Transitions of care for older adults discharged home from the emergency department: an inductive thematic content analysis of patient comments.

OBJECTIVE: Improving care transitions for older adults can reduce emergency department (ED) visits, adverse events, and empower community autonomy. We conducted an inductive qualitative content analysis to identify themes emerging from comments to better understand ED care transitions. METHODS: The LEARNING WISDOM prospective longitudinal observational cohort includes older adults (≥ 65 years) who experienced a care transition after an ED visit from both before and during COVID-19. Their comments on this transition were collected via phone interview and transcribed. We conducted an inductive qualitative content analysis with randomly selected comments until saturation. Themes that arose from comments were coded and organized into frequencies and proportions. We followed the Standards for Reporting Qualitative Research (SRQR). RESULTS: Comments from 690 patients (339 pre-COVID, 351 during COVID) composed of 351 women (50.9%) and 339 men (49.1%) were analyzed. Patients were satisfied with acute emergency care, and the proportion of patients with positive acute care experiences increased with the COVID-19 pandemic. Negative patient comments were most often related to communication between health providers across the care continuum and the professionalism of personnel in the ED. Comments concerning home care became more neutral with the COVID-19 pandemic. CONCLUSION: Patients were satisfied overall with acute care but reported gaps in professionalism and follow-up communication between providers. Comments may have changed in tone from positive to neutral regarding home care over the COVID-19 pandemic due to service slowdowns. Addressing these concerns may improve the quality of care transitions and provide future pandemic mitigation strategies.

Long-term care staffs' experience in facilitating the use of videoconferencing by cognitively impaired long-term care residents during the COVID-19 pandemic: a mixed-methods study.

BACKGROUND: During the COVID-19 pandemic, numerous long-term care (LTC) homes faced restrictions that prevented face-to-face visits. To address this challenge and maintain family connections, many LTC homes facilitated the use of electronic tablets to connect residents with their family caregivers. Our study sought to explore the acceptability of this practice among staff members and managers, focusing on their experiences with facilitating videoconferencing. METHODS: A convergent mixed method research was performed. Qualitative and quantitative data collection through semi-structured interviews to assess the acceptability of videoconferencing in long-term care homes and to explore the characteristics of these settings. Quantitative data on the acceptability of the intervention were collected using a questionnaire developed as part of the project. The study included a convenience sample of 17 staff members and four managers. RESULTS: Managers described LTC homes' characteristics, and the way videoconferencing was implemented within their institutions. Affective attitude, burden, ethicality, opportunity costs, perceived effectiveness, and self-efficacy are reported as per the constructs of the Theoretical Framework of Acceptability. The results suggest a favorable acceptability and a positive attitude of managers and staff members toward the use of videoconferencing in long-term care to preserve and promote contact between residents and their family caregivers. However, participants reported some challenges related to the burden and the costs regarding the invested time and staff shortage. CONCLUSIONS: LTC home staff reported a clear understanding of the acceptability and challenges regarding the facilitation of videoconferencing by residents to preserve their contact with family caregivers.

Fundamental Care's state of knowledge around the world: Where are we now? A scoping review.

AIMS: To investigate and describe the current state of knowledge about Fundamental Care in terms of population, contexts, concepts and gaps. DESIGN: A scoping review. DATA SOURCES: CINAHL, Medline, PsycINFO and EMBASE databases were searched in April 2021 for eligible literature, published from January 2010, onwards. REVIEW METHODS: This scoping review was built around the recommendations of Peters et al. (2020 version). Two researchers conducted the literature search, and three researchers independently screened the titles and abstracts of the retrieved studies' data, using the eligibility criteria and the review questions as a guide. RESULTS: The search yielded 763 records, of which 107 were included. Results are presented under seven subheadings: (a) Countries and Continents, (b) Context, (c) Research Design, (d) Publishing/Journal, (e) Participants and Population, (f) Keywords and (g) Fundamental of Care Framework and Practice Process. All the retrieved articles describe the current state of knowledge about Fundamental Care in terms of population, contexts, concepts and gaps. CONCLUSION: This scoping review highlighted the elevated number of articles that have been published since the beginning of the work on Fundamental Care, 10 years ago. The included articles are related to different dimensions of research, practice and teaching and to the Fundamentals of Nursing Care, but also to nursing theory. Finally, most of the articles had a nursing focus. IMPACT: The results of this scoping review allow us to highlight the work from the past 10 years. This may be of interest to learn more about the research surrounding Fundamental Care. This scoping review allows us to better target the theoretical and empirical developments to focus on in the coming years.

