Disruptions in Relational Continuity: The Impact of Pandemic Public Health Measures on Families in Long-Term Care

Using a Trauma-Informed Care Approach to Understand Family Caregivers' Experiences of Accessing Formal Supports in Dementia Care

Family caregivers provide essential care and support for individuals living with dementia, yet their contributions and needs are often unrecognized within formal health care systems. Over time, this marginalization can contribute to long-term trauma. Guided by a trauma-informed care (TIC) framework, we explored the experiences of 15 family caregivers in a longitudinal, qualitative study. Set in British Columbia, Canada, data were collected through semi-structured interviews and reflective diaries. Data were analyzed using inductive-deductive thematic analysis. Deductive analyses demonstrated that participants' experiences aligned with existing TIC principles. Inductive analysis identified "Uncertainty" as a novel principle, reflecting the ongoing challenges caregivers face from diagnosis to the inadequacy of in-home supports. Our study highlights the importance of recognizing trauma induced by interactions with formal health care services and the value of using a TIC approach with family caregivers of people living with dementia.

Caregivers' Experiences of Nursing Home Restrictions During the COVID-19 Pandemic

BACKGROUND

Pandemic-related restrictions in nursing homes have undermined the critical role that family and friend caregivers play in enhancing resident quality of life.

OBJECTIVE

We examined how family caregiver access restrictions in nursing homes were implemented and how they impacted the mutual well-being of and relationships between residents and their caregivers over time. Methods Between March 2021 and march 2022, 24 'designated caregivers' in Atlantic Canada were interviewed three times.

FINDINGS

We identified changes in family relationships and activities over time, constricted support networks, the increasing need for advocacy and monitoring, and the generally negative cumulative impacts of restrictions, especially during residents' end-of-life. Subsequent adaptations to access restrictions allowed caregivers to contribute to essential monitoring, care relationships, and advocacy roles.

DISCUSSION

We argue that the role of designated caregivers in nursing homes must be maintained during public health emergencies to ensure resident's supportive family relationships and general well-being.

Trauma-informed family carer education and practical skills training in dementia: a systematic scoping review protocol

INTRODUCTION

The incurable and progressive nature of dementia requires complex care, the majority of which is provided via informal caring by family members within the family home. Carers experience significant stress absorbing the challenging care needs of their family member and require education and training that can support and sustain family caring arrangements while considering the psychological distress that threatens caring breakdown. The aim of this scoping review was to map the evidence of trauma-informed principles within education and practical skills training in dementia family caring.

METHODS AND ANALYSIS

A two-step approach to the selection of literature will be used. In step 1, the review will consider research on active intervention education and practical skills training to support family home-based informal care for individuals with a formal diagnosis of dementia. The review will exclude passive education and self-accessed information/training provision. Only literature in the context of 'informal' day-to-day family caring provided by a family member or friend that takes place in the family home or residence will be included. Education and practical skills training provision within specialist care environments will be excluded. In step 2, during the full-text screen, only research where either explicit or implicit use of trauma-informed approaches has been used will be included.Preliminary searches of MEDLINE Ovid and Cumulative Index to Nursing and Allied Health Literature (CINAHL) were carried out between March and May 2023 to identify literature in this area. In line with the Johanna Briggs Institute scoping review guidance, we will conduct a search of published literature within MEDLINE Ovid, Embase Ovid, CINAHL EBSCO, Cochrane Data for Systematic Reviews and Cochrane Central Register for Controlled Trials in the Cochrane Library, PsycINFO Ovid and the British Library EThOS e-theses online. Publications in English with a date range of 1990 to current, with no restriction on geographical region will be considered. The search will be managed by Rayyan software and screened by multiple independent researchers. Results will be presented using narrative summaries and tables.We collaborated with an experienced Academic Support Librarian to develop the MEDLINE Ovid search strategy (Appendix 1), which will be adapted for searching other databases.

ETHICS AND DISSEMINATION

Ethical approval was not required for this review, as it involved the synthesis of publicly available secondary data. The findings will be disseminated through publication in peer-reviewed journals, as well as presentations at national and international conferences. Additionally, stakeholder events will engage carers, individuals with lived experience, and healthcare professionals.

"You're the only thing he comes out [of his room] for": A qualitative study of engagement between Laughter Care Specialists and families of people with dementia in long-term care

OBJECTIVES

Family involvement in the lives of people who have dementia and live in long-term care is important, but family members may face challenges communicating and connecting with their loved one as dementia progresses. A type of therapeutic humor (Laughter Care) delivered by trained specialists aims to engage people with dementia who reside in long-term care through creative play and laughter. This study aimed to explore the perceptions of Laughter Care Specialists (LCSs) regarding families' engagement with the program.

METHODS

Semi-structured interviews were conducted with LCSs (n = 8) and analyzed inductively using thematic analysis.

RESULTS

Family members were reported to initially have varied degrees of openness toward Laughter Care, but often become more accepting after observing positive engagement with the person with dementia. Family members were perceived to benefit from the program through witnessing the person with dementia enjoy joyous and light interactions, learn new ways of communicating and connecting with the person with dementia, and engage in positive interactions at end of life.

SIGNIFICANCE OF RESULTS

Laughter Care may provide family members with novel ways of communicating and connecting with people who have dementia at end of life as well as comfort into bereavement.

Filling In: Family Member Support for Nonrelative Residents in Long-Term Care Homes

BACKGROUND AND OBJECTIVES

Past research about family involvement in long-term care (LTC) homes mainly focuses on family members' involvement with their own relative, interactions with staff, and collective activities such as Family Councils. Our research provides novel insights into family member's involvement in the care of residents who are not their relatives, an area that has not previously been explored.

