Boucher, P., Schindel Martin, L., McLelland, V.C. (Oral) Evidence-based dementia education: Advancing best practice using a not-for-profit social enterprise model.

McLelland, V.C., Schindel Martin, L., Boucher, P. (Oral) An educational intervention to build staff capacity to provide person-centred dementia care for residents experiencing responsive behaviour: Outcomes within long-term care homes from two Canadian provinces.

Schindel Martin, L., Julian, P.(ss), McLelland, V.C., Bliss, M., Boucher, P., (Oral) Responsive Behaviour Related to Bathing in the Dementia Context: A Literature of Evidence-Based Best Practice Interventions.

Schindel Martin, L., Julian, P.(ss), McLelland, V.C., Boucher, P., (Oral) Sexual Expression and Dementia: Shelter or Shadow.

Schindel Martin, L., McLelland, V.C., Wilding, L., Ryan, D.P., Lee, J., Cowan, D., Julian, P.(ss), (Oral) Qualitative findings of a study to evaluate dementia education for emergency department staff.

Abstract accepted for presentation at the 32nd International Conference of Alzheimer’s Disease International, Kyoto, Japan, April 26-29, 2017:

Schindel Martin, L., Newman, K., Romaniuk D., Purdy, N., Kenmir, A., Verkuyl, M., Hughes, M., Wisenthal, S., McLelland V.C., Boucher, P., Freeman, C., Julian, P.(ss), (Poster) Evaluation on an online dementia-specific education intervention in a baccalaureate collaborative nursing degree program.

Dr. Kristine Newman, Assistant Professor, Ryerson University, will present on our project team’s behalf at the conference.


15th Annual Crossroads Interdisciplinary Health Research Conference. Ryerson University, Toronto, March 10-11, 2017.
Julian, P. (ss), Schindel Martin, L., McLelland, V.C., Ryan, P., Lee, J., Cowan, D., Wilding, L., Online dementia education for emergency department staff: Participant voices support the need.

WHAT’S IN THE PIPELINE?

1) Pilot evaluation of the GPA eLearning project was applied to Emergency Departments.
Grantsmanship. Grant awarded to Lori Schindel Martin, David Ryan (Director, Regional Geriatric Program Toronto), Jacques Lee (Director, Emergency Medicine, Sunnybrook Health Sciences Centre), David Cowan (Medical Director, Health for Older Adults Program, St. Joseph’s Centre for Ambulatory Health Services,) and Laura Wilding (Advanced Practice Nurse – Geriatrics, The Ottawa Hospital, and a GPA Certified Coach), by Ryerson Health Research Fund, Office of the Vice-President for Research and Innovation.

55 GEM staff enrolled in the GPA eLearning program in summer of 2016 and preliminary results show positive impacts of the GPA program on staff knowledge, competence, and self-efficacy. Initial findings were presented at the Geriatric Emergency Management Conference on September 20, 2016, and in October 2016 at the Canadian Association on Gerontology, Montreal.

A manuscript is now in preparation which will be submitted to the Canadian Journal on Aging.

2) Current Pilot Study of an Innovative Online Dementia Education Intervention for Multi-Disciplinary Post-Secondary Health Care Students in Ontario

Principal Investigators: Schindel Martin, L., Woo, P. (Associate Professor, Division of Geriatric Medicine, Department of Medicine, McMaster University) Co-Investigators: Cowan, D. (Medical Director, Health for Older Adults Program, St. Joseph’s Centre for Ambulatory Health Services), McLelland, V., Miller, P. (Physiotherapist), Newman, K. (Assistant Professor, Daphne Cockwell School of Nursing, Ryerson University), Rose, D. (Associate Professor, Daphne Cockwell School of Nursing, Ryerson University); Student Investigators: Ashbourne, J., Ashley, M., Julian, P., McNee, M., Vieira Zamora, F.

Grantsmanship: Special thank you to the Retired Teachers of Ontario Foundation (RTOF) – Geriatrics / Gerontology Research & Training at Post-Secondary Institutions and also to the McMaster Geriatric Interest Group (GIG).

3) School Board PSW Program Pilot: During the 2016-17 academic school semester, AGE is piloting a hybrid version of GPA eLearning with PSWs completing their program with a sample of Ontario school boards.

The school boards involved will be York Region, Simcoe County and Algonquin Lakeshore Catholic District School Boards. Approximately 120 students across the three school boards will complete the online GPA eLearning program beginning in January 2017. We will evaluate the program using measures of participant self-efficacy (SE) and competence in dementia care, caring, knowledge of responsive behaviours (via multiple choice questions), and satisfaction (using both quantitative ratings and open-ended questions), with the first four measures administered both pre- and post-intervention.

After completing the eLearning program, all students will also participate in a 2-hour follow-up classroom session that will serve to reinforce the concepts learned. We will evaluate this follow-up session using focus groups and in doing so, inform the building of a hybrid GPA curriculum (eLearning and classroom combined).

The development of such a curriculum was prompted by feedback from participants in the GEM nurse eLearning project, who identified concerns that eLearning alone is not sufficient for transfer to practice.

Following this evaluation, there will be a broader roll-out of the program across 21 school boards (data collection in May-June 2017).

Funding: Thank you to the Association of the Ontario Continuing Education School Board Administrators (CESBA) for funding towards the GPA eLearning course fees for this project.

