R i v e r view Research Centre - Riverview Health Centre · R i v e r view Research Centre ... e x p e r tise can be combined with knowledge in project design, development ... b rea

R i v e rview Research CentreAdvancing Care Through Researc h

The Riverview Research Centre strives to create knowledge through re s e a rch –

knowledge that, in turn, can be shared with the international health care

community and put into practice. The Centre supports, creates and develops

re s e a rch opportunities in a variety of important are a s .

People who come to the Centre to take advantage of its re s e a rch capacity include

academics from universities and other educational institutions, graduate and medical

students, as well as Riverview staff members with an interest in a particular area of health

c a re. Often, academics and staff members function as a team so that on-the-job

e x p e rtise can be combined with knowledge in project design, development

and analysis. In all cases, the goal of these energetic, focused and

m u l t i - d i s c i p l i n a ry re s e a rchers reflects the mission of the

R i v e rview Research Centre: to benefit the lives of patients,

their families and their caregivers through ongoing

i n v e s t i g a t i o n s .

Three Years of Studies

This publication presents descriptions of

re s e a rch studies that have taken place

t h rough the Riverview Research Centre

f rom 2005 to 2007. The depth and

b readth of topic areas vary widely:

they range from spatial and motor

issues to product investigations to

end-of-life care considerations.

Some of the studies are complete

and the results are available to

the public, while others are

ongoing.

Anyone who would like furt h e r

i n f o rmation about any of the

re s e a rch projects described

within are invited to contact

the investigators dire c t l y.

Researchers are encouraged to take

full advantage of the benefits available

through the Riverview Research Centre,

including:

• a diverse patient population base with programs

that care for people with acquired brain injury,

Alzheimer disease, cancer, stroke, diabetes, heart

disease, respiratory disorders and specialized geriatric

medicine.

• dedicated research space with individual offices, large

and small conference rooms, high speed internet access

and statistical software systems.

• financial resources through an open annual research

competition.

• the assistance of on-site clinical nurse specialists.

• data storage to protect confidentiality of information.

• multi-media services.

• provincial Telehealth site.

Riverview Research Centre P2

Working Together:Academic Researchers and Clinicians Join Forces to Improve Patient Care

The Riverview Research Centre is a leader in collaborative research in rehabilitative,

palliative and long term care. Here, the bond between re s e a rchers from the academic

world and those in clinical practice are encouraged and supported. It is a worthwhile

partnership: university-based researchers bringing expertise in project design join forces with

health care clinicians who are equipped with hands-on, front-line experience. Mobility and

balance in frail older adults, patient safety, advance care planning and spirituality in long

term care residents are the topics addressed in this section as researchers blend their

knowledge and efforts to benefit patients and their families.

P3 Advancing Care Through Research

Planning for PatientSafety

Older people who live in the community face a higherrisk of experiencing events that could compro m i s etheir health and safety. Known as adverse events,these include falling, mixing medications or becomingmalnourished. This study looks at how day hospitalswork to reduce the risk of these unanticipated healthand safety problems for community-dwelling clients.R i v e rview Health Centre is housing the team ofre s e a rchers working on the pro j e c t .

The study identifies the strengths and weaknesses in the process of how day hospital teams pre p a re d i s c h a rge plans and how they communicate the contentof these plans to community-based health carep roviders. Once this information is gathered, there s e a rchers will work with key stakeholders – includingday hospital teams, families, physicians, home carec o o rdinators, community pharmacists and health policy decision makers – to identify strategies that willwork to decrease the risk of adverse events for olderpeople who reside in the community.

The team will gather the information in three stagest h rough focus groups, interviews and chart reviews. Itis hoped that the recommendations that emerge willhelp clinicians to address and potentially resolve healthrisks for older adults.

Investigators: Cornelia vanI n e v e l d , MD, MSc, FRCPC, St. Boniface Hospital, ElizabethBoustcha, MScA, MD, FRCPC,Riverview Health Centre, DarylD y c k , RN, MN, Wi n n i p e gRegional Health Authority, RubyG ry m o n p re , B S c P h a rm, Pharm D ,F C S H P, Faculty of Pharm a c y,University of Manitoba, A l a nKatz, MBChB, MSc, CCFP, FCFP,Departments of Family Medicineand Community Health Sciences,University of Manitoba, M i c h e l l eNelson, BA, BRS, MA, Faculty ofP h a rm a c y, University of Manitoba,Linda Smyrski, RN, ManitobaHealth, Laurie Thompson, RN,MN, Manitoba Institute for PublicSafety, Gina Trinidad, BA, RN,MN, Winnipeg Regional HealthAuthority


Cornelia van Ineveld

RehabilitationAssessment Measures:Application of theHierarchical Assessmentof Balance and Mobilityand Perceived Control ina Geriatric Medicine Unit

Being mobile and having good balance are essentiali n g redients to independent living and the highest possible quality of life. But for frail older adults, p roblems with mobility and balance significantly aff e c thow they manage their activities of daily living.

Psychological barriers, such as feelings of helplessness,may negatively influence a person's re h a b i l i t a t i o np ro g ress. Some older adults may believe that theyhave no personal control or influence over theirhealth, and there f o re are not likely to be motivated to“ t ry” with their therapy. The result? Fewer benefitsf rom the rehabilitation program and, in the long ru n ,a more dependent quality of life.