Job Satisfaction for Caregivers and Other Employees in Innovative Long-Term Care Homes for Residents With Cognitive Problems.

New housing models have emerged in Europe, Australia, the United States, and Canada. Intended for individuals with neurocognitive disorders, these models are characterized by a philosophy centered on the person, self-determination, liberty of choice, flexibility of care, acceptance of risk, and autonomy. Work and care are organized according to the pace and preferences of residents. The current multiple case study highlights the main sources of job satisfaction for caregivers and other employees in four innovative residential settings. Five themes are addressed as perceived by 58 employees: Work Motivation, Work Organization, Collaboration and Decision-Making Latitude, Quality of Work Life, and Continuing Education. These data will help inform clinical staff, policymakers, and the scientific community about clinical and organizational practices that contribute to job satisfaction in innovative residential settings. [Journal of Gerontological Nursing, 49(10), 36-43.].

Acceptability of videoconferencing to preserve the contact between cognitively impaired long-term care residents and their family caregivers: A mixed-methods study.

Visiting restrictions had to be imposed to prevent the spread of the COVID-19 virus and ensure the safety of long-term care home (LTCH) residents. This mixed method study aimed to explore residents' and family caregivers' acceptability of electronic tablets used to preserve and promote contact. Semi-structured individual interviews with 13 LTCH residents and 13 family caregivers were done to study their experiences, as well as the challenges and resources encountered in the implementation and use of videoconferencing. They had to rate, on a scale from 0 to 10, each of the 6 Theoretical Framework of Acceptability' constructs of the acceptability of the intervention. The results confirm acceptability of videoconferencing, giving residents and caregivers the opportunity to talk to and see each other during the pandemic. Videoconferencing had some benefits, such as being less expensive, and taking less time and effort for family caregivers.

[Receiving support for self-care skills during post-hospitalization transition in homes for the elderly: An unmet need]. / Recevoir un soutien aux capacités d'autosoins lors de la transition posthospitalisation en résidence pour aînés en perte d'autonomie : un besoin non comblé.

INTRODUCTION: Elderly people who receive appropriate transitional care after hospitalization experience fewer complications. CONTEXT: However, in Quebec, transitional care for the elderly is limited to case management and targets elderly people who are in need of resources. This often excludes those who remain in homes for the elderly. OBJECTIVES: The objective of this study was to identify the unmet needs of elderly people during the posthospitalization transition to intermediate care facilities in Quebec, as well as the strategies they use on a daily basis to cope with these needs. METHODS: A descriptive qualitative study was conducted as part of an intervention research process. Eleven elderly participants and health professionals were recruited (n=11). RESULTS: The results presented suggest a need to support patients' capacity for self-care, unmet during the post-hospitalization transition to intermediate care facilities. DISCUSSION: Supporting the self-care abilities of elderly people can help ensure their safety when living in homes for the elderly. CONCLUSION: Supporting the capacity for self-care is an important component of transitional care after hospitalization, including for elderly people with disabilities.

Recevoir un soutien aux capacités d'autosoins lors de la transition posthospitalisation en résidence pour aînés en perte d'autonomie : un besoin non comblé.

INTRODUCTION: Elderly people who receive appropriate transitional care after hospitalization experience fewer complications. CONTEXT: However, in Quebec, transitional care for the elderly is limited to case management and targets elderly people who are in need of resources. This often excludes those who remain in homes for the elderly. OBJECTIVES: The objective of this study was to identify the unmet needs of elderly people during the posthospitalization transition to intermediate care facilities in Quebec, as well as the strategies they use on a daily basis to cope with these needs. METHODS: A descriptive qualitative study was conducted as part of an intervention research process. Eleven elderly participants and health professionals were recruited (n=11). RESULTS: The results presented suggest a need to support patients' capacity for self-care, unmet during the post-hospitalization transition to intermediate care facilities. DISCUSSION: Supporting the self-care abilities of elderly people can help ensure their safety when living in homes for the elderly. CONCLUSION: Supporting the capacity for self-care is an important component of transitional care after hospitalization, including for elderly people with disabilities.

