Factors influencing nursing professionals' adherence to facial protective equipment usage: A comprehensive review.

BACKGROUND: Facial protective equipment (FPE) adherence is necessary for the health and safety of nursing professionals. This review was conducted to synthesize predisposing, enabling, and reinforcing factors that influence FPE adherence, and thus inform efforts to promote adherence. METHODS: Articles were collected using Cumulated Index to Nursing and Allied Health Literature and MEDLINE and screened for inclusion. Included articles were original studies focused on FPE adherence by nurses to prevent respiratory infection which contained occupation-specific data from at least 10 individuals and were published in English between January 2005 and February 2022. RESULTS: Thirty articles were included, 21 of which reported adherence rates. Adherence ranged from 33% to 100% for respiratory protection and 22% to 100% for eye protection. Predisposing demographic factors influencing adherence included tenure and occupation, while modifiable predisposing factors included knowledge and perception of FPE, infection transmission, and risk. Enabling factors included geography, care settings, and FPE availability. Reinforcing factors included organizational support for health and safety, clear policies, and training. CONCLUSIONS: The identified demographic factors suggest populations that may benefit from targeted interventions, while modifiable factors suggest opportunities to enhance education as well as operational processes and supports. Interventions that target these areas have the potential to promote adherence and thereby improve the occupational safety of nurses.

Efficacy of Installation of Temporary Bathing Transfer Aids by Older Adults.

Grab bars facilitate bathing and reduce the risk of falls during bathing. Suction cup handholds and rim-mounted tub rails are an alternative to grab bars. The objective of this study was to determine whether older adults could install handholds and tub rails effectively to support bathing transfers. Participants installed rim-mounted tub rails and suction cup handholds in a simulated bathroom environment. Installation location and mechanical loading performance were evaluated. Participant perceptions during device installation and a bathing transfer were characterized. While 85% of suction cup handholds met loading requirements, more than half of participants installed the suction cup handhold in an unexpected location based on existing guidance documents. No rim-mounted tub rails were successfully installed. Participants were confident that the devices had been installed effectively. Suction cup handholds and rim mounted tub rails are easy to install, but clients may need additional guidance regarding where, and how to install them.

Shifting the Safety Culture: Evaluation of a Novel Approach to Understanding and Responding to Workplace Harassment and Violence Experienced by Homecare Workers.

BACKGROUND: Workplace violence and harassment are commonplace for healthcare workers and most incidents are unreported. Normalization of these experiences, lack of confidence in reporting systems, and fear of the consequences of reporting contribute to the invisibility of these experiences. Challenges are exacerbated in homecare settings and for precarious workforces including Personal Support Workers (PSWs). We created, piloted, and evaluated an intervention to enhance safety culture and encourage reporting of workplace violence and harassment. METHODS: A multi-stakeholder steering committee designed an intervention combining policy changes, a pre-visit screening tool, education, and brief end-of-visit reporting. This was piloted with a PSW care team which provided >55,000 client visits during the 32-week intervention. Operational metrics characterized screening, education, and reporting uptake. Pre- and post-intervention surveys characterized PSWs' experiences with workplace violence and harassment, reporting experiences, training history and intervention feedback. FINDINGS: PSWs reported increased comfort discussing workplace violence and harassment, and increased confidence managing client-to-worker incidents. The screening went smoothly with most clients in private homes. Most PSWs (75%) engaged at least once with end-of-visit reporting and nearly half submitted reports regularly. During the pilot, 21% of PSWs reported incidents and 52% of reports shared client-specific strategies for managing these situations. APPLICATION TO PRACTICE: Changes in comfort and behavior with reporting indicated a shift toward a more open culture surrounding workplace violence and harassment. Tools created for this intervention and lessons for implementation are shared for consideration by occupational health practitioners throughout the homecare sector.

Developing and Retaining Homecare Nurses Through Employer-Based Tuition Assistance Programs: A Mixed Methods Study.

PURPOSE: This study describes how an employer-based tuition-assistance program for homecare workers at one Canadian homecare organization enabled nursing career advancement and retention. DESIGN: A convergent parallel mixed-methods design. METHODS: We reviewed existing administrative data and concurrently conducted semi-structured interviews. Descriptive statistics were used on quantitative data and qualitative data was analyzed using thematic analysis. A joint data display was developed to integrate findings from both quantitative and qualitative data together. FINDINGS: Tuition assistance reduced financial barriers to career advancement; 83% of recipients remained with their employer for at least 1-year post-studies but only 29% experienced career advancement. Psychosocial supports, career navigation and coaching to ease the licensing and role transition processes were identified as opportunities to support learners. CONCLUSION: Employer-based tuition assistance programs are impactful in helping to develop skilled employees. Practical enhancements to further support career transitions may maximize retention to address urgent homecare staffing challenges. CLINICAL EVIDENCE: Employer-based tuition assistance can be a useful strategy to support nursing career growth and staff retention.