D r. We i n b e rg is concerned with the hypothesis thatlower levels of function in frail older adults may berelated to feelings of helplessness or weaker beliefs inc o n t rol over health, whereas higher levels of functionmay be related to stronger beliefs in control overhealth. Those with weaker control beliefs may beunmotivated to put eff o rt into their rehabilitation p rogram, leading to poorer functional outcomes.

H o w e v e r, available tools or methods of assessing a weak or frail person's basic physical abilities, such asbalance and mobility, do not always meet the need toassess the degree of frailty experienced by the person.By studying the relationship or links between physicalassessment and health-related control beliefs, futurere s e a rch can develop ways to enhance perceived c o n t rol, which may in turn motivate older adults toachieve success in their rehabilitation programs.

The goal of this investigation was to establish thevalidity and reliability of a physical function assessmenttool called the Hierarchical Assessment of Balance andMobility (HABAM) in 26 older adults from Riverv i e wHealth Centre's Geriatric Medicine Unit. As well,h e a l t h - related control beliefs were assessed using bothquantitative and qualitative interview questions.

I n v e s t i g a t o r s : Leah We i n b e rg, PhD, MSc, BPT, Department ofPhysical Therapy, University of Manitoba, Colleen Alecci, D P T,R i v e rview Health Centre, Heli Dedi, RN, BScN, MScA, Riverv i e wHealth Centre

Leah Weinberg

Institutional AdvanceCare Planning: Practiceand Policies in ThreeWestern Canadian Long Term CareFacilities

Donna Goodridge and her colleagues, Pat Yamada and Carole Hamel, are examining the way residents inlong term care settings, and their families, areinvolved in planning their future care and the meansby which staff facilitate this process. This study developsan efficient method for gathering information aboutpolicies and best practices in institutional advancec a re planning in Canada.

Institutional advance care planning (IACP) is an institutioninitiated discussion between professionals, patientsand families about health care to ensure that end-of-lifet reatment aligns with a patient's wishes. It may be am a n d a t o ry component of the admission pro c e s s ,especially in long term care. When a resident or patientis cognitively impaired, decisions about tre a t m e n toptions may include or re q u i re family or proxy involvement. In some Canadian institutions, IACP is

Donna Goodridge

replacing advance directives (“living wills”) which areoften too vague or limiting to be clinically useful. IACPalso fills the void where no advance directive exists.U n f o rt u n a t e l y, there has been no systematic investigationof how IACP has evolved in Canada.

The study explores practice and policy in three w e s t e rn Canadian long term care facilities: Riverv i e wHealth Centre in Winnipeg and Parkridge andS h e r b rooke centres in Saskatoon. A major goal of thep roject is the development of an effective method ofdata-gathering rather than the information itself.

Five staff members at each of the three centres arecompleting a web-based survey about IACP, designedby the investigators. As this is web-based, rather thanbeing mailed and requiring a written response, it iseconomical, fast and easy for busy professionals tocomplete, thus increasing the response rate. Theinvestigators are also developing a tool for analyzingthe administrative policies relating to IACP at thet h ree centres. Two patients, two family members andtwo staff members from Riverview and Parkridge arep a rticipating in a qualitative interview designed toelicit feedback from those involved in the IACPp ro c e s s .

I n v e s t i g a t o r s : Donna Goodridge, RN, PhD, CHPCN(c),College of Nursing, University of Saskatchewan, Pat Yamada,RN, MSN, Riverview Health Centre, Carole Hamel, RN, MN,

Riverview Health Centre


Achieving Wisdom:Older Adults’ Definitionsof Spirituality andExpectations forSpiritual Care in a Long Term ResidentialSetting

Do older people who live in long term care settingsreceive the opportunity to meet their personal spiritualneeds? These re s e a rchers decided to investigate thisissue because the importance of spirituality hasrecently been recognized as a fundamental compo-nent of holistic health.

Twenty cognitively capable older adult residents ofR i v e rview Health Centre participated in this study.Using individual in depth interviews, the investigatorsexamined the residents’ definitions of spirituality andspiritual well-being, as well as their attitudes towardtheir own social and physical aging. Interviewees werealso asked to express their expectations and aspirationsp e rtaining to spiritual care. More specifically, whatcould their caregivers, both formal and informal, doto enhance the older adults’ expression and experi-ence of spirituality, in part i c u l a r, and quality of life, ingeneral?

The interviews were audio taped and transcribed.NVIVO qualitative data analysis software was used toseparate responses according to dominant themes.The extensive data which emerged is curre n t l ybeing analyzed.

In their final analysis, the re s e a rchers expect toidentify linkages between older adults’ defini-tions of spirituality, expectations for spiritualc a re and their experiences of the aging pro c e s s ,p a rticularly their present self-assessed healthstatus. In short, do they use spirituality to copewith the aging pro c e s s ?

The practical implications for long term carefacilities could be the need to create a climate inwhich older adults can ask for spiritual help orbe able to express their spiritual needs easily.For example, residents in long term care needo p p o rtunities to attend a religious service ifthey wish to. They need to be made aware of available spiritual programs, such as a

Doreen Smith

meditation session or a reading from a spirituala u t h o r. Other needs can be identified by the re s i d e n t sthemselves, and health care staff, in addition to beingattentive and helpful, should be trained to respond toissues of spiritual care .

“Spirituality is an integral part of the life long learn i n gp rocess,” says principal investigator Doreen Smith.“People need to be able to experience and practicetheir spirituality in a long term care setting just as theywould if they were living in the community.” It isanticipated that the results of this re s e a rch will be ofuse, not only to theoreticians and re s e a rchers from a variety of disciplines, but also to professionals, practitioners and volunteers who work with olderadults, especially those in long term care settings.

