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Kaasalainen S, Wickson-Griffiths A, Hunter P, Thompson G, Kruizinga J, McCleary L, Sussman T, Venturato L, Shaw S, Boamah SA, Bourgeois-Guérin V, Hadjistavropoulos T, Macdonald M, Martin-Misener R, McClement S, Parker D, Penner J, Ploeg J, Sinclair S, Fisher K. Evaluation of the Strengthening a Palliative Approach in Long Term Care (SPA-LTC) programme: a protocol of a cluster randomised control trial. BMJ Open 2023; 13:e073585. [PMID: 37880170 PMCID: PMC10603462 DOI: 10.1136/bmjopen-2023-073585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 09/28/2023] [Indexed: 10/27/2023] Open
Abstract
INTRODUCTION Despite the high mortality rates in long-term care (LTC) homes, most do not have a formalised palliative programme. Hence, our research team has developed the Strengthening a Palliative Approach in Long Term Care (SPA-LTC) programme. The goal of the proposed study is to examine the implementation and effectiveness of the SPA-LTC programme. METHODS AND ANALYSIS A cross-jurisdictional, effectiveness-implementation type II hybrid cluster randomised control trial design will be used to assess the SPA-LTC programme for 18 LTC homes (six homes within each of three provinces). Randomisation will occur at the level of the LTC home within each province, using a 1:1 ratio (three homes in the intervention and control groups). Baseline staff surveys will take place over a 3-month period at the beginning for both the intervention and control groups. The intervention group will then receive facilitated training and education for staff, and residents and their family members will participate in the SPA-LTC programme. Postintervention data collection will be conducted in a similar manner as in the baseline period for both groups. The overall target sample size will be 594 (297 per arm, 33 resident/family member participants per home, 18 homes). Data collection and analysis will involve organisational, staff, resident and family measures. The primary outcome will be a binary measure capturing any emergency department use in the last 6 months of life (resident); with secondary outcomes including location of death (resident), satisfaction and decisional conflict (family), knowledge and confidence implementing a palliative approach (staff), along with implementation outcomes (ie, feasibility, reach, fidelity and perceived sustainability of the SPA-LTC programme). The primary outcome will be analysed via multivariable logistic regression using generalised estimating equations. Intention-to-treat principles will be used in the analysis. ETHICS AND DISSEMINATION The study has received ethical approval. Results will be disseminated at various presentations and feedback sessions; at provincial, national and international conferences, and in a series of manuscripts that will be submitted to peer-reviewed, open access journals. TRIAL REGISTRATION NUMBER NCT039359.
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Affiliation(s)
- Sharon Kaasalainen
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
- Gladys Sharpe Chair in Nursing, School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | | | | | | | - Julia Kruizinga
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Lynn McCleary
- Department of Nursing, Faculty of Applied Health Sciences, Brock University, St. Catharines, Ontario, Canada
| | - Tamara Sussman
- School of Social Work, McGill University, Montreal, Québec, Canada
| | | | - Sally Shaw
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Sheila A Boamah
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | | | | | | | | | - Susan McClement
- College of Nursing, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Deborah Parker
- Aged Care, University of Technology Sydney Faculty of Health, Sydney, New South Wales, Australia
| | - Jamie Penner
- College of Nursing, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jenny Ploeg
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Shane Sinclair
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Kathryn Fisher
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
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Bennett FB, O'Conner-Von S. Continuous Commitment: Long-Term Care RNs' Experience Communicating With Residents and Their Families About End-of-Life Care Preferences. J Gerontol Nurs 2022; 48:29-36. [DOI: 10.3928/00989134-20221003-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Rekatsina M, Paladini A, Viswanath O, Urits I, Myrcik D, Pergolizzi J, Breve F, Varrassi G. Opioids in the Elderly Patients with Cognitive Impairment: A Narrative Review. Pain Ther 2022; 11:381-394. [PMID: 35380373 PMCID: PMC9098742 DOI: 10.1007/s40122-022-00376-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 03/10/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction Assessment and management of pain in elderly people with cognitive impairment is particularly challenging. Physiological changes due to aging as well as comorbidities and polypharmacy are responsible for a complex clinical approach. Concomitantly, in cognitive impairment, including advanced dementia, changes in the central nervous system along with changes in the peripheral nervous system due to aging have a significant impact on pain perception. Sometimes clinicians decide to prescribe opioids to relieve pain, also without a clear indication. This review aims to investigate the effect of opioids in elderly patients with cognitive impairment. Methods A literature search of PubMed/Medline, Scopus, and Cochrane databases was conducted using keyword searches to generate lists of articles that were screened for relevance by title and abstract to give a final list of articles for full-text review. Further articles were identified by scanning the reference lists of the full-text articles. Discussion This review discusses the complex physiological and pharmacological changes in the elderly as well as the neurological changes that affect pain perception in this population. Additionally, it focuses on cognitive impairment and pain in Alzheimer’s disease and other dementias, the pain assessment in the elderly with cognitive impairment as well as the safety of opioid use in the elderly. Information regarding opioid prescription in nursing homes and recorded indications for opioid use, type and dosing of opioids, and compliance of treatment in advanced dementia are also provided. Conclusions Opioid prescription in the elderly population with cognitive impairment is particularly complex. All healthcare professionals involved in the care of such patients need to be aware of the challenges and strive to ensure analgesic use is guided by appropriate and accurate pain assessment.
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Affiliation(s)
- M Rekatsina
- Mid and South, Essex University Hospitals Group, Orsett Hospital, Grays, RM16 3EU, Essex, UK
| | - A Paladini
- Department MESVA, University of L'Aquila, 67100, L'Aquila, Italy
| | - O Viswanath
- Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE, USA
- Department of Anesthesiology, Louisiana State University Health Shreveport, Shreveport, LA, USA
| | - I Urits
- Department of Anesthesiology, Louisiana State University Health Shreveport, Shreveport, LA, USA
- Southcoast Physician Group Pain Medicine, Southcoast Health, Wareham, MA, USA
| | - D Myrcik
- Department of Internal Medicine, Silesian University of Medicine, 42-600, Byton, Poland
| | | | - F Breve
- NEMA Research Group, Naples, FL, USA
| | - G Varrassi
- Paolo Procacci Foundation, 00193, Rome, Italy.
- NEMA Research Group (European Chapter), Naples, FL, USA.