4) London Health Sciences Centre Quality Improvement Project: AGE has assisted London Health Sciences Centre (LHSC) with the implementation of an Acute Care for the Elderly (ACE) Collaborative quality improvement project. Approximately 100 LHSC Medicine Unit staff members have completed the GPA eLearning program and evaluation measures, and attended a workshop in November 2016 with content designed to assist them with putting GPA principles into practice. Evaluation measures included participant self-efficacy (SE) and competence in dementia care, knowledge of responsive behaviours (via multiple choice questions), and satisfaction (using both quantitative ratings and open-ended questions), with the first three measures administered immediately pre-intervention, immediately post-intervention, and six to eight weeks post-intervention.

Status: Data collection is now complete, and AGE will be analyzing the evaluation data and providing LHSC with a report of the findings in February 2017.

5) Pilot Evaluation of GPA Face-to-Face [F2F) (LTCH sector, BC, Canada) – 6 (3 intervention, 3 control sites) Revera LTC sites/units in British Columbia. The data analysis was completed by AGE and the findings showed significant increases in self-efficacy, competence and knowledge of dementia after the intervention group completed GPA.

Funding: Thank you to SafeCare BC for research funding.

Status: The final report has been completed and submitted to SafeCare BC and Revera Homes, and publication of the findings is now under discussion.

6) Ryerson 2015-16 eLearning cohort – Data analysis to be completed in January 2017 and a manuscript will be submitted to the Canadian Journal on Aging or the Journal of Nursing Education.

Outcome: Ryerson University, Daphne Cockwell School of Nursing has made the decision to continue to embed GPA eLearning as part of their course content for NSE12 – Nursing Practice.

7) WSIB GPA-R Evaluation – Data to be analyzed in February 2017, and a manuscript will be submitted to the journal, Dementia.

Funding: Thank you to Workplace Safety & Insurance Board.

GPA Recharged (GPA-R) is a follow-up for care providers who have already completed the GPA Basics Education. Recharged is typically carried out by GPA Certified Coaches in an in-house organizational setting.

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ORIGINAL GPA PILOT PROJECT, FULL REPORT, July 2005

Funding: Thank you to the Regional Geriatric Program Central

The Development and Pilot Evaluation of an Educational Program to Train Long-Term Care Front-Line Staff in the Management of Responsive Behaviours of a More Catastrophic Nature Associated with Dementia.

Project Steering Committee: Schindel Martin, L., Loiselle, L., Montemuro, M., Cowan, D., Crane, R., Dempsey, M., McCoy, B., Penko, M., Tassonyi, A.

Curriculum Team: Schindel Martin, L., Montemuro, M., Crane, R., Dempsey, M.

Evaluation Team: Loiselle, L., Schindel Martin, L., Cowan, D., Dupuis, S, L.,

Operations Team: McCoy, B., Penko, M., Tassonyi, A., Luh, J.

Download Full Report

Contact Us to Enroll Your Staff in GPA eLearning GPA eLearning Flyer

FIRST RESULTS (RELEASED MARCH 2017): AGE’S EVALUATIONS OF GPA ONLINE eLEARNING

Two Acute Care Hospitals in Southern Ontario (started 2016)

94 members of acute care staff engaged in GPA eLearning in October/November 2016. 86 participated in the quality improvement measures (not an official research project). We saw significant improvements in their self-efficacy, competence and knowledge of person-centred dementia care. In the open-ended questions, they gave specific examples of how they had successfully used GPA techniques to determine the cause of responsive behaviours and defuse those behaviours.

District School Boards (2017)

Project now underway, with 26 PSW students from Algonquin Lakeshore Catholic District School Board completing a hybrid version of GPA eLearning (online course and a 2-hour face-to-face follow-up session) in Jan/Feb 2017. Approximately 40 students from Simcoe County District School Board begin GPA eLearning starting March 27thcontinuing for two weeks, followed by the face-to-face session. We will be evaluating changes in their self-efficacy, competence and knowledge, as well as conducting focus groups to hear their perspectives about the relevance of GPA eLearning to their PSW programs.

Post-Secondary Multidisciplinary Healthcare Students

Funded by the Retired Teachers of Ontario Foundation, 100 multidisciplinary post-secondary health care students (medicine, nursing, OT/PT) from McMaster and Ryerson are currently enrolled in GPA eLearning in preparation for attending the 9th Annual Geriatric Skills Day at St. Peter’s Hospital in Hamilton, Ontario.

We are measuring changes in their self-efficacy, competence, knowledge and caring and conducting focus groups to learn about their perceptions of the GPA eLearning program.

Geriatric Emergency Management (GEM) Nurses

In the summer of 2016, 55 Geriatric Emergency Management nurses completed GPA eLearning and did online measures of self-efficacy, competence and knowledge. We saw significant improvements in all three measures after completion of GPA. Nurses also participated in telephone interviews in which they described how they thought GPA had influenced their practice, and how GPA eLearning could be better tailored to the Emergency Department environment.

Download Poster

Thompson Rivers University

Beginning in April 2017, cohorts of Health Care Assistant and Bachelor of Nursing students will complete a hybrid version of GPA eLearning, and over the next 1.5 years, we will be looking at changes in their self-efficacy, competence and knowledge, relative to control groups of students who will complete their standard existing curriculum.

Ryerson University

Each year, GPA eLearning is given to a cohort of approximately 500 undergraduate nursing students at Ryerson’s Daphne Cockwell School of Nursing.

Specific details on our evaluations of these studies is coming soon.