I n v e s t i g a t o r s : D o reen Smith, BA, MA, PhD, Department ofS o c i o l o g y, University of Winnipeg, Glen Horst, M D i v, DMin,CPE(TS), Riverview Health Centre, Gwen Friedrich, B PAS, MSc, Canadian Centre on DisabilityStudies (form e r l y )


University-based researchers are discovering a rich resource at Riverview Health

Centre. With the diverse client population, investigators are able to identify and

successfully solicit patient groups that fit their area of study. From examining the

impact of textiles on the skin to assessing dignity and distress in those nearing end-of-life, the

possibilities for research are almost limitless. Recently, two new patient programs were added

to Riverview’s mix: Neurology Rehabilitation in the areas of Acquired Brain Injury and Stroke.

Already, patients in these programs have shown a willingness to participate in research

studies initiated by academic investigators. The common goal of these studies is to incorporate

research-based knowledge into practice so that rehabilitation patients will experience better

outcomes.

Researchers coming to Riverview from academic settings enjoy a myriad of supports, such as

assistance from on-site clinical nurse specialists, the availability of office space and conference

rooms, confidential data storage and the backing of an administration that

values collaboration in evidence-based research practices.

From the Halls of Learning:University-based Researchers Experience Benefits of On-site Studies


Nursing student and instructor at a bedside equipped with a transfer pole.

Researching PatientSafety from anEducation-SystemsPerspective

When errors that endanger patient safety occurin health care settings, they are rarely the re s u l tof the purposeful action of any one person.With this in mind, emphasis is shifting awayf rom the culture of blaming individuals to exam-ining systemic factors in the health care systemthat may contribute to errors in clinical practice.

This gro u n d - b reaking re s e a rch looks at learn i n gm o re about patient safety within the context ofnursing education by taking this systemica p p roach to errors that occur during nursingstudents’ clinical placements. Could anything bechanged in nursing education that could re d u c ethe number of nursing students’ errors, nearmisses and adverse events? For example, is theratio of students to clinical education facilitators

adequate? Are there characteristics of studentsthat need to be addressed from a systemic p e r s p e c t i v e ?

To establish a baseline of the types and frequenciesof nursing students’ errors, near misses andadverse events, the re s e a rchers analyzedP e rf o rmance Improvement Plans (PIPs) of studentsp a rticipating in placements at Riverview HealthC e n t re, Health Sciences Centre and Vi c t o r i aGeneral Hospital. (PIPs are individual studentre c o rds that include inadequate perf o rmance inclinical practice, selected remedial action andre-evaluation.) As well, focus groups with nursingstudents, classroom and clinical faculty membersand nursing education administrators took

Lorna Guse


place, along with individual interviews with theclinical course leaders and nurse managers ands t a ff nurses in the facilities.

Data is currently being analyzed and will bemade available in the fall of 2007. It is expectedthat the results will assist educational andhealth care agencies to work together toa d d ress systemic changes in nursing studenteducation, with an eye to reduce errors andthus improve patient safety.

I n v e s t i g a t o r s : David Gre g o ry, RN, PhD, School of HealthSciences, University of Lethbridge, L o rna Guse, RN, PhD,Faculty of Nursing, University of Manitoba, Penny Davis,BScN, MEd, Faculty of Nursing, University of Manitoba,Diana Davidson Dick, RN, Past Dean of Nursing,Nursing Division of the Saskatchewan Institute ofApplied Science and Technology (SIAST), C y n t h i aR u s s e l l , RN, PhD, ANP, University of Te n n e s s e e( M e m p h i s )

E rrors that endanger patient safety a re rarely the result of the purposefulaction of individuals.

David Gregory

Dignity and DistressAcross Various End-of-Life Populations

When someone is nearing the end of life, how dofamily members and caregivers ensure that the personis dying with dignity? A team of re s e a rchers lead byD r. Harvey Max Chochinov has been working fornearly two decades, focusing primarily on end-stagec a n c e r, to find answers to this question. From theirbody of re s e a rch has come a deeper understanding of dignity and a model of dignity in the terminally ill. This empirical model guides caregivers on how to deliver holistic, quality, “dignity-conserving” end-of-life care .

H o w e v e r, people facing end-of-life circ u m s t a n c e sother than cancer may experience diff e rent c i rcumstances because their conditions may manifestthemselves and pro g ress diff e re n t l y. Chochinov andhis team are now taking their re s e a rch further in ord e r

to understand the experiences occurring in theseother end-of-life circumstances, including: patientswith amyotrophic lateral sclerosis (also known as LouGehrig's disease); patients with end-stage renal disease; patients with advanced chronic obstru c t i v ep u l m o n a ry disease; the institutionalized frail elderly;and patients with end-stage cancer (to enable there s e a rchers to compare how the issues differ betweenthis group and the previous four).

In the first phase of this study, the re s e a rchers aretesting a psychometric instrument – the PatientDignity Inventory (PDI), which has been used withcancer patients – to determine whether it is suitablefor other end-of-life populations. Developed byChochinov's team, the PDI allows patients to rate

H a rvey Max Chochinov

their degree of distress on various items that mightinfluence their sense of dignity and includes psychosocial, existential and spiritual perspectives.One hundred patients in several Winnipeg facilities,including Riverview Health Centre, that offer longt e rm or end-of-life care are participating in this pro j e c t .The results from this phase will help the re s e a rchers toadjust their protocol for the various end-of-life popu-lations being studied. This first phase will serve to validate the PDI in these non-cancer populations andestablish its feasibility for use in the proposed Phase II of the study – a national, multi-site studyexamining dignity in people facing various end-of-lifec i rc u m s t a n c e s .