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Bennett FB, Hadidi NN, O'Conner-Von SK. End-Of-Life Care Communication in Long-Term Care Among Nurses, Residents, and Families: A Critical Review of Qualitative Research. J Gerontol Nurs 2021; 47:43-49. [PMID: 34191654 DOI: 10.3928/00989134-20210604-03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
RNs in long-term care (LTC) are a critical nexus for end-of-life (EOL) care communication with older adult residents and their families. A critical review of 17 qualitative research studies examined nurses' experience with EOL care in LTC. Findings indicate that time, preparation, advocacy, organizational resources, and a continuous, relational approach support EOL care communication. Regulatory burdens, understaffing, workflow demands, family and organizational dysfunction, anxiety, and depression impede EOL care communication. The current review revealed a gap in the literature describing LTC RNs' unique perspectives and knowledge regarding EOL care communication with residents and families. There is a current, pressing need to understand the facilitators LTC RNs use to overcome obstacles to effective EOL care communication. Future research could inform clinical practice guidelines and EOL care nursing education, enhancing LTC nurses' capacity to develop trust-based relationships and improving the efficacy of current EOL care communication interventions in LTC. [Journal of Gerontological Nursing, 47(7), 43-49.].
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Just DT, O'Rourke HM, Berta WB, Variath C, Cranley LA. Expanding the Concept of End-of-life Care in Long-term Care: A Scoping Review Exploring the Role of Healthcare Assistants. Int J Older People Nurs 2021; 16:e12353. [PMID: 33124160 DOI: 10.1111/opn.12353] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 09/11/2020] [Accepted: 09/19/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND The context of care provided in long-term care homes is changing, as an increasing number of older adults are entering long-term care with advance stages of illness and higher care needs. Long-term care homes are quickly becoming the place of death for an increasing number of older adults, despite recent literature identifying inadequate and suboptimal levels of end-of-life care. Within long-term care, healthcare assistants represent 60%-70% of the unregulated workforce and provide 70%-90% of the direct care to residents. Research indicates that a high level of uncertainty exists surrounding the role of healthcare assistants in end-of-life care, with numerous studies reporting the role of healthcare assistants to be 'unclear' with varying levels of responsibilities and autonomy. OBJECTIVE The purpose of this scoping review was to explore healthcare assistants' experiences and perspectives of their role in end-of-life care in long-term care. METHODS We applied Arksey and O'Malley's methodological framework, with recommendations from Levac and colleagues' guiding principles. Electronic databases and the grey literature were searched for relevant articles. Search concepts included end-of-life care and healthcare assistants. Articles were included in this review if they explored healthcare assistants' experiences or perspectives of providing end-of-life care in long-term care. The peaceful end of life theory by Ruland and Moore (1998) was used to organise data extraction and analysis. RESULTS A total of n = 15 articles met the inclusion criteria. The most predominant role-required behaviours reported by healthcare assistants were as follows: psychosocial support to significant others, knows the resident's care wishes and physical care with respect and dignity. The most predominant extra-role behaviours reported by healthcare assistants were as follows: becoming emotionally involved, acting as extended family and ensuring residents do not die alone. CONCLUSIONS Findings from this review expanded the concept of end-of-life care by illustrating the role-required and extra-role behaviours healthcare assistants perform when providing end-of-life care in long-term care. IMPLICATIONS FOR PRACTICE Findings from this scoping review highlight the numerous behaviours healthcare assistants perform outside their role description in order to provide end-of-life care to dying residents in long-term care. These findings could inform policymakers and managers of long-term care homes.
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Affiliation(s)
- Danielle T Just
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | | | - Whitney B Berta
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Caroline Variath
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Lisa A Cranley
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
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Sutherland N. Structures, tensions, and processes shaping long-term care home staff's role in end of life decision-making for residents with dementia. J Aging Stud 2020; 54:100874. [PMID: 32972618 DOI: 10.1016/j.jaging.2020.100874] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 08/23/2020] [Accepted: 08/26/2020] [Indexed: 12/27/2022]
Abstract
Although long-term care (LTC) home staff of nurses and personal support workers spend the most time providing direct care, their role in end of life decision-making for residents with dementia has largely been unacknowledged. Staff's perceptions of their role play a significant part in how they support people with dementia and family care partners. The purpose of this study was to examine LTC home staff's perspectives of their role in end of life decision-making for LTC home residents with dementia. For this interpretive descriptive study, 21 semi-structured interviews were conducted in two urban LTC homes with nine personal support worker (PSWs), eight registered practical nurses (RPNs), and four registered nurses (RNs). Additionally, a focus group was conducted, consisting of each a PSW, RPN, and RN. A voice-centred relational analysis was used to situate LTC home staff's perspectives within broader social contexts. Findings suggest that little has changed in LTC homes in the last 50 years. Rooted in dichotomies between medical and social care paradigms, ideologies of rationality and professionalism created tensions, hierarchical roles, and staff's minimal involvement in decision-making. A relational approach is needed to account for the interdependency of care and the relationships that LTC home staff have with residents, family care partners, and the sociopolitical environment.
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Affiliation(s)
- Nisha Sutherland
- Lakehead University, 955 Oliver Road, Thunder Bay, ON P7B 5E1, Canada.
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Smith C, Newbury G. Palliative care for community patients diagnosed with dementia: a systematic review. Br J Community Nurs 2020; 24:570-575. [PMID: 31800308 DOI: 10.12968/bjcn.2019.24.12.570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Despite many efforts made by health organisations to deliver effective end-of-life care to patients with dementia, research indicates that palliative care is predominantly aimed at patients with terminal cancer, and that patients with dementia face challenges in accessing end-of-life care. This article explores the views of health professionals on providing palliative care to those patients diagnosed with dementia within the community setting. A systematic review of seven qualitative studies was performed to identify the best available evidence. The findings show that effective palliative care for patients with dementia continues being affected by many barriers and challenges. Good practice seems to be inconsistent and fragmented throughout the UK and European countries, and many health professionals are faced with difficulties associated with services and financial implications, training and education, staff support, communication, family support and dementia care.
