RESUMO
BACKGROUND: The purpose of this study was to compare the differences across occupational groups related to their end-of-life care-specific educational needs and reported intensity of interprofessional collaboration in long-term care (LTC) homes. METHODS: A cross-sectional survey, based on two questionnaires, was administered at four LTC homes in Ontario, Canada using a modified Dilman's approach. The first questionnaire, End of Life Professional Caregiver Survey, included three domains: patients and family-centered communication, cultural and ethical values, effective care delivery. The Intensity of Interprofessional Collaboration Scale included two subscales: care sharing activities, and interprofessional coordination. In total, 697 LTC staff were given surveys, including personal support workers, support staff (housekeeping, kitchen, recreation, laundry, dietician aids, office staff), and registered staff (licensed nurses, physiotherapists, social workers, pharmacists, physicians). RESULTS: A total of 317 participants completed the survey (126 personal support workers, 109 support staff, 82 registered staff) for a response rate of 45%. Significant differences emerged among occupational groups across all scales and subscales. Specifically, support staff rated their comfort of working with dying patients significantly lower than both nurses and PSWs. Support staff also reported significantly lower ratings of care sharing activities and interprofessional coordination compared to both registered staff and personal support workers. CONCLUSIONS: These study findings suggest there are differing educational needs and sense of interprofessional collaboration among LTC staff, specific to discipline group. Both the personal support workers and support staff groups appeared to have higher needs for education; support staff also reported higher needs related to integration on the interdisciplinary team. Efforts to build capacity within support staff related to working with dying residents and their families are needed. Optimal palliative care may require resources to increase the availability of support for all staff involved in the care of patients.
Assuntos
Avaliação das Necessidades , Ocupações , Cuidados Paliativos/métodos , Educação de Pacientes como Assunto/métodos , Adulto , Estudos Transversais , Feminino , Humanos , Relações Interprofissionais , Assistência de Longa Duração , Masculino , Pessoa de Meia-Idade , Casas de Saúde , Ontário , Psicometria/instrumentação , Psicometria/métodos , Inquéritos e Questionários , Recursos HumanosRESUMO
INTRODUCTION: Efforts are needed to improve palliative care in rural communities, given the unique characteristics and inherent challenges with respect to working within the physical aspects of residential settings. Nurses who work in rural communities play a key role in the delivery of palliative care services. Hence, the purpose of this study was to explore nurses' experiences of providing palliative care in rural communities, with a particular focus on the impact of the physical residential setting. METHODS: This study was grounded in a qualitative approach utilizing an exploratory descriptive design. Individual telephone interviews were conducted with 21 community nurses. Data were analyzed by thematic content analysis. RESULTS: Nurses described the characteristics of working in a rural community and how it influences their perception of their role, highlighting the strong sense of community that exists but how system changes over the past decade have changed the way they provide care. They also described the key role that they play, which was often termed a 'jack of all trades', but focused on providing emotional, physical, and spiritual care while trying to manage many challenges related to transitioning and working with other healthcare providers. Finally, nurses described how the challenges of working within the physical constraints of a rural residential setting impeded their care provision to clients who are dying in the community, specifically related to the long distances that they travel while dealing with bad weather. CONCLUSIONS: These study findings contribute to our understanding of the experiences of nurses working in rural communities in terms of the provision of palliative care and the influence of the physical residential setting that surrounds them. These findings are important since nurses play a major role in caring for community-dwelling clients who are dying, but they are confronted with many obstacles. As such, these results may help inform future decisions about how to best improve access to important services and ways to support them while providing palliative care to rural individuals.