This study is the beginning of investigation into end-of-life issues in non-cancer populations so re s e a rc h e r scan identify ways to intervene in an empathetic,understanding and helpful way.

I n v e s t i g a t o r s : H a rvey Max Chochinov, MD, PhD, FRSC,OM, Department of Psychiatry, University of Manitoba, S u s a nM c C l e m e n t , RN, BN, MA, PhD, Faculty of Nursing, Universityof Manitoba, Tom Hack, PhD, CPsych, Faculty of Nursing,University of Manitoba, Mike Harlos, MD, Medical Director ofPalliative Care, WRHA, Tom Hassard , PhD, Department ofCommunity Health Sciences, University of Manitoba, M u rr a yE n n s , MD, Head, Department of Psychiatry, University ofManitoba, Chris Bourq u e , MD, Faculty of Medicine,University of Manitoba, C l a re Ramsey, MD, PhD,D e p a rtment of Community Health Sciences,University of Manitoba, James Zacharias, M D ,FRCPC, Section of Nephrology in the Faculty ofMedicine, University of Manitoba, D a v i dS t r a n g , MD, FRCPC, Deer Lodge Centre

The PDI allows patients to rate theird e g ree of distress on various items thatmight influence their sense of dignity.


People with hemispatial neglect, a common result

of stroke, are unable to c o m p rehend anything to theleft, such as the numbers on

the left side of a clock.

is also impaired, possibly because the brain can'tf o rm a complete image of the object for which theperson is reaching. Using participants re c ru i t e dt h rough Riverview Health Centre, Dr. Marotta isexploring this area to provide a better understandingof the neurological basis of hemispatial neglect andits effects on perception and action.

In collaboration with health professionals at Riverv i e wHealth Centre, the Dr. Marotta is re c ruiting part i c i-pants in each of three categories: a group of healthy,elderly people; people with brain damage but not inthe area that causes hemispatial neglect; and people

with hemispatial neglect. The experimental pro c e d u re sa re being conducted at the university, at Riverv i e w, orin the patient's home.

D r. Marotta and his investigative team use twosets of 12 wooden shapes to do same/differe n t

discrimination tests and grasping tasks.Specialized technology tracks the move-

ment of the participants' index finger,thumb, wrist and eyes as they re a c h

and grasp for the wooden shapes.Functional magnetic re s o n a n c eimaging is also used to learn whatthe brain is doing while perf o rm i n gc e rtain tasks.

Insights from this re s e a rch willnot only tell scientists moreabout the human brain, but willultimately lead to the developmentof sophisticated diagnostic toolsand more theore t i c a l l y - m o t i v a t e d

a p p roaches to the rehabilitation ofpatients with hemispatial neglect.

I n v e s t i g a t o r : Jonathan Maro t t a , Ph D ,D e p a rtment of Psychology, and Director of

the Neuropsychology of Vision Perception andAction Laboratory, University of Manitoba

Hemispatial Neglect: A MultidisciplinaryInvestigation of theEffects on VisualPerception and VisuallyGuided Action

Hemispatial neglect, a common result of stroke, is a disorder that erases the left half of its victim's world.It's as if the person is unable to comprehend anythingto the left – neither the numbers on the left side of a clock nor the food on the left side of a plate, fore x a m p l e .

H o w e v e r, re s e a rch by Jonathan Marotta reveals thatp rogramming and control of visually guided grasping

Jonathan Marotta

The goal is to provide a better understanding of the neuro l o g i c a l

basis of hemispatial neglect and itse ffects on perception and action.


Assessment of FoodService Satisfaction of Older Adults in aPersonal Care Home

People with cognitive impairment are often excludedf rom food service satisfaction surveys in personal carehomes, even though they re p resent over 50 per centof the population. “Researchers often don't ask people with dementia for their opinions because theydon't think their answers will be accurate,” says D r. Christina Lengyel.

In this study, Dr. Lengyel conducted a food service satisfaction survey addressing three areas of foods e rvice satisfaction: aspects of food; aspects of foods e rvice delivery; and quality of life. One hundred andf o rty residents at Riverview Health Centre part i c i p a t e din this investigation. Their average age was 81; 36 per cent had cognitive impairment and 64 per centdid not.

Both cognitively impaired and non-impaired re s i d e n t sw e re highly satisfied with all three areas, and no significant diff e rences were found between theresponses of cognitively impaired and non-impaire dp a rticipants. Only “aspects of food” received less positive responses. The responses from cognitivelyi m p a i red residents were generally more positive.

This project demonstrates that if the surv e yis designed appro p r i a t e l y, institutionscan include residents with mildto moderate cognitivei m p a i rment.

Investigator:Dr. ChristinaLengyel, PhD,Department of HumanNutritionalSciences,UniversityofManitoba

Stroke CanadaOptimization of Rehabilitation by EvidenceImplementation Trial (SCORE IT)

R e s e a rch re g a rding the best practices to use in stro k erehabilitation has great potential to improve the livesof people who have suff e red a stroke. However,re s e a rchers at the Canadian Stroke Network havefound that the knowledge gained from re s e a rch studies is often not translated into practice, or there issignificant variation amongst rehabilitation sites inCanada.

