Motivations of family advisors in engaging in research to improve a palliative approach to care for persons living with dementia: an interpretive descriptive study.

BACKGROUND: A Strategic Guiding Council (SGC) was created within a Family Carer Decisions Support study, to engage family carers of persons with advanced dementia as advisors to inform the design and implementation of the study. The SGC consists of an international group of family advisors from Canada, the Republic of Ireland, the United Kingdom, the Netherlands, and the Czech Republic. There are limited studies that have explored the integration of Patient and Public Involvement (PPI) in dementia research, end-of-life care and long-term care. Therefore, this study explores PPI engagement in health research with family carers to understand further their interest in being involved in the SCG within the FCDS intervention which is focused on supporting caregivers to make decisions about end-of-life care for residents with advanced dementia. METHODS: This study utilized an interpretive descriptive design and explored the motivations of ten family advisors from Canada, the Republic of Ireland, the United Kingdom, and the Netherlands in being part of the SGC. Semi-structured interviews were conducted by phone or videoconferencing and were recorded, transcribed, and analyzed using thematic analysis. RESULTS: Three themes generated from the findings of the study were (1) engaging in reciprocal learning; (2) using lived experience to support other family carers; and (3) creating a collective momentum for advocacy and change. CONCLUSIONS: Family carers motivations to being part of the SCG was driven by their intent to help carers navigate the health system and to create a psychosocial support system for other carers experiencing end-of-life with their loved ones. Being part of the SCG provided a benefit to family carers which provided a venue for them to contribute meaningful information from their experience, learn from other health professionals, research and other advisors and an avenue for advocacy work to improve access to end-of-life care supports through education. To our knowledge, this is the first study that explores the motivations of an international group of family advisors' engagement in health research to promote integration of a palliative approach to dementia care in long-term care homes. This study further contributes to the literature from an international perspective the importance of PPI in research. Further research is warranted that explores PPI in research to improve access to end-of-life supports.

Patient and public involvement (PPI) in research has been growing worldwide and ensures that research conducted is relevant to the needs of patients. Within the Family Carer Decisions Support study, we created a Strategic Guiding Council (SGC) to engage family carers of persons with advanced dementia as advisors to improve access to a palliative approach to care. The SGC includes family advisors from Canada, the Republic of Ireland, the United Kingdom, the Netherlands, Italy and the Czech Republic. The goal of the strategy was to engage with family advisors in research activities to improve access to a palliative approach and quality of care provided to people with dementia receiving end-of-life care. Including patients and family in research is extremely important, therefore our aim in this study was to explore family advisors' motivations to engaging in the SGC. Family advisors reported encountering challenges with navigating the health system with end-of-life care and they chose to participate in the SGC to support other carers who are experiencing a similar situation. Being part of the SGC also provided the family advisors with an avenue to advocate on the importance of improving access to end-of-lifesupports and the opportunity to learn from other advisors, health professionals and researchers.

Patient and public involvement in international research: Perspectives of a team of researchers from six countries on collaborating with people with lived experiences of dementia and end-of-life.

BACKGROUND: Patient and public involvement (PPI) is a critical priority in research, policy, academia and advocacy organizations. PPI in dementia research is gaining momentum. However, these efforts are missing in international projects aimed at those living with advanced dementia in long-term care (LTC) homes. Additional complexities can arise in enacting PPI within the context of integration of a palliative approach to care and experiences around end-of-life in (EOL) dementia. The mySupport study involved implementing the Family Carer Decision Support (FCDS) intervention for care partners of those living with advanced dementia in LTC in six countries. RESEARCH DESIGN AND OBJECTIVE: An interpretive description study was conducted to explore the perspectives of international researchers from six countries on engaging people with lived experiences of dementia and EOL care in research processes. The findings from this study informed the development of a PPI strategy and a subsequent toolkit for the FCDS intervention. FINDINGS: Thirty-eight interviews were completed with project researchers: 12 from the United Kingdom, 8 from Canada, 7 from Ireland, 4 each from Italy and The Netherlands and 3 from the Czech Republic. Four broad themes describe international researchers' perspectives on advancing methods of engagement for people with lived experiences of dementia and EOL in international PPI activities: (1) Groundwork to engage in research; (2) planning for research activities is key; (3) focus on meaningful engagement and (4) having foresight for practical issues shaping PPI. DISCUSSION AND IMPLICATIONS: International projects that involve PPI can present many sources of challenges. The findings in this study highlight important considerations for foundational work for incorporating PPI in international projects. Learning from world leaders and those with lived experiences in various regions can be insightful and help share tools and resources. PATIENT OR PUBLIC CONTRIBUTION: PPI was envisioned as a critical part of conducting the mySupport study. The findings from this study informed the development of a PPI strategy and an international Strategic Guiding Council that included family carers of those living with advanced dementia in LTC homes in six countries. This manuscript focused on the perspectives of researchers on their engagement with people with lived experiences of dementia and EOL. The perspectives of persons with lived experiences on engaging in the mySupport research study will be reported in a forthcoming manuscript.