Assuntos
Enfermeiras e Enfermeiros/psicologia , Cuidados Paliativos/organização & administração , Características de Residência/estatística & dados numéricos , Serviços de Saúde Rural/organização & administração , Adolescente , Adulto , Idoso , Comportamento Cooperativo , Feminino , Humanos , Relações Interprofissionais , Satisfação no Emprego , Pessoa de Meia-Idade , Papel do Profissional de Enfermagem , Adulto JovemRESUMO
Community support services (CSSs) have been developed in Canada and other Western nations to enable persons coping with health or social issues to continue to live in the community. This study addresses the extent to which awareness of CSSs is structured by the social determinants of health. In a telephone interview conducted in February-March 2006, 1152 community-dwelling older adults (response rate 12.4%) from Hamilton, Ontario, Canada were made to read a series of four vignettes and were asked whether they were able to identify a CSS they may turn to in that situation. Across the four vignettes, 40% of participants did name a CSS as a possible source of assistance. Logistic regression was used to determine factors related to awareness of CSSs. Respondents most likely to have awareness of CSS include the middle-aged and higher-income groups. Being knowledgeable about where to look for information about CSSs, having social support and being a member of a club or voluntary organisations are also significant predictors of awareness of CSSs. Study results suggest that efforts be made to improve the level of awareness and access to CSSs among older adults by targeting their social networks as well as their health and social care providers.
Assuntos
Serviços de Saúde Comunitária , Conhecimentos, Atitudes e Prática em Saúde , Serviços de Saúde para Idosos , Apoio Social , Idoso , Feminino , Humanos , Entrevistas como Assunto , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , OntárioRESUMO
This paper presents a detailed description of health care resource utilisation and costs of a pilot interdisciplinary health care model of palliative home care in Ontario, Canada. The descriptive evaluation entailed examining the use of services and costs of the pilot program: patient demographics, length of stay broken down by disposition (discharged, alive, death), access to services/resources, use of family physician and specialist services, and drug use. There were 434 patients included in the pilot program. Total costs were approximately CAN$2.4 million, and the cost per person amounted to approximately CAN$5586.33 with average length of stay equal to over 2 months (64.22 days). One may assume that length of stay would be influenced by the amount of service and support available. Future research might investigate whether in-home palliative home care is the most cost effective and suitable care setting for those patients requiring home care services for expected periods of time.
Assuntos
Recursos em Saúde/estatística & dados numéricos , Serviços de Assistência Domiciliar/economia , Tempo de Internação/economia , Neoplasias/terapia , Cuidados Paliativos/economia , Equipe de Assistência ao Paciente/economia , Adolescente , Idoso , Idoso de 80 Anos ou mais , Feminino , Recursos em Saúde/economia , Acessibilidade aos Serviços de Saúde/economia , Serviços de Assistência Domiciliar/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/economia , Ontário , Equipe de Assistência ao Paciente/estatística & dados numéricos , Projetos Piloto , Avaliação de Programas e Projetos de Saúde , Adulto JovemRESUMO
INTRODUCTION: Variation across research ethics boards (REBs) in conditions placed on access to medical records for research purposes raises concerns around negative impacts on research quality and on human subject protection, including privacy. AIM: To study variation in REB consent requirements for retrospective chart review and who may have access to the medical record for data abstraction. METHODS: Thirty 90-min face-to-face interviews were conducted with REB chairs and administrators affiliated with faculties of medicine in Canadian universities, using structured questions around a case study with open-ended responses. Interviews were recorded, transcribed and coded manually. RESULTS: Fourteen sites (47%) required individual patient consent for the study to proceed as proposed. Three (10%) indicated that their response would depend on how potentially identifying variables would be managed. Eleven sites (38%) did not require consent. Two (7%) suggested a notification and opt-out process. Most stated that consent would be required if identifiable information was being abstracted from the record. Among those not requiring consent, there was substantial variation in recognising that the abstracted information could potentially indirectly re-identify individuals. Concern over access to medical records by an outside individual was also associated with requirement for consent. Eighteen sites (60%) required full committee review. Sixteen (53%) allowed an external research assistant to abstract information from the health record. CONCLUSIONS: Large variation was found across sites in the requirement for consent for research involving access to medical records. REBs need training in best practices for protecting privacy and confidentiality in health research. A forum for REB chairs to confidentially share concerns and decisions about specific studies could also reduce variation in decisions.