Le sentier en spirale du développement du savoir infirmier : l'apport de la proposition de Reed.

This article presents Reed’s perspective on the development of nursing knowledge. Her concept is embedded in the perspective of intermodernism. For Reed, intermodernism is a philosophy for nursing science and practice and thus represents a way of looking at the content, structure, and process of scientific theory. Reed presents her concept in the form of a spiral path composed of the philosophical, practical, and theoretical dimensions of nursing knowledge. After an overview of Reed’s perspective, we offer an illustration of her proposal with Lawler’s theoretical development of somology. Lawler’s development pathway can be used to incorporate the components of Reed’s spiral path in a meaningful way. The discussion shows how Reed’s concept can improve the description and understanding of a nursing knowledge development process. Finally, the article provides a rare summary of Reed’s work in French.

Un développement de savoir disciplinaire infirmier influencé par deux visions de la science.

The historical development of nursing knowledge reflects the political, social, and professional contexts that have shaped it, but also different visions of science and scientific knowledge. This article focuses on these two elements, science and scientific nursing knowledge, in order to examine nursing knowledge in the context in which it was proposed. Examining the influences that have shaped its development allows us to situate it among what were recognized as the modalities of knowledge development and the structures of knowledge formulation. By looking back we thus seek to appreciate the true value of nursing knowledge by providing keys to understanding its particular nature in relation to contemporary views of knowledge formulation, and to highlight the merits of those who helped lay the foundations for disciplinary knowledge. This historical overview of the development of nursing knowledge raises awareness of the status and growth of nursing knowledge and of the theorists who made it possible. It also seeks to restore and inspire a respect for its pioneers that is often lacking in nursing.

La proposition de structuration du savoir infirmier selon Fawcett : filiations et limites.

This analysis of Fawcett’s ideas will situate the role played by her model in the discipline in relation to its organization of knowledge and its role in the move to institutionalize the nursing discipline. By providing an in-depth epistemological analysis, locating the relationships between this concept and Popper’s work, and showing how Fawcett draws on a specific vision of science, the article presents a fresh look at the model while situating it within its assumptions. It also addresses some of its limitations and draws conclusions about its role in the move to institutionalize the nursing discipline.

L'impératif cosmique universel : l'apport du modèle de Roy au savoir infirmier.

The contemporary challenge in the field of health is undeniably that of devising a way to integrate humans and the environment that is beneficial to health. This article presents the universal cosmic imperative (UCI) philosophical perspective and the notion of the cosmic imperative that leads human beings to be creative in their relationship to nature. It begins by consolidating the exegesis of the internal evolution of Roy’s theory and identifying its influences. The epistemological and philosophical postulates upon which Roy’s theory was built are specified, and then the evolution of Roy’s thought is described in three main phases. The article then moves on to describe and explain the epistemological openings that Roy’s theory allows from the point of view of current health issues, especially environmental medicine, in a macro-meso-micro perspective of global health. Roy’s thinking is part of the question of the current turning point in the discipline of nursing (cure-care-healing) and the definition of its focus. Roy’s theory resists current theoretical developments, which it allows us to describe and question in a pattern that is fruitful for researchers.

The clinical microsystems approach: Does it really work? A systematic review of organizational theories of health care practices.

OBJECTIVES: Faced with increased expectations regarding the quality and safety of health care delivery systems, a number of stakeholders are increasingly looking for more efficient ways to deliver care. This study was conducted to provide a critical appraisal and synthesize the best available evidence on the impact of implementing clinical microsystems (CMS) on the quality of care and safety of the health care delivery. DATA SOURCES: A comprehensive and systematic search of 6 electronic databases, from 1998 to 2018, was conducted to identify empirical literature published in both English and French, evaluating the impact of implementing CMS in health care settings. STUDY SELECTION: We included all study designs that evaluate the impact of implementing CMS in health care settings. DATA EXTRACTION: Independent reviewers screened abstracts, read full texts, extracted data from the included studies, and appraised the methodological quality. RESULTS: Of the 1907 records retrieved, 35 studies met the inclusion criteria. The settings included general practice clinics (n = 18), specialized care units (n = 14), and emergency and ambulatory units (n = 3). The implementation of CMS helped to develop the patient-centered approach, promote interdisciplinarity and quality improvement skills, increase the fluidity of the clinical acts performed, and increase patient safety. It contributed to increasing patients' and clinicians' satisfaction, as well as reducing hospital length of stay and reducing hospital-acquired infections. The implementation of CMS also contributed to the development and refinement of diagnostic tools and measurement instruments. CONCLUSION: The CMS approach is unique because of the primacy given to the quality of care offered and the safety of patients over any other consideration, and its ability to redesign health care delivery systems. Efforts still need to be made to legitimize the approach in various health care settings worldwide.

