Long-term Care Home Staff Research Articles

Understanding COVID-19 vaccine education for long-term care workers: An environmental scan

Aim: We sought to understand educational interventions delivered to long-term care home staff in Ontario, Canada, about COVID-19 vaccines.
 Background: Vaccinating staff in long-term care homes is critical to protecting vulnerable residents from COVID-19. However, significant COVID-19 vaccine hesitancy has been observed amongst healthcare workers globally. While knowledge exists around why healthcare workers may express hesitancy towards vaccines, there remains an evidence gap on the most effective interventions for promoting COVID-19 vaccine uptake in this population.
 Methods: We conducted an environmental scan consisting of 15 structured interviews with nurse practitioners and management in long-term care homes about education implemented to address staff vaccine hesitancy. We also extracted data from 3 relevant articles identified through an ongoing scoping review.
 Findings: One-to-one informal conversations were the primary method of delivering education, often supplemented with formal presentations and written information. Facilitators were often peers, nurse practitioners, and directors of care. Equity, diversity, and inclusion (EDI) (e.g., providing education in multiple languages) were rarely embedded in formal delivery. The most common barrier to providing education was time constraints.
 Conclusions: A train-the-trainer approach may be helpful to empower educators to have more effective conversations about COVID-19 vaccines with their staff. EDI considerations are important for accessibility and trust.

Perspectives of substitute decision-makers and staff about person-centred physical activity in long-term care.

This paper aims to explore the care processes that best exemplify person-centred care during physical activity (PA) for long-term care (LTC) residents with dementia from the perspectives of substitute decision-makers (SDMs) and LTC home staff. Little is known about how person-centred care is reflected during PA for residents with dementia, or the barriers and benefits to enacting person-centred care during PA. Semistructured interviews were used to collect SDMs and LTC home staffs' perspectives on the importance of person-centred care during PA from two LTC homes in Canada. The McCormack and McCance person-centredness framework was used to guide thematic content analysis of responses. SDM (n = 26) and staff (n = 21) identified actions categorized under the sympathetic presence or engagement care processes from the person-centredness framework as most reflecting person-centred care. Benefits of person-centred care during PA were categorized into three themes: functional and physical, behavioural and communication and psychosocial improvements. Barriers to person-centred care during PA identified were lack of time, opportunities for meaningful activity in LTC setting and staff experiences with resident aggression. Understanding the care processes that are most recognized as person-centred care and valued by SDMs and LTC home staff has implications for education and training. Insights into SDMs' care expectations regarding person-centred care can inform staff about which actions should be prioritized to meet care expectations and can foster relationships to the benefit of residents with dementia. Study participants were not involved in the development of research questions, research design or outcome measures of this study.

Exploration of the acceptability and usability of advance care planning tools in long term care homes

ObjectivesDespite known benefits, advance care planning (ACP) is rarely a component of usual practice in long-term care (LTC). A series of tools and workbooks have been developed to support ACP uptake amongst the generable population. Yet, their potential for improving ACP uptake in LTC has yet to be examined. This study explored if available ACP tools are acceptable for use in LTC by (a) eliciting staff views on the content and format that would support ACP tool usability in LTC (b) examining if publicly available ACP tools include content identified as relevant by LTC home staff. Ultimately this study aimed to identify the potential for existing ACP tools to improve ACP engagement in LTC.MethodsA combination of focus group deliberations with LTC home staff (N = 32) and content analysis of publicly available ACP tools (N = 32) were used to meet the study aims.ResultsFocus group deliberations suggested that publicly available ACP tools may be acceptable for use in LTC if the tools include psychosocial elements and paper-based versions exist. Content analysis of available paper-based tools revealed that only a handful of ACP tools (32/611, 5%) include psychosocial content, with most encouraging psychosocially-oriented reflections (30/32, 84%), and far fewer providing direction around other elements of ACP such as communicating psychosocial preferences (14/32, 44%) or transforming preferences into a documented plan (7/32, 22%).ConclusionsACP tools that include psychosocial content may improve ACP uptake in LTC because they elicit future care issues considered pertinent and can be supported by a range of clinical and non-clinical staff. To increase usability and engagement ACP tools may require infusion of scenarios pertinent to frail older persons, and a better balance between psychosocial content that elicits reflections and psychosocial content that supports communication.

Structures, tensions, and processes shaping long-term care home staff's role in end of life decision-making for residents with dementia

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.

Social integration and loneliness among long-term care home residents: protocol for a scoping review

IntroductionSocial well-being is associated with better physical and mental health. It is also important for quality of life, including from the perspectives of those living in long-term care (LTC) homes....

Barriers to Staff Involvement in End-of-Life Decision-Making for Long-Term Care Residents with Dementia.

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.

