Direct Care Providers Research Articles

Hospice Administrators' and Providers' Perspectives on Providing Upstream Palliative Care: Facilitators, Barriers, and Policy Prescriptions.

Background: Among patients with serious illness, palliative care before hospice enrollment is associated with improved quality of life, reduced symptom burden, and earlier transitions to hospice. However, fewer than half of eligible patients receive specialty palliative care referrals. As most hospice clinicians and administrators have experience in specialty palliative care, several emerging programs propose engaging hospice clinicians to provide early palliative care. Objective: We sought to identify barriers and facilitators to upstream palliative care. Design: We conducted a key informant qualitative study among hospice administrators and clinicians. Setting/Subjects: We conducted semi-structured interviews with 23 hospice administrators and clinicians in eight states from March to August 2022. We identified participants using snowball and purposive sampling using states that participate in Medicare Advantage's value-based insurance design Model. Results: Respondents indicated that barriers to early palliative care included inadequate staffing and reimbursement. Hospice clinicians providing community-based palliative care can address access barriers and improve transitions to hospice. Respondents expressed desire for payer guidance in identifying eligible patients but were cautious about payers acting as direct palliative care providers. However, payers could facilitate uptake by broadening and specifying coverage of services to include goals of care conversations and symptom management. Routine referrals initiated by objective measures could potentially increase access. Conclusions: Utilizing hospice providers to provide upstream palliative care can increase access, improve outcomes, and ease the transition to hospice.

Moderating role of relationships between workloads, job burnout, turnover intention, and healthcare quality among nurses

BackgroundIn Jordan, nurses consider a primary providers of direct patient care, and play a multifaceted role in ensuring healthcare quality. The study aimed to examines the moderating effect of job satisfaction in the relationship between workload and healthcare quality, job burnout and healthcare quality, and turnover intention and healthcare quality.MethodsA cross-sectional research approach was adopted among 311 from Registered Nurses (RN) across Jordanian hospitals. Job satisfaction, workload scale and job burnout scale were shared between March and April 2023.ResultsThe overall findings indicate that workload, job burnout, and turnover intention are negatively and significantly related to healthcare quality, and that job satisfaction moderates the relationship between workload and healthcare quality, job burnout and healthcare quality, and turnover intention and healthcare quality. These findings have broad implications for healthcare organizations, emphasizing the pivotal role of job satisfaction in mitigating the negative effects of workload, burnout, and turnover intentions among nurses.ConsulsionStrategies to enhance job satisfaction, such as reducing work-related stress and fostering supportive work environments, should be prioritized by healthcare policymakers and institutions to ensure the delivery of high-quality patient care.

From stigma to increased social acceptance? Living with Machado-Joseph disease in São Miguel, Azores, Portugal.

This study describes the experiences with the stigma attached to Machado-Joseph disease (MJD) in São Miguel Island, the Azores (Portugal). We draw on semi-structured interviews with persons with MJD, family members, healthcare professionals, and direct care providers recruited through the local patient's association (n = 28). Qualitative thematic analysis revealed three main themes: (i) the intense stigma associated with MJD in the past; (ii) the current tendency towards increased openness; and (iii) increased availability of information about MJD and support. The findings suggest that stigmatization was more frequent and intense in the past. Still, there is currently a decrease in the intensity of perceived stigma, accompanied by an increasing awareness about MJD within the community. The local patient's association is noted for playing a pivotal role in raising awareness about MJD in the community and fostering the confidence of individuals with MJD and their families to engage socially, which may help to reduce or mitigate feelings of stigma. This raises questions about whether the diminished stigma towards MJD in São Miguel results from heightened awareness about the condition, a decrease in the social acceptability of stigma, or a gradual internalization and normalization of stigma among individuals with MJD as a coping mechanism.

Perceived Competencies and Training Needs of Public Health Nurses in the Philippines: Basis for the Development of NurseLEAD: A Leadership Course on Advanced Practice Nursing in Public Health.