Assuntos
Pesquisa Biomédica/ética , Confidencialidade/legislação & jurisprudência , Comitês de Ética em Pesquisa/ética , Prontuários Médicos/legislação & jurisprudência , Privacidade/legislação & jurisprudência , Sujeitos da Pesquisa/legislação & jurisprudência , Pesquisa Biomédica/normas , Canadá , Confidencialidade/psicologia , Confidencialidade/normas , Comitês de Ética em Pesquisa/normas , Humanos , Privacidade/psicologia , Sujeitos da Pesquisa/psicologiaRESUMO
Previous findings on older adults' awareness of community support services (CSSs) have been inconsistent and marred by acquiescence or over-claiming bias. To address this issue, this study used a series of 12 vignettes to describe common situations faced by older adults for which CSSs might be appropriate. In telephone interviews, 1,152 adults aged 50 years and over were read a series of vignettes and asked if they were able to identify a community organization or agency that they may turn to in that situation. They were also asked about their most important sources of information about CSSs. The findings show that, using a vignette methodology, awareness of CSSs is much lower than previously thought. The most important sources of information about CSSs included information and referral sources, the telephone book, doctors' offices, and word of mouth.
Assuntos
Envelhecimento , Conscientização , Serviços de Saúde Comunitária , Seguridade Social , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Avaliação Geriátrica , Processos Grupais , Humanos , Masculino , Pessoa de Meia-Idade , Ontário , Projetos de Pesquisa , Estudos de Amostragem , Inquéritos e QuestionáriosRESUMO
Changes in the health care system have meant that increasing numbers of the terminally ill receive the majority of their care at home. The purpose of this paper was to document patterns of informal and formal care provided to the terminally ill and assess the impact caregiving has on family members. One hundred and fifty-one family caregivers were recruited for interviews from two community-nursing agencies in an urban region of the province of Ontario, Canada. The majority of respondents 119 (79%) were the female spouses of the patient. The numbers of caregivers providing assistance in specific functional activities were: bathing, 133 (88%); mobility, 123 (81%); dressing and undressing, 114 (76%); toileting, 101(67%), and assistance at night 97 (64%). Sixty-two (41%) respondents reported that they had been providing some form of caregiving for over one year. They also reported that physical demands in caregiving increased substantially during the last three months of the care recipient's life. As family caregivers provided more assistance in activities of daily living they were at greater risk of reporting high caregiver burden. The results of this paper identify the types of care provided by family caregivers of the terminally ill and the impact these demands have on the family caregiver.
Assuntos
Cuidadores/psicologia , Efeitos Psicossociais da Doença , Família/psicologia , Assistência Domiciliar/psicologia , Qualidade de Vida/psicologia , Assistência Terminal/psicologia , Atividades Cotidianas , Idoso , Estudos de Coortes , Feminino , Serviços de Assistência Domiciliar/estatística & dados numéricos , Humanos , Entrevistas como Assunto , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Ontário , Cuidados Paliativos , Apoio Social , Cônjuges/psicologia , TempoRESUMO
BACKGROUND: Infections pose a substantial burden to the health of older adults. In this report, we describe the proceedings of a workshop to formulate and prioritize research questions about infections in older adults using an interdisciplinary approach. METHODS: Researchers from four sectors (basic science, clinical sciences, health services and epidemiology/determinants of health) and representatives from various Canadian local, provincial, and federal stakeholder groups were invited to a two-day workshop. Five multi-disciplinary groups and stakeholders from each of three healthcare settings (long term, acute care and community) discussed research priorities for each of the settings. Five to ten research questions were identified for each setting. RESULTS: The research questions proposed ranged from risk factors and outcomes for different infections to the effect of nutrition on infection and the role of alternative and complementary medicine in treating infections. Health service issues included barriers to immunization, prolongation of hospital length of stay by infection, use of care paths for managing infections, and decision-making in determining the site of care for individuals with infections. Clinical questions included risk factor assessment for infection, the effectiveness of preventative strategies, and technology evaluation. Epidemiologic issues included the challenge of achieving a better understanding of respiratory infections in the community and determining the prevalence of colonization with multi-resistant bacteria. CONCLUSIONS: The questions are of direct relevance to researchers in a wide variety of fields. Bringing together a multi-disciplinary group of researchers to frame and prioritize research questions about aging is feasible, participants valued the opinions of people working in other areas.
