Negotiating culturally incongruent healthcare systems : the process of accessing dementia care in northern Saskatchewan

This study is an exploration of the process of accessing dementia care for Aboriginal Older Adults living in Northern Saskatchewan. The research question for this project was, “What is the process of accessing formal healthcare for dementia from the perspective of Northern Saskatchewan Aboriginal communities, and what factors specifically impede or encourage accessing formal care?” Grounded theory methodology informed the research process. Theoretical sampling resulted in a sample of thirty participants. Data were generated through eighteen in-person, semi-structured interviews; two in-person, semi-structured group interviews; and three focus group discussions including a directed activity led by participants. Analysis of data using the grounded theory constant comparison method led to an emergent theory that was verified by research participants.The theory that emerged explains the basic social process at the heart of the research question. The grounded theory, “The process of negotiating culturally incongruent healthcare systems” explains the access to and use of formal healthcare from the perspective of those living in Northern Saskatchewan. Specific attention to the social context of healthcare access helped to illuminate the challenges faced by Aboriginal Older Adults when accessing healthcare services. The findings indicate a need for enhancing the cultural competence of healthcare provision to Older Adults with dementia in Northern Saskatchewan while providing formal support for those persons with dementia as well as for their informal caregivers

NUTRITION CARE FOR LONG-TERM CARE RESIDENTS WITH DEMENTIA IN URBAN AND RURAL CONTEXTS: AN EVIDENCE BASED PRACTICE EXAMINATION OF THE ROLE OF CARE AIDES AND REGISTERED DIETITIANS

This doctoral dissertation contributes to the body of knowledge pertaining to nutrition care for persons with dementia. The aging population adds to the increased risk for and prevalence of dementia globally. Alongside this is a recognition of the need for care strategies for persons with dementia, and preventive strategies to delay onset of dementia or to delay secondary or tertiary comorbidity associated with dementia. Of strong interest is the field of nutrition, in terms of dietary strategies for primary prevention of dementia, for secondary and tertiary prevention of comorbidities, and for medical nutrition therapies to treat those with dementia, across the spectrum of dementing illnesses and degree of severity. Over the course of three related studies, nutrition care for long-term care (LTC residents was addressed using an evidence-based practice lens. Study 1 investigated care aides’ perception of nutrition care for urban and rural LTC residents with dementia. Key findings included the complexity of operationalizing person centered care into nutrition care activities, the mechanistic focus on feeding, and many organizational factors that direct nutrition care for care aides and residents with dementia. Study 2 examined the role of registered dietitians (RDs) in providing nutrition care for residents with dementia in urban and rural LTC. The key finding in this study was the downstream role of RDs in dementia care. As opposed to a more upstream preventive model of care, RDs were consulted or involved only at late stages or when comorbid decline had occurred, limiting their abilities to use their specialized nutrition knowledge and skills effectively. The 3rd study was an umbrella review of the peer-reviewed body of systematic reviews on nutrition care for residents with dementia in LTC. The major findings of this study include the lack of consistency in terms of nutritional outcomes considered and intervention tested, as well as a considerable gap in the published literature regarding both care aides and RDs. Taken together, these studies make a valuable contribution to the growing body of research on nutrition care and dementia. There is a need to continue to work with RDs and care aides in developing and testing interventions that can enhance both the physical health and quality of life for LTC residents with dementia

Educating healthcare professionals as change agents to champion dementia care in acute care settings

Persons with dementia and family carers identify several challenges when hospitalized including poor communication with professionals and loss of independence. Acute healthcare professionals cite understaffing and lack of dementia education as barriers to optimal care. To address these issues, the purpose of this project is to co-produce an educational program based on the Scottish National Dementia Champions Programme

Collaborating to co-produce educational content to champion dementia care in acute settings:Lessons learned