Perspectives across Canada about implementing a palliative approach in long-term care during COVID-19.

BACKGROUND: Long-term care (LTC) homes have been disproportionately impacted during COVID-19. PURPOSE: To explore the perspectives of stakeholders across Canada around implementing a palliative approach in LTC home during COVID-19. METHODS: Qualitative, descriptive design using one-to-one or paired semi-structured interviews. RESULTS: Four themes were identified: (1) the influence of the pandemic on implementing a palliative approach, (2) families are an essential part of implementing a palliative approach, (3) prioritizing advance care planning (ACP) and goals of care (GoC) discussions in anticipation of the overload of deaths and (4) COVID-19 highlighting the need for a palliative approach as well as several subthemes. CONCLUSION: The COVID-19 pandemic influenced the implementation of a palliative approach to care, where many LTC homes faced an overwhelming number of deaths and restricted the presence of family members. A more concentrated focus on home-wide ACP and GoC conversations and the need for a palliative approach to care in LTC were identified.

Palliative Approach to Care Education for Multidisciplinary Staff of Long-Term Care Homes: A Pretest Post-Test Study.

This study used a single-group pre-test and post-test design to evaluate an educational workshop for multidisciplinary staff working in long-term care homes on implementing a palliative approach to care and perceptions about advanced care planning conversations. Two outcomes were measured to assess the preliminary efficacy of the educational workshop at baseline and 1-month post-intervention. Knowledge regarding implementing a palliative approach to care was assessed using the End-of-Life Professional Caregivers Survey and changes in staff perception toward ACP conversations were assessed using the Staff Perceptions Survey. Findings suggest that staff experienced an improvement in self-reported knowledge regarding a palliative approach to care (p ≤ .001); and perceptions of knowledge, attitude, and comfort related to advance care planning discussions (p ≤ .027). The results indicate that educational workshops can assist in improving multidisciplinary staff's knowledge about a palliative approach to care and comfort in carrying out advance care planning discussions with residents, family care partners, and among long-term care staff.

Interações entre usuários brasileiros sobre enfrentamento e apoio social durante pandemias: um estudo de análise de mídia / Interacciones sobre el apoyo social de afrontamiento durante la pandemia por parte de usuarios brasileños: un estudio de análisis de medios / Interactions about Coping-Social Support during Pandemics by Brazilian Users: a Media Analysis Study

Objective: explore how the Brazilian online community mobilized its own coping resources during the COVID-19 pandemic to deal with mass vaccination concerns, manage and cope with personal stressors brought on by the pandemic, and seek social support. Method: the Canadian Population Health Promotion Model and the Transactional Model of Stress and Coping framed this media content analysis focusing on a socially impactful event: the authorization of COVID-19 vaccinations in Brazil. Results: the retrieval of posts (January-May 2021) found 488 contents distributed as modus operandi (n=117; 24%), coping strategies focused on emotion (n=175; 35.8%), on problem (n=40; 8.1%), on reflection (n=67; 13.7%), and offer of social support (n=89; 18.2%). Among the top-five (n=393; 80.5%) actions and coping strategies, 255 contents about coping strategies with a predominant discourse on emotion-focused coping (n=160; 63.2 %). Conclusion: interactions sustained a feeling of connection and created a context for belonging, support, and motivation.

Objetivo: explorar como a comunidade online brasileira mobilizou seus próprios recursos de enfrentamento durante a pandemia de COVID-19 para lidar com as preocupações com a vacinação em massa, gerenciar e lidar com os estressores pessoais provocados pela pandemia e buscar apoio social. Método: o Modelo Canadense de Promoção da Saúde da População e o Modelo Transacional de Estresse e Coping enquadraram esta análise de conteúdo midiático com foco em um evento de impacto social: a autorização da vacinação contra a COVID-19 no Brasil. Resultados: a recuperação das postagens (janeiro-maio de 2021) encontrou 488 conteúdos distribuídos como modus operandi (n=117; 24%), estratégias de enfrentamento focadas na emoção (n=175; 35,8%), no problema (n=40; 8,1%), na reflexão (n=67; 13,7%) e na oferta de apoio social (n=89; 18,2%). Entre as cinco principais (n=393; 80,5%) ações e estratégias de enfrentamento, 255 conteúdos sobre estratégias de enfrentamento predominaram com discurso de enfrentamento focado na emoção (n=160; 63,2%). Conclusão: as interações mantiveram um sentimento de conexão e criaram um contexto de pertencimento, apoio e motivação.