Public health nurses (PHNs) perform more than the provision of direct care to clients. They are also expected to perform roles as leaders, managers, and collaborators in different settings, especially in areas where there are no physicians. Their continuous professional development must be facilitated to empower them to lead the delivery of health programs and services in pursuit of universal healthcare. This study aims to determine the perceived competencies of public health nurses and describe their training needs. A descriptive, cross-sectional study was utilized, where an online survey was administered to PHNs across the Philippines to determine their self-perceived competencies and training needs based on the eight domains of core competencies of public health professionals. Descriptive statistics was used to summarize the data. A total of 330 PHNs answered the survey. The results showed that at baseline, PHNs perceived themselves to be competent (from most to least) in the following: communication, analytical/assessment, community dimensions of practice, policy development/ program planning, leadership and systems thinking, cultural competency skills, public health science, and financial planning and management. In terms of training needs, the enablers mentioned include a supportive work environment that can provide a work schedule that is inclusive of time for professional development and work-life balance; a learning environment where colleagues and supervisors support the need for training and innovation; strong internet connection; and enough equipment to participate and submit deliverables for courses taken. Filipino public health nurses perceived themselves to be competent in the areas of communication and community practice, but less competent in public health science, and financial planning and management. Future capacity-building programs must be designed to meet this demand. Furthermore, to make training programs truly responsive to the needs of nurses, steps must be taken to promote capacity-building enablers.

Establishing Best Practices in Telehealth Care for Adults with Developmental Disabilities in the United States: An e-Delphi Study.

Background: Telehealth care is now a key element of mainstream health care since the COVID-19 pandemic, with all types of health care providers joining the digital revolution. As a population experiencing health care disparities, adults with developmental disabilities and their supporters have described variable experiences with telehealth care that contribute to overall care quality and health outcomes. Methods: This e-Delphi study established consensus on best practices in telehealth care for adults with developmental disabilities in the United States. Online surveys and videoconferencing interviews were conducted with 44 expert panelists with experience with telehealth care and developmental disabilities, including adults with developmental disabilities, family members, direct support professionals, nurses, and health care providers. Results: Three rounds of surveys resulted in a set of 9 guidelines consisting of 42 items. The guidelines addressed 1) appropriate situations for telehealth care, 2) communication needs and preferences, 3) support person collaboration, 4) education and anticipatory guidance, 5) reminders, 6) coordination of care, 7) equitable and fair access, 8) privacy and safety, and 9) evidence-based practice. Conclusion: Health care providers can adopt these best practice guidelines to ensure telehealth care is provided equitably and safely to adults with developmental disabilities. Policy advocacy is needed for the uptake of these guidelines and for health care providers and adults with developmental disabilities to access the resources needed for safe and effective telehealth care use.

Experiences of dental behaviour support techniques: A qualitative systematic review.

Little is known about patients' or carers' reported experiences of dental care provided using dental behaviour support (DBS) techniques. Qualitative literature can provide unique insight into these experiences. To explore and synthesize qualitative literature related to patient experience of dental behaviour support. A PROSPERO-registered systematic review of qualitative articles was undertaken. Studies were identified through MEDLINE, Embase and PsycINFO. Abstracts were screened by two reviewers and data were extracted to summarize the qualitative findings included within them. A thematic summary approach was used to synthesize the qualitative data identified. Twenty-three studies were included. Studies primarily explored experiences of dental care of children by speaking to their parents (n = 16), particularly regarding paediatric dental general anaesthesia (DGA) (n = 8). Studies of adults' experiences of DBS (n = 7) covered a range of techniques. Nine studies explored broader dental care experiences and did not study specific DBS approaches. A thematic synthesis identified five themes applicable across the studies identified: Trust and the therapeutic alliance supporting effective care delivery; considered information sharing often alleviated anticipatory anxiety; control and autonomy-reduced anxieties; variations in the perceived treatment successes and failures of DBS techniques; and DBS techniques produced longer positive and negative impacts on patients beyond direct care provision. Qualitative research has been under-utilized in research on DBS techniques. Care experiences of most DBS techniques outside of paediatric DGA are poorly understood. Building trust with patients and enabling autonomy appear to support positive patient-reported experiences of care.

Perspectives on the state of cleft lip and cleft palate patient care in Africa.