Enhancing dementia care to benefit people with dementia and their family carers requires both global and local initiatives. The purpose of this presentation is to share how we adapted a successful Scottish initiative (known as the Scottish National Dementia Champions Programme) to our local Canadian context with the ultimate aim to ‘champion’ dementia care provided by healthcare professionals in acute care settings. To guide our co-production, we are employing Hawkins et al.’s three-phase framework: (1) evidence review and stakeholder consultation, (2) co-production of intervention content, and (3) prototyping. After phase one was completed (in February 2020) we embarked on phase two and learned several key lessons from the co-production of the program content. These include the importance of (a) partnering with those with lived experience to infuse their voices in all aspects of the program; (b) learning and benefitting from our Scottish colleagues’ rich experiences; (c) capitalizing on long-standing Pan-Canadian relationships and launching new ones; (d) meeting virtually, on a consistent basis over 12 months, with established agendas and precise minute-taking; and (e) building consensus on what and how to prioritize program content and resources to align with the Canadian Charter of Rights for People with Dementia, within the foundation of person-/family-centred care. The results of our work in phase two enables us to proceed with phase three to pilot the co-produced program’s content and resources in the Canadian province of Saskatchewan

Navigating Mealtimes to Meet Public Health Mandates in Long-Term Care During COVID-19: Staff Perspectives

Context: Mealtimes in long-term care (LTC) settings play a pivotal role in the daily lives of residents. The COVID-19 pandemic and the required precautionary infection control mandates influenced many aspects of resident care within LTC homes, including mealtimes. Limited research has been conducted on how mealtimes in LTC were affected during the pandemic from staff perspectives. Objective: To understand the experiences of LTC staff on providing mealtimes during the pandemic. Methods: Semi-structured telephone interviews were conducted with 22 staff involved with mealtimes between February and April 2021. Transcripts were analysed using interpretive description. Findings: Three themes emerged from the analysis: (1) recognizing the influence of homes’ contextual factors. Home size, availability of resources, staffing levels and resident care needs influenced mealtime practices during the pandemic; (2) perceiving a compromised mealtime experience for residents and staff. Staff were frustrated and described residents as being dissatisfied with mealtime and pandemic-initiated practices as they were task-focused and socially isolating and (3) prioritizing mealtimes while trying to stay afloat. An ‘all hands-on deck’ approach, maintaining connections and being adaptive were strategies identified to mitigate the negative impact of the mandates on mealtimes during the pandemic. Limitations: Perspectives were primarily from nutrition and food service personnel. Implications: Overly restrictive public health measures resulted in mealtime practices that prioritized tasks and safety over residents’ quality of life. Learning from this pandemic experience, homes can protect the relational mealtime experience for residents by fostering teamwork, open and frequent communication and being flexible and adaptive

Obesity, Diet, and Activity in relation to Asthma and Wheeze among Rural Dwelling Children and Adolescents

Aims and Objectives. We investigated associations between weight status, activity level, and diet with asthma or wheeze as well as the interrelationship between these factors. Methods. We conducted a case-control study of 6–18-year olds from 2005 to 2007. Cases () were subjects reporting episodes or breathing medication use along with doctor-diagnosed asthma or wheeze in the past 12 months. Controls were randomly selected () and without asthma or wheeze. Data regarding health outcomes, diet, and activity were obtained from questionnaire. Objectively measured height and weight were collected. Results. In the adjusted analysis, there was a trend () towards an increased risk of asthma or wheeze associated with high fast food and/or pop consumption. Among cases, a significantly lower proportion (66%) classified as overweight participated in hard exercise in ≥9 of the past 14 days compared to those who were not overweight (86%). This pattern was not seen among controls (76% participating in hard exercise versus 78%, resp.). However, based on perceived weight status by the parent, the patterns were similar regardless of case-control status. Conclusions. Overweight status may negatively impact activity level among those with asthma or wheeze. Efforts should be made to encourage healthy food choices, and activity programming must consider the needs of overweight children with asthma

Obesity, Diet, and Activity in relation to Asthma and Wheeze among Rural Dwelling Children and Adolescents

Aims and Objectives. We investigated associations between weight status, activity level, and diet with asthma or wheeze as well as the interrelationship between these factors. Methods. We conducted a case-control study of 6-18-year olds from 2005 to 2007. Cases ( = 87) were subjects reporting episodes or breathing medication use along with doctor-diagnosed asthma or wheeze in the past 12 months. Controls were randomly selected ( = 208) and without asthma or wheeze. Data regarding health outcomes, diet, and activity were obtained from questionnaire. Objectively measured height and weight were collected. Results. In the adjusted analysis, there was a trend ( = 0.07) towards an increased risk of asthma or wheeze associated with high fast food and/or pop consumption. Among cases, a significantly lower proportion (66%) classified as overweight participated in hard exercise in ≥9 of the past 14 days compared to those who were not overweight (86%). This pattern was not seen among controls (76% participating in hard exercise versus 78%, resp.). However, based on perceived weight status by the parent, the patterns were similar regardless of case-control status. Conclusions. Overweight status may negatively impact activity level among those with asthma or wheeze. Efforts should be made to encourage healthy food choices, and activity programming must consider the needs of overweight children with asthma