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Affiliation(s)
| | - Gina Newbury
- Senior Lecturer and Director of Recruitment and Admissions, both at School of Healthcare Sciences, Cardiff University, Cardiff, Wales
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Kaasalainen S, Hunter PV, Dal Bello-Haas V, Dolovich L, Froggatt K, Hadjistavropoulos T, Markle-Reid M, Ploeg J, Simard J, Thabane L, van der Steen JT, Volicer L. Evaluating the feasibility and acceptability of the Namaste Care program in long-term care settings in Canada. Pilot Feasibility Stud 2020; 6:34. [PMID: 32161658 PMCID: PMC7053118 DOI: 10.1186/s40814-020-00575-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 02/17/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Residents living and dying in long-term care (LTC) homes represent one of society's most frail and marginalized populations of older adults, particularly those residents with advanced dementia who are often excluded from activities that promote quality of life in their last months of life. The purpose of this study is to evaluate the feasibility, acceptability, and effects of Namaste Care: an innovative program to improve end-of-life care for people with advanced dementia. METHODS This study used a mixed-method survey design to evaluate the Namaste Care program in two LTC homes in Canada. Pain, quality of life, and medication costs were assessed for 31 residents before and 6 months after they participated in Namaste Care. The program consisted of two 2-h sessions per day for 5 days per week. Namaste Care staff provided high sensory care to residents in a calm, therapeutic environment in a small group setting. Feasibility was assessed in terms of recruitment rate, number of sessions attended, retention rate, and any adverse events. Acceptability was assessed using qualitative interviews with staff and family. RESULTS The feasibility of Namaste Care was acceptable with a participation rate of 89%. However, participants received only 72% of the sessions delivered and only 78% stayed in the program for at least 3 months due to mortality. After attending Namaste Care, participants' pain and quality of life improved and medication costs decreased. Family members and staff perceived the program to be beneficial, noting positive changes in residents. The majority of participants were very satisfied with the program, providing suggestions for ongoing engagement throughout the implementation process. CONCLUSIONS These study findings support the implementation of the Namaste Care program in Canadian LTC homes to improve the quality of life for residents. However, further testing is needed on a larger scale.
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Affiliation(s)
- Sharon Kaasalainen
- School of Nursing, McMaster University, 1280 Main Street West, HSC 3H48C, Hamilton, ON L8S 3Z1 Canada
- Department of Family Medicine, McMaster University, 1280 Main Street West, 3H48C, Hamilton, ON L8N 3Z5 Canada
| | | | | | - Lisa Dolovich
- Department of Family Medicine, McMaster University, 1280 Main Street West, 3H48C, Hamilton, ON L8N 3Z5 Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON Canada
| | | | | | - Maureen Markle-Reid
- Aging, Community and Health Research Unit, School of Nursing, McMaster Institute for Research on Aging/Collaborative for Health and Aging, McMaster University, 1280 Main Street West, HSc 3N25B, Hamilton, ON L8S 4K1 Canada
| | - Jenny Ploeg
- Aging, Community and Health Research Unit, School of Nursing, McMaster University, 1280 Main Street West, HSc 3N25C, Hamilton, ON L8S 4K1 Canada
| | | | - Lehana Thabane
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON Canada
| | - Jenny T. van der Steen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Ladislav Volicer
- School of Aging Studies, University of South Florida, Tampa, FL USA
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Nasu K, Sato K, Fukahori H. Rebuilding and guiding a care community: A grounded theory of end-of-life nursing care practice in long-term care settings. J Adv Nurs 2020; 76:1009-1018. [PMID: 31845377 DOI: 10.1111/jan.14294] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 10/26/2019] [Accepted: 12/03/2019] [Indexed: 11/30/2022]
Abstract
AIMS To investigate the end-of-life (EOL) nursing care practice process in long-term care (LTC) settings for older adults in Japan. DESIGN A qualitative study based on grounded theory developed by Corbin and Strauss. METHODS Sampling, interviewing, and analysis were performed cyclically, with results for each stage used as the basis for data collection and next-stage analysis decisions. Semi-structured interviews were conducted from March 2015-March 2019 with 22 nurses from eight LTC settings. Analysis was performed using coding, constant comparison, and emerging categories. RESULTS The core category, "guiding the rebuilt care community to assist the dying resident" comprised five categories: "assessing the resident's stage," "harmonizing care with the dying process," "rebuilding a care community," "helping community members care for the resident," and "encouraging community members to give meaning." The participants were described as "traditional village elders" who were the integral members of the care community, as well as guides who helped and encouraged the community. CONCLUSION Results revealed the holistic process of EOL nursing-care practice in Japan. Nurses aimed to allow LTC residents to die as social human beings, surrounded by people, and not just responding physical and psychological distress. Such practice requires nursing expertise, healthcare skills, and leadership qualities to build and serve care communities. Nurses must also consider residents' uncertainties and vulnerabilities as well as their cultural backgrounds. IMPACT This study showed that the nurses hold unique roles in providing dying people with care from a community. These findings can potentially be applied for developing a universal model for LTC nurses in many aging populations, to modify their EOL care practice, educate new LTC nurses, and collaborate with other healthcare professionals.
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Affiliation(s)
- Katsumi Nasu
- Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kana Sato
- Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroki Fukahori
- Faculty of Nursing and Medical Care, Keio University, Fujisawa, Kanagawa, Japan
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Nasu K, Konno R, Fukahori H. End-of-life nursing care practice in long-term care settings for older adults: A qualitative systematic review. Int J Nurs Pract 2019; 26:e12771. [PMID: 31364244 DOI: 10.1111/ijn.12771] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 02/03/2019] [Accepted: 06/15/2019] [Indexed: 12/19/2022]
Abstract
AIM To synthesize qualitative evidence on nurses' end-of-life care practices in long-term care settings for older adults. BACKGROUND Qualitative evidence on how nurses describe their own end-of-life care practice has not been reviewed systematically. DESIGN Qualitative systematic review. DATA SOURCES Databases MEDLINE, CINAHL, PsycINFO, EMBASE, Mednar, Google Scholar, and Ichushi were searched for published and unpublished studies in English or Japanese. METHODS The review followed the Joanna Briggs Institute approach to qualitative systematic reviews. Each study was assessed by two independent reviewers for methodological quality. The qualitative findings were pooled to produce categories and synthesized through meta-aggregation. RESULTS Twenty studies met all inclusion criteria. Their 137 findings were grouped into 10 categories and then aggregated into three synthesized findings: playing multidimensional roles to help residents die with dignity, needing resources and support for professional commitment, and feeling mismatch between responsibilities and power, affecting multidisciplinary teamwork. CONCLUSION Nurses play multidimensional roles as the health care professionals most versed in residents' complex needs. Managers and policymakers should empower nurses to resolve the mismatch and help nurses obtain needed resources for end-of-life care that ensures residents die with dignity.