Patients with cleft lip -palate (CLP) experience morbidity and social stigma, particularly in low-income and middle-income countries (LMICs) such as those of sub-Saharan Africa (SSA). Delays in treatment secondary either to lack of awareness, skills, equipment and consumables; poor health infrastructure, limited resources or a combination of them, has led to SSA having the highest rates of death and second highest rates of disability-adjusted life years in patients with CLP globally. Here we review current perspectives on the state of comprehensive cleft lip and palate repair in Africa. To bridge gaps in government health services, nongovernmental organizations (NGOs) have emerged to provide care through short-term surgical interventions (STSIs). These groups can effect change through direct provision of care, whereas others strengthen internal system. However, sustainability is lacking as there continue to be barriers to achieving comprehensive and longitudinal cleft care in SSA, including a lack of awareness of CLP as a treatable condition, prohibitive costs, poor follow-up, and insufficient surgical infrastructure. With dedicated local champions, a comprehensive approach, and reliable partners, establishing sustainable CLP services is possible in countries with limited resources. The replacement of CLP 'missions' with locally initiated, internationally supported capacity building initiatives, integrated into local healthcare systems will prove sustainable in the long-term.

Provider perceptions of systems-level barriers and facilitators to utilizing family-based treatment approaches in adolescent and young adult opioid use disorder treatment

BackgroundAmidst increasing opioid-related fatalities in adolescents and young adults (AYA), there is an urgent need to enhance the quality and availability of developmentally appropriate, evidence-based treatments for opioid use disorder (OUD) and improve youth engagement in treatment. Involving families in treatment planning and therapy augments medication-based OUD treatment for AYA by increasing treatment engagement and retention. Yet, uptake of family-involved treatment for OUD remains low. This study examined systems-level barriers and facilitators to integrating families in AYA OUD treatment in Rhode Island.MethodsAn online survey was administered to clinic leaders and direct care providers who work with AYA in programs that provide medication and psychosocial treatments for OUD. The survey assessed attitudes towards and experiences with family-based treatment, barriers and facilitators to family-based treatment utilization, as well as other available treatment services for AYA and family members. Findings were summarized using descriptive statistics.ResultsA total of 104 respondents from 14 distinct treatment programs completed the survey. Most identified as White (72.5%), female (72.7%), and between 25 and 44 years of age (59.4%). Over half (54.1%) of respondents reported no experience with family based treatment and limited current opportunities to involve families. Barriers perceived as most impactful to adopting family-based treatment were related to limited available resources (i.e. for staff training, program expansion) and lack of prioritization of family-based treatment in staff productivity requirements. Barriers perceived as least impactful were respondent beliefs and attitudes about family-based treatment (e.g., perception of the evidence strength and quality of family-based treatment, interest in implementing family-based treatment) as well as leadership support of family-based treatment approaches. Respondents identified several other gaps in availability of comprehensive treatment services, especially for adolescents (e.g. services that increase social recovery capital).ConclusionsFamily-based treatment opportunities for AYA with OUD in Rhode Island are limited. Affordable and accessible training programs are needed to increase provider familiarity and competency with family-based treatment. Implementation of programming to increase family involvement in treatment (i.e. psychoeducational and skills-based groups for family members) rather than adopting a family-based treatment model may be a more feasible step to better meet the needs of AYA with OUD.Trial registration: not applicable.

Tensions experienced by case managers working in home care for older adults in Quebec: first level analysis of an institutional ethnography

BackgroundCase managers play a vital role in integrating the necessary services to optimise health-related goals and outcomes. Studies suggest that in home care, case managers encounter tensions in their day-to-day work, that is, disjuncture between what they should do, in theory, and what they actually do, in practice. However, direct exploration of these tensions is lacking. As such, this study aimed to describe the tensions encountered by case managers in public home care for older adults in Quebec and their influence on day-to-day work.MethodsAn institutional ethnography was conducted through observations of work, interviews and a survey with case managers working in home care in Quebec. Data were analysed using institutional ethnography first-level analysis procedures. This included mapping the work sequences as well as identifying the tensions experienced by case managers through the words they used.ResultsThree main tensions were identified. First, case managers perceive that, despite working to return hospitalised older adults at home safely, their work also aims to help free up hospital beds. Thus, they often find themselves needing to respond quickly to hospital-related inquiries or expedite requests for home care services. Second, they are supposed to delegate the care to “partners” (e.g., private organisations). However, they feel that they are in effect managing the quality of the services provided by the “partners.” Consequently, they go to great lengths to ensure that good care will be provided. Finally, they must choose between meeting organisational requirements (e.g., reporting statistics about the work, documenting information in the older adults’ file, doing mandatory assessments) and spending time providing direct care. This often leads to prioritising direct care provision over administrative tasks, resulting in minimal reporting of essential information.ConclusionThe results are discussed using the three lenses of professional practice context analyses (i.e., accountability, ethics, and professional-as-worker) to formulate recommendations for practice and research. They suggest that, despite their important role, case managers have limited power in home care (e.g., with partners, with the hospital).