How Might We Have Known? Using Administrative Data to Predict 30-Day Hospital Readmission in Clients Receiving Home Care Services from 2018 to 2021.

Background: Reducing hospital readmissions can improve individual health outcomes and lower system-level costs. This study aimed to understand the characteristics of home care Personal Support clients who experienced a hospital admission (ie, hospital hold) and to identify factors that predict hospital readmission within 30 days of resuming home care Personal Support services. Methods: We conducted a retrospective cohort study using client administrative data from a home healthcare provider organization (2018-2021). The sample included clients (⩾18 years) who received publicly funded Personal Support services and experienced a hospital hold. Descriptive statistics and a binary logistic regression model analyzed the relationship between demographics, hospital service utilization, home care service utilization, and contextual factors on the outcome of 30-day hospital readmission. Results: Approximately 17% (n = 662) of all clients with a hospital hold (n = 3992) were readmitted to hospital within 30 days. Compared with non-readmitted clients, those with greater home care Personal Support service intensity after the index hospital hold were less likely to experience a hospital 30-day readmission. In contrast, those with greater acuity, higher assessed care needs, more hospital holds overall, more extended hospital stays (⩾2 weeks), and lower social support had a higher likelihood of 30-day hospital readmission. Conclusion: The findings from this study provide a greater understanding of factors associated with home care clients' risk of hospital readmission within 30 days and can be used to inform targeted, evidence-based support to reduce home care clients' hospital readmissions.

Why Did Home Care Personal Support Service Volumes Drop During the COVID-19 Pandemic? The Contributions of Client Choice and Personal Support Worker Availability.

Home care personal support service delivery decreased during the COVID-19 pandemic, and qualitative studies have suggested many potential contributors to these reductions. This paper provides insight into the source (client or provider) of reductions in home care service volumes early in the pandemic through analysis of a retrospective administrative dataset from a large provider organization. The percentage of authorized services not delivered was 17.2% in Wave 1, 12.6% in Wave 2 and 10.5% in Wave 3, nearing the pre-pandemic baseline of 8.9%. The dominant contribution to reduced home care service volumes was client-initiated holds and cancellations, collectively accounting for 99.3% of the service volume; missed care visits by the provider accounted for 0.7%. Worker availability also declined due to long-term absences (which increased 5-fold early in Wave 1 and remained 4× above baseline in Waves 2 and 3); short-term absences rose sharply for 6 early-pandemic weeks, then dropped below the pre-pandemic baseline. These data reveal that service volume reductions were primarily driven by client-initiated holds and cancellations; despite unprecedented decreases in Personal Support Worker availability, missed care did not increase, indicating that the decrease in demand was more substantial and occurred earlier than the decrease in worker availability.

Whole versus hole: enabling community nurses to implement holistic wound care.

OBJECTIVE: To improve wound-related quality of life (QoL) in clients with hard-to-heal wounds in their lower limbs and to increase referrals to multidisciplinary teams in the management of care for these clients. METHOD: This was a quality improvement project with a two-group pretest-posttest interventional evaluation design. We implemented a package of interventions including the WounDS app, education related to wound care, and client engagement through a QoL self-assessment. Wound-related QoL was measured using the Cardiff Wound Impact Schedule and referrals to the multidisciplinary team were tracked through chart audits. We explored nurses' experiences with the interventions through semi-structured interviews. RESULTS: Clients' average ratings for 'wellbeing', 'physical symptoms and daily living', and 'overall QoL' improved by 27%, 38% and 54%, respectively. The number of referrals increased by 78% post intervention. Nurses described the interventions as effective strategies that motivated them to implement a holistic approach to care. CONCLUSION: The project was successful in creating a culture shift to practice holistic wound care. This package of interventions (WounDS app, education and client self-assessment of QoL) led to improvements in the QoL of clients with hard-to-heal wounds. Further studies are needed to generalise the findings. Strategies for sustainability include forming a champion group and providing the education and decision supports based on nurses' educational needs assessment.

