Connecting Through Conversation: A Novel Video-Feedback Intervention to Enhance Long-Term Care Aides' Person-Centred Dementia Communication.

Objective: To pilot test a novel communication intervention incorporating a video-feedback component on the person-centred dementia communication skills of long-term care aides.

Methods: Effectiveness was assessed using a single group pre-test/post-test design. 11 care aide-resident dyads participated in the study.

Expanding the conversation: A Person-centred Communication Enhancement Model.

The intricacy and impact of human communication has long captured the attention of philosophers, scholars and practitioners. Within the realm of care and service provision, efforts to maximize outcomes through optimal person-provider communication have drawn research and clinical focus to this area for several decades. With the dawning of the person-centred care movement within healthcare, and in particular long-term care home and dementia care settings, improvement in care providers' use of person-centred communication strategies and enhancement of relationships between residents, their families and care providers are desired outcomes.

More than just a task: intimate care delivery in the nursing home.

: Intimate care procedures, such as bathing and toileting, are often regarded as simple, humble tasks. However, the provision of such care transforms a very private, personal activity into a social process. U this complex process and the psychological impact it has on those providing and receiving care is critical in order to mitigate potential distress.

No Other Safe Care Option: Nursing Home Admission as a Last Resort Strategy.

Background And Objectives: Nursing homes are intended for older adults with the highest care needs. However, approximately 12% of all nursing home residents have similar care needs as older adults who live in the community and the reasons they are admitted to nursing homes is largely unstudied. The purpose of this study was to explore the reasons why lower-care nursing home residents are living in nursing homes.

Video feedback: A novel application to enhance person-centred dementia communication.

Aim: A discussion of the use of video feedback as an effective and feasible method to promote person-centred communication approaches within dementia care and long-term care.

Background: Effective strategies to integrate person-centred approaches into health care settings have attracted global attention and research in the past two decades. Video feedback has emerged as technique to enhance reflective learning and person-centred practice change in some care settings; however, it has not been tested in the context of person-centred dementia communication in long-term care.

Critical nursing and health care aide behaviors in care of the nursing home resident dying with dementia.

Background: With the aging of the population, dying with dementia will become one of the most common ways in which older adults will end their final years of life, particularly for those living in a nursing home. Though individuals living with dementia have complex care needs and would benefit from a palliative approach to care, they have traditionally not been recipients of such care. An important aspect of determining quality in end-of-life care is the identification of expert practices, processes or behaviors that may help achieve this care.

Ethical and moral considerations of (patient) centredness in nursing and healthcare: Navigating uncharted waters.

This discussion paper aims to explore potential ethical and moral implications of (patient) centredness in nursing and healthcare. Healthcare is experiencing a philosophical shift from a perspective where the health professional is positioned as the expert to one that re-centres care and service provision central to the needs and desires of the persons served. This centred approach to healthcare delivery has gained a moral authority as the right thing to do.

Meaningful connections in dementia end of life care in long term care homes.

Background: Most persons with dementia die in long term care (LTC) homes, where palliative approaches are appropriate. However, palliative approaches have not been widely implemented and there is limited understanding of staff and family experiences of dying and bereavement in this context.

Method: This descriptive qualitative study explored family and staff experiences of end of life and end of life care for persons with dementia in LTC homes.

Assessing Symptoms, Concerns, and Quality of Life in Noncancer Patients at End of Life: How Concordant Are Patients and Family Proxy Members?

Context: It has become commonplace to use family caregivers as proxy responders where patients are unable to provide information about their symptoms and concerns to health care providers.

Objectives: The objective of this study was to determine the degree of concordance between patients' and family members' reports of patient symptoms and concerns at end of life.

Methods: Sample dyads included a mix of patients residing at home, in a nursing home, in a long-term care facility, or in hospice.

Developing and testing a nursing home end -of -life care chart audit tool.

Background: Nursing home (NH) administrators need tools to measure the effectiveness of care delivered at the end of life so that they have objective data on which to evaluate current practices, and identify areas of resident care in need of improvement.

Methods: A three-phase mixed methods study was used to develop and test an empirically derived chart audit tool aimed at assessing the care delivered along the entire dying trajectory.

Results: The Auditing Care at the End of Life (ACE) instrument contains 27 questions captured across 6 domains, which are indicative of quality end-of-life care for nursing home residents.

Pain Trajectories of Nursing Home Residents Nearing Death.

Background/objectives: Although examining point in time prevalence of pain among nursing home (NH) residents has value, there is a lack of evidence describing the actual changes (ie, trajectories) in pain that take place during their last 6 months of life. The main objective of this study is to describe the major pain trajectories experienced by NH residents during their last 6 months of life.

Design: Secondary analysis of Resident Assessment Instrument-Minimum Data Set (MDS) 2.

Identifying Markers of Dignity-Conserving Care in Long-Term Care: A Modified Delphi Study.

Ensuring that people living in nursing homes (NHs) are afforded with dignity in their daily lives is an essential and humane concern. Promoting dignity-conserving care is fundamentally important. By nature, however, this care is all-encompassing and holistic, and from current knowledge it is challenging to create explicit strategies for measuring dignity-conserving care.

Impact of Symptoms and Care Practices on Nursing Home Residents at the End of Life: A Rating by Front-line Care Providers.