The SCORE-IT project includes 20 rehabilitation sites (including Riverview Health Centre) acro s sCanada. The study compares two diff e rent methodsof assisting practitioners to put into clinical practicesome rehabilitation interventions that have beenfound to be effective. The two diff e rent methods a re “outcome-oriented” and “pro c e s s - o r i e n t e d ”implementation strategies.

C o n t i n u e d …

Christina Lengyel Mark Bayley


Textiles and the Skin:Impact on Formationand Prevention ofBedsores

B e d s o res and pre s s u re ulcers, which are areas of localized damage to the skin and underlying tissuecaused by pre s s u re, present a significant risk to longt e rm care patients in health care institutions, part i c u-larly those who lack mobility. This study investigatesthe interactions between fabric and skin and theirimpact on the formation and prevention of bedsore s .

D r. Zhong was granted access to pre s s u re ulcer monitoring surveys of the patient population atR i v e rview Health Centre. Twenty-one patients werere c ruited to participate – some had pre s s u re ulcersand other skin problems, some did not. Staff caringfor these patients completed a questionnaire coveringdetailed information about the patients’ skin pro b l e m s ,as well as the fiber content of a variety of textile p roducts used by the patients, such as bed sheets,sleep wear, wheelchair seat covers and incontinencep roducts. The questionnaire also asked for inform a t i o nre g a rding the frequency and length of time patientsuse these pro d u c t s .

F rom the data collected, correlations were madebetween the pro p e rties of fabrics used and the pre s e n c eof bedsores, pre s s u re ulcers and other skin pro b l e m s .C u rre n t l y, the re s e a rcher is testing these fabricsre g a rding pro p e rties such as pre s s u re, moisture dissipation, shear (the force that is parallel to theplane of the contact surface) and friction.

Investigation into the impact of textile projects on the formation of bedsores will ultimately lead to p revention and re l i e fof problematic skinconditions, optimizingc o m f o rt and impro v i n gquality of life forpatients.

Investigator:Wen Zhong, PhD,Faculties of Human Ecologyand Medicine, University ofManitoba

Wen Zhong

Health care teams allocated to the outcome-orientedstrategy are provided education about how patientrehabilitation outcome measures can be used to impro v ethe team's practice. Health care teams assigned to thep rocess-oriented method receive strategies to pro m o t ehow the team works together to use evidence to meetthe rehabilitation goals of the patients.

In Phase I of this study, completed in 2003, there s e a rchers created best practice guidelines for p o s t - s t roke arm and leg rehabilitation based on thelatest re s e a rch evidence. In Phase II, re h a b i l i t a t i o n

teams in the 20 centres are taught the five arm and legoutcome measures. Each centre is randomly assignedto either the outcome-oriented or the process- oriented implementation strategy. A site coord i n a t o rcollects these outcomes and measures the extent towhich the rehabilitation team members follow theidentified best practices using a variety of methods,including patient charts, observation of therapy sessions,checklists completed by the team and a focus gro u p .

The results should help rehabilitation practitionerschange their practice to incorporate re s e a rc h - b a s e dknowledge so that stroke patients will experience better outcomes.

Investigators: Mark Bayley, MD, FRCPC, To ro n t oRehabilitation Institute, S h a ron Wood Dauphinee, P h D ,P T, Department of Epidemiology & Biostatistics, McGillU n i v e r s i t y, M e rrick Zwarenstein, MBBCh, Institute forClinical Evaluative Sciences, University of To ro n t o


Helping rehabilitation practitionerschange their practice to incorporatere s e a rch-based knowledge is a goal of the study.

play the video game by standing on a computerizedp re s s u re mat set to mimic diff e rent outdoor terr a i n s .They move or sway their bodies to control a cursor onthe computer screen. Simultaneously, the computertracks how long the patient plays, re c o rds the intensitylevel, and assesses perf o rmance.

All participants in the study come to Riverview HealthC e n t re's Day Hospital twice a week for six weeks to doeither interactive video gaming exercise, or conventionalphysical therapy. Fifteen patients receive therapy usingthe interactive gaming device, and 15 patients re c e i v econventional physical therapy. Most of the part i c i p a n t sa re over the age of 80 and have significant mobilityand balance issues.

A long term goal is to make the video game device inexpensive enough so that rehabilitation patients can do their therapeutic exercises at home on their personal computer, at no cost, while being monitore dand assessed by a health professional at another site(e.g. clinic or hospital). Feedback can be instant via e-mail.

I n v e s t i g a t o r s : Tony Szturm, BSc (PT), PhD, Department of Physical Therapy, School of Medical Rehabilitation, University of Manitoba, Val Goodman, DPT, Riverview Health Centre

Evaluation of a NovelRehabilitation andEducational InteractiveGaming Enviro n m e n t :M u l t i f u n c t i o n a lTherapeutic Exercises forBalance and MobilityMade Fun and Exciting

As they age, adults can lose some of their balance andmobility skills. The reasons for this vary, but in manycases, the result is the same: seniors become afraid togo outside for fear of falling. Confined to their homes,they become sedentary and isolated.