RESUMO
OBJECTIVE: To identify risk factors for falls and injuries among seniors living in a long-term care facility. METHOD: Case-control study of 335 residents living at St. Joseph's Villa, Dundas, Ontario. Cases were defined as residents who fell between July 1, 1996 and June 30, 1997; controls were those who did not fall. To identify risk factors for injury, cases were defined as those with completed incident injury forms and controls as those without. RESULTS: The most important risk factors for falls included: having fallen in the past three months; residing in a secured unit; living in the facility for two or more years; having the potential to cause injury to others; and having an illness, disease or behaviour that may cause a fall. The most important risk factor for injury among those who fell was altered mental state. CONCLUSION: The risk factors identified may be helpful to those planning falls prevention initiatives within long-term care settings.
Assuntos
Acidentes por Quedas/estatística & dados numéricos , Instituições de Cuidados Especializados de Enfermagem/estatística & dados numéricos , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/etiologia , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Confusão/complicações , Feminino , Avaliação Geriátrica , Humanos , Modelos Logísticos , Masculino , Ontário/epidemiologia , Medição de Risco , Fatores de Risco , Gestão de RiscosRESUMO
Data obtained with any research tool must be reproducible, a concept referred to as reliability. Three techniques are often used to evaluate reliability of tools using continuous data in aging research: intraclass correlation coefficients (ICC), Pearson correlations, and paired t tests. These are often construed as equivalent when applied to reliability. This is not correct, and may lead researchers to select instruments based on statistics that may not reflect actual reliability. The purpose of this paper is to compare the reliability estimates produced by these three techniques and determine the preferable technique. A hypothetical dataset was produced to evaluate the reliability estimates obtained with ICC, Pearson correlations, and paired t tests in three different situations. For each situation two sets of 20 observations were created to simulate an intrarater or inter-rater paradigm, based on 20 participants with two observations per participant. Situations were designed to demonstrate good agreement, systematic bias, or substantial random measurement error. In the situation demonstrating good agreement, all three techniques supported the conclusion that the data were reliable. In the situation demonstrating systematic bias, the ICC and t test suggested the data were not reliable, whereas the Pearson correlation suggested high reliability despite the systematic discrepancy. In the situation representing substantial random measurement error where low reliability was expected, the ICC and Pearson coefficient accurately illustrated this. The t test suggested the data were reliable. The ICC is the preferred technique to measure reliability. Although there are some limitations associated with the use of this technique, they can be overcome.
Assuntos
Envelhecimento , Interpretação Estatística de Dados , Bases de Dados Factuais , Humanos , Reprodutibilidade dos TestesRESUMO
OBJECTIVES: to measure the extent to which the recommendations of a geriatric outreach assessment service were being followed, and to determine what patient-related factors were associated with compliance with assessment recommendations. METHODS: eighty-one eligible patients or caregivers who had an assessment in a geriatric outreach service participated in a telephone interview. The interview focused on the use of health services and compliance with assessment recommendations. Patient-related variables obtained from charts included demographics, caregiver support and stability, health status and assessment recommendations. RESULTS: overall compliance with recommendations from the geriatric outreach assessment service was 65%. Patients were less likely comply fully with recommendations if they had a high number of recommendations [odds ratio (OR) = 0.23; 95% confidence interval (CI) = 0.12-0.46; P = 0.0001], inadequate caregiver support (OR = 0.212; 95% CI = 0.04 to 1.02; P = 0.0523), or the ability to transfer themselves independently (OR = 0.12; 95% CI = 0.02-0.63; P = 0.0124). They were more likely to have full compliance if they had normal vision (OR = 6.67; 95% CI = 1.22-36.46; P = 0.0284). CONCLUSION: it is important to focus on key issues when developing service recommendations and on the role of the informal caregiver in facilitating compliance with them. Good communication between the patient or caregiver and the family physician and geriatric services can help to identify strategies which might improve acceptance of recommendations.
