Healthcare aide involvement in team decision-making in long-term care: A narrative review of the literature.

AIMS AND OBJECTIVES: To provide an overview and synthesis of the current evidence on healthcare aides' involvement in team decision-making in long-term care. BACKGROUND: Healthcare aides provide the most direct care to residents in long-term care homes and are uniquely positioned to influence the quality of care. Yet, they are not typically included in team decisions for improving resident care. As demand for long-term care increases, it is essential that we have a comprehensive understanding of ways to support healthcare aides' role on the interprofessional team for decision-making about resident care. DESIGN: Narrative review. METHOD: Five electronic databases were searched for articles published in English between 2008 and 2020. Thematic analysis was conducted to synthesise findings using an organising framework. Reporting followed the PRISMA-ScR. RESULTS: Twelve studies were included. Results indicate that work environment factors that influenced (supported or hindered) healthcare aides' involvement in decision-making included information access/availability, hierarchical staffing structures and supervisor support/shared governance. Relational processes that influenced team decision-making included team communication and collaboration, information sharing and exchange, and the quality of work relationships among team members. Strategies are discussed that could address the identified barriers and support healthcare aides' active involvement in team decisions regarding resident care. CONCLUSIONS: This review highlights the pervasive underutilization of healthcare aides, who have the most knowledge of residents to support person-centred care. There remains a paucity of research on healthcare aides' involvement in team decision-making. Research is needed to examine the effectiveness of interventions to support healthcare aides' participation in decision-making and the impact on staff and resident outcomes. RELEVANCE TO CLINICAL PRACTICE: It is crucial that healthcare aides are afforded opportunities to be part of the interprofessional team for information sharing and decision-making for resident care. Managers play a key role in supporting healthcare aides' inclusion in decision-making.

Home care providers' perceptions of shared decision-making with older clients (and their caregivers): A cross-sectional study.

Interprofessional care teams can play a key role in supporting older adults (and caregivers) in making informed health decisions, yet shared decision making is not widely practiced in home care. Based on an earlier needs assessment with older adults (and caregivers) with home care experience, we aimed to explore the perceptions of home care teams on the decisions facing their clients and their perceived involvement in shared decision making. A cross-sectional study was conducted with 614 home care providers (nurses, personal support workers, rehabilitation professionals) in three Canadian provinces (Quebec, Ontario, and Alberta). Home care providers considered the decision "to stay at home or move" as the most difficult for older adults. Those most frequently involved in decision making with older adults were family members and least involved were physicians. Although all home care providers reported high levels of shared decision-making, we detected an effect of respondent's discipline on self-perceived shared decision-making; nurses and rehabilitation professionals reported significantly higher levels of shared decision making than personal support workers. A more tailored approach is required to support shared decision making in interprofessional care teams.

Adapting "Shut Up & Write!®" to Foster Productive Scholarly Writing in Graduate Nursing Students.

Productive scholarly writing is important for succeeding in graduate nursing programs such as thesis-and practice-based master's or doctoral degrees. Nurses pursuing graduate-level programs are expected to produce high-level scholarly writing manuscripts. However, writing typically is an independent and isolating endeavor. This article describes a student-led writing group ("Sit Down & Write!") that was adapted from the "Shut Up & Write!" (SUAW) structure. Five strategies were incorporated to meet the unique needs of graduate nursing students and foster productivity: (a) provide space for diverse groups of nursing students to participate, (b) offer flexible scheduling, (c) accommodate a flexible group structure, (d) host longer sessions, and (e) allow time to discuss writing goals. Overall, Sit Down and Write! provided a community of productive writing support. Future adaptations may consider providing a virtual option so sessions are accessible to students who are unable to join in-person. [J Contin Educ Nurs. 2021;52(7):313-318.].

Delirium incidence, risk factors, and treatments in older adults receiving chemotherapy: A systematic review and meta-analysis.

INTRODUCTION: Older adults with cancer are at increased risk of delirium due to age, comorbidities, medications, cognitive impairment, and possibly cancer treatments. However, there is scant information on the risks of delirium with chemotherapy and approaches to prevent or treat it. We performed a systematic review and meta-analysis to summarize available evidence. MATERIALS AND METHODS: We systematically searched peer-reviewed journal articles in English, French, German, and Dutch from five databases from 1990 to May 2019 to identify studies examining delirium in adult patients receiving chemotherapy. We also attempted to identify delirium risk prediction models and prevention or treatment trials. All reviews and data extraction were performed by two independent reviewers. Summary estimates were derived from random effects models. RESULTS: A total of 23,389 titles and abstracts were screened, and 1272 full-text articles were reviewed. Nineteen articles reported on delirium using an acceptable diagnostic standard. Sample sizes varied from 7 to 324. The incidence of delirium ranged from 0 to 51% (weighted mean 9%, 95% confidence interval 5-16%). In a sensitivity analysis including 122 studies that used terminology suggestive of delirium but did not meet our inclusion criteria, the weighted incidence of delirium was 10% (95% confidence interval 8-12%). Age was not consistently associated with increased delirium risk. No intervention studies to prevent or treat delirium were identified. CONCLUSIONS: Delirium may occur in 1 in 11 older adults receiving chemotherapy; however, there were substantial limitations in reported studies. This systemic review highlights key gaps in knowledge, particularly regarding risk factors, prevention, and treatments.

Identifying and understanding the health and social care needs of older adults with multiple chronic conditions and their caregivers: a scoping review.

BACKGROUND: As the population is aging, the number of persons living with multiple chronic conditions (MCC) is expected to increase. This review seeks to answer two research questions from the perspectives of older adults with MCC, their caregivers and their health care providers (HCPs): 1) What are the health and social care needs of community-dwelling older adults with MCC and their caregivers? and 2) How do social and structural determinants of health impact these health and social care needs? METHODS: We conducted a scoping review guided by a refinement of the Arksey & O'Malley framework. Articles were included if participants were 55 years or older and have at least two chronic conditions. We searched 7 electronic databases. The data were summarized using thematic analysis. RESULTS: Thirty-six studies were included in this review: 28 studies included participants with MCC; 12 studies included HCPs; 5 studies included caregivers. The quality of the studies ranged from moderate to good. Five main areas of needs were identified: need for information; coordination of services and supports; preventive, maintenance and restorative strategies; training for older adults, caregivers and HCPs to help manage the older adults' complex conditions; and the need for person-centred approaches. Structural and social determinants of health such as socioeconomic status, education and access influenced the needs of older adults with MCC. CONCLUSION: The review highlights that most of the needs of older adults with MCC focus on lack of access to information and coordination of care. The main structural and social determinants that influenced older adults' needs were their level of education/health literacy and their socioeconomic status.