A long term exercise program can help some re h a b i l i-tation patients regain mobility and improve their balance. The challenge is to make the therapeutic e x e rcise interesting enough to sustain part i c i p a t i o n .Tony Szturm and Val Goodman are evaluating a novela p p roach, using a video game they have developed,that makes therapeutic exercise interesting. The interactive video game, coupled with a computerizedp re s s u re mat, allows patients to stand and move orsway their body to play the game. Day Hospital patients

Tony Szturm


Six rounds of “experiential blocks” (training students in interprofessional education), havebeen completed. Since the project began in July2005, the investigators and project team havep resented the IEGC project at various seminarsand conferences locally, nationally and intern a-t i o n a l l y.

I n v e s t i g a t o r s : Ruby Gry m o n p re, B S c ( P h a rm), Pharm D ,F C S H P, Faculty of Pharm a c y, University of Manitoba,C o rnelia van Ineveld, MD, MSc, FRCPC, St. BonifaceHospital, Elizabeth Boustcha, MScA, MD, FRCPC, Faculty ofMedicine, University of Manitoba; Riverview Health Centre.

I n t e r p ro f e s s i o n a lEducation in GeriatricC a re

The Interprofessional Education for Geriatric Care(IEGC) project is being conducted at Riverv i e w ' sDay Hospital, as well as at Deer Lodge and St. Boniface Day Hospitals – sites considered to begood role models for team-based health cared e l i v e ry. The project is designed to train groups ofUniversity of Manitoba students from medicine,nursing, pharm a c y, occupational therapy andphysical therapy in the importance of patient-c e n t red collaborative practice during their clinicalrotations.

In addition to learning clinicalskills, participating studentsspend 15 hours learning with,f rom and about each other, with an emphasis on interpro-fessional teaming in a re a lworld setting. Students re c e i v ementoring from the clinicalteam, do hands-on projects, andl e a rn how to model teambehaviours. Particular focus isplaced on learning about theroles of other pro f e s s i o n a l s ,how to collaborate with thesep rofessionals, and developingthe necessary attitudes andbehaviours to make a teamfunction. Participating facultyand preceptors are also re c e i v-ing education and trainingo p p o rtunities in the area ofi n t e r p rofessional teaming.

A goal of interpro f e s s i o n a lteaming is to show that, witha p p ropriate training, healthp rofessionals can work as ateam to deliver efficient ande ffective service, resulting inhigher patient satisfaction.

Ruby Grymonpre


Many medical and graduate students strive to extend their education beyond the

normal university experience through research conducted on-site at Riverview

Health Centre. Their goal may be to enhance their own ability to mastermind an

original research project, or their thesis may be part of a larger project overseen by a

seasoned academic working within the students’ areas of interest. In the five studies

described here, students have found a good fit in client population, as well as informed

assistance from health care professionals at Riverview. Both parties benefit: knowledge

gleaned from students’ studies is used to

improve patient care, while students develop

the research skills needed for their future

academic endeavours.

Medical and Graduate Students:Choosing Riverview’s Diverse ClientPopulation


The Clinical Utility of the biVA B Aas a Vision Screen for Determ i n i n gRisk for Falls, Suitability of PowerMobility and Appropriateness ofCognitive and Visual Perc e p t u a lTesting in Older Adults

Visually impaired individuals who also have cognitive impairment from stroke, dementia or a brain injury may be unable to communicatevision problems to caregivers. Unidentifiedvision problems can negatively affect day-to-dayfunctioning for these individuals, as they may beunable to safely participate in unit activities,such as self-care, hobbies or driving powerwheelchairs.

The investigators examined the clinical utility ofa vision scre e n i n g test called biVABA (Brain InjuryVisual Assessment Battery for Adults), which is akit containing visual assessment equipmentdesigned to be used by occupational therapists( O Ts).

Once the re s e a rchers taught Riverview HealthC e n t re OTs to use the test, it was found that the biVABA enabled the them to identify deficitsin visual acuity, contrast sensitivity, visual fields,visual attention and oculomotor control. Thisi n f o rmation is valuable since it can aid the ophthalmologist with diagnosis. After a diagnosisis determined, the OTs can request specific infor-mation from the ophthalmologist to help themp rovide visual treatment interventions that willallow the individuals to make use of existingvision or learn efficient visual search strategies.E n v i ronment modifications can also be part of a treatment intervention.

As well, it was found that use of the biVA B Ahelped speed re f e rrals to specialists. Potentially,the biVABA could save a person's vision if an OT'so b s e rvations identify serious vision impairm e n t s ,such as macular degeneration, while tre a t m e n tis still an option.

I n v e s t i g a t o r s : Alisa Kaplan, OTM (Student), University of Manitoba, Jennifer Nychek, OTM (Student), University ofM a n i t o b a , Stéfanie Prince, OTM (Student), University of Manitoba

CommunityEnvironments andParticipation inOccupations: A Studywith Women withCOPD

The incidence of chronic obstructive pulmonarydisease (COPD) is on the rise in women. Its debilitating effects – shortness of bre a t h ,fatigue, a chronic cough, and increased suscepti-bility to infections and pneumonia – create challenges for women living with the disease.Rita Taylor formed an advisory group of fourwomen with COPD who provided input to helpher design an interview guide on the subject ofwomen with COPD. She then conducted s e m i - s t ru c t u red interviews with 10 women withCOPD, with some follow-up interviews for f u rther clarification. These interviews pro b e dhow the women experienced their enviro n m e n tand discovered what helps and what hinderstheir ability to get out and participate in the community. The pre l i m i n a ry results werethen taken back tothe participants forverification.

