Profiling the medical, functional, cognitive, and psychosocial care needs of adults assessed for home care in Ontario, Canada: The case for long-term 'life care' at home.

Calls to leverage routinely collected data to inform health system improvements have been made. Misalignment between home care services and client needs can result in poor client, caregiver, and system outcomes. To inform development of an integrated model of community-based home care, grounded in a holistic definition of health, comprehensive clinical profiles were created using Ontario, Canada home care assessment data. Retrospective, cross-sectional analyses of 2017-2018 Resident Assessment Instrument Home Care (RAI-HC) assessments (n = 162,523) were completed to group home care clients by service needs and generate comprehensive profiles of each group's dominant medical, functional, cognitive, and psychosocial care needs. Six unique groups were identified, with care profiles representing home care clients living with Geriatric Syndromes, Medical Complexity, Cognitive Impairment and Behaviours, Caregiver Distress and Social Frailty. Depending on group membership, between 51% and 81% of clients had identified care needs spanning four or more Positive Health dimensions, demonstrating both the heterogeneity and complexity of clients served by home care. Comprehensive clinical profiles, developed from routinely collected assessment data, support a future-focused, evidence-informed, and community-engaged approach to research and practice in integrated home-based health and social care.

A Quasi-Experimental Evaluation of an Education Program for the Use of Electrical Stimulation Therapy to Heal Pressure Injuries.

Electrical stimulation (E-Stim) involves applying low levels of electrical current. Despite high-level recommendations for E-stim use in many pressure injury (PrI) best practice treatment guidelines, clinicians seldom use E-Stim. PURPOSE: This quasi-experimental design study aimed to determine whether an educational program could improve health care providers' knowledge and attitudes regarding the use of E-Stim for treating PrIs in community-dwelling individuals with spinal cord injury living in 1 region of Ontario, Canada. METHODS: An educational intervention based on a university-level continuing education program was developed as part of a multifaceted knowledge mobilization project. Health care providers (eg, nurses, physicians, and allied health professionals) from multiple agencies were invited to participate. The instructional series included 8 online modules on background theory and knowledge and a hands-on workshop that familiarized participants with the equipment necessary to deliver E-Stim. Knowledge (percentage of correct answers using a knowledge test developed by the research team) and attitudes (assessed using the E-Stim Attitude Survey in which items were scored using a 5-point Likert scale (where 0 indicated a negative attitude and 5 a positive attitude) were evaluated 3 times (pre-education, post-online, and post-workshop). Data were aggregated into unit-weighted averaged composites of 3 attitude subscales (resources, evidence-based practice, and education), which were compared before and after educational sessions using a linear mixed effect model. RESULTS: Among the 83 participants, a significant increase in knowledge scores was noted from pre-education (55.9%) to post-online (78.4%) and post-workshop (78.0%) (X² [2] = 89.34; P <.001). A significant increase in attitude scores was noted across time points (resources: X² [2] = 27.32, P <.0001; evidence-based practice: X² [2] = 38.93, P <.0001; and education: X² [2] = 92.88, P <.0001). For the evidence-based practice subscale, attitude increased significantly post-online (t[127] = 6.03, P <.0001). For the resources subscale, a significant increase was detected after post-workshop (t[113] = 5.23, P <.001]. CONCLUSIONS: Online education increased health care providers' knowledge about E-Stim; however, hands-on workshops were required to change certain attitudes about the use of E-Stim for wound healing. Further research is required to evaluate 1) whether a change in knowledge and attitude scores translates to a practice change for health care providers and 2) the potential importance of ongoing coaching and mentorship for a sustainable change in the clinical setting.

Organization-level principles and practices to support spiritual care at the end of life: a qualitative study.

BACKGROUND: Though most models of palliative care specifically include spiritual care as an essential element, secular health care organizations struggle with supporting spiritual care for people who are dying and their families. Organizations often leave responsibility for such care with individual care providers, some of whom are comfortable with this role and well supported, others who are not. This study looked to hospice programs founded and operated on specific spiritual foundations to identify, if possible, organizational-level practices that support high-quality spiritual care that then might be applied in secular healthcare organizations. METHODS: Forty-six digitally-recorded interviews were conducted with bereaved family members, care providers and administrators associated with four hospice organizations in North America, representing Buddhist, Catholic, Jewish, and Salvation Army faith traditions. The interviews were analyzed iteratively using the constant comparison method within a grounded theory approach. RESULTS: Nine Principles for organizational support for spiritual care emerged from the interviews. Three Principles identify where and how spiritual care fits with the other aspects of palliative care; three Principles guide the organizational approach to spiritual care, including considerations of assessment and of sacred places; and three Principles support the spiritual practice of care providers within the organizations. Organizational practices that illustrate each of the principles were provided by interviewees. CONCLUSIONS: These Principles, and the practices underlying them, could increase the quality of spiritual care offered by secular health care organizations at the end of life.