Internet Journal of Allied Health Sciences and Practice
The purposes of this study were to describe and compare the emotional-social intelligence (ESI) o... more The purposes of this study were to describe and compare the emotional-social intelligence (ESI) of students in nursing, physical therapy and health science programs, and to determine the relationship between ESI and each of leadership, caring and moral judgment. Subjects were 154 students from nursing, physical therapy and bachelor of health science (BHSc) programs in a Canadian university and a physical therapy program in an American college. Data were collected by means of self-report measures of ESI, leadership, caring, and moral judgment. The measures included the Bar-On Emotional Quotient Inventory Short (EQ-i:S), the Self-Assessment Leadership Inventory (SALI), the Caring Ability Inventory (CAI), the Caring Dimensions Inventory - 35 (CDI-35) [for nursing only] and the Defining Issues Test (DIT-2) [for physical therapy and BHSc only]. One-way analyses of variance (ANOVA ) revealed no differences between groups for the EQ-i:S, SALI, or DIT-2. There were significant differences f...
Youth with medical complexity (YMC) are a small subset of youth who have a combination of severe ... more Youth with medical complexity (YMC) are a small subset of youth who have a combination of severe functional limitations and extensive health service use. As these youth become adults, they are required to transition to adult health, education, and social services. The transition to adult services is especially difficult for YMC due to the sheer number of services that they access. Service disruptions can have profound impacts on YMC and their families, potentially leading to an unsuccessful transition to adulthood. This meta-ethnography aims to synthesize qualitative literature exploring how YMC and their families experience the transition to adulthood and transfer to adult services. An in-depth understanding of youth and family experiences can inform interventions and policies to optimize supports and services to address the needs of this population at risk for unsuccessful transition to adulthood. Using Noblit and Hare’s approach to meta-ethnography, a comprehensive search of Medl...
Long-term care (LTC) staffing practices are poorly understood as is their influence on quality of... more Long-term care (LTC) staffing practices are poorly understood as is their influence on quality of care. We examined the relationship between staffing characteristics and residents' quality of care indicators at the unit level in LTC homes. This cross-sectional study collected data from administrative records and resident assessments from July 2014 to June 2015 at 11 LTC homes in Ontario, Canada comprising of 55 units and 32 residents in each unit. The sample included 69 registered nurses, 183 licensed/registered practical nurses, 858 nursing assistants, and 2173 residents. Practice sensitive, risk-adjusted quality indicators were described individually, then combined to create a quality of care composite ranking per unit. A multilevel regression model was used to estimate the association between staffing characteristics and quality of care composite ranking scores. Nursing assistants provided the majority of direct care hours in LTC homes (76.5%). The delivery of nursing assista...
Background: Following institutionalization of a relative with Alzheimer disease and related demen... more Background: Following institutionalization of a relative with Alzheimer disease and related dementias (ADRD), family carers continue to provide care. They must learn to negotiate with staff and navigate the system all of which can affect their mental health. A web-based intervention, My Tools 4 Care-In Care (MT4C-In Care) was developed by the research team to aid carers through the transitions experienced when their relative/friend with ADRD resides in a long-term care (LTC) facility. The purpose of this study was to evaluate MT4C-In Care for feasibility, acceptability, ease of use, and satisfaction, along with its potential to help decrease carer's feelings of grief and improve their hope, general self-efficacy, and health-related quality of life. Methods: The study was a mixed-methods single-arm repeated measures feasibility study. Participants accessed MT4C-In Care over a 2-month period. Data were collected at baseline and 1 and 2 months. Using a checklist, participants evaluated MT4C-In Care for ease of use, feasibility, acceptability, and satisfaction. Measures were also used to assess the effectiveness of the MT4C-In Care in improving hope (Herth Hope Index), general self-efficacy (GSES), loss and grief (NDRGEI), and health-related quality of life (SF12v2) of participants. Qualitative data were collected at 2 months and informed quantitative findings. Results: The majority of the 37 participants were female (65%; 24/37), married (73%; 27/37), and had a mean age of 63.24 years (SD = 11.68). Participants reported that MT4C-In Care was easy to use, feasible, and acceptable. Repeated measures ANOVA identified a statistically significant increase over time in participants hope scores (p = 0.03) and a significant decrease in grief (< 0.001). Although significant differences in mental health were not detected, hope (r = 0.43, p = 0.03) and grief (r = − 0.66, p < 0.001) were significantly related to mental health quality of life. Conclusion: MT4C-In Care is feasible, acceptable, and easy to use and shows promise to help carers of family members with ADRD residing in LTC increase their hope and decrease their grief. This study provides the foundation for a future pragmatic trial to determine the efficacy of MT4C-In Care.