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Affiliation(s)
- Katsumi Nasu
- Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Rie Konno
- School of Nursing, Hyogo University of Health Sciences, Hyogo, Japan
| | - Hiroki Fukahori
- Faculty of Nursing and Medical Care, Keio University, Kanagawa, Japan
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Smith-MacDonald L, Venturato L, Hunter P, Kaasalainen S, Sussman T, McCleary L, Thompson G, Wickson-Griffiths A, Sinclair S. Perspectives and experiences of compassion in long-term care facilities within Canada: a qualitative study of patients, family members and health care providers. BMC Geriatr 2019; 19:128. [PMID: 31060500 PMCID: PMC6503362 DOI: 10.1186/s12877-019-1135-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 04/11/2019] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION This paper details a subset of the findings from a participatory action research project exploring a palliative intervention in long-term care sites across Canada. The findings presented in this paper relate to understanding compassion within the context of a palliative approach to long-term care. METHODS Findings presented are drawn from qualitative interviews and focus groups with residents, family members, healthcare providers, and managers from 4 long-term care sites across 4 provinces in Canada. In total, there were 117 individuals (20 residents, 16 family members, 72 healthcare providers, and 9 managers) who participated in one of 19 focus groups. Data was analyzed by multiple members of the research team in accordance with thematic analysis. Individual concepts were organized into themes across the different focus groups and the results were used to build a conceptual understanding of compassion within Long Term Care . FINDINGS Two themes, each comprised of 5 sub-themes, emerged from the data. The first theme 'Conceptualizing Compassion in Long-Term Care generated a multidimensional understanding of compassion that was congruent with previous theoretical models. 'Organizational Compassion: resources and staffing', the second major theme, focused on the operationalization of compassion within the practice setting and organizational culture. Organizational Compassion subthemes focused on how compassion could support staff to enact care for the residents, the families, one another, and at times, recognizing their pain and supporting it through grief and mourning. CONCLUSIONS Results suggest that compassion is an essential part of care and relationships within long-term care, though it is shaped by personal and professional relational aspects of care and bound by organizational and systemic issues. Findings suggest that compassion may be an under-recognised, but essential element in meeting the promise of person-centred care within long-term care environments.
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Affiliation(s)
- Lorraine Smith-MacDonald
- Faculty of Nursing, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
| | - Lorraine Venturato
- Faculty of Nursing, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada.,Dementia and Cognitive Impairment NeuroTeam, Hotchkiss Brain Institute, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
| | - Paulette Hunter
- St. Thomas More College, University of Saskatchewan, 1437 College Drive, Saskatoon, SK, S7N 0W6, Canada
| | - Sharon Kaasalainen
- School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Tamara Sussman
- School of Social Work, McGill University, 845 Sherbrooke Street West, Montreal, QC, H3A 0G4, Canada
| | - Lynn McCleary
- Department of Nursing, Brock University, 1812 Sir Isaac Brock Way, St. Catharines, ON, L2S 3A1, Canada
| | - Genevieve Thompson
- College of Nursing, Max Rady Faculty of Health Sciences, University of Manitoba, Helen Glass Centre for Nursing, 89 Curry Place, Winnipeg, MB, R3T 2N2, Canada
| | | | - Shane Sinclair
- Faculty of Nursing, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada. .,Division of Palliative Medicine, Department of Oncology, Cumming School of Medicine, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada. .,Compassion Research Lab, Faculty of Nursing, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N1N4, Canada.
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Barriers to Staff Involvement in End-of-Life Decision-Making for Long-Term Care Residents with Dementia. Can J Aging 2019; 38:255-267. [PMID: 30739636 DOI: 10.1017/s0714980818000636] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
ABSTRACTAlthough providing direct care to residents with dementia, long-term care (LTC) home staff of registered nurses', registered practical nurses', and personal support workers' involvement in end-of-life decision-making is rarely acknowledged. The purpose of this study was to examine barriers and facilitators to LTC home staff involvement in end-of-life decision-making for people with advanced dementia. We report on the barriers to staff involvement in decision-making. Using an interpretive descriptive design, four major barriers to staff involvement in decision-making were identified: (a) the predominance of a biomedical model of care; (b) a varied understanding of a palliative approach; (c) challenging relationships with families; and (d) a discomfort with discussing death. Findings suggest that the predominant biomedical model in LTC homes, while important, must be imbued with a philosophy that emphasizes relationships among residents with dementia, family and staff.
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Abstract
AbstractThe average expected lifespan in Canadian long-term care (LTC) homes is now less than two years post-admission, making LTC a palliative care setting. As little is known about the readiness of LTC staff in Canada to embrace a palliative care mandate, the main objective of this study was to assess qualities relevant to palliative care, including personal emotional wellbeing, palliative care self-efficacy and person-centred practices (e.g. knowing the person, comfort care). A convenience sample of 228 professional and non-professional staff (e.g. nurses and nursing assistants) across four Canadian LTC homes participated in a survey. Burnout, secondary traumatic stress and poor job satisfaction were well below accepted thresholds, e.g. burnout: mean = 20.49 (standard deviation (SD) = 5.39) for professionals; mean = 22.09 (SD = 4.98) for non-professionals; cut score = 42. Furthermore, only 0–1 per cent of each group showed a score above cut-off for any of these variables. Reported self-efficacy was moderate, e.g. efficacy in delivery: mean = 18.63 (SD = 6.29) for professionals; mean = 15.33 (SD = 7.52) for non-professionals; maximum = 32. The same was true of self-reported person-centred care, e.g. knowing the person; mean = 22.05 (SD = 6.55) for professionals; mean = 22.91 (SD = 6.16) for non-professionals; maximum = 35. t-Tests showed that non-professional staff reported relatively higher levels of burnout, while professional staff reported greater job satisfaction and self-efficacy (p < 0.05). There was no difference in secondary traumatic stress or person-centred care (p > 0.05). Overall, these results suggest that the emotional wellbeing of the Canadian LTC workforce is unlikely to impede effective palliative care. However, palliative care self-efficacy and person-centred care can be further cultivated in this context.
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Sims-Gould J, Wiersma E, Arseneau L, Kelley ML, Kozak J, Habjan S, MacLean M. Care Provider Perspectives on End-Of-Life Care in Long-Term-Care Homes: Implications for Whole-Person and Palliative Care. J Palliat Care 2018. [DOI: 10.1177/082585971002600208] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study holistically explores the experience of dying and end-of-life care for older persons with dementia in long-term care (LTC) from the perspective of care providers. Using a focused ethnography methodology, seven researchers interviewed LTC staff, residents’ families, volunteers, management staff, and spiritual advisers/clergy over a five-day period. Research was guided by two key questions: What is the dying experience of people living in LTC from the perspective of different care providers? and, What are the salient issues in providing palliative care for elderly people dying in LTC? Based on a thematic analysis of verbatim data, three common themes were identified: tension between completing job tasks on time and “being there” for residents; the importance of familylike bonds between front-line staff and residents; and the importance of communication among staff and between staff and residents and their families at the end of life. Findings are discussed in relation to their implications for policies and practices that can support whole-person care and ultimately a good death for residents of LTC facilities.