Assuntos
Avaliação Geriátrica , Fidelidade a Diretrizes , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Entrevistas como Assunto , MasculinoRESUMO
We conducted a qualitative case study as part of a needs assessment for a day hospice in a small Ontario city. Data were gathered from semi-structured interviews with 28 stakeholders: nine health care administrators, 11 health care providers, and eight lay people (terminally ill adults and informal caregivers). Respondents described support, counselling, social activities, and respite as key day hospice services. They also described several barriers to accessing services, including location, transportation, admission criteria, referrals, and fees. For most respondents, the ideal staff mix includes both volunteers and paid professionals in either a free-standing organization or institutionally linked hospice. Although the vast majority of participants were reluctant to impose admission criteria or other limitations on hospice clientele, they expressed the need to ensure equitable access to this scarce resource. Opinions varied greatly across stakeholder groups, highlighting the need to collect information from all relevant stakeholder groups when planning hospices.
Assuntos
Hospital Dia , Cuidados Paliativos na Terminalidade da Vida , Avaliação das Necessidades , Humanos , Entrevistas como Assunto , OntárioRESUMO
OBJECTIVE: To identify, assess, and rank the importance of health care needs of community-dwelling older adults. METHOD: A structured telephone interview with 107 respondents (physicians, direct service providers and administrators) about the importance of a list of 31 health care needs of older adults. Respondents also identified the single most important health issue facing local older adults now and in the next 5 to 10 years. RESULTS: The five most important health care needs, in descending order, are: care-giver support services, community long-term care services, services for people with dementia/Alzheimer's disease, palliative/end-of-life care, and services for cancer patients and their families. Community long-term care services were identified as the single most important health issue both now and in the next 5 to 10 years. CONCLUSION: The study findings should be of value to health and social service researchers, planners, providers and administrators regarding the needs of community-dwelling older adults.
Assuntos
Planejamento em Saúde Comunitária/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde/classificação , Serviços de Saúde para Idosos/classificação , Avaliação das Necessidades/estatística & dados numéricos , Atividades Cotidianas , Idoso , Atitude do Pessoal de Saúde , Estudos Transversais , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Serviços de Saúde para Idosos/estatística & dados numéricos , Humanos , Entrevistas como Assunto , Ontário , Inquéritos e Questionários , TelefoneRESUMO
The purpose of this paper is to provide a framework for developing an effective evaluation practice within health care settings. Three features are reviewed; capacity building, the application of evaluation to program activities and the utilization of evaluation recommendations. First, the organizational elements required to establish effective evaluation practice are reviewed emphasizing that an organization's capacity for evaluation develops over time and in stages. Second, a comprehensive evaluation framework is presented which demonstrates how evaluation practice can be applied to all aspects of a program's life cycle, thus promoting the scope of evidence-based decision making within an organization. Finally, factors which influence the adoption of evaluation recommendations by decision makers are reviewed accompanied by strategies to promote the utilization of evaluation recommendations in organization decision making.
Assuntos
Pesquisa sobre Serviços de Saúde/métodos , Avaliação de Programas e Projetos de Saúde/métodos , Canadá , Tomada de Decisões Gerenciais , Organização do Financiamento , Gestão da Informação , Avaliação das Necessidades , Cultura Organizacional , Política Organizacional , Avaliação de Resultados em Cuidados de Saúde , Responsabilidade SocialRESUMO
The purpose of the study was to evaluate the influence of a geriatric nursing education workshop on nursing staff competency. Forty-three nurses participated in the study, which used an intervention and comparison group research design with pretest and posttest measures. The results indicated that participation in the workshop increased nurses' knowledge of gerontologic issues and improved nurses' ability to assess patients and to plan and document nursing interventions in patient charts. The intervention did not have a significant impact on collaborative practice, role ambiguity, or job satisfaction.