Un aperçu de l'évolution de la formation d'apprenti à une formation professionnelle en Amérique du Nord.

This text is not intended to be a detailed historical account of the evolution of nursing education. It will instead highlight steps in the evolution of types and sites of nursing education, providing an overview of the steps that nursing has taken toward being a subject of study at university. It will also present an overview of the challenges and obstacles, in order to gain a better understanding of what is happening in a specific country and to enable comparisons between countries. This article is based on the idea that exploring specific conditions could help in understanding general trends. A general overview of the current situation is also proposed in order to highlight the steps taken in what has been an eventful evolution.

[Using lived experiences and theoretical insights to gain a better understanding of the adaptation difficulties encountered by elderly patients with chronic heart failure during the hospital-to-home transition]. / Mieux saisir les difficultés d'adaptation des personnes âgées insuffisantes cardiaques en transition de l'hôpital vers le domicile à partir des expériences vécues et d'un éclairage théorique.

Heart failure is one of the most common reasons for hospitalization in older people, and the hospital-to-home transition can be unsuccessful for these patients. Existing care programs focus primarily on the physiological aspects of the disease and are rarely based on theory. Using Roy's adaptation model (1), the aim of this study was to develop a thorough understanding of the adaptation difficulties and factors that influence how well elderly patients with chronic heart failure cope with the hospital-to-home transition, in order to develop a nursing interventions program. Based on the process proposed by Sidani and Braden (2011), this qualitative descriptive study adopted a deductive approach, with the use of intermediary theories and empirical data, as well as an inductive approach, where older people with chronic heart failure (n=7), caregivers (n=6), and healthcare professionals (n=14) participated in semi-structured individual interviews. The triangulation of data highlights the difficulties and factors influencing adaptation at the physical, psychological, and social levels. Gaining a better understanding of the experience of older people with heart failure when it comes to their transition from hospital to home, and doing so with a holistic vision, provides information for interventions that can contribute to better management of chronic disease and a better quality of life for these elderly patients.

Mieux saisir les difficultés d'adaptation des personnes âgées insuffisantes cardiaques en transition de l'hôpital vers le domicile à partir des expériences vécues et d'un éclairage théorique.

Heart failure is one of the most common reasons for hospitalization in older people, and the hospital-to-home transition can be unsuccessful for these patients. Existing care programs focus primarily on the physiological aspects of the disease and are rarely based on theory. Using Roy's adaptation model (1), the aim of this study was to develop a thorough understanding of the adaptation difficulties and factors that influence how well elderly patients with chronic heart failure cope with the hospital-to-home transition, in order to develop a nursing interventions program. Based on the process proposed by Sidani and Braden (2011), this qualitative descriptive study adopted a deductive approach, with the use of intermediary theories and empirical data, as well as an inductive approach, where older people with chronic heart failure (n=7), caregivers (n=6), and healthcare professionals (n=14) participated in semi-structured individual interviews. The triangulation of data highlights the difficulties and factors influencing adaptation at the physical, psychological, and social levels. Gaining a better understanding of the experience of older people with heart failure when it comes to their transition from hospital to home, and doing so with a holistic vision, provides information for interventions that can contribute to better management of chronic disease and a better quality of life for these elderly patients.

Fondamentaux des soins : un cadre et un processus pratique pour répondre aux besoins physiques, psychosociaux et relationnels des personnes soignées.