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Affiliation(s)
- Joanie Sims-Gould
- J Sims-Gould (corresponding author): Department of Family Practice, Faculty of Medicine, Centre for Hip Health and Mobility, University of British Columbia, 315–2647 Willow Street, Vancouver, BC V5Z 1M9
| | - Elaine Wiersma
- E Wiersma: Master of Public Health Program, Lakehead University, Thunder Bay, Ontario, Canada
| | - Lise Arseneau
- L Arseneau: Department of Sociology, Lakehead University, Thunder Bay, Ontario
| | - Mary Lou Kelley
- ML Kelley: School of Social Work, Lakehead University, Thunder Bay, Ontario
| | - Jean Kozak
- J Kozak: School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sonja Habjan
- S Habjan: Centre for Education and Research on Aging and Health, Lakehead University, Thunder Bay, Ontario
| | - Michael MacLean
- M MacLean: Faculty of Social Work, University of Regina, Regina, Saskatchewan, Canada
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Durepos P, Sussman T, Ploeg J, Akhtar-Danesh N, Punia H, Kaasalainen S. What Does Death Preparedness Mean for Family Caregivers of Persons With Dementia? Am J Hosp Palliat Care 2018; 36:436-446. [DOI: 10.1177/1049909118814240] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Purpose: The purpose of this study was to clarify the concept of death preparedness for family caregivers in dementia. Conceptualization was required to support the assessment, promotion, and operationalization (ie, measurement) of death preparedness through palliative care interventions such as advance care planning. Methods: Rodgers evolutionary method of concept analysis was selected to guide this study because of the dynamic nature of death preparedness influenced by context, setting, and time. A comprehensive literature search was conducted. Authors performed constant comparative analysis to identify and interpret surrogate/related concepts, attributes, antecedents, and consequences of death preparedness. Results: Most importantly attributes included (1) knowing and recognizing the symptoms of decline in dementia and what dying looks like; (2) understanding emotions and grief responses; (3) accessing and appraising supports needed to manage and care for dying; (4) organizing affairs and completing tasks in advance; (5) accepting that losses are inevitable and imminent; (6) reflecting on caregiving and finding meaning, “a silver-lining”; and (7) closing, reconciling, and renewing relationship bonds and completing the family member’s life. Discussion: This study contributed a full definition of death preparedness in dementia. Findings aligned with/expanded upon Hebert et al Theoretical Framework of Preparedness for End-of-Life. The use of problem- and emotion-based coping strategies by caregivers with support from health-care providers to promote feelings of death preparedness (including self-efficacy and control) and minimize uncertainty was the implication of this study. Development of a holistic preparedness instrument is underway.
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Affiliation(s)
- Pamela Durepos
- Faculty of Health Sciences, School of Nursing, McMaster University, Hamilton, Ontario, Canada
- Hamilton Health Sciences Corporation, Hamilton, Ontario, Canada
| | - Tamara Sussman
- Department of Social Work, McGill University, Hamilton, Ontario, Canada
| | - Jenny Ploeg
- Faculty of Health Sciences, School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Noori Akhtar-Danesh
- Faculty of Health Sciences, School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Harveer Punia
- Faculty of Health Sciences, School of Nursing, McMaster University, Hamilton, Ontario, Canada
- Hamilton Health Sciences Corporation, Hamilton, Ontario, Canada
| | - Sharon Kaasalainen
- Faculty of Health Sciences, School of Nursing, McMaster University, Hamilton, Ontario, Canada
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Midtbust MH, Alnes RE, Gjengedal E, Lykkeslet E. A painful experience of limited understanding: healthcare professionals' experiences with palliative care of people with severe dementia in Norwegian nursing homes. BMC Palliat Care 2018; 17:25. [PMID: 29433497 PMCID: PMC5809908 DOI: 10.1186/s12904-018-0282-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 02/06/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND People dying with dementia have significant healthcare needs, and palliative care, with its focus on comfort and quality of life, should be made available to these patients. The aim of this study was to explore and increase knowledge of healthcare professionals' experiences with palliative care to people with severe dementia in nursing homes. METHODS To describe the phenomenon under investigation, we used a phenomenological research approach grounded in the philosophy of Husserl. Data were collected using in-depth interviews with 20 healthcare professionals from four Norwegian nursing homes. RESULTS The general meaning structure of the healthcare professionals' experiences with providing palliative care to people with severe dementia is painfulness, due to their limited understanding of patients' individual modes of expression. The painfulness is illustrated by the following themes: challenges related to "reading" the patients' suffering, coming up short despite occasional success, handing the patients over to strangers, and disagreeing on the patients' best interests. The healthcare professionals struggled to understand patients by "reading" their suffering. Occasionally, they succeeded and were able to calm the patients, but they often had the feeling of coming up short in situations related to pain relief and coping with behavioural symptoms, such as aggression and rejection of care. They also found it painful when the weakest patients were moved from the sheltered unit to a somatic long-term unit and were handed over to strangers who did not know the patients' ways of expression. Although the healthcare professionals emphasized the importance of good collaboration with the patients' relatives to ensure the best possible palliative care, they frequently found themselves in difficult situations when they disagreed with the family on the patients' best interests. CONCLUSIONS We found healthcare professionals' experiences of providing palliative care to people with severe dementia to be painful. To be able to understand the patients better, long-term familiarity and knowledge of how to "read" and observe patients with severe dementia are necessary. Openness in cooperation with the patients' relatives and with the professional team may increase healthcare professionals' understanding of the patients' situations and hence improve the quality of care.
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Affiliation(s)
- May Helen Midtbust
- Department for Health Sciences in Aalesund, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Serviceboks 17, 6025, Aalesund, NO, Norway.
| | - Rigmor Einang Alnes
- Department for Health Sciences in Aalesund, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Serviceboks 17, 6025, Aalesund, NO, Norway
| | - Eva Gjengedal
- University of Bergen, Global Public Health and Primary Care, Box 7804, 5020, Bergen, Norway.,Molde University College, Faculty of Health Sciences and Social Care, Box 2110, 6402, Molde, Norway
| | - Else Lykkeslet
- Molde University College, Faculty of Health Sciences and Social Care, Box 2110, 6402, Molde, Norway
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Kaasalainen S, Sussman T, Durepos P, McCleary L, Ploeg J, Thompson G, the SPA-LTC Team. What Are Staff Perceptions About Their Current Use of Emergency Departments for Long-Term Care Residents at End of Life? Clin Nurs Res 2017; 28:692-707. [PMID: 29271241 PMCID: PMC7328671 DOI: 10.1177/1054773817749125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The goal of this study was to examine current rates of resident deaths, Emergency Department (ED) use within the last year of life, and hospital deaths for long-term care (LTC) residents. Using a mixed-methods approach, we compared these rates across four LTC homes in Ontario, Canada, and explored potential explanations of variations across homes to stimulate staff reflections and improve performance based on a quality improvement approach. Chart audits revealed that 59% of residents across sites visited EDs during the last month of life and 26% of resident deaths occurred in hospital. Staff expressed surprise at the amount of hospital use during end of life (EOL). Reflections suggested that clinical expertise, comfort with EOL communication, clinical resources (i.e., equipment), and family availability for EOL decision making could all affect nondesirable hospital transfers at EOL. Staff appeared motivated to address these areas of practice following this reflective process.
