O holismo no treinamento dos profissionais de saúde para o atendimento ao público LGBTQ+

n/

O holismo no treinamento dos profissionais de saúde para o atendimento ao público LGBTQ+

n/

Meaningful connections in dementia end of life care in long term care homes

Background: Most persons with dementia die in long term care (LTC) homes, where palliative approaches are appropriate. However, palliative approaches have not been widely implemented and there is limited understanding of staff and family experiences of dying and bereavement in this context. Method: This descriptive qualitative study explored family and staff experiences of end of life and end of life care for persons with dementia in LTC homes. Eighteen focus groups were conducted with 77 staff members and 19 relatives of persons with dementia at four LTC homes in four Canadian provinces. Results: Three themes emerged: knowing the resident, the understanding that they are all human beings, and the long slow decline and death of residents with dementia. Discussion: Intimate knowledge of the person with dementia, obtained through longstanding relationships, was foundational for person-centred end of life care. Health care aides need to be included in end of life care planning to take advantage of their knowledge of residents with dementia. There were unmet bereavement support needs among staff, particularly health care aides. Persons with dementia were affected by death around them and existing rituals for marking deaths in LTC homes may not fit their needs. Staff were uncomfortable answering relatives’ questions about end of life. Conclusions: Longstanding intimate relationships enhanced end of life care but left health care aides with unmet bereavement support needs. Staff in LTC homes should be supported to answer questions about the trajectory of decline of dementia and death. Further research about residents’ experiences of deaths of other residents is needed.Brock University Library Open Access Publishing Fun

A pilot evaluation of the Strengthening a Palliative Approach in Long-Term Care (SPA-LTC) program

Background: Despite increased annual mortality in long-term care (LTC) homes, research has shown that care of dying residents and their families is currently suboptimal in these settings. The purpose of this study was to evaluate resident and family outcomes associated with the Strengthening a Palliative Approach in LTC (SPA-LTC) program, developed to help encourage meaningful end of life discussions and planning. Methods: The study employs a mixed method design in four LTC homes across Southern Ontario. Data were collected from residents and families of the LTC homes through chart reviews, interviews, and focus groups. Interviews with family who attended a Palliative Care Conference included both closed-ended and open-ended questions. Results: In total, 39 residents/families agreed to participate in the study. Positive intervention outcomes included a reduction in the proportion of emergency department use at end of life and hospital deaths for those participating in SPA-LTC, improved support for families, and increased family involvement in the care of residents. For families who attended a Palliative Care Conference, both quantitative and qualitative findings revealed that families benefited from attending them. Residents stated that they appreciated learning about a palliative approach to care and being informed about their current status. Conclusions: The benefits of SPA-LTC for residents and families justify its continued use within LTC. Study results also suggest that certain enhancements of the program could further promote future integration of best practices within a palliative approach to care within the LTC context. However, the generalizability of these results across LTC homes in different regions and countries is limited given the small sample size

The BARRIERS scale -- the barriers to research utilization scale: A systematic review

<p>Abstract</p> <p>Background</p> <p>A commonly recommended strategy for increasing research use in clinical practice is to identify barriers to change and then tailor interventions to overcome the identified barriers. In nursing, the BARRIERS scale has been used extensively to identify barriers to research utilization.</p> <p>Aim and objectives</p> <p>The aim of this systematic review was to examine the state of knowledge resulting from use of the BARRIERS scale and to make recommendations about future use of the scale. The following objectives were addressed: To examine how the scale has been modified, to examine its psychometric properties, to determine the main barriers (and whether they varied over time and geographic locations), and to identify associations between nurses' reported barriers and reported research use.</p> <p>Methods</p> <p>Medline (1991 to September 2009) and CINHAL (1991 to September 2009) were searched for published research, and ProQuest^®digital dissertations were searched for unpublished dissertations using the BARRIERS scale. Inclusion criteria were: studies using the BARRIERS scale in its entirety and where the sample was nurses. Two authors independently assessed the study quality and extracted the data. Descriptive and inferential statistics were used.</p> <p>Results</p> <p>Sixty-three studies were included, with most using a cross-sectional design. Not one study used the scale for tailoring interventions to overcome identified barriers. The main barriers reported were related to the setting, and the presentation of research findings. Overall, identified barriers were consistent over time and across geographic locations, despite varying sample size, response rate, study setting, and assessment of study quality. Few studies reported associations between reported research use and perceptions of barriers to research utilization.</p> <p>Conclusions</p> <p>The BARRIERS scale is a nonspecific tool for identifying general barriers to research utilization. The scale is reliable as reflected in assessments of internal consistency. The validity of the scale, however, is doubtful. There is no evidence that it is a useful tool for planning implementation interventions. We recommend that no further descriptive studies using the BARRIERS scale be undertaken. Barriers need to be measured specific to the particular context of implementation and the intended evidence to be implemented.</p

Family burden and expressed emotion in the parents of adults with schizophrenia, a critique and empirical test of an integrated model

grantor: University of TorontoThis study critiqued the dominant theoretical models of families and schizophrenia and empirically tested relationships between subjective family burden and expressed emotion (EE) of parents of adults with schizophrenia. Integration of the models is theoretically plausible, consistent with empirical evidence, congruent with dominant social work practice models, and has the potential to advance clinical practice. An integrated EE/family burden model was proposed and formed the basis of research questions. Exploratory secondary data analyses were conducted. The research tested whether the EE components, EOI and criticism, mediate relationships between parent subjective burden and each of patient social functioning, patient symptoms, parent knowledge about schizophrenia, and parent experience with schizophrenia. The results were indefinite. The findings that neither EOI nor criticism act as statistical mediators were inconclusive because of low statistical power for the tests. There were trends for associations between the EE components, subjective burden, and patient social functioning. Relationships between EE change and subjective burden change were tested. The results indicate that EE may explain, at most, a small part of subjective burden change. There was a trend for a relationship between EE change and subjective burden change. Among parents who were initially high EE, lower subjective burden was associated with subsequent change to low EE. EE was more likely to be stable than to change. Change from high to low EE was more common than change from low to high EE. The major limitations of the research design were the: (1) non probability sample; (2) small sample size and the associated low statistical power for many of the tests; and (3) the large number of univariate tests which increased the chance of Type I error. Thus, the findings must be interpreted with caution. Design features which compensate for weaknesses in the published research include: (1) use of a theoretical framework; (2) avoiding confounding in measurement; (3) preservation of sample size through the use of multiple imputation for ignorable missing data; (4) analysis of potential sample bias; and (5) use of multivariate statistical techniques.Ph.D