A Good Investment: Expanding Capacity to Care for Older Adults in the Home and Community Care Sector Through Increased Personal Support Worker Wages.

Most older adults prefer to age in place, which for many will require home and community care (HCC) support. Unfortunately, HCC capacity is insufficient to meet demand due in part to low wages, particularly for personal support workers (PSWs) who provide the majority of paid care. Using Ontario as a case study, this paper estimates the cost and capacity impacts of implementing wage parity between PSWs employed in HCC and institutional long-term care (ILTC). Specifically, we consider the cost of increased HCC PSW wages versus expected savings from avoiding unnecessary ILTC placement for those accommodated by HCC capacity growth. The expected increase in HCC PSW retention would create HCC capacity for approximately 160,000 people, reduce annual health system costs by approximately $7 billion, and provide an 88 per cent return on investment. Updating wage structures to reduce turnover and enable HCC capacity growth is a cost-efficient option for expanding health system capacity.

Economic Evidence for Home and Community Care Investment: The Case for Ontario Personal Support Workers' Wage Parity.

The home and community care (HCC) sector is in a health human resource crisis. Particularly concerning is the shortage of personal support workers (PSWs) who provide the majority of HCC. This paper outlines a strategy to mitigate the HCC PSW shortage by applying appropriate funding to HCC and focusing on equal pay between HCC and institutional long-term care facilities' PSWs. Using publicly available data, our calculations estimate substantial government cost-savings from investing in HCC PSWs to increase HCC capacity. Beyond the economic evidence, how such investments would benefit those seeking care are also highlighted.

Is 911 The Answer? A Retrospective Review of Emergency Medical Services Use by Home Care Providers.

With the Ontario healthcare system under strain the use of resources-particularly emergency medical services (EMS) is an increasing focus. Recent work has identified long-term care facilities as high users of EMS despite access to health-related support outside of the hospital. However, such insights are not available for home care. A retrospective review of administrative records of EMS calls drawn from over 6 million visits by home care providers found relatively low call rates: 8.4 calls per 100 000 personal support visits, 4.1 calls per 100 000 for rehabilitation providers, and 0.9 calls per 100 000 for nurses. The majority (85%) of calls resulted in transport to the hospital; the notable exception was fall-related events, and of these falls, a third (32%) were treated at home. Classification of reported physical symptoms suggests opportunities for leveraging in-home clinical specialists to avoid hospital transport where possible and preserve EMS capacity to respond to the most urgent and severe events.

"You Have to Be Careful About Every Detail" How the COVID-19 Pandemic Shaped the Experiences of Canadian Personal Support Workers Working in Home Care.

OBJECTIVES: Personal support workers (PSWs) are an essential but vulnerable workforce supporting the home care sector in Canada. Given the impact COVID-19 has had on healthcare workers globally, understanding how PSWs have been impacted is vital. METHODS: We conducted a qualitative descriptive study to understand the working experiences of PSWs over the COVID-19 pandemic. Nineteen semistructured interviews were conducted, and analysis was guided by the collaborative DEPICT framework. RESULTS: Personal support workers are motivated by an intrinsic duty to work and their longstanding client relationships despite feeling vulnerable to transmission and infection. They experienced co-occurring occupational stressors and worsening work conditions, which impacted their overall well-being. CONCLUSIONS: Pandemic conditions have contributed to increased occupational stress among PSWs. Employers must implement proactive strategies that promote and protect the well-being of their workforce while advocating for sector improvements.

Occupational Hand Dermatitis in Health Care: Development and Evaluation of an Online Training E-Module.

Background: Occupational hand dermatitis (OHD) is an important health concern for health care workers (HCWs), yet there is a lack of accessible training materials on this topic. Objectives: The objective of this study was to develop and evaluate an OHD training e-module for HCWs. Methods: The e-module was created in collaboration with an expert advisory committee and tested by Ontario HCWs through pre- and post-training OHD knowledge tests, a usability survey, and a survey about intent to change work skin care practices. Analyses of survey results included means and paired t-tests. Results: The 10-minute OHD training e-module for HCWs was tested by 254 HCWs and found to be highly usable, to increase OHD knowledge immediately and sustainably, and to change workplace skin care practices. Average OHD knowledge test scores significantly improved by 19% between the pretest (64.50%) and post-test (83.50%). Most 6-month follow-up survey respondents reported changing their skin care work practices (76.69%). Conclusions: This research addresses the previous lack of accessible OHD training for workers in health care settings. The creation and evaluation of a no-cost accessible OHD training e-module for workers in health care settings showed promising results across knowledge increase, knowledge retention, skin care behavior changes, and usability.