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Affiliation(s)
- Sharon Kaasalainen
- McMaster University, Hamilton, Ontario, Canada
- Sharon Kaasalainen, Faculty of Health Sciences, 3N25F, McMaster University, 1280 Main Street West, Hamilton, Ontario, Canada L8N 3Z5.
| | | | | | | | - Jenny Ploeg
- McMaster University, Hamilton, Ontario, Canada
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18
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Abstract
This study aimed to (1) explore how palliative care in long-term care (LTC) addresses the tensions associated with caring for the living and dying within one care community, and (2) to inform how palliative care practices may be improved to better address the needs of all residents living and dying in LTC as well as those of the families and support staff. This article reports findings from 19 focus groups and 117 participants. Study findings reveal that LTC home staff, resident, and family perspectives of end-of-life comfort applied to those who were actively dying and to their families. Our findings further suggest that eliciting residents' perceptions of end-of-life comfort, sharing information about a fellow resident's death more personally, and ensuring that residents, families, and staff can constructively participate in providing comfort care to dying residents could extend the purview of end-of-life comfort and support expanded integration of palliative principles within LTC.
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19
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Kaasalainen S, Sussman T, Bui M, Akhtar-Danesh N, Laporte RD, McCleary L, Wickson Griffiths A, Brazil K, Parker D, Dal Bello-Haas V, Papaioannou A, O'Leary J. What are the differences among occupational groups related to their palliative care-specific educational needs and intensity of interprofessional collaboration in long-term care homes? BMC Palliat Care 2017; 16:33. [PMID: 28521799 PMCID: PMC5437548 DOI: 10.1186/s12904-017-0207-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 05/03/2017] [Indexed: 11/27/2022] Open
Abstract
Background The purpose of this study was to compare the differences across occupational groups related to their end-of-life care-specific educational needs and reported intensity of interprofessional collaboration in long-term care (LTC) homes. Methods A cross-sectional survey, based on two questionnaires, was administered at four LTC homes in Ontario, Canada using a modified Dilman’s approach. The first questionnaire, End of Life Professional Caregiver Survey, included three domains: patients and family-centered communication, cultural and ethical values, effective care delivery. The Intensity of Interprofessional Collaboration Scale included two subscales: care sharing activities, and interprofessional coordination. In total, 697 LTC staff were given surveys, including personal support workers, support staff (housekeeping, kitchen, recreation, laundry, dietician aids, office staff), and registered staff (licensed nurses, physiotherapists, social workers, pharmacists, physicians). Results A total of 317 participants completed the survey (126 personal support workers, 109 support staff, 82 registered staff) for a response rate of 45%. Significant differences emerged among occupational groups across all scales and subscales. Specifically, support staff rated their comfort of working with dying patients significantly lower than both nurses and PSWs. Support staff also reported significantly lower ratings of care sharing activities and interprofessional coordination compared to both registered staff and personal support workers. Conclusions These study findings suggest there are differing educational needs and sense of interprofessional collaboration among LTC staff, specific to discipline group. Both the personal support workers and support staff groups appeared to have higher needs for education; support staff also reported higher needs related to integration on the interdisciplinary team. Efforts to build capacity within support staff related to working with dying residents and their families are needed. Optimal palliative care may require resources to increase the availability of support for all staff involved in the care of patients.
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Affiliation(s)
- S Kaasalainen
- Faculty of Health Sciences, 3N25F, McMaster University, 1280 Main Street West, Hamilton, ON, L8N 3Z5, Canada. .,Queen's University Belfast, Belfast, UK.
| | - T Sussman
- McGill University, Montreal, QC, Canada
| | - M Bui
- Faculty of Health Sciences, 3N25F, McMaster University, 1280 Main Street West, Hamilton, ON, L8N 3Z5, Canada
| | - N Akhtar-Danesh
- Faculty of Health Sciences, 3N25F, McMaster University, 1280 Main Street West, Hamilton, ON, L8N 3Z5, Canada
| | | | - L McCleary
- Brock University, St. Catharines, ON, Canada
| | | | - K Brazil
- Queen's University Belfast, Belfast, UK
| | - D Parker
- Deborah Parker, University of Western Sydney, Sydney, Australia
| | - V Dal Bello-Haas
- Faculty of Health Sciences, 3N25F, McMaster University, 1280 Main Street West, Hamilton, ON, L8N 3Z5, Canada
| | - A Papaioannou
- Faculty of Health Sciences, 3N25F, McMaster University, 1280 Main Street West, Hamilton, ON, L8N 3Z5, Canada
| | - J O'Leary
- Faculty of Health Sciences, 3N25F, McMaster University, 1280 Main Street West, Hamilton, ON, L8N 3Z5, Canada
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20
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Schulz M. Taking the lead: Supporting staff in coping with grief and loss in dementia care. Healthc Manage Forum 2017; 30:16-19. [PMID: 27940999 DOI: 10.1177/0840470416658482] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Healthcare providers working with people living with dementia often experience a profound sense of grief when the person they support dies or moves to an alternative level of care. Unattended staff grief can impact healthcare leaders by reducing quality of care, increasing staff turnover and absenteeism, lowering morale, and creating a greater risk of long-term staff health problems. Organizational and self-care strategies can mitigate these challenges.
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Affiliation(s)
- Mary Schulz
- 1 Alzheimer Society of Canada, Toronto, Ontario, Canada
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21
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Cable-Williams B, Wilson DM. Dying and death within the culture of long-term care facilities in Canada. Int J Older People Nurs 2016; 12. [DOI: 10.1111/opn.12125] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 05/23/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Beryl Cable-Williams
- Trent/Fleming School of Nursing; Fleming College; Trent University; Peterborough ON Canada
| | - Donna M. Wilson
- Faculty of Nursing; University of Alberta; Edmonton AB Canada
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22
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Kaasalainen S, Stewart N, Middleton J, Knezacek S, Hartley T, Ife C, Robinson L. Development and evaluation of the Pain Assessment in the Communicatively Impaired (PACI) tool: part I. Int J Palliat Nurs 2016; 17:387-91. [PMID: 22067678 DOI: 10.12968/ijpn.2011.17.8.387] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Pain is a common symptom for long-term care residents, particularly those in need of palliative care. However, pain assessment in residents who have communication limitations is challenging. A study was conducted with the aim of developing a pain assessment tool that could feasibly be used by direct care providers in long-term care with minimal training yet demonstrating strong psychometric properties. The study used both qualitative and quantitative methods to develop and test the Pain Assessment in the Communicatively Impaired (PACI) tool. Part I of this paper reports on the development phase; a forthcoming second part will report on the testing phase. The overall results of this study support the psychometric properties and feasibility of the PACI tool, offering preliminary support for its use in clinical practice.
