A Toolkit for Delirium Identification and Promoting Partnerships Between Carers and Nurses: A Pilot Pre-Post Feasibility Study.

BACKGROUND: Delirium is frightening for people experiencing it and their carers, and it is the most common hospital-acquired complication worldwide. Delirium is associated with higher rates of morbidity, mortality, residential care home admission, dementia, and carer stress and burden, yet strategies to embed the prevention and management of delirium as part of standard hospital care remain challenging. Carers are well placed to recognize subtle changes indicative of delirium, and partner with nurses in the prevention and management of delirium. OBJECTIVE: To evaluate a Prevention & Early Delirium Identification Carer Toolkit (PREDICT), to support partnerships between carers and nurses to prevent and manage delirium. DESIGN: A pre-post-test intervention and observation study. MAIN MEASURES: Changes in carer knowledge of delirium; beliefs about their role in partnering with nurses and intended and actual use of PREDICT; carer burden and psychological distress. Secondary measures were rates of delirium. PARTICIPANTS: Participants were carers of Indigenous patients aged 45 years and older and non-Indigenous patients aged 65 years and older. INTERVENTION: Nurses implemented PREDICT, with a view to provide carers with information about delirium and strategies to address caregiving stress and burden. KEY RESULTS: Participants included 25 carers (43% response rate) (n = 17, 68% female) aged 29-88 (M = 65, SD = 17.7 years). Carer delirium knowledge increased significantly from pre-to-post intervention (p = < .001; CI 2.07-4.73). Carers' intent and actual use of PREDICT was (n = 18, 72%; and n = 17, 68%). Carer burden and psychological distress did not significantly change. The incidence of delirium in the intervention ward although not significant, decreased, indicating opportunity for scaling up. CONCLUSION: The prevention and management of delirium are imperative for safe and quality care for patients, carers, and staff. Further comprehensive and in-depth research is required to better understand underlying mechanisms of change and explore facets of nursing practice influenced by this innovative approach.

Community-Dwelling Older Adults Attending a Fire and Falls Health Promotion Program and the Experience of Social Isolation and Loneliness.

Many health promotion programs are designed for older adults who live in the community. This research describes a health promotion program called "Remembering When" (a fire and fall prevention program). In 2020, a quality improvement project was developed to examine the effectiveness and impact of Remembering When among community-dwelling older adults. After analyzing the qualitative data collected for the project, an interesting observation of why older adults attended Remembering When emerged. Older adults might attend Remembering When because they experience social isolation and/or loneliness. The concepts of objective and subjective social isolation and loneliness were defined, and the implications of Remembering When around social isolation and loneliness were discussed. Secondary data analysis followed Braun and Clarke's (2006) thematic analysis steps. Four themes were generated: It is about me having choices, Joining the program as an old friend, We all need referrals , and I am housebound . Overall, 2 significant observations were made: (1) some older adults valued the opportunity to interact with Remembering When's team, which might help older adults decrease social isolation and loneliness, and (2) older adults needed more individualized programs to address their emotional and mental health and well-being needs.

Capacity of nurses working in long-term care: A systematic review qualitative synthesis.

BACKGROUND: The United Nations calculates there were 703 million adults 65 years and older globally as of 2019 with this number projected to double by 2050. A significant number of older adults live with comorbid health conditions, making the role of a nurse in long-term care (LTC) complex. Our objective was to identify the challenges, facilitators, workload, professional development and clinical environment issues that influence nurses and nursing students to seek work and continue to work in LTC settings. METHODS: Eligibility criteria included being a nurse in a LTC setting and research with a substantial qualitative component. Multiple databases (including Medline and CINAHL) were searched between 2013 and 2019 along with grey literature. Covidence was used to organise a team of 10 into a paired review of titles and abstracts to the final full text screening, extraction and appraisal with the CASP Qualitative Studies Checklist. Analysis involved a thematic synthesis approach. The Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) checklist informed the writing of the review. RESULTS: The search resulted in 18 articles and dissertations. Areas investigated included recruitment, resilience, employment and retention, how nurses perceived their professional work, rewards and difficulties, supervision, student preceptorship and career aspiration, nurses' perceptions of occupational status, along with leadership, education and development needs, and intentions to manage resident deteriorating health. The five themes were (1) perspectives of nursing influenced by the organisation, (2) pride in, and capacity to build relationships, (3) stretching beyond the technical skills, (4) autonomy, and (5) taking on the challenge of societal perceptions. DISCUSSION: This review revealed what is required to recruit nursing students to careers in LTC and retain nurses. To be explored is how staff can work to their full scope of practice and the resultant impact on resident care, including how to maximise a meaningful life for residents and their families. REGISTRATION: National Institute for Health Research UK (Prospero ID: CRD42019125214).

Are You Prepared for End-of-Life Care? A Content Review of Canadian End-of-Life Care Standards and Competencies for Saskatchewan.