Cross-Cultural Validation of the Portuguese Version of the Quality of Oncology Nursing Care Scale.

Quality assessment in oncology nursing care has been a growing topic in the literature, gaining relevance as oncological nursing care becomes more complex as the science progresses. However, there are no instruments that assess the perception of the quality of oncology nursing care from the point of view of patients for the Portuguese population. Thus, the cross-cultural translation and validation of the Quality of Oncology Nursing Care Scale (QONCS) was performed for the Portuguese context. This instrument allows nurses to assess patients' self-perception of the quality of nursing care provided in an oncological setting. It also allows researchers to compare the results obtained internationally with the application of this scale. This is a methodological study, with two distinct phases: the first corresponded to the translation and cultural adaptation of the scale to the Portuguese context, and the second consisted of the psychometric validation of the QONCS, which included factor analysis and the evaluation of the psychometric properties of the instrument. We obtained responses from 402 patients from a Portuguese oncology hospital. The Portuguese version of the Quality of Oncology Nursing Care Scale (QONCS_PT) consists of 34 items inserted into a tetra-factorial model, which explains a total variance of the instrument of 69.8%. A Cronbach's alpha of 0.93 was obtained for the complete instrument. QONCS_PT has a competent and reliable structure. The scale's validity was assured and can be used in the Portuguese population, as it is useful for direct care provision but also for researchers and managers.

Exploring experiential learning within interprofessional practice education initiatives for pre-licensure healthcare students: a scoping review

BackgroundInterprofessional collaborative team-based approaches to care in health service delivery has been identified as important to health care reform around the world. Many academic institutions have integrated interprofessional education (IPE) into curricula for pre-licensure students in healthcare disciplines, but few provide formal initiatives for interprofessional practice (IPP). It is recognized that experiential learning (EL) can play a significant role supporting IPP education initiatives; however, little is known of how EL is used within education for IPP in healthcare settings.MethodsWe conducted a scoping review to map peer-reviewed literature describing IPP education initiatives involving EL for pre-licensure students in healthcare disciplines. A literature search was executed in MEDLINE, CINAHL, EMBASE, ERIC, PsycINFO, Scopus, and Social Services s. After deduplication, two independent reviewers screened titles and abstracts of 5664 records and then 252 full-text articles that yielded 100 articles for data extraction. Data was extracted using an Excel template, and results synthesized for presentation in narrative and tabular formats.ResultsThe 100 included articles represented 12 countries and IPP education initiatives were described in three main typologies of literature – primary research, program descriptions, and program evaluations. Forty-three articles used a theory, framework, or model for design of their initiatives with only eight specific to EL. A variety of teaching and learning strategies were employed, such as small interprofessional groups of students, team huddles, direct provision of care, and reflective activities, but few initiatives utilized a full EL cycle. A range of perspectives and outcomes were evaluated such as student learning outcomes, including competencies associated with IPP, impacts and perceptions of the IPP initiatives, and others such as client satisfaction.ConclusionFew educational frameworks specific to EL have been used to inform EL teaching and learning strategies to consolidate IPE learning and prepare students for IPP in healthcare settings. Further development and evaluation of existing EL frameworks and models would be beneficial in supporting robust IPP educational initiatives for students in healthcare disciplines. Intentional, thoughtful, and comprehensive use of EL informed by theory can contribute important advances in IPP educational approaches and the preparation of a future health care workforce.

Utilizing Experience Bundles: A Novel Approach to Improving Quality of Care in Long-Term Care.