Condition-Specific Pamphlets to Improve End-of-life Communication in Long-term Care: Staff Perceptions on Usability and Use

ObjectivesThis article reports findings on the usability and staff use of 5 condition- specific pamphlets of high prevalence in long-term care (LTC): dementia, heart failure, chronic obstructive pulmonary disease, renal failure, and frailty. The pamphlets were created in response to residents', families', and staff's recommendations for activating early reflections and communication about end-of-life care. DesignA mixed-method (qualitative and quantitative) survey design was used. Step 1 collected survey data on the usability of the pamphlets. Step 2 collected survey data on pamphlet use. Settings and ParticipantsTwo nurses with specialized palliative care training, 2 resident/family representatives, 10 condition-specific specialists, and 33 LTC palliative leads reviewed the pamphlets for usability prior to distribution. A total of 178 LTC home staff in 4 participating LTC homes reported on pamphlet use. MeasuresSpecialists and resident/family representatives were asked to provide open comments and LTC home palliative leads were asked to complete a survey on the accuracy, readability, and relevance of the pamphlets. After 6 months of distribution, all staff in participating LTC homes were asked to complete a survey on pamphlet use, usefulness, and comfort with distribution. ResultsThe pamphlets were reportedly accurate, relevant, and easy to understand. Following 6 months of availability, most staff in LTC had read the pamphlets, found the information useful, and planned to share them. However, half of the staff questioned their role in pamphlet distribution and most had not distributed them. Regulated staff (ie, staff affiliated with a regulated profession) expressed more comfort sharing the pamphlets than care aides and support staff. Conclusions/ImplicationsCondition-specific pamphlets appear to hold promise in providing residents and families with relevant information that may activate early reflections and conversations about end-of-life care. However, structured implementation strategies, training, and discussions are required to improve staff comfort with distribution and explore roles in distribution and follow-up.

Dying in Long-Term Care: Perspectives from Sexual and Gender Minority Older Adults about Their Fears and Hopes for End of Life

As lesbian, gay, bisexual, transgender, and queer (LGBTQ+) communities age, many individuals expect a need to enter the long-term care system toward the end of life. Not unlike most aging Canadians, this anticipation is met with concern and fear. However, previous research suggests that older LGBTQ + individuals have unique fears often related to personal safety and discrimination. This qualitative study examined the hopes and fears of older LGBTQ + adults considering long-term care as they face end of life. Data were collected from three focus groups in Ontario, Canada, and analyzed using inductive thematic analysis. Specific and frequent reference to fear of entering long-term care homes was common across all focus groups, as participants anticipated: social isolation, decreased independence and capacity for decision-making, increased vulnerability to LGBTQ+-related stigma as well as exposure to unsafe social and physical environments. The results from this study, therefore, emphasize the need for palliative care specialists and long-term care home staff to address the unique health needs of older LGBTQ + adults nearing the end of life in order to work toward allaying fears and creating supportive and inclusive long-term care environments.

Broadening End-of-Life Comfort to Improve Palliative Care Practices in Long Term Care.

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.

Developing and Implementing Peer-Led Intervention to Support Staff in Long-Term Care Homes Manage Grief

Front-line staff in long-term care (LTC) homes often form strong emotional bonds with residents. When residents die, staffs’ grief often goes unattended, and may result in disenfranchised grief. The aim of this article is to develop, implement, and assess the benefits of a peer-led debriefing intervention to help staff manage their grief and provide LTC homes an organizational approach to support them. This research was nested within a 5-year participatory action research to develop and implement palliative care programs within four LTC homes in Canada. Data specific to this debriefing intervention included questionnaires from six peer debriefers, field observations of six debriefings, and qualitative interviews with 23 staff participants. An original peer-led debriefing intervention (INNPUT) for LTC home staff was developed and implemented. Data revealed that the intervention offered staff an opportunity to express grief in a safe context with others, an opportunity for closure and acknowledgment. The INNPUT intervention benefits staff and offers an innovative, sustainable, easy to use strategy for LTC homes.

Comfort Care Rounds: a staff capacity-building initiative in long-term care homes.

This article reports a pilot evaluation of Comfort Care Rounds (CCRs)--a strategy for addressing long-term care home staff's palliative and end-of-life care educational and support needs. Using a qualitative descriptive design, semistructured individual and focus group interviews were conducted to understand staff members' perspectives and feedback on the implementation and application of CCRs. Study participants identified that effective advertising, interest, and assigning staff to attend CCRs facilitated their participation. The key barriers to their attendance included difficulty in balancing heavy workloads and scheduling logistics. Interprofessional team member representation was sought but was not consistent. Study participants recognized the benefits of attending; however, they provided feedback on how the scheduling, content, and focus could be improved. Overall, study participants found CCRs to be beneficial to their palliative and end-of-life care knowledge, practice, and confidence. However, they identified barriers and recommendations, which warrant ongoing evaluation.