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23
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Bužgová R, Špatenková N, Fukasová-Hajnová E, Feltl D. Assessing needs of family members of inpatients with advanced cancer. Eur J Cancer Care (Engl) 2016; 25:592-9. [DOI: 10.1111/ecc.12441] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2015] [Indexed: 10/22/2022]
Affiliation(s)
- R. Bužgová
- Department of Nursing and Midwifery; Faculty of Medicine; University of Ostrava; Ostrava Czech Republic
| | - N. Špatenková
- Department of Nursing and Midwifery; Faculty of Medicine; University of Ostrava; Ostrava Czech Republic
| | - E. Fukasová-Hajnová
- Department of Nursing and Midwifery; Faculty of Medicine; University of Ostrava; Ostrava Czech Republic
- Clinic of Oncology; University Hospital Ostrava; Ostrava Czech Republic
| | - D. Feltl
- Department of Imaging Methods; University of Ostrava; Ostrava Czech Republic
- Clinic of Oncology; University Hospital Ostrava; Ostrava Czech Republic
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Abstract
Background: An important aim of palliative care is to ensure the highest possible quality of life (QoL) for the family members of patients. Aim: We aimed to determine the QoL of family members of hospitalized patients with end-stage disease, as well as differences in QoL based on socio-demographic characteristics and the patient's functional status, psychological distress, and QoL. Methods: Study participants were 292 family members of terminally ill patients at University Hospital, Ostrava, Czech Republic. To evaluate family members' QoL, we used the Quality of Life in Life-Threatening Illness — Family Carer Version (QOLLTI-F). We used the Hospital Anxiety and Depression Scale (HADS) and the Karnofsky Performance Status (KPS) Scale to assess patients' functional status and psychological distress. Results: A statistically significant difference was found in QoL evaluation based on family members' socio-demographic characteristics in education, employment, and age. A significantly lower QoL score was observed for patients' life partners in six domains. A correlation was found between patients' poorer functional status and family members' lower QoL. We found lower global QoL in family members of patients with depression. Conclusion: Family support is a cornerstone of palliative care. Palliative care professionals should focus on at-risk family members — the life partners of patients, the unemployed, younger people, and those whose ill loved one has a poor functional status.
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25
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Funk LM, Waskiewich S, Stajduhar KI. Meaning-Making and Managing Difficult Feelings: Providing Front-Line End-of-Life Care. OMEGA-JOURNAL OF DEATH AND DYING 2014; 68:23-43. [DOI: 10.2190/om.68.1.b] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Managing grief and difficult emotions related to end-of-life (EOL) care is an often under-recognized part of the work of resident care aides (RCAs). In this interpretive analysis we explore the shared and socially constructed ideas that 11 RCAs in 1 Canadian city employ to make sense of death and the provision of EOL care. RCAs spoke of personal challenges involved in witnessing death and experiencing loss, as well as helplessness and frustration when they could not provide quality EOL care. RCAs invoked “consoling refrains” to manage grief, including “such is life,” “they are better off,” and “they had a full life.” To manage guilt and moral distress, RCAs reminded themselves “I did my best” and “I experience rewards.” Though these ideas help RCAs, some may need to be reframed through coaching and mentorship, to prevent unintended negative effects on care or the reproduction of ageist beliefs more broadly.
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26
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Cable-Williams B, Wilson D. Awareness of impending death for residents of long-term care facilities. Int J Older People Nurs 2014; 9:169-79. [DOI: 10.1111/opn.12045] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Accepted: 08/30/2013] [Indexed: 11/30/2022]
Affiliation(s)
| | - Donna Wilson
- Faculty of Nursing; University of Alberta; Edmonton Alberta Canada
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27
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Social Workers’ and Nurses’ Illness Representations About Alzheimer Disease. Alzheimer Dis Assoc Disord 2014; 28:73-8. [DOI: 10.1097/wad.0000000000000001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kaasalainen S, Ploeg J, McAiney C, Schindel Martin L, Donald F, Martin-Misener R, Brazil K, Taniguchi A, Wickson-Griffiths A, Carter N, Sangster-Gormley E. Role of the nurse practitioner in providing palliative care in long-term care homes. Int J Palliat Nurs 2013; 19:477-85. [PMID: 24162278 DOI: 10.12968/ijpn.2013.19.10.477] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIM The purpose of this study, which was part of a large national case study of nurse practitioner (NP) integration in long-term care (LTC), was to explore the NP role in providing palliative care in LTC. METHODS Using a qualitative descriptive design, data was collected from five LTC homes across Canada using 35 focus groups and 25 individual interviews. In total, 143 individuals working in LTC participated, including 9 physicians, 20 licensed nurses, 15 personal support workers, 19 managers, 10 registered nurse team managers or leaders, 31 allied health care providers, 4 NPs, 14 residents, and 21 family members. The data was coded and analysed using thematic analysis. FINDINGS NPs provide palliative care for residents and their family members, collaborate with other health-care providers by providing consultation and education to optimise palliative care practices, work within the organisation to build capacity and help others learn about the NP role in palliative care to better integrate it within the team, and improve system outcomes such as accessibility of care and number of hospital visits. CONCLUSIONS NPs contribute to palliative care in LTC settings through multifaceted collaborative processes that ultimately promote the experience of a positive death for residents, their family members, and formal caregivers.