People-centred care is foundational to healthcare excellence. One urban Canadian long-term care residence recently participated in an initiative titled "Improving the Care Conference Experience" to engage residents and families in annual care conferences. The Institute for Healthcare Improvement introduced "care bundles" to group evidence-based practices within standard processes. For this initiative, one health region's Experience in Care team co-developed, implemented and evaluated an "experience bundle" for inclusive care conferences with key stakeholders including residents, family members, direct care providers and leadership. Our ongoing goal is to collaboratively create a culture shift from "doing to/for" to "doing with."

An app to support oral hygiene care: Increasing attitudes, knowledge, and confidence in identifying oral health problems among caregivers of persons living with dementia.

To develop and pilot test an App to help family and paid caregivers perform high quality oral hygiene care. A prototype of the App was refined based on stakeholder feedback (e.g., dental care professionals, direct care providers, nursing home administrator, family caregivers). The refined App was pilot tested with 16 family caregivers and 15 paid care providers of persons living with dementia (PLWD). Participants completed a pre-test, watched an App demonstration, used it for 2 weeks, and completed a post-test. Surveys included both structured and open-ended questions. Phase 1 data informed the refinement of the App that led to high acceptability and usability by the Phase 2 participants. Both family and paid caregivers reported a significant increase in attitudes toward providing oral hygiene care to frail older adults (p=.05 and p=.02 for family and paid providers, respectively), knowledge about oral health and care (p=.01 and p=.02), and ability to identify oral health problems (p=.005 and p=.01). Additionally, paid caregivers reported increase in perceived support available in providing oral hygiene care (p<.001). Stakeholder engaged approach helped increase the acceptability and usability of the App that successfully increase caregivers' attitude, knowledge, and abilities in oral hygiene care provision.

Home Care Practices that Improve Performance of Activities of Daily Living of Patients Post-stroke:A Systematic Review.

Evidence is inconsistent on the effectiveness of home rehabilitation for patients post-stroke. This review aims to explore home care practices that improve the performance of activities of daily living of patients post-stroke. Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA), clinical trials and mixed-methods studies published from 2012 to 2022 were gathered from PubMed, ScienceDirect, EBSCO, and ProQuest in December 2022. The Mixed Method Appraisal Tool (MMAT) was used for quality appraisal. Narrative synthesis approach was utilized to present the findings. A total of 758 articles were screened, and 10 were included in the final analysis. Five out of ten programs were found superior compared with usual care. Factors that influence the effectiveness of the programs include the age of the participants, severity of disabilities, family participation, and presence of a multidisciplinary team. A multidisciplinary healthcare team approach toward the enhancement of knowledge, skills, and behaviors of patients and their families is common in effective home care. The role of nurses is emphasized not only as providers of direct patient care but also as coordinators of the healthcare team and patients and their families. This study provides insights for policymakers in developing healthcare system for post-stroke care. J. Med. Invest. 71 : 197-204, August, 2024.

Midwifery education in Ghana: Time for further advancement

Maternal mortality continues to remain high in Ghana. Similarly, gynaecological cancers contribute immensely to the leading causes of deaths among Ghanaian women of reproductive age. Midwives play an important role in the provision of direct care to these categories of patients. Nonetheless, the training of midwives, a critical workforce in Ghana over the past years, does not seem to commensurate with the roles they are required to perform, especially, at the referral hospitals. The purpose of this article is to discuss the discrepancy between competencies acquired by midwives through their education and the roles they are expected to perform at referral hospitals, and to make a recommendation for policy change. It is strongly recommended that a new cadre of midwives (nurse-midwives) with an undergraduate (bachelor’s degree) training in general nursing plus post-qualification clinical experience in medical-surgical care plus post graduate education in midwifery be trained to provide the level of advanced care required in the referral facilities.

Integrating health and social care in the community to support a new model of Long-term Life Care at home.