Determinants of nurse's and personal support worker's adherence to facial protective equipment in a community setting during the COVID-19 pandemic in Ontario, Canada: A pilot study.

BACKGROUND: Appropriate and consistent facial protective equipment (FPE) use is critical for preventing respiratory illness transmission. Little is known about FPE adherence by home care providers. The purpose of this study is to adapt an existing facial protection questionnaire and use it to develop an initial understanding of factors influencing home care providers' adherence to FPE during the COVID-19 pandemic. METHODS: A survey was shared with home care providers during Wave 2 of the COVID-19 pandemic in Ontario. Descriptive statistics and logistic regression by FPE adherence were conducted across individual, organizational, and environmental factors. RESULTS: Of the 199 respondents (140 personal support workers; 59 nurses), 71% reported that they always used FPE as required, with greater adherence to masks (89%) than eye protection (73%). The always-adherent reported greater perceived FPE efficacy, knowledge of recommended use and perceived occupational risk, lower education, and not experiencing personal barriers (including difficulty seeing, discomfort, communication challenges). DISCUSSION: Adherence rates were relatively high. In this context, with participants reporting high levels of organizational support, individual-level factors were the significant predictors of adherence. CONCLUSIONS: Initiatives addressing perceived FPE efficacy, knowledge of recommended use, perception of at-work risk, and personal barriers to use may improve FPE adherence.

Consumer perspectives on grab bars: A Canadian national survey of grab bar acceptability in homes.

Given the prevalence and severity of bathroom falls and injuries across age groups, there is growing interest in policy-level approaches to bathroom fall prevention. Grab bars reduce fall risk during bathing transfers and improve bathing accessibility for adults of all ages and abilities. However, they are frequently absent from bathing environments, even in the homes of individuals who have a specific need for a grab bar. While mandatory bathroom grab bar installation has been suggested, it is unclear whether this would be supported by Canadians. The purpose of this study was to characterize Canadian public perceptions on the installation and use of grab bars in home bathrooms. We surveyed 443 Canadians about whether they currently had a grab bar and their perspectives on grab bar policy. 65.4% of respondents did not have a grab bar. However, 88.5% of respondents would allow a grab bar to be installed in their bathroom at no cost to them, only 11.5% of respondents would object to grab bar installation becoming mandatory in new builds, and 85.6% of respondents would use a grab bar if it were installed in their bathroom. Responses were affected by age (in four groups: 18-39, 40-59, 60-79, and 80+ years), self-reported impairment, and home ownership status. Older adults, respondents who reported having impairments, and home owners were more likely to respond favorably toward grab bars. Based on these results, the majority of Canadians would respond positively to policy mandating bathroom grab bars in new homes.

Bathing frail seniors at home: Home care providers' approaches.

BACKGROUND: Home care providers assisting with seniors' personal care often experience high rates of musculoskeletal disorders, particularly affecting the lower back. Assisting with bathing is consistently identified as one of their most physically demanding activities. OBJECTIVE: To identify and describe care providers' procedures for assisting a frail senior to bathe that are likely to contribute most to the development of back injuries. METHODS: Eight community-based personal support workers (home care aides) assisted a frail senior (actor) to bathe in a simulated home bathroom. Video recordings of the activity were coded according to providers' postures and to characterize techniques for providing care. RESULTS: Exposure to severe trunk flexion and high posture-induced back loads was greatest during transfers in and out of the bathtub. In particular, lifting the legs over the rim of the tub, assisting the client to shift across the bath transfer bench, and providing care to the legs and feet involved the care provider spending substantial time in highly flexed postures. No observed techniques for these activities showed substantially lower exposures. CONCLUSIONS: Further tools and/or techniques must be identified or developed to improve caregiver safety during these strenuous activities.

Use of handrails for balance and stability: Characterizing loading profiles in younger adults.