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Affiliation(s)
- Sharon Kaasalainen
- Associate Professor, School of Nursing, McMaster University, Ontario, Canada
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Arcand M, Brazil K, Nakanishi M, Nakashima T, Alix M, Desson JF, Morello R, Belzile L, Beaulieu M, MPM Hertogh C, T van der Steen J, Toscani F. Educating families about end-of-life care in advanced dementia: acceptability of a Canadian family booklet to nurses from Canada, France, and Japan. Int J Palliat Nurs 2013; 19:67-74. [DOI: 10.12968/ijpn.2013.19.2.67] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Marcel Arcand
- Research Center on Ageing, Sherbrooke (CDRV), and Department of Family Medicine, University of Sherbrooke, Canada
| | - Kevin Brazil
- School of Nursing and Midwifery, Queen’s University Belfast, Northern Ireland
| | | | - Taeko Nakashima
- Institute for Health Economics and Policy (IHEP) Tokyo, Japan
| | - Michel Alix
- Département de Gériatrie et de Gérontologie, Centre Hospitalier de La Rochelle, France
| | | | - Rémy Morello
- Unite de Biostatistique et Recherche Clinique, Centre Hospitalier Universitaire de Caen, France
| | | | | | | | - Jenny T van der Steen
- EMGO Institute for Health and Care Research, Department of General Practice & Elderly Care Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Franco Toscani
- Lino Maestroni-Palliative Medicine Research Institute, Cremona, Italy
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Abstract
RÉSUMÉNous avons examiné les caractéristiques contextuelles qui façonnent les soins de fin de vie (SFV) dans les établissements de soins pour bénéficiaires, en s’appuyant sur les perspectives de 11 aidants résidents (AR) dans un centre urbain canadien de l’Ouest. ARs décrivent les soins de fin de vie comme “offrant un confort,” y compris le bien-être physique et émotionnel. Les inquiétudes au sujet des défis posés par le temps et la charge de travail ont dominé les comptes et ont généré la culpabilité, la tristesse et de la frustration. ARs ont essayé de “trouver le temps” en le prenant d’eux-mêmes ou les autres résidents, et en s’appuyant sur l’engagement des collègues et sur les familles. Les résultats soulignent l’importance du rôle d’AR (en particulier en offrant un confort émotionnel), mais faire appel à l’attention à l’interprétation de ce qui est impliqué dans ce travail, et à la définition du portée de la pratique et de la formation. Les résultats également réitère l’importance, entre aidants résidents canadiens, des charges de travail adéquates pour faciliter les soins de fin de vie de qualité, et soulève des préoccupations au sujet des contraintes et comment elles forment la pratique de soins de fin de vie et les significations qui infusent une telle pratique.
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Kaasalainen S, Brazil K, Kelley ML. Building capacity in palliative care for personal support workers in long-term care through experiential learning. Int J Older People Nurs 2012; 9:151-8. [PMID: 23051621 DOI: 10.1111/opn.12008] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Accepted: 08/16/2012] [Indexed: 12/01/2022]
Abstract
BACKGROUND Providing palliative care in long-term care (LTC) homes is an area of growing importance. As a result, attention is being given to exploring effective palliative care learning strategies for personal support workers (PSWs) who provide the most hands-on care to LTC residents. AIM The purpose of this intervention was to explore hospice visits as an experiential learning strategy to increase the capacity of PSWs in palliative care, specifically related to their new learning, and how they anticipated this experience changed their practices in LTC. DESIGN This study utilised a qualitative descriptive design. METHODS Eleven PSWs from four Ontario LTC homes were sent to their local hospice to shadow staff for one to two days. After the visit, PSWs completed a questionnaire with open-ended questions based on critical reflection. Data were analysed using thematic content analysis. RESULTS PSWs commented on the extent of resident-focused care at the hospice and how palliative care interventions were tailored to meet the needs of residents. PSWs were surprised with the lack of routine at the hospice but felt that hospice staff prioritised their time effectively in order to meet family and client care needs. Some PSWs were pleased to see how well integrated the PSW role is on the community hospice team without any hierarchical relationships. Finally, PSWs felt that other LTC staff would benefit from palliative care education and becoming more comfortable with talking about death and dying with other staff, residents and family members. CONCLUSION This study highlighted the benefits of PSWs attending a hospice as an experiential learning strategy. Future work is needed to evaluate this strategy using more rigorous designs as a way to build capacity within PSWs to provide optimal palliative care for LTC residents and their family members. IMPLICATIONS FOR PRACTICE PSWs need to be recognised as important members within the interdisciplinary team. PSWs who shadow staff at hospices view this experience as a positive strategy to meet their learning needs related to palliative care.
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Brazil K, Kaasalainen S, McAiney C, Brink P, Kelly ML. Knowledge and perceived competence among nurses caring for the dying in long-term care homes. Int J Palliat Nurs 2012; 18:77-83. [DOI: 10.12968/ijpn.2012.18.2.77] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Kevin Brazil
- Department of Clinical Epidemiology and Biostatistics
| | | | - Carrie McAiney
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Mary Lou Kelly
- School of Social Work, Lakehead University, Thunder Bay, Ontario
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none. Bibliography – Nursing and Palliative care. PROGRESS IN PALLIATIVE CARE 2010. [DOI: 10.1179/096992610x12775428637105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Wang J, Chang LH, Eberly LE, Virnig BA, Kane RL. Cognition Moderates the Relationship Between Facility Characteristics, Personal Impairments, and Nursing Home Residents' Activities of Daily Living. J Am Geriatr Soc 2010; 58:2275-83. [DOI: 10.1111/j.1532-5415.2010.03173.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Approaching the end of life and dying with dementia in care homes: the accounts of family carers. ACTA ACUST UNITED AC 2010. [DOI: 10.1017/s0959259810000092] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
SummaryResearch into end of life and dying with dementia in care homes from the family carer's perspective is limited. From the available evidence, it appears that family carers find themselves in an unfamiliar situation about which they lack knowledge and experience. Whilst dementia tends not to be acknowledged as a terminal illness by many family carers, they are expected to make end of life decisions on behalf of their relatives. Family carer decision-making is underpinned by values of quality of life, previously expressed wishes, comfort provision and dignity preservation. This is often approached when family carers are grieving for the anticipated loss of their relative and have their own personal needs that require to be addressed. Within a care home setting, a curative care–palliative care split is unhelpful in resolving these tensions and a model of comprehensive care appears a more appropriate approach. This requires ongoing communication between the person with dementia, family members and professionals from the early stages of the condition.
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Pascual AM, Santamaría JL. [Grieving among relatives and caregivers]. Rev Esp Geriatr Gerontol 2009; 44 Suppl 2:48-54. [PMID: 19837483 DOI: 10.1016/j.regg.2009.05.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2009] [Accepted: 05/20/2009] [Indexed: 10/20/2022]
Abstract
This article provides a definition and description of grief, its characteristics, and the current explanatory models of this phenomenon (the stage model, task model, constructivist model and dual process model). The authors argue that a state of mourning in advance is produced in the process of dementia as a result of significant relational loss before death and describe the risk factors for complicated grief in caregivers: overload, lack of personal and material resources, delegation of care, and complex feelings such as guilt. The need for healthcare organizations to provide professional caregivers with the appropriate means to help with grief and to develop their own measures to prevent burnout is stressed. These measures could include protocols that provide bereavement intervention with the family, the primary caregiver, other patients and/or residents and the professional caregiving team. Finally, losses in persons with dementia must be taken into consideration, avoiding phenomena such as silencing and overprotection and encouraging acceptance and emotional support of their pain so that organic and emotional complications do not occur.
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Affiliation(s)
- Angel María Pascual
- Centro de Psicología Clínica y Psicoterapia ADES, Cruces-Barakaldo, Bizkaia, Spain.
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