RESEARCH DESIGN AND METHODS

This critical ethnographic study examined ways that family members negotiate and navigate their roles within LTC homes. Data collection and analysis took place at 3 LTC homes in British Columbia, Canada, between 2014 and 2018. Data were collected through participant observation and semistructured interviews. Eleven family member participants shared experiences of caring for residents who were not their relatives.

RESULTS

The umbrella theme was "filling in," which takes place in a care environment that is understaffed and underresourced. The subthemes reflect the various ways that families are "filling in": responding to resident's needs, supporting staff to respond to resident needs, and filling in for residents' families.

DISCUSSION AND IMPLICATIONS

Caring for residents who are not their relatives is facet of family involvement in LTC homes that has not been previously explored. Many family members have expertise in providing person-centered care and they extend this expertise to residents who are not their relatives. Policies and legislation are needed to formalize family involvement in caring for nonrelative residents as it is a component of quality of care for all residents.

'Confidence and fulfillment': a qualitative descriptive study exploring the impact of palliative care training for long-term care physicians and nurses

Objective

To explore the impact of a 2-day, in-person interprofessional palliative care course for staff working in long-term care (LTC) homes.

Methods

A qualitative descriptive study design was employed. LTC staff who had participated in Pallium Canada's Learning Essential Approaches to Palliative Care LTC Course in Ontario, Canada between 2017 and 2019 were approached. Semi-structured interviews were conducted, using an online videoconferencing platform in mid-2021 in Ontario, Canada. These were done online, recorded, and transcribed. Data were coded inductively.

Results

Ten persons were interviewed: four registered practical nurses, three registered nurses, one nurse practitioner, and two physicians. Some held leadership roles. Participants described ongoing impact on themselves and their ability to provide end-of-life (EOL) care (micro-level), their services and institutions (meso-level), and their healthcare systems (macro-level). At a micro-level, participants described increased knowledge and confidence to support residents and families, and increased work fulfillment. At the meso-level, their teams gained increased collective knowledge and greater interprofessional collaboration to provide palliative care. At the macro level, some participants connected with other LTC homes and external stakeholders to improve palliative care across the sector. Training provided much-needed preparedness to respond to the impact of the COVID-19 pandemic, including undertaking advance care planning and EOL conversations. The pandemic caused staff burnout and shortages, creating challenges to applying course learnings.

Significance of results

The impact of palliative care training had ripple effects several years after completing the training, and equipped staff with key skills to provide care during the COVID-19 pandemic. Palliative care education of staff remains a critical element of an overall strategy to improve the integration of palliative care in LTC.

Family Involvement Training for Staff and Family Caregivers: Case Report on Program Design and Mixed Methods Evaluation

The COVID-19 pandemic underscored the imperative for meaningful family involvement in long-term care, aligning with policy and safety standards while enhancing outcomes for caregivers, residents, and staff. The objectives of this article are as follows: (1) a case study report on implementing a family involvement intervention designed to facilitate the formal and safe engagement of family caregivers in resident care and (2) the pilot evaluation of the intervention. We used Knapp's six-step implementation science model to guide and describe intervention development to provide insight for others planning family involvement projects. We employed sequential mixed methods, including surveys with quantitative and qualitative questions before and after program implementation for providers, and surveys and interviews with family caregivers a year after. We used the Mann-Whitney U test (p < 0.05) to assess differences in health providers' perceptions pre- and post-education. Families and staff perceived that the Family Involvement Program was important for improving the quality of care, residents' quality of life and family/staff relationships. Providers' perceptions of the program's positive impact on residents' quality of life (p = 0.020) and quality of care (p = 0.010), along with their satisfaction with working relationships with families (p = 0.039), improved significantly after the program. Qualitative data confirmed improvements in family-staff relationships. In conclusion, we documented the design of this family involvement initiative to encourage family caregivers and staff to work together in residents' care. Youville's Family Involvement Program gives families and family caregivers an explicit role as partners in long-term care. The mixed methods pilot evaluation documented improvements in staff and family relationships.

Providing palliative and end-of-life care in long-term care during the COVID-19 pandemic: a qualitative study of clinicians' lived experiences

BACKGROUND

A disproportionate number of COVID-19-related deaths in Canada occurred in long-term care homes, affecting residents, families and staff alike. This study explored the experiences of long-term care clinicians with respect to providing palliative and end-of-life care during the COVID-19 pandemic.

METHODS

We used a qualitative research approach. Long-term care physicians and nurse practitioners (NPs) in Ontario, Canada, participated in semistructured interviews between August and September of 2021. Interviews were undertaken virtually, and results were analyzed using thematic analysis.

RESULTS

Twelve clinicians (7 physicians and 5 NPs) were interviewed. We identified 5 themes, each with several subthemes: providing a palliative approach to care, increased work demands and changing roles, communication and collaboration, impact of isolation and visitation restrictions, and impact on the providers' personal lives. Clinicians described facing several concurrent challenges, including the uncertainty of COVID-19 illness, staffing and supply shortages, witnessing many deaths, and distress caused by isolation. These resulted in burnout and feelings of moral distress. Previous training and integration of the palliative care approach in the long-term care home, access to resources, increased communication and interprofessional collaboration, and strong leadership mitigated the impact and led to improved palliative care and a sense of pride while facing these challenges.

INTERPRETATION

The pandemic had a considerable impact on clinicians caring for residents in long-term care homes at the end of life. It is important to address these lived experiences and use the lessons learned to identify strategies to improve palliative care in long-term care homes and reduce the impact of future pandemics with respect to palliative care.