Since 2008, an international group has been helping to promote a better response to the fundamental needs of individuals receiving care. This group provides a framework on the fundamentals of care that focuses on the relationship between the nurse, the individual being cared for, and his or her relatives, as well as on the response to the patient’s physical, psychosocial, and relational needs. A practice process supports the concrete application of this framework. The purpose of this discursive article is to present the French translation of the Fundamentals of Care Framework and its Practice Process. To begin with, the translation process will be briefly explained. Next, the Fundamentals of Care Framework and the stages in its Practice Process will be presented. To help the reader better understand the proposal, a clinical illustration will be used to present the situation of Mr. Perron, who is living with Alzheimer’s disease, and his spouse, who is his family caregiver. Finally, the article discusses the usefulness of the Fundamentals of Care Framework and its Practice Process in terms of the four main areas of the discipline of nursing : practice, management, training, and research. This article paves the way for the development of knowledge on the fundamentals of care in the French-speaking world.

[An overview of how nursing education has evolved into professional training in North America]. / Un aperçu de l'évolution de la formation d'apprenti à une formation professionnelle en Amérique du Nord.

This text is not intended to be a detailed historical account of the evolution of nursing education. It will instead highlight steps in the evolution of types and sites of nursing education, providing an overview of the steps that nursing has taken toward being a subject of study at university. It will also present an overview of the challenges and obstacles, in order to gain a better understanding of what is happening in a specific country and to enable comparisons between countries. This article is based on the idea that exploring specific conditions could help in understanding general trends. A general overview of the current situation is also proposed in order to highlight the steps taken in what has been an eventful evolution.

[The complementarity of clinical and administrative nursing roles in a hospital setting: A case study.] / Complémentarité des rôles clinico-administratifs infirmiers en contexte hospitalier : une étude de cas.

INTRODUCTION AND BACKGROUND: The roles of head nurse (HN) and charge nurse (CN) in hospital care units are intended to be complementary, but still remain ambiguous. Studying the complementarity of these roles is a unique way of looking at them. OBJECTIVE: To explain in which circumstances the complementarity of HNs and CNs occurs in a hospital setting. METHODS: A single case study with the inclusion of complementary data from fifteen interviews with HNs and CNs and from documentary sources (n = 80). RESULTS: Fifteen independent or interdependent role components with potential complementarity were identified. This complementarity can be explained by way of three elements: 1) the CN's partial perspective and the HN's global perspective; 2) bidirectional communication; 3) common objectives requiring team mobilization. DISCUSSION AND CONCLUSION: Studying complementarity is an innovative approach that provides an understanding of the work of both HNs and CNs, as well as allowing us to understand how they complement each other and how one's work increases the value of the other's and vice-versa, resulting in improved quality of care.

[Science and nursing science: What links, what issues and what future development for the discipline of nursing?] / Science et science infirmière : quels liens, quels enjeux et quelle évolution future pour la discipline infirmière.

This article examines the terms science, discipline and knowledge from the perspective of the use and advancement of knowledge in the discipline of nursing. It views the notion of organized knowledge as the foundation of a science as well as considering the use of scientific methods as imperative in any discipline that aims to contribute to the world of ideas by relying on rationality. This paper aims to trace the link between science and nursing science, to clarify scientific issues for nursing, and to begin thinking about understanding the concept of diversity and the effective contribution of doctoral training in nursing as a guarantee of the future evolution of this discipline.

Which priority indicators to use to evaluate nursing care performance? A discussion paper.

AIMS: A discussion of an optimal set of indicators that can be used on a priority basis to assess the performance of nursing care. BACKGROUND: Recent advances in conceptualization of nursing care performance, exemplified by the Nursing Care Performance Framework, have revealed a broad universe of potentially nursing-sensitive indicators. Organizations now face the challenge of selecting, from this universe, a realistic subset of indicators that can form a balanced and common scorecard. DESIGN: Discussion paper drawing on a systematic assessment of selected performance indicators. DATA SOURCES: Previous works, based on systematic reviews of the literature published between 1990 - 2014, have contributed to the development of the Nursing Care Performance Framework. These works confirmed a robust set of indicators that capture the universe of content currently supported by the scientific literature and cover all major areas of nursing care performance. Building on these previous works, this study consisted in gathering the specific evidence supporting 25 selected indicators, focusing on systematic syntheses, meta-analyses and integrative reviews. IMPLICATIONS FOR NURSING: This study has identified a set of 12 indicators that have sufficient breadth and depth to capture the whole spectrum of nursing care and that could be implemented on a priority basis. CONCLUSIONS: This study sets the stage for new initiatives aiming at filling current gaps in operationalization of nursing care performance. The next milestone is to set up the infrastructure required to collect data on these indicators and make effective use of them.