Background: Long-term care (LTC) reform was an international priority well before the COVID-19 pandemic. While strategies to promote de-institutionalization, rehabilitation, caregiver support and enhanced home and community care have varied by country in terms of implementation and success, the pandemic universally reinforced existing system-specific barriers and weaknesses. In Canada, heightened access issues and silo-ed delivery of community-based medical, functional and social care and support services contributed to increased caregiver burnout and growing residential care waitlists.&#x0D; Aims: This study aimed to develop an alternative model to residential LTC that would enable older adults to live, age and receive care at home long-term. The specific objectives were to: 1) describe variation in medical, functional and psychosocial ‘life care’ needs of community-dwelling older adults; 2) develop a model of needs-based care with packages to support variation in needs; and 3) to assess preliminary feasibility of the model using the Ontario, Canada (population 15 million) health care market. &#x0D; Approach: An exploratory, sequential, mixed methods design was applied (5). Phase 1 involved historical analysis of 2017-18 Ontario interRAI home care assessments (n=283,601) and 2018-19 Ontario service utilization data (n=115,000) to develop unique patient vignettes. Phase 2 was a 6-week modified eDelphi process with interdisciplinary home care clinicians (n=42) to develop care packages for the model, including types and dose of care and services. Six focus groups (n=67) were then conducted with older adults, caregivers and health and social care providers across Ontario to validate and refine the model. Phase 3 explored feasibility of the emerging model through comparison of the home care patient vignettes with the needs of the residential LTC population using 2017-18 Ontario interRAI data (n=115,000). Preliminary costing of the model was based on existing system per diems and direct care costs in comparable transitional care models.&#x0D; Results: A model of ‘Long-term Life Care’ at home (LTLifeC model) includes care packages to meet the dominant life care needs of 6 unique patient groups representing known predictors of LTC home admission: social frailty, caregiver distress, chronic disease, cognition/ behaviours, medical complexity, and geriatric syndromes. Overlap in care needs of home care and LTC populations confirms potential to shift care to the community; yet current home care clients receive six times less daily care hours on average, compared to residential LTC standards. New LTLifeC packages of home-based interdisciplinary care ranged from 3.1-8.9 hours daily, including comprehensive assessment, integrated care planning, direct care provision and community referral(s). Initial cost comparisons suggest plausible short and long-term system benefits of model adoption.&#x0D; Learnings: Evidence-informed decision making for sustainable home and community care as part of an integrated system of LTC requires attention to both routinely collected health information, or ‘big data’, and expertise by lived-experience. Adoption of the LTLifeC model will require decision-making to prioritize societal values for living and aging at home and in community. &#x0D; Next Steps: An evaluation framework will be developed to guide pilot implementation and testing of the LTLifeC model through the lens of the quadruple aim.

Assessment of Depression, Anxiety, and Stress among Health Care Professionals due to Covid - 19

Abstract: Background: The emergence of an undisclosed pneumonia outbreak in Wuhan, China, in December 2019 led to the global spread of Corona virus Disease (COVID-19), declared a pandemic by the WHO on March 12, 2020. Healthcare workers (HCPs) faced unprecedented challenges, with studies revealing elevated stress, depression, and anxiety. Despite differing roles, direct health care providers reported higher psychological distress. The absence of a definitive treatment compounded fears, resulting in anxiety, depression, and stress among patients, Healthcare professionals and normal subject. Objective: To identify the level of anxiety, depression, and stress among health care professionals due to the wave of Covid- 19. Materials and Methods: Analytical cross-sectional survey was done among health care workers who were working in a tertiary care hospitals, Sohail Trust Hospital Korangi Industrial Area, Karachi, and Medicare Cardiac and Dental Hospital, Tariq Road, Karachi from January 2022 to April 2022 in the third wave of Covid-19. The Depression, Anxiety, and Stress Scale-21 Items (DASS-21) self reporting scale based questionnaire was used to examine mental health. During data analysis, descriptive and inferential statistics were calculated in SPSS. Result: Out of 416 participants, 56% were females and 56.2% were single. The mean age of the respondents was 29.36 years (± 5.5). The symptoms of anxiety were reported by 47%, depression by 35% and stress was reported by 21% of participants. The level of anxiety, depression, and stress was higher in male technicians, frontline workers, HCP with chronic illnesses, and those who got covid-19 infection. Based on the results, it was identified that male had higher odds of developing anxiety while female, HCPs belonging to age groups of above 25 years and those with work experience lesser than 5 years showed to have greater odds of having stress. Conclusion: COVID-19 has caused Anxiety, Depression, and Stress among Pakistani healthcare workers. Early intervention with focused strategies and psychological therapies could help to prevent more serious problems.