Person-centered care (PCC) is fundamental for providing high-quality care in long-term care homes... more Person-centered care (PCC) is fundamental for providing high-quality care in long-term care homes. This study aimed to evaluate the psychometric properties of an 11-item Team Member Perspectives of Person-Centered Care (TM-PCC) survey, adapted from White and colleagues (2008). In a cross-sectional study, 461 staff from four long-term care homes in Ontario, Canada, completed the TM-PCC. Construct validity and internal consistency of the TM-PCC were examined with a principal component analysis and Cronbach’s alpha coefficient. Findings revealed a three-component structure with factor 1, Supporting Social Relationships; factor 2, Familiarity with Residents’ Preferences; and factor 3, Meaningful Resident⁻Staff Relationships. The TM-PCC, as compared to the original survey, presented with less components (i.e., did not address Resident Autonomy, Personhood, Comfort, Work with Residents, Personal Environment, and Management Structure), yet included one new component (Meaningful...
The goal of this study was to examine current rates of resident deaths, Emergency Department (ED)... more The goal of this study was to examine current rates of resident deaths, Emergency Department (ED) use within the last year of life, and hospital deaths for long-term care (LTC) residents. Using a mixed-methods approach, we compared these rates across four LTC homes in Ontario, Canada, and explored potential explanations of variations across homes to stimulate staff reflections and improve performance based on a quality improvement approach. Chart audits revealed that 59% of residents across sites visited EDs during the last month of life and 26% of resident deaths occurred in hospital. Staff expressed surprise at the amount of hospital use during end of life (EOL). Reflections suggested that clinical expertise, comfort with EOL communication, clinical resources (i.e., equipment), and family availability for EOL decision making could all affect nondesirable hospital transfers at EOL. Staff appeared motivated to address these areas of practice following this reflective process.
Globally, as older adults are living longer and with more chronic conditions, there is a need to ... more Globally, as older adults are living longer and with more chronic conditions, there is a need to support their ability to age optimally in their homes and communities. Community-based interprofessional teams working closely with these older adults, their families, and informal caregivers will be instrumental in achieving this goal. Interprofessional education (IPE) is the means through which these teams can develop expertise in collaboratively working together with older adults. However, most IPE occurs in academic settings, and acute and long-term care sectors and little is known about IPE in the context of home and community care of older adults. The purpose of this study was to describe perceptions of academic and practice experts related to the current state of IPE in home and community care of older adults and the changes that are necessary to meet the future needs of practitioners and older adults. Using a qualitative descriptive design, interviews were conducted with 32 national and international key informants representing practitioners, educators, researchers, and health system decision-makers in the field of IPE. Thematic analysis of the data identified six themes: (a) client and family-centred care at the core of IPE, (b) the community as a unique learning setting across the learning continuum; (c) an aging-relevant IPE curriculum; (d) faculty commitment and resources for IPE; (e) technological innovation to support IPE; and (f) comprehensive IPE programme evaluation and research. These findings are explored through the lens of an interprofessional learning continuum model. The article concludes with a discussion of the study implications for IPE practice and research specifically in the care of community-living older adults.