BACKGROUND: The provision of end-of-life care is receiving attention locally, provincially, and nationally in Canada. It is important to ensure that interprofessional standards and competencies are in place to provide quality end-of-life care that meets the needs of patients and their families. The purpose of this content review was to identify core standards and competencies essential to an interprofessional team providing end-of-life care. METHODS: The researchers conducted a review of health professional associations and registration bodies that support professionals providing end-of-life care to identify existing standards and competencies. Key concepts were reviewed and organized using thematic analysis; relationships were developed; and core themes for interprofessional end-of-life care were identified. RESULTS: Four themes essential to the provision of end-of-life care were common across all health professions: (1) access to care, (2) professional practice, (3) person-centered care, and (4) the process and delivery of care. CONCLUSIONS: Health professional associations need to ensure end-of-life care standards and competencies are in place for the provision of appropriate and holistic care. Aligning standards and competencies across professions improves the preparedness of health professionals to provide interprofessional end-of-life care.

Does problem-based learning in Nursing Education Empower Learning?

In this discussion paper, we explored our experiences with the integration of problem-based learning and use of evaluation tools in an undergraduate nursing research class. Six content areas in the course were adapted to problem-based learning. Understanding of concepts and being able to link concepts to the real world of practice can be achieved when nursing students actively engage to construct and reconstruct their knowledge. This journey has demonstrated to us the importance of reflecting on practice as faculty and student. We encourage discussion among nursing faculty to more deeply understand the significance of moving from traditional didactic towards learner-centered approaches that enhance critical thinking.

Home First: Exploring the Impact of Community-based Home Care for Older Adults and Their Family Caregivers.

Given the rapidly expanding older adult population, finding health care approaches that support older adults to age in their choice of place, with an accompanying philosophical re-orientation of health services, is becoming more urgent. We studied the Home Care Home First - Quick Response Project to understand how clients over age 75 and their family caregivers perceived the enhanced community-based services delivered through Home First. Using interpretive description as the methodological design, we explored the experiences of eight older adults and 11 family caregivers; all older adults were enrolled in Home First due to a significant change in their health status. We identified four themes: growing older in chosen places with support, philosophy of care, processes of Home First, and the significance of Home First for clients. Overall, clients and family caregivers responded positively to the Home First services. Clients valued their independence and growing older in places they had specifically chosen.

A Narrative Care approach for persons living with dementia in institutional care settings.

AIMS AND OBJECTIVES: We will provide insights in the theoretical background and key concepts of a Narrative Care approach, such as narrative cultures, narrative curiosity, narrative co-composition and narrative reflective practice. BACKGROUND: Care understood as narrative practice underscores the importance of experiences and how these shape identities. Important to the quality of care in institutional care settings is the ability of care providers to cope with complexities and uncertainties in older adults' stories, which can be realised by attending to ways that foster and co-compose evolving and forward-looking narratives. Recognising these ongoing co-compositions means that persons living in institutional care settings and care providers live, tell, retell and relive their experiences. A change in the current institutional culture is necessary to implement care as narrative practice. To support such a change, approaches are needed that foster a focus on experiences and relationships and make relational ethics central to care. METHODS: The proposed Narrative Care approach is the result of an iterative development process involving a literature review, interviews with, and observations of, care providers, dialogues with an advisory committee, and consultation with experts. MAIN CONTRIBUTIONS: The proposed Narrative Care approach aims to help care providers (a) to recognise the importance of curiosity in a person's verbal and embodied narratives-especially for those living with dementia; (b) to take note of individual experiences in all of their complexity and uncertainty; (c) to respect these narratives; (d) to open up spaces to co-compose new narratives; and (e) to allow care providers to engage in narrative reflective practices that shape who they are and are becoming. CONCLUSION: The introduced approach responds to the need of implementing strategies to think and work narratively in institutional care settings. IMPLICATIONS FOR PRACTICE: Narrative Care has the potential to reshape task-oriented, technical notions of care. Concepts such as embodied narratives, relational ethics, narrative co-composition and narrative reflective practice must be integrated in the education of all care providers.

Comparison of Nursing Student and Instructor Preferences for Block and Nonblock Clinical Models.

Clinical experiences are the hallmark of prelicensure nursing programs and assist students with applying nursing theory into practice. The literature is limited with respect to nursing student and instructor preferences for type of clinical model to facilitate student learning. This article explores these perceptions in the nursing programs of 5 universities located in 4 Western Canadian provinces. Findings support the use of both nonblock and block clinical models throughout nursing education programs.

Nursing Student Preference for Block Versus Nonblock Clinical Models.

BACKGROUND: Clinical experiences are essential in undergraduate nursing student education to develop professionalism and integrate theory into practice. However, little evidence is available to guide curricular planners in determining the appropriate and effective use of different clinical models in nursing education. METHOD: Nursing students and four schools of nursing in two western Canadian provinces participated in this descriptive exploratory study examining student preference for clinical models. Thematic analysis of qualitative data addressed two research questions: What type of clinical model is preferred by nursing students? and How does clinical structure influence nursing students' perceived learning? RESULTS: Nonblock clinical practice is preferred by students with respect to a balanced lifestyle, concurrent integration of theory and practice, and critical reflection, whereas the block model is preferred for assimilation, consolidation, and socialization. CONCLUSION: Integration of both clinical models is recommended within undergraduate nursing curricula, as each model can facilitate student learning. [J Nurs Educ. 2017;56(3):152-157.].