OPPORTUNITIES AND BARRIERS IN INTEGRATING PALLIATIVE CARE SERVICES INTO PERMANENT SUPPORTIVE HOUSING

Abstract Despite well-known inequities in rates of serious illness and premature mortality among people experiencing homelessness, as well as the unique biopsychosocial and spiritual care needs of people with homelessness histories, there is a lack of translational research focused on palliative care service delivery within permanent supportive housing. This presentation will present data from the Research, Action, &amp; Supportive Care at Later-life for Unhoused People (RASCAL-UP study) to describe the current practices, perceived barriers, and recommendations in providing support to older permanent supportive housing residents during serious illness and end-of-life. Through a thematic analysis of interviews with direct care providers (n=30) across multiple care settings, themes were identified: 1) the importance of on-site relationships; 2) cross-sector collaboration barriers; 3) interdisciplinary communication barriers within permanent supportive housing teams; 4) environmental and spatial considerations; and 5) missing levels of care between supportive housing and higher levels of medical care. From these results, we put forth recommendations for translational research, supportive housing policy, and capacity-building efforts for interdisciplinary and cross-sector healthcare and housing teams.

SECONDARY ROLE STRAIN AND GRIEF OF DEMENTIA FAMILY CAREGIVING AS PREDICTORS OF BURDEN

Abstract Services often aim to improve caregiver experiences for dementia family caregivers by addressing challenges in daily care activities and enhancing care quality for care-recipients. Supporting caregivers should not exclusively focus on supporting activities related to direct care provision (e.g., primary stressors), but should also include services that holistically support the caregiver’s well-being. Identifying an individual’s unique needs beyond their caregiving role is crucial; the growing phenomenon of caregiver burnout, burden, and psychosocial struggle includes experiencing a loss of identity, increased desire to escape, and intense role captivity. While some services are more individualized, such as one-on-one therapy, there is an overall gap in caregiver support in secondary domains. The current study examined whether primary stressors (e.g., activities of daily living and everyday care tasks) or secondary stressors (e.g., strain on other relationships and responsibilities) were more predictive of burden in a sample of 46 participants who completed a mixed-method study examining the heterogenous experiences and unmet needs of dementia family caregivers. Analysis shows that interference of the care role with responsibilities to other family (i.e., secondary role strain) and feeling pre-loss grief over their loved one’s illness were significant predictors of greater burden compared to primary stressors. Results indicate the importance of addressing secondary stressors such as pre-loss grief and deterioration of one’s microenvironment (including social support, familial relationships, and identity) in intervention efforts to better enhance quality of life and well-being in dementia care.

Barriers to healthcare-worker adherence to infection prevention and control practices in British Columbia during the coronavirus disease 2019 (COVID-19) pandemic: A cross-sectional study.

The coronavirus disease 2019 (COVID-19) pandemic highlighted the importance of robust infection prevention and control (IPAC) practices to maintain patient and staff safety. However, healthcare workers (HCWs) face many barriers that affect their ability to follow these practices. We identified barriers affecting HCW adherence to IPAC practices during the pandemic in British Columbia, Canada. Cross-sectional web-based survey. Acute care, long-term care or assisted living, outpatient, mental health, prehospital care, and home care. Eligible respondents included direct-care providers and IPAC professionals working in these settings in all health authorities across British Columbia. We conducted a web-based survey from August to September 2021 to assess respondent knowledge and attitudes toward IPAC within the context of the COVID-19 pandemic. Respondents were asked to rate the extent to which various barriers affected their ability to follow IPAC practices throughout the pandemic and to make suggestions for improvement. The final analysis included 2,488 responses; 36% of respondents worked in acute care. Overall, perceptions of IPAC practice among non-IPAC professionals were positive. The main self-perceived barriers to adherence included inadequate staffing to cover absences (58%), limited space in staff rooms (57%), multibed rooms (51%), and confusing messages about IPAC practices (51%). Common suggestions for improvement included receiving more support from IPAC leadership and clearer communication about required IPAC practices. Our findings highlight frontline HCW perspectives regarding priority areas of improvement for IPAC practices. They will inform policy and guideline development to prevent transmission of COVID-19 and future emerging infections.