Background: Patients with dementia have increased healthcare utilization and often have comorbid ... more Background: Patients with dementia have increased healthcare utilization and often have comorbid chronic conditions. It is not clear if the increase in utilization is driven by dementia, the comorbidities or both. The objective of this study was to describe the number and types of comorbid conditions in a population-based cohort of older adults with dementia and how the level of comorbidity impacts dementia-related and non-dementia-related health service utilization. Methods: This study is a retrospective cohort study using multiple linked administrative databases to examine health service utilization and costs of 100,630 community-living older adults living with pre-existing dementia in Ontario, Canada. Comorbid conditions and health service utilization were measured using administrative data (physician visits, emergency department visits, hospitalizations, and homecare contacts). Results: Nearly all, 96.3 %, had at least one comorbid condition, while 18.4 % had five or more comorbid conditions. The most common comorbid conditions were hypertension (77.8 %), and arthritis (66.2 %). All types of utilization increased consistently with the number of comorbid conditions. The average number of dementia-related services tended to be similar across all levels of comorbidity while the average number of non-dementia related visits tended to increase with the level of comorbidity. Conclusions: Comorbidities in community-living older adults with dementia are common and account for a substantial proportion of health service use and costs in this population. Our results suggest that comprehensive programs that take a holistic view to identify the needs of patients in the context of other comorbidities are required for persons with dementia living in the community.
To characterize comorbid chronic conditions, describe health services use, and estimate health ca... more To characterize comorbid chronic conditions, describe health services use, and estimate health care costs among community-dwelling older adults with prior stroke. This is a retrospective cohort study using administrative data from Ontario, Canada. We identified all community-dwelling individuals aged 66 and over on April 1, 2008 (baseline), who had experienced a stroke at least 6 months prior. We estimated the prevalence of 14 comorbid conditions at baseline; we captured all physician visits, emergency department visits, hospital admissions, home care contacts, and associated costs over 5 years stratifying by number of comorbid conditions. Where possible, we distinguished between health services use for stroke- and non-stroke-related reasons. A total of 29,673 individuals met our criteria. Only 1% had no comorbid conditions, while 74.9% had 3 or more. The most common conditions were hypertension (89.8%) and arthritis (65.8%); 5 other conditions had a prevalence of 20% or more (ische...
Dependent older hospitalized patients rely on nurses to assist them with the removal of plaque fr... more Dependent older hospitalized patients rely on nurses to assist them with the removal of plaque from their teeth, dentures, and oral cavities. Oral care interventions by 25 nurses on post-acute units, where patients have longer hospital stays, were observed during evening care. In addition to efforts to engage patients in oral care, nurses provided the following interventions: (a) supporting the care of persons with dentures; (b) supporting the care of natural teeth; (c) cleansing the tongue and oral cavity; and (d) moisturizing lips and oral tissues. Patients' oral hygiene care was supported in just over one-third of encounters. Denture care was inconsistently performed, and was infrequently followed by care of the oral cavity. Nurses did not encourage adequate self-care of natural teeth by patients, and infrequently moisturized tissues. Evidence-based oral hygiene care standards are required to assist nurses to support patients in achieving optimal oral hygiene outcomes.
The majority of care for older adults with multiple chronic conditions (MCC) is provided by famil... more The majority of care for older adults with multiple chronic conditions (MCC) is provided by family (including friends) caregivers. Although caregivers have reported positive benefits to caregiving they also experience decreases in their physical and mental health. As there is a critical need for supportive interventions for this population, it is important to know what influences the health of family caregivers of persons with MCC. This research examined relationships among the changes from baseline to 6 months in health related quality of life (SF12v2) of family caregivers caring for older adults with multiple chronic conditions and the following factors: a) demographic variables, b) gender identity [Bem Sex Role Inventory (BSRI)] c) changes in general self-efficacy [General Self Efficacy Scale (GSES) (baseline to 6 months) and d)) changes in caregiver burden [Zarit Burden Inventory (ZBI)] baseline to 6 months. Specific hypothesis were based on a conceptual framework generated from...