Well-designed handrails significantly enhance balance recovery, by allowing users to apply high forces to the rail and stabilize their center of mass. However, data on user-applied handrail forces during balance recovery are limited. We characterized the peak forces that 50 young adults applied to a handrail during forward and backward falling motions; quantified effects of handrail height (34, 38, 42 inches) and position prior to balance loss (standing beside the rail with or without hand contact, or facing the handrail with two-handed contact); and examined the relationship between handrail forces and individual mass. The testing environment consisted of a robotic platform that translated rapidly to destabilize participants, and a height-adjustable handrail that was mounted to the platform. Our findings support our hypotheses that starting position and handrail height significantly affect peak handrail forces in most axes. The highest handrail forces were applied when participants faced the handrail and grasped with two hands. In these cases, increased handrail height was associated with increased anterior forces and decreased downward, upward and resultant forces. As hypothesized, peak handrail forces correlated strongly with individual weight in most axes. Implications of these findings for handrail design are discussed.

Assisting Frail Seniors With Toileting in a Home Bathroom: Approaches Used by Home Care Providers.

Home care providers experience high occupational injury rates. Improving safety is becoming increasingly urgent as this sector expands to support the aging population. Caregivers identify assisting with toileting as a particularly frequent and difficult activity. This mixed-methods observational study identified and analyzed the toileting subactivities that place care providers at the greatest risk of musculoskeletal injury. Eight personal support workers (home care aides) assisted a frail older adult (actor) in a simulated home bathroom. Overall technique and body postures were analyzed. Exposure to musculoskeletal injury risk factors (low back loads and time in extreme trunk postures) was greatest when removing/replacing clothing and providing posterior perineal care; high loads were also possible during transfers. Exposures can be reduced by lowering the pants only to knee level or squatting to raise them. A bidet seat or attachment can perform perineal cleaning, which accounted for 32% of time in severe trunk flexion.

Care Challenges in the Bathroom: The Views of Professional Care Providers Working in Clients' Homes.

In home care, bathroom activities-particularly bathing and toileting-present a unique set of challenges. In this focus group study, professional home care providers identified factors that increase the danger and difficulty of assisting their clients with bathing and toileting. These included small restrictive spaces, a poor fit between available equipment and the environment, a reliance on manual handling techniques (but insufficient space to use optimal body mechanics), attempts to maintain normalcy, and caring for unsteady and unpredictable clients. Specific elements of each activity that care providers found difficult included multitasking to support client stability while performing care below the waist (dressing/undressing, providing perineal care) and helping clients to lift their legs in and out of a bathtub. Participants did not feel that available assistive devices provided enough assistance to reduce the danger and difficulty of these activities.

Effect of Bathroom Aids and Age on Balance Control During Bathing Transfers.

Bathroom assistive devices are used to improve safety during bathing transfers, but biomechanical evidence to support clinical recommendations is lacking. This study evaluated the effectiveness of common bathroom aids in promoting balance control during bathing transfers. Twenty-six healthy adults (12 young, 14 older) stepped into and out of a slippery bathtub while using a vertical grab bar on the side wall, a horizontal grab bar on the back wall, a bath mat, a side wall touch, or no assistance. Balance control was characterized using center of pressure measures and showed greater instability for older adults. The vertical grab bar and wall touch resulted in the safest (best controlled) transfers. The bath mat provided improved balance control in the axis parallel to the bathtub rim but was equivalent to no assistance perpendicular to the rim, in the direction of obstacle crossing. These results can support clinical recommendations for safe bathing transfers.

The influence of prenatal exercise and pre-eclampsia on maternal vascular function.

During healthy pregnancy, the cardiovascular system undergoes diverse adaptations to support adequate transfer of oxygen and nutrients from mother to fetus. In order to accommodate the large expansion of blood volume and associated cardiac output, the structure, mechanics, and function of the arteries are altered. Specifically, in healthy pregnancy there is a remodeling of arteries (increased angiogenesis and vasodilation), a generalized reduction in arterial stiffness (increased compliance), and an enhanced endothelial function. The development of pregnancy complications, specifically pre-eclampsia, is associated with poor placentation (decreased angiogenesis), increased arterial stiffness, and vascular dysfunction (reduced endothelial function). Many of the positive adaptations that occur in healthy pregnancy are enhanced in response to chronic exercise. Specifically, placental angiogenesis and endothelial function have been shown to improve to a greater extent in women who are active during their pregnancy compared with those who are not. Prenatal exercise may be important in helping to reduce the risk of vascular dysfunction in pregnancy. However, our knowledge of the vascular adaptations resulting from maternal exercise is limited. This review highlights maternal vascular adaptations occurring during healthy pregnancy, and contrasts the vascular maladaptation associated with pre-eclampsia. Finally, we discuss the role of prenatal exercise on vascular function in the potential prevention of vascular complications associated with pre-eclampsia.