Objectives: Burdensome symptoms and potentially inappropriate care practices are common at the end of life for nursing home residents. Appropriately managing symptoms and limiting aggressive care practices is key to high-quality end-of-life care. Little research is available, however, on the opinions of nursing home care providers about the impact of symptoms and practices for both residents and care facilities.

Dying in a nursing home: treatable symptom burden and its link to modifiable features of work context.

Importance: High-quality care at the end of life supports freedom from pain and other potentially burdensome symptoms. Lowering symptom burden at the end of life is an urgent and achievable goal in delivering services in nursing home settings. Few published reports describe symptom burden among older adults in nursing homes; none examine links between symptom burden and modifiable features of nursing home organizational context (work environment).

Understanding the needs of family caregivers of older adults dying with dementia.

Objectives: A challenge in understanding the needs of dementia family caregivers (DFC) within the purview of dementia as a terminal illness rests on the fact that literature in this area is dispersed across disciplines and not specifically grounded within the realm of palliative care. The objective of this paper is to describe the domains of DFC needs and their impact on the delivery of palliative care services.

Methods: A literature search pertaining to dementia family caregivers and palliative/end-of-life care was conducted using the databases Medline, CINHAL, Ageline, PsychInfo, and Scopus for articles published in the English language between 1997 and 2011.

Understanding bereaved family members' dissatisfaction with end-of-life care in nursing homes.

With increasing numbers of older adults identifying a nursing home (NH) as their final place of care, it is important to assess the quality of dying in this setting and understand factors that impact family members' dissatisfaction with end-of-life care. A retrospective bereaved family member survey (N = 208) was conducted in 21 NHs located in urban areas of central Canada. Bereaved family members who were dissatisfied with care identified significantly more concerns in all domains assessed and were more likely to have problems with: (a) receiving confusing information from nursing staff about the resident's care, including medical treatments; (b) receiving inadequate information from nursing staff; and (c) feeling that end-of-life care was different than they had expected.

How respect and kindness are experienced at the end of life by nursing home residents.

Respect and kindness are core principles of nursing practice, yet little is known about how they are experienced by nursing home (NH) residents at the end of life. The aim of this study was to examine the factors associated with being treated with respect and kindness in the last month of life as an NH resident. A retrospective survey of 208 bereaved family members was conducted in 21 NHs located in a city in central Canada.

Reducing the potential for suffering in older adults with advanced cancer.

Objective: To deliver quality care at the end of life, understanding the impact of various changes and life transitions that occur in older age is essential. This review seeks to uncover potential sources of distress in an elder's physical, psychological, social, and spiritual well-being to shed light on the unique challenges and needs facing this age group.

Methods: Papers relating to older adults (aged 65 years and older or a mean age of 65 years and older) with advanced/terminal cancer receiving palliative, hospice, or end-of-life care published after 1998 were reviewed.

Prognostic acceptance and the well-being of patients receiving palliative care for cancer.

Purpose: To identify the impact of prognostic acceptance/nonacceptance on the physical, psychological, and existential well-being of patients with advanced cancer.

Patients And Methods: A Canadian multicenter prospective national survey was conducted of patients diagnosed with advanced cancer with an estimated survival duration of 6 months or less (n = 381) receiving palliative care services.

Results: Of the total number of participants, 74% reported accepting their situation and 8.

Family satisfaction with care of a dying loved one in nursing homes: what makes the difference?

As part of a larger study examining end-of-life care in nursing homes, qualitative focus groups were conducted with bereaved family members to explicate those factors contributing to satisfaction and dissatisfaction with end-of-life care in the nursing home setting. Content analysis of focus group data revealed two overarching themes that influenced family members' satisfaction with care. These included: (a) ability of staff to recognize signs of imminent dying, and (b) communication and information sharing about the resident's status and plan of care.

Dignity-based approaches in the care of terminally ill patients.

Purpose Of Review: Promoting dignified dying is an altruistic goal in palliative care. Until recently, what was meant by this construct was poorly understood. This review seeks to clarify what is meant by dignity at the end of life, what threatens dignity, and evidence of the domains that define dignity.

"Changing lanes": facilitating the transition from curative to palliative care.

Little empirical work has been conducted assessing the perspectives of nurses regarding the barriers, facilitators, and strategies associated with achieving quality patient care at the end of life. A grounded theory study was conducted examining nursing behaviours and social processes inherent in the provision of quality end-of-life care from the perspective of generalist nurses (n = 10) working in an acute care setting. An inductively derived preliminary model, "creating a haven for safe passage", was developed based on the findings from this study and has been published elsewhere (1).

Methodological challenges in measuring quality care at the end of life in the long-term care environment.

Understanding what constitutes quality end-of-life care from the perspective of the patient, their family, and health care professionals has been a priority for many researchers in the past few decades. Literature in this area has helped describe many of the barriers to measuring the quality of care in various environments, such as the hospital, hospice, and home. However, much of the work to date in defining the domains of quality care at the end of life has not been conducted within the long-term care environment.

Clarifying the concepts in knowledge transfer: a literature review.

Aim: The aim of this paper is to examine the concepts of opinion leaders, facilitators, champions, linking agents and change agents as described in health, education and management literature in order to determine the conceptual underpinnings of each.

Background: The knowledge utilization and diffusion of innovation literature encompasses many different disciplines, from management to education to nursing. Due to the involvement of multiple specialties, concepts are often borrowed or used interchangeably and may lack standard definition.