Nursing faculty play an important role in facilitating nursing student learning and shaping stude... more Nursing faculty play an important role in facilitating nursing student learning and shaping student experience in the clinical setting. Emotional intelligence (EI) in clinical nursing faculty may be one avenue to develop teaching effectiveness. This study investigated the relationship between EI and clinical teaching effectiveness of nursing faculty in an undergraduate nursing program. Using a crosssectional correlation design, data were collected from a convenience sample of nursing faculty (N = 47) using the BarOn Emotional Quotient Inventory: Short (EQ-i:S), the Nursing Clinical Teacher Effectiveness Inventory (NCTEI) and a demographic data page. The results indicated a statistically significant positive relationship between the EQ-i:S and the NCTEI total scores (rs = .599, P b .01) and between many subscales of these tools. These findings contribute new knowledge to nursing education, including the following: (a) a significant relationship between EI and clinical teaching effectiveness exists, (b) faculty exhibit effective overall EI functioning with room to enhance competencies, and (c) faculty members see themselves as effective in their clinical teaching. Implications for clinical teaching practice include the need for faculty development and strengthening the faculty-student relationship. Possibilities for future research are discussed.
Worldwide, the literature reports that many residents in long-term care (LTC) homes are sedentary... more Worldwide, the literature reports that many residents in long-term care (LTC) homes are sedentary. In Canada, personal support workers (PSWs) provide most of the direct care in LTC homes and could play a key role in promoting activity for residents. The purpose of this institutional ethnographic study was to uncover the social organization of LTC work and to discover how this organization influenced the physical activity of residents. Data were collected in two LTC homes in Ontario, Canada through participant observations with PSWs and interviews with people within and external to the homes. Findings explicate the links between meals, lifts and transfers, and the LTC standards to reveal that physical activity is considered an add-on program in the purview of physiotherapists. Some of the LTC standards which are intended to product good outcomes for residents actually disrupt the work of PSWs making it difficult for them to respond to the physical activity needs of residents. This descriptive ethnographic account is an important first step in trying to find a solution to optimize real activities of daily living into life in LTC.
Immigrants represent 28%of the Canadian population over 65,and older immigrants–more of them are ... more Immigrants represent 28%of the Canadian population over 65,and older immigrants–more of them are women –now comprise the majority of the aging population in Canada’s large metropolitan cities. Despite ample research about abuse of older adults in general, few Canadian studies have focused on abuse of older immigrant women. This paper reports policy-relevant findings from a project that aimed to develop a shared program of research to prevent abuse of older immigrant women in Canada. The project involved a review of the literature on elder abuse and immigrant women, local meetings with key stakeholders in seven provinces, a public event in Toronto, and a two-day interdisciplinary symposium with provincial stakeholders. Two significant themes emerged from these activities: the value of bringing together professionals representing multiple disciplines and service sectors as well as older immigrant women and the need for changes in social policies to reduce older immigrant women’s vulne...
Community support services (CSSs) enable persons coping with health or social problems to maintai... more Community support services (CSSs) enable persons coping with health or social problems to maintain the highest possible level of social functioning and quality of life. Access to these services is challenging because of the multiplicity of small agencies providing these services and the lack of a central access point. A review of the literature revealed that most service awareness studies are marred by acquiescence bias. To address this issue, service providers developed a series of 12 vignettes to describe common situations faced by older adults for which CSSs might be appropriate. In a telephone interview, 1152 older adults were presented with a series of vignettes and asked what they would do in that situation. They were also asked about their most important sources of information about CSSs. Findings show awareness of CSSs varied by the situation described and ranged from a low of 1% to 41%. The most important sources of information about CSSs included informational and referral...