Assuntos
Competência Clínica/normas , Educação Continuada em Enfermagem/normas , Enfermagem Geriátrica/educação , Satisfação no Emprego , Recursos Humanos de Enfermagem Hospitalar/educação , Recursos Humanos de Enfermagem Hospitalar/psicologia , Desenvolvimento de Pessoal/normas , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Avaliação de Programas e Projetos de SaúdeRESUMO
The purpose of the present study was to examine the role of a rapid access home-based service as a means for the elderly to avoid admission to an acute-care hospital. The setting for the study included emergency departments in three acute care hospitals and a home care program in a mid-size Canadian city. Multiple sources of information were obtained to evaluate the service. Hospital emergency department records and home care records were reviewed. Patients who participated in the service (n = 96) and physicians and nurses (n = 119) who had involvement with the service were surveyed appraising the service in terms of relevance, access, quality and coordination. Study results revealed that elderly women with multiple health problems who lived alone were the most frequent users of the service. The majority of the patients admitted to the service presented with problems of a functional nature that were the result of a fall or mobility problems. The results indicated that the service did avert hospital admissions and facilitated a process by which patients could avoid the intermediate step of hospitalization before placed in a higher level of care or returning to previous levels of functioning. Economic analysis indicated that the value of the service stemmed from the benefits to patients and caregivers rather than from cost savings offered to acute care hospitals.
Assuntos
Avaliação Geriátrica , Serviços de Assistência Domiciliar/organização & administração , Hospitalização/estatística & dados numéricos , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Redução de Custos , Feminino , Serviços de Assistência Domiciliar/economia , Serviços de Assistência Domiciliar/estatística & dados numéricos , Custos Hospitalares , Hospitalização/economia , Humanos , Masculino , Saúde Mental , Ontário , Inquéritos e QuestionáriosRESUMO
The purpose of this study was to examine differences in asthma management among families with a child who has moderate to severe asthma. Half of the 50 families chosen for study had participated in an intensive in-patient asthma treatment program and half had participated in an out-patient day camp. Two broad categories of outcome were examined-illness and self-management skills. Families who participated in the in-patient program exhibited a pattern of illness behaviours which indicated asthma symptoms were better managed in comparison to those families that participated in the out-patient program. It was also observed that children who participated in the in-patient program had a tendency to feel more positive about having asthma with the more self-management behaviours they practised. On the other hand, children from the out-patient program reported a more negative attitude about having asthma with the more self-management behaviours they practised.
Assuntos
Adaptação Psicológica , Asma/terapia , Saúde da Família , Hospitalização , Educação de Pacientes como Assunto , Criança , Feminino , Humanos , Masculino , Índice de Gravidade de DoençaRESUMO
As fiscal pressures mount, health-planning and decision-making at smaller geographics scales must be more effective. Involving local constituents in needs assessments, it is believed, would lead to better identification and serving of regional demands and needs for health services. This article examines needs assessment as a tool to determine a community's service needs and establish priorities for the creation of programs. Various approaches used in needs assessments are described, including survey methods, structured groups and geographic information systems.
Assuntos
Planejamento em Saúde Comunitária/métodos , Necessidades e Demandas de Serviços de Saúde , Canadá , Área Programática de Saúde , Geografia , Prioridades em Saúde , Pesquisa sobre Serviços de Saúde/métodos , Sistemas de Informação , Avaliação de Resultados em Cuidados de Saúde , Dinâmica Populacional , Índice de Gravidade de Doença , Revisão da Utilização de Recursos de SaúdeRESUMO
1. Decreasing the prevalence of pressure ulcers in a chronic care hospital presents a challenge to care providers. 2. The promotion of staff nurses as educational resources has a positive effect on their participation in a wound and skin care team. 3. When basic prevention practices are not in place, risk factors are less useful indicators to predict the development of pressure ulcers. 4. Educating nurses about pressure ulcer etiology, prevention strategies, and treatments has a positive impact on reducing the number of patients who develop pressure ulcers and the number of pressure ulcers that develop on patients in a chronic care hospital.