The findings pre s e n trecommendations tohealth pro f e s s i o n a l sand service agencypersonnel who workwith women withCOPD. These includeadditional low costoptions for transpor-tation, expandingp rograms for personswith lung diseaseand improving accessto public and privateb u i l d i n g s .

Investigator:Rita Taylor, BOT,OT Reg(MB), student,Masters of Science inRehabilitation, Universityof Manitoba

Rita Taylor


Family Perceptions and Satisfaction withEnd-of-Life Care inLong Term CareFacilities

When an individual is approaching the end of life in a long term care facility, family members areencouraged to be present to provide meaningful andloving support.

Because they are so often at their loved one's bedsideand are privy to the care provided, family membersa re in a good position to comment on the quality ofend-of-life care and to offer recommendations onhow to improve that care.

Genevieve Thompson assessed satisfaction with end-of-life care from a family perspective to obtainc o n c rete recommendations for changes facilities can

Genevieve Thompson


make that will enhance the end-of-life experience forall involved. She conducted telephone interviews with87 family members of recently deceased re s i d e n t sf rom 12 long term care facilities in Winnipeg. She alsoheld three focus groups with family members todevelop recommendations for change.

T h ree predictors of family member satisfaction withthe end-of-life care were found: good communicationand contact with the nurses; involved health care aidsand other health team members; death occurring inthe facility rather than in a hospital after a transfer.

Recommendations emerging from the focus gro u p sincluded: development by the facility of clear guidelinesfor care of the terminally ill, including pain contro land other symptom management; physician continuity;exit interviews and bereavement follow-up; and the embracing by management of a philosophy ofpalliative care.

Investigator: Genevieve Thompson, RN, PhD, Department ofCommunity Health Sciences, University of Manitoba

Face Recognition andAlzheimer Disease

“ We used to think that people with Alzheimer's find it difficult to recognize a face simply because theirm e m o ry is gone. But we're finding there may also be perceptual difficulties,” says Cassandra Adduri, a student looking into face recognition and Alzheimerd i s e a s e .

People without cognitive impairment can more quicklyand accurately recognize a face when it appears turn e dat an approximately 45-degree angle. In her Master'sthesis in Psychology at the University of Manitoba,Adduri tested whether persons with Alzheimer diseasewould also have this “pre f e rred view. ”

Adduri re c ruited ten people with Alzheimer's fro mDeer Lodge Centre, the Alzheimer Society of Manitobaand Riverview Health Centre, and asked them tomatch a face at the top of a computer screen with oneof two faces at the bottom of the screen. Some faceswere shown at the same angle, and some were rotated.C o n t r a ry to previous re s e a rch, participants in the studyfound it difficult to match the faces at all, re g a rdless ofthe angle of orientation.

Adduri concluded that people with Alzheimer diseasemay have face-specific impairment that makes ite x t remely difficult to recognize a face re g a rdless of theangle it is presented. Instead, people with the diseasemust be given contextual clues to aid in re c o g n i t i o n ,such as reminding the person of the relationship ands h a red experiences he or she has with the visitor.

Investigator: Cassandra Adduri, BSc (Hon. Psychology),Graduate Student, Department of Psychology, University ofManitoba

Risk Factors for Fallsand Injuries Associatedwith Physical AssistiveEquipment Use AmongPeople with MotorNeuron Diseases inManitoba

Alice Kam, a second-year medical student at theUniversity of Manitoba, is investigating whether therea re risk factors that can lead to falls and injuries forpeople who use assistive equipment – such as grabbars, walkers, wheelchairs, commodes and raised toilet seats – to facilitate their daily living activities.Kam is administering a written survey and interv i e w i n gpeople with motor neuron diseases, includingA m y o t rophic Lateral Sclerosis (ALS) or Kennedy'sDisease, who use these devices.

The objective is to determine whether there are riskfactors, such as a change in a person's physical needs,faulty design, or inappropriate use of the equipment,that can lead to falls and injuries. These falls andinjuries may result in a loss of independence and functioning, a chronic fear of falling, as well as re s t r i c tactivity and cause further physical deterioration.

The participants in this studya re patients from the MotorN e u ron Disease Clinic at theDeer Lodge Centre. The studyis designed to produce recommendations to helpeliminate or mitigate adverseevents that can compro m i s esafety among people withmotor neuron disease. It shouldalso help increase pro f e s s i o n a l s 'a w a reness re g a rding equip-ment safety and result in saferequipment utilization strategiesfor patients.

Investigator: Alice Kam, BSc,BMR(OT), Medical Student,University of Manitoba

Cassandra Adduri Alice Kam


The re s e a rcher concluded that people with Alzheimer disease needcontextual clues to aid in re c o g n i t i o n .


Riverview Health Centre staff members are committed to resolving the issues,

problems and concerns that confront them in their day-to-day work. On the front

line of health care delivery, they are best able to identify areas that may require

further investigation and discovery. While the projects described in this section are not

externally funded research studies, the staff members involved are using established research

methods, procedures and approaches to delve into the issues of concern. They are included

in this publication because they shed light on three important aspects of patient care:

assessing care needs of patients, assessing pain management in the communicatively and

cognitively impaired, and influencing policy with regards to the safe lifting and transferring

of bariatric patients. Recommendations from these three projects will improve the quality of

life and care for patients both at Riverview Health Centre and elsewhere.