The purpose of this systematic overview was to summarize evidence about the effectiveness of adol... more The purpose of this systematic overview was to summarize evidence about the effectiveness of adolescent suicide prevention curricula programs. A comprehensive search of published and unpublished literature resulted in retrieval of 11 relevant studies. The findings, of this overview indicate that there is currently insufficient evidence to support curriculum-based suicide prevention programs. The evidence suggests that there may be both beneficial and harmful effects of the programs on students. In most studies, knowledge related to suicide improved as a result of the programs. However, studies found both beneficial and harmful effects on attitudes related to suicide. One study found in increase in hopelessness and maladaptive coping for males following the intervention. The literature suggests that more broadly based comprehensive school health programs should be evaluated for their effectiveness in addressing the determinants of adolescent risk behaviour.
Canadian family physician Médecin de famille canadien, 2014
takeholder engagement is critical in the development of a new program intervention. 1-3 Focus gro... more takeholder engagement is critical in the development of a new program intervention. 1-3 Focus groups 2 or interviews 4 are traditional data collection strategies typically used for this process. The persona-scenario exercise, an alternative to traditional strategies, originated from the feld of human computer interface design. 4-6 This article describes how personascenario exercises were applied in the codesign of the complex primary care intervention TAPESTRY (Teams Advancing Patient Experiences: Strengthening Quality). (For more information on TAPESTRY, visit www. healthtapestry.ca). The goal of the TAPESTRY program is to determine how health care teams can be more responsive to the needs of our aging population. The program involves trained community volunteers reaching out to older adults in their homes to assess their health needs. Volunteers will be linked to patients' health care teams using technology, which will improve communication with providers and will also maximize engagement with community service providers. The persona-scenario exercise is a structured approach that asks participants to create a fictitious, authentic "persona" based on guiding questions (eg, What is your name, age, and sex? What is your experience with intervention components?). Personas should characterize the stakeholder group that participants represent (eg, primary care provider, patient). Participants use their personas to create the potential intervention (the scenario) using another set of guiding questions (eg, How does the person get involved in the program? What are the volunteers, patients, and providers doing in the scenario? How are they interacting?). Scenarios allow for "multiple views of an interaction" and "diverse kinds and amounts of detailing." 5 This does not happen by using focus groups, in which participants take turns responding to guided questions based on past experiences and their context. The persona-scenario exercise has several potential advantages. It allows participants to use their own experiences and perceptions to help guide the development of complex interventions through the personas and scenarios that they create. In program development, in which some intervention elements are not known and incorporation of stakeholder opinion is vital, this method helps introduce the program components and identify potential interactions between them.
Internet Journal of Allied Health Sciences and Practice
The purposes of this study were to describe and compare the emotional-social intelligence (ESI) o... more The purposes of this study were to describe and compare the emotional-social intelligence (ESI) of students in nursing, physical therapy and health science programs, and to determine the relationship between ESI and each of leadership, caring and moral judgment. Subjects were 154 students from nursing, physical therapy and bachelor of health science (BHSc) programs in a Canadian university and a physical therapy program in an American college. Data were collected by means of self-report measures of ESI, leadership, caring, and moral judgment. The measures included the Bar-On Emotional Quotient Inventory Short (EQ-i:S), the Self-Assessment Leadership Inventory (SALI), the Caring Ability Inventory (CAI), the Caring Dimensions Inventory - 35 (CDI-35) [for nursing only] and the Defining Issues Test (DIT-2) [for physical therapy and BHSc only]. One-way analyses of variance (ANOVA ) revealed no differences between groups for the EQ-i:S, SALI, or DIT-2. There were significant differences f...
