A scoping review of decision-making tools to support substitute decision-makers for adults with impaired capacity.

Background: Substitute decision-makers (SDMs) make decisions that honor medical, personal, and end-of-life wishes for older adults who have lost capacity, including those with dementia. However, SDMs often lack support, information, and problem-solving tools required to make decisions and can suffer with negative emotional, relationship, and financial impacts. The need for adaptable supports has been identified in prior meta-analyses.

: The Challenges of Advance Care Planning Engagement in Long-Term Care.

This interpretative, qualitative study explored residents' and families' perspectives on advance care planning (ACP) in long-term care (LTC). Perspectives on when, how, and with whom ACP discussions should be introduced and barriers and solutions to improving ACP engagement were examined. Fifty-one residents and families participated in seven focus groups.

The availability of support and peritoneal dialysis survival: A cohort study.

Background: Providing support is important to maintain a patient on peritoneal dialysis (PD), though its impact on outcomes has not been investigated thoroughly. We examined the association between having support and risk of a transfer to hemodialysis.

Methods: In this retrospective observational cohort study, we used data captured in the Dialysis Measurement Analysis and Reporting system about patients who started PD in Alberta, Canada, between 1 January 2013 and 30 September 2018.

Exploring clinical leadership in long-term care: An integrative literature review.

Aim: The aim of this study is to understand the concept of clinical leadership and clinical leadership development for nurses working with older adults in long-term care health care facilities.

Background: In Canada, clinical care within long-term care is undertaken by registered nurses and licenced practical nurses working with health care aides. Effective clinical leadership is essential for providing quality nursing care.

Multi-disciplinary supportive end of life care in long-term care: an integrative approach to improving end of life.

Background: Optimal supportive end of life care for frail, older adults in long term care (LTC) homes involves symptom management, family participation, advance care plans, and organizational support. This 2-phase study aimed to combine multi-disciplinary opinions, build group consensus, and identify the top interventions needed to develop a supportive end of life care strategy for LTC.

Methods: A consensus-building approach was undertaken in 2 Phases.

Development of a Toolkit to support sustainable culture change in residential aged care.

Objective: This study aimed to develop and evaluate a Toolkit to support implementation of the Towards Organisational Culture Change (TOrCCh) intervention, with minimal external facilitation, in aged care facilities, to implement long-lasting organisational change.

Methods: Eight residential aged care facilities across two Australian states participated. A Toolkit was drafted iteratively, engaging staff from participating sites and a reference group.

Social Support in the Peritoneal Dialysis Experience: A Qualitative Descriptive Study.

Background: People with end-stage kidney disease can either pursue conservative (palliative) management or kidney replacement therapy. Although transplant is preferred, there is a limited number of organs available rendering the majority of patients treated with some form of dialysis. Hemodialysis and peritoneal dialysis are equivalent regarding clinical outcomes, but peritoneal dialysis is much less costly to provide.

Barriers and facilitators to optimal supportive end-of-life palliative care in long-term care facilities: a qualitative descriptive study of community-based and specialist palliative care physicians' experiences, perceptions and perspectives.

Objective: The COVID-19 pandemic has highlighted ongoing challenges to optimal supportive end-of-life care for adults living in long-term care (LTC) facilities. A supportive end-of-life care approach emphasises family involvement, optimal symptom control, multidisciplinary team collaboration and death and bereavement support services for residents and families. Community-based and palliative care specialist physicians who visit residents in LTC facilities play an important role in supportive end-of-life care.

A pilot evaluation of the Strengthening a Palliative Approach in Long-Term Care (SPA-LTC) program.

Background: Despite increased annual mortality in long-term care (LTC) homes, research has shown that care of dying residents and their families is currently suboptimal in these settings. The purpose of this study was to evaluate resident and family outcomes associated with the Strengthening a Palliative Approach in LTC (SPA-LTC) program, developed to help encourage meaningful end of life discussions and planning.

Methods: The study employs a mixed method design in four LTC homes across Southern Ontario.

A Stakeholder Analysis of the Strengthening a Palliative Approach in Long-Term Care Model.

Objective: The purpose of this study was to conduct a stakeholder analysis of the strengthening a palliative approach to long-term care (SPA-LTC) model and refine it based on feedback from long-term care (LTC) residents and their families, staff, researchers and decision makers.

Methods: We used a mixed-methods design to conduct a stakeholder analysis of the SPA-LTC model that consisted of two sequential components: qualitative focus groups with LTC staff followed by a quantitative survey with key stakeholders.