Research and Projects from Within:Centre Staff Strive to Add to Knowledge Base


Examination of RAIData: RelationshipBetween ManitobaHealth DependencyAssessment Care Levels& the RAI 2.0 ResourceUtilization Groups

When patients are admitted to Riverview HealthC e n t re, an assessment takes place to identifytheir care needs. Until re c e n t l y, a tool known asthe Manitoba Health Dependency AssessmentC a re Levels was used. A subjective measure, thistool assesses care needs based on six parametersof function – such as ambulation and the abilityto dress themselves – to identify the level ofindependence patients exhibit when perf o rm i n gthese basic functions.

In 2004, the Winnipeg Regional Health Authorityadopted the use of a new assessment tool called the Minimum Data Set – Residential AssessmentI n s t rument (MDS–RAI). Internationally used and validated, the MDS–RAI is a software pro g r a mwith applications that are used to objectivelyidentify patients’ problem areas, develop careplans and enhance the understanding of careo u t c o m e s .

This project compares the relationship betweenthe results found in both of these tools to ensurethat the MDS-RAI validly and reliably assessesthe care needs of the patients. Curre n t l y, thefindings are being reviewed, and any re c o m m e n-dations for change will be presented in a futurere p o rt .

I n v e s t i g a t o r s : Pat Ya m a d a , RN, MSN, Riverview HealthC e n t re , A u d rey Blandford , BA, Centre on Aging,Lori Mitchell, MA, Centre on Aging, Ve rena Menec, P h D ,C e n t re on Aging

Bariatric SystematicReview

Modified techniques and specialized equipmenta re needed when lifting, transferring and movingbariatric patients. In this project, literature andp roduct reviews were completed in order toi n f o rm the policy re g a rding safe, dignified carefor persons of size.

E m e rging from the project was a definition of a bariatric patient based on a combination ofweight, height and distribution of weight. As well, the literature review enabled there s e a rchers to identify modifications re q u i re dwhen lifting and transferring persons of size. The product review resulted in a compilation ofi n f o rmation about the products available, as wellas vendors, contact numbers and websites.

R i v e rview Health Centre has already used thisi n f o rmation in the purchase of lifting and t r a n s f e rring equipment. Also, the work involvedin the project has formed the basis for pro c e-d u res and policies developed by both Riverv i e wHealth Centre and the Winnipeg RegionalHospital Authority re g a rding the safe lifting and t r a n s f e rring of bariatric patients.

Investigators: Shirley Ladd, BPT, Riverview Health Centre,Lynda Wolf, BOT(C), OTM, Riverview Health Centre, Kerry-Anne Tyrell, MOT (Student), School of OccupationalTherapy, University of Manitoba

Pat YamadaShirley Ladd

Patients admitted to Riverview Health Centre undergo an assessment

to identify their care needs.

Comparison of PainAssessment Tools inthe Cognitively andCommunicativelyImpaired at RiverviewHealth Centre

Accurately assessing pain in cognitively and commu-nicatively impaired patients is important because theseindividuals may have limited ability to verbally describetheir pain. The Winnipeg Regional Health Authority(WRHA) has sanctioned two instruments, both validatedt h rough re s e a rch, for assessing pain in this group ofpatients, and these instruments are available for useby health care practitioners.

The purpose of this project is to establish a case forf u t u re validation of a third pain assessmenti n s t rument called Pain Assessment in theCognitively and CommunicativelyI m p a i red (PACCI). This instru-ment was developed,tested and intro-duced by an i n t e rd i s c i p l i n a ry

Carole Hamel

team at Riverview Health Centre in an eff o rt toi m p rove pain assessment practices for this patientg roup. PACCI uses a checklist of behavioural indicators of pain – such as fidgeting, pacing andwincing with movement – which is completed byhealth care staff .

In this project, 30 residents from the special careunit were assessed for pain by health care staffover all shifts in a one week period using PA C C Iand one of the two WRHA-sanctioned i n s t ruments. The two tests will be compared one ffectiveness, sensitivity, interrater reliability andease of use. If results indicate that PACCI is ase ffective as the WRHA-sanctioned tool, the stagewill be set for a future study to validate the PA C C I .This would provide health care staff with a thirdoption for assessing pain in those patients whoa re unable to verbalize. This work helps toenhance pain assessment strategies and ultimatelyi m p rove pain treatment for these patients.

Investigators: Carole Hamel, RN, MN, Riverview HealthCentre, Lynette Badenhorst, MB, CHB, Riverview HealthCentre, Pamela Bager, MSc, SLP(C), Riverview HealthC e n t re, Laurie Lavis Cerqueti, BA, RN, BN, MSA,R i v e rview Health Centre, Lynda Wolf, BOT(C), OTM,Riverview Health Centre


Cognitively impaired individuals may have limited ability

to verbally describe their pain.

Riverview Health Centre has a long history of active participation in academic research activities. While our forebears taught us how to control the contagious

diseases common at the turn of the century, today’s researchers use their talents to address the challenges of life in the 21st Century. These include investigating elements that will

enhance the quality of life of individuals requiring long term care and rehabilitation services.

For more information contact:Manager, Education and Research

Riverview Health CentreOne Morley Avenue, Winnipeg, Manitoba R3L 2P4

Phone: (204) 478-6213 Fax: (204) 287-8718Email: [email protected]

Website: www.riverviewhealthcentre.com

NORMAN R. KASIANPRESIDENT & CEO

Copyright © Riverview Health Centre 2007. All rights re s e rved.

No portion of this document may be re p roduced mechanically,

e l e c t ronically or by any other means, including photocopying, without

the written permission of Riverview Health Centre .

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