The hidden complexity of long-term care:How context mediates knowledge translation and use of best practices

Purpose: Context is increasingly recognized as a key factor to be considered when addressing healthcare practice. This study describes features of context as they pertain to knowledge use in long-term care (LTC). Design and Methods: As one component of the research program Translating Research in Elder Care, an in-depth qualitative case study was conducted to examine the research question "How does organizational context mediate the use of knowledge in practice in long-term care facilities?" A representative facility was chosen from the province of Saskatchewan, Canada. Data included document review, direct observation of daily care practices, and interviews with direct care, allied provider, and administrative staff. Results: The Hidden Complexity of Long-Term Care model consists of 8 categories that enmesh to create a context within which knowledge exchange and best practice are executed. These categories range from the most easily identifiable to the least observable: physical environment, resources, ambiguity, flux, relationships, and philosophies. Two categories (experience and confidence, leadership and mentoring) mediate the impact of other contextual factors. Inappropriate physical environments, inadequate resources, ambiguous situations, continual change, multiple relationships, and contradictory philosophies make for a complicated context that impacts care provision. Implications: A hidden complexity underlays healthcare practices in LTC and each care provider must negotiate this complexity when providing care. Attending to this complexity in which care decisions are made will lead to improvements in knowledge exchange mechanisms and best practice uptake in LTC settings

Palliative and end-of-life care for people living with dementia in rural areas: A scoping review.

Background and objectivesPeople living with dementia deserve to experience the benefits of receiving palliative care and end-of-life services and supports, yet they often do not receive this care compared to those with other terminal diseases. People living with dementia in rural areas often face additional challenges to accessing such care. The purpose of this scoping review was to systematically review and synthesize the literature on palliative and end-of-life care for people with dementia living in rural areas, and to identify and describe key findings and gaps in the literature.MethodsA collaborative research team approach was used in an iterative process across all stages of this review. Systematic, comprehensive searches were conducted across ten databases and eight targeted websites for relevant peer-reviewed, original research and other less formal literature, published in English, which yielded a total of 4476 results. After duplicate removal, screening, and review, 24 items were included for synthesis.ResultsAll items were described and illustrated by frequency distribution, findings were grouped thematically, and five key themes emerged, including: 1) Knowledge about dementia, 2) Availability, accessibility, and utilization of palliative and end-of-life care services and supports, 3) Decision-making about care, the value of a person-centered approach and collaborative support, 4) Perspectives on artificial nutrition, hydration, and comfort care, and 5) Quality of life and death. The main gap identified was literature pertaining to rural populations, especially from locations other than the United States. The influence of rurality on relevant findings was mixed across rural-urban comparison studies, as was the effect of sex and gender across the literature.ConclusionsSeveral areas were highlighted including the importance of increasing knowledge about dementia, having early conversations about advanced care and treatment options, providing a person-centered approach, and the potential for using technology to address rural access issues. These findings can be used to inform future research and policy and the development of services, supports, and strategies for rural people living with dementia. Further research is recommended

Taking the Hit: Focusing on Caregiver Error Masks Organizational-Level Risk Factors for Nursing Aide Assault

Beliefs about the causes of events have implications for emotional reactions, distress, expectations for the future, and behavioral responses. In this article we report on two issues: the organizational context that contributes to nursing aide (NA) assault and reporting, and serendipitous findings that arose from investigating unexpected response rates to a survey. Data were collected in 11 rural nursing homes using a structured prospective event-reporting diary to collect detailed information about incidents of physical aggression, followed by focus groups to further explore NAs\u27 perceptions of these events. Here we report on analysis of 19 focus groups conducted with 138 NAs. Participants described organizational-level factors that constrained their practice, affected their interactions with residents, and created a context that put them at risk for physical assault. These factors also affected their willingness to provide written documentation about aggressive incidents. The key issues were frustration at being blamed for causing aggression, lack of action to address the problem, and a desire for respect and involvement in decision making. Organizational changes are needed to modify the contextual factors contributing to assault risk. Researchers must be willing to modify study designs to more fully understand the nature of the problem studied