Objetivo: explorar cómo la comunidad brasileña en línea movilizó sus propios recursos de afrontamiento durante la pandemia de COVID-19 para hacer frente a las preocupaciones sobre la vacunación masiva, gestionar y hacer frente a los factores estresantes personales provocados por la pandemia y buscar apoyo social. Método: el Modelo Canadiense de Promoción de la Salud de la Población y el Modelo Transaccional de Estrés y Afrontamiento enmarcaron este análisis de contenido mediático centrándose en un evento de impacto social: la autorización de la vacunación contra la COVID-19 en Brasil. Resultados: la recuperación de publicaciones (enero-mayo de 2021) encontró 488 contenidos distribuidos como modus operandi (n=117; 24%), estrategias de afrontamiento centradas en la emoción (n=175; 35,8%), en el problema (n=40; 8,1%), en la reflexión (n=67; 13,7%) y en la oferta de apoyo social (n=89; 18,2%). Entre las cinco acciones y estrategias de afrontamiento más destacadas (n=393; 80,5%), 255 contenidos sobre estrategias de afrontamiento con un discurso predominante sobre el afrontamiento centrado en las emociones (n=160; 63,2 %). Conclusión: las interacciones mantuvieron un sentimiento de conexión y crearon un contexto de pertenencia, apoyo y motivación.

Perceptions on implementation of a new standardized reporting tool to support structured morning rounds: Recommendations for interprofessional teams and healthcare leaders.

Structured morning rounds have been used to improve communication, provide learning opportunities, and support patient care in various healthcare settings. The leadership team in an inner-city Inpatient Mental Health Unit identified a gap in the structure of morning rounds; to remedy this, a standardized reporting tool and structured morning rounding process were implemented. This short communication reports on an evaluation of staff...s perceptions on the outcomes of using a standardized reporting tool and structured rounding process to improve efficiency and communication regarding patient care among an interprofessional team. Feedback was provided on logistics, attendance, supporting factors that ensured ease of use for the new structure, and benefits of the program. While this evaluation focuses on the opinions of nurses, it serves as an example for leadership in various healthcare units on the benefits of a structured rounding program, and key factors that contribute to making the process successful. This short communication also provides an example for an efficient communication tool that can be adapted to meet the needs of various groups of healthcare disciplines.

Finding the Silver Lining: Aging Well Amongst Older Brazilian Women in the Post-Migration Context.

STUDY BACKGROUND: The aging population in Canada has been increasing steadily over the past 40 years, however, there is limited information about the meaning of aging well amongst older Brazilian women in Canada. METHODS: A Heideggerian interpretive phenomenology study was conducted to understand the meaning of aging well amongst older Brazilian women in the post-migration context living in the Greater Toronto Area (GTA) in Ontario, Canada. RESULTS: Eight older Brazilian women residing in the GTA were recruited through purposive and snowball sampling and participated in individual face-to-face interviews. Through data analysis and the incorporation of Heidegger's four existentials of human existence, the themes that emerged were (a) Embracing being part of a mosaic, (b) Aging with grace, (c) Chasing your dreams and (d) Being a bridge and not a fence. The overarching theme was: Finding the silver lining: Aging well. CONCLUSION: This study informs nursing practice, research and policy development to advance the health of older immigrant adults in Canada.

Promoting Safety: Behavioural Emergency Response during the COVID-19 Pandemic.

During the ongoing COVID-19 pandemic, patients with and without pre-existing mental health diagnoses will either be admitted to the hospital as patients under investigation for COVID-19 or patients positive for COVID-19. A safe and timely response is required for patients exhibiting escalating behaviours (e.g., responsive, agitated and/or aggressive behaviours) to prevent harm to the patient, nearby patients and staff. In this paper, we report on a new protocol that has been implemented throughout our institution to address Code White calls for escalating behaviours during the COVID-19 pandemic. This procedure uses a least restraint-based philosophy for the management of an escalating situation, involves the use of an interprofessional team of healthcare providers (including mental health clinicians) and security team members and accounts for the need for personal protective equipment. We believe that other hospitals could benefit from knowing about this approach as a strategy to improve patient care and diminish disease transmission.