Results: Twenty-one LTC staff provided feedback about the SPA-LTC model after residents relocated to LTC, during advanced illness and at end of life and in the period of grief and bereavement.

Palliative Care Models in Long-Term Care: A Scoping Review.

Objective: The goal of this scoping review was to identify existing palliative models in long-term care (LTC) homes and differentiate between the key components of each in terms of training/capacity-building strategies; resident, family and staff support; and advance care planning (ACP) and goals-of-care discussions.

Methods: We conducted a scoping review based on established methods to summarize the international literature on palliative models and programs for LTC. We analyzed the data using tabular summaries and content analysis.

Will Women Interact with Technology to Understand Their Cardiovascular Risk and Potentially Increase Activity?

Cardiovascular disease (CVD) continues to be one of the leading causes of death for women. New approaches need to be identified that will enable women to recognize modifiable risk factors and target their efforts toward prevention. The objectives of this study were to (1) determine if women would access Vivametrica to assess CVD risk, (2) identify whether women would increase their physical activity as measured by their daily step counts, and (3) elicit women's opinions about using the system, prospective observational study design.

Development and evaluation of an organisational culture change intervention in residential aged care facilities.

Objective: To develop and evaluate an organisational culture change intervention for residential aged care settings.

Methods: This study was undertaken in five residential aged care facilities (RACFs). All staff working within participating RACFs were invited to take part.

An Analysis of Documents Guiding Palliative Care in Five Canadian Provinces.

ABSTRACTThe purpose of this study was to analyse the consistency and extent of palliative content across high-level guiding documents related to the care of persons residing in Canadian long-term care homes. A systematic search was conducted examining documents at the national level and across five provinces (Alberta, Ontario, Saskatchewan, Manitoba, and Quebec). Twenty-five documents were selected based on inclusion criteria from 273 documents identified in the systematic search.

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.

From apprehension to advocacy: a qualitative study of undergraduate nursing student experience in clinical placement in residential aged care.

Background: Undergraduate nursing placement in aged care is forecast to grow in importance with the increasing aging population, and to help to reverse trends in student lack of interest in gerontology careers. However, there is a need to better understand undergraduate nursing students' experiences on placement with older adults, as well as key features of quality learning within residential aged care. The aim of this study was to explore how nursing students understand learning within residential aged care.

Comparison of Patient Survival Between Hemodialysis and Peritoneal Dialysis Among Patients Eligible for Both Modalities.

Background: Although peritoneal dialysis (PD) costs less to the health care system compared to in-center hemodialysis (HD), it is an underused therapy. Neither modality has been consistently shown to confer a clear benefit to patient survival. A key limitation of prior research is that study patients were not restricted to those eligible for both therapies.

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.

Bringing a novel to practice: An interpretive study of reading a novel in an undergraduate nursing practicum course.

Novels are one humanities resource available to educators in health disciplines to support student reflection on their own professional practice and therapeutic relationships with patients. An interdisciplinary team, including nurses, a physician, and an English instructor, carried out an interpretive study of the use of a novel by clinical nursing instructors in an undergraduate practicum course. Students placed in assisted living or long term care facilities for the elderly were expected to read a contemporary work, Exit Lines, by Joan Barfoot, which is set in a comparable facility.

Selection of peritoneal dialysis among older eligible patients with end-stage renal disease.

Background: Older patients with end-stage renal disease (ESRD) are less likely to choose peritoneal dialysis (PD) over hemodialysis (HD). The reasons behind their choice of dialysis modality are not clear. This study seeks to determine the patient-perceived factors that influence ESRD patients' choice of dialysis modality among older ESRD patients who are deemed eligible for both PD and HD.

Compassion fatigue: A meta-narrative review of the healthcare literature.

Background: Compassion fatigue describes a work-related stress response in healthcare providers that is considered a 'cost of caring' and a key contributor to the loss of compassion in healthcare.

Objective: The purpose of this review was to critically examine the construct of compassion fatigue and to determine if it is an accurate descriptor of work-related stress in healthcare providers and a valid target variable for intervention.

Design: Meta-narrative review.

Inside a Postpartum Nursing Center: Tradition and Change.

Purpose: The purpose of this study was to explore how traditional ritual practices are incorporated into the context of contemporary healthcare.

Methods: An ethnographic study was conducted, using observations and interviews with 27 first-time mothers and 3 nurses at a postpartum nursing center in Taipei, Taiwan.

Results: Nursing routines, policies and care provision at the center affected the way traditional ritual practices were conducted.