Novas vidas, novos desafios: acesso a serviços de violência por parceiro íntimo para mulheres imigrantes de língua portuguesa / New lives, new challenges: access to intimate partner violence services for portuguese-speaking immigrant women

A violência por parceiro íntimo é um problema global e mais comum sofrida pelas mulheres. Este estudo explorou barreiras aos serviços de saúde relacionadas à violência por parceiro íntimo entre mulheres imigrantes de língua portuguesa em Toronto, Canadá. Estudo exploratório de discussões em grupo com 12 mulheres imigrantes de língua portuguesa. Os resultados esclarecem lutas enfrentadas pelas mulheres imigrantes e seus caminhos para cuidar e buscar ajuda. O medo de serem deportadas, a obtenção de evidências de abuso e a falta de serviços no idioma específico foram as barreiras relatadas. Fé e religião foram apontadas como fatores-chave no apoio a resiliência das mulheres, quando disponíveis os serviços comunitários no idioma específico. Enfermeiros que prestam assistência às mulheres que lidam com a violência por parceiro íntimo devem repensar o escopo de suas ações de defesa para abordar essas barreiras estruturais, construindo alianças com organizações para melhor servir e proteger as mulheres em situações vulneráveis.

Intimate partner violence is a global health issue and the most common form of violence experienced by women. This study explored barriers to accessing help to Intimate partner violence related health services among Portuguese-speaking immigrant women in Toronto, Canada. Exploratory study conducted by a survey and focus group discussions with 12 Portuguese-speaking immigrant women. Results clarify the struggles faced by Portuguese-speaking immigrant women and their pathways to care and help-seeking. Participants reported that the fear of being deported, obtaining evidence of abuse, and lack of language-specific services were the key barriers to seeking help. When available, language-specific community-based services, along with faith and religion, were noted as key factors that supported women's resilience. Nurses who provide care and services to women who are dealing with Intimate partner violence should rethink the scope of their advocacy actions toward addressing these structural barriers by building alliances with organizations to better serve and protect women in such vulnerable situations.

Bold background of nurse-scientist / Formação audaciosa do enfermeiro-cientista / Formación audaz del enfermero-científico

Nursing science includes the management of contemporary critical thinking for the appropriation of innovations in technology. This aspect is intrinsic to the training of the nurse and leads us to the binomials teaching-learning, creativity-intuition and theory-practice. Nursing, from its origin, has its conceptual frameworks with the complexities of reality. The expanded perspective of such complexity and systemic chaos calls for a new identity of nurses as producers of knowledge, revolutionizing and materializing their role in society. To do so, democratizing knowledge about research methodology, demystifying it as an exclusive practice of few, would result in awakening the passion for research. With whom? The new generation of undergraduates must realize that in today's world of internationalization of university education, opportunities exist, but only those who are ready to take them can reach professional achievements.

A ciência da Enfermagem inclui o manejo do pensamento crítico contemporâneo para a apropriação de inovações da tecnologia. Este aspecto é intrínseco à formação do enfermeiro e nos remete aos binômios ensino-aprendizagem, criatividade-intuição e teoria-prática. A Enfermagem, desde sua origem, tem seus marcos conceituais com as complexidades da realidade. A perspectiva ampliada de tal complexidade e do caos sistêmico clama por uma nova identidade do enfermeiro como produtor de conhecimentos, revolucionando e concretizando seu papel na sociedade. Para tanto, democratizar o conhecimento sobre metodologia de pesquisa, desmistificando-a como uma prática exclusiva de poucos, resultaria em despertar a paixão pela pesquisa. Com quem? A nova geração de graduandos deve se conscientizar que no mundo atual da internacionalização da educação universitária, oportunidades existem, mas somente aqueles que estejam prontos para delas se apoderarem podem alcançar conquistas profissionais.

La ciencia de Enfermería incluye la apropiación de las innovaciones de la tecnología usando el pensamiento crítico contemporáneo. Este aspecto es intrínseco a la formación del enfermero y nos remete a los binomios enseñanza-aprendizaje, creatividad-intuición y teoría-práctica. La Enfermería, desde su origen, tiene sus marcos conceptuales en las complejidades de la realidad. La perspectiva ampliada de tal complejidad y del caos sistémico, clama por una nueva identidad del enfermero como productor de conocimientos, revolucionando y concretizando su papel en la sociedad. Por tanto, democratizar el conocimiento sobre la metodología de investigación, al desmitificarla como una práctica exclusiva de pocos, resultaría en el despertar de la pasión por la investigación. ¿Con quién? La nueva generación de graduandos debe tener la concientización de en el mundo actual de la internacionalización de la educación universitaria, las oportunidades existen, pero que solamente aquellos que estén listo para obtenerlas, podrán alcanzar las conquistas profesionales.