Youth with medical complexity (YMC) are a small subset of youth who have a combination of severe ... more Youth with medical complexity (YMC) are a small subset of youth who have a combination of severe functional limitations and extensive health service use. As these youth become adults, they are required to transition to adult health, education, and social services. The transition to adult services is especially difficult for YMC due to the sheer number of services that they access. Service disruptions can have profound impacts on YMC and their families, potentially leading to an unsuccessful transition to adulthood. This meta-ethnography aims to synthesize qualitative literature exploring how YMC and their families experience the transition to adulthood and transfer to adult services. An in-depth understanding of youth and family experiences can inform interventions and policies to optimize supports and services to address the needs of this population at risk for unsuccessful transition to adulthood. Using Noblit and Hare’s approach to meta-ethnography, a comprehensive search of Medl...
Long-term care (LTC) staffing practices are poorly understood as is their influence on quality of... more Long-term care (LTC) staffing practices are poorly understood as is their influence on quality of care. We examined the relationship between staffing characteristics and residents' quality of care indicators at the unit level in LTC homes. This cross-sectional study collected data from administrative records and resident assessments from July 2014 to June 2015 at 11 LTC homes in Ontario, Canada comprising of 55 units and 32 residents in each unit. The sample included 69 registered nurses, 183 licensed/registered practical nurses, 858 nursing assistants, and 2173 residents. Practice sensitive, risk-adjusted quality indicators were described individually, then combined to create a quality of care composite ranking per unit. A multilevel regression model was used to estimate the association between staffing characteristics and quality of care composite ranking scores. Nursing assistants provided the majority of direct care hours in LTC homes (76.5%). The delivery of nursing assista...
Background: Following institutionalization of a relative with Alzheimer disease and related demen... more Background: Following institutionalization of a relative with Alzheimer disease and related dementias (ADRD), family carers continue to provide care. They must learn to negotiate with staff and navigate the system all of which can affect their mental health. A web-based intervention, My Tools 4 Care-In Care (MT4C-In Care) was developed by the research team to aid carers through the transitions experienced when their relative/friend with ADRD resides in a long-term care (LTC) facility. The purpose of this study was to evaluate MT4C-In Care for feasibility, acceptability, ease of use, and satisfaction, along with its potential to help decrease carer's feelings of grief and improve their hope, general self-efficacy, and health-related quality of life. Methods: The study was a mixed-methods single-arm repeated measures feasibility study. Participants accessed MT4C-In Care over a 2-month period. Data were collected at baseline and 1 and 2 months. Using a checklist, participants evaluated MT4C-In Care for ease of use, feasibility, acceptability, and satisfaction. Measures were also used to assess the effectiveness of the MT4C-In Care in improving hope (Herth Hope Index), general self-efficacy (GSES), loss and grief (NDRGEI), and health-related quality of life (SF12v2) of participants. Qualitative data were collected at 2 months and informed quantitative findings. Results: The majority of the 37 participants were female (65%; 24/37), married (73%; 27/37), and had a mean age of 63.24 years (SD = 11.68). Participants reported that MT4C-In Care was easy to use, feasible, and acceptable. Repeated measures ANOVA identified a statistically significant increase over time in participants hope scores (p = 0.03) and a significant decrease in grief (< 0.001). Although significant differences in mental health were not detected, hope (r = 0.43, p = 0.03) and grief (r = − 0.66, p < 0.001) were significantly related to mental health quality of life. Conclusion: MT4C-In Care is feasible, acceptable, and easy to use and shows promise to help carers of family members with ADRD residing in LTC increase their hope and decrease their grief. This study provides the foundation for a future pragmatic trial to determine the efficacy of MT4C-In Care.
Person-centered care (PCC) is fundamental for providing high-quality care in long-term care homes... more Person-centered care (PCC) is fundamental for providing high-quality care in long-term care homes. This study aimed to evaluate the psychometric properties of an 11-item Team Member Perspectives of Person-Centered Care (TM-PCC) survey, adapted from White and colleagues (2008). In a cross-sectional study, 461 staff from four long-term care homes in Ontario, Canada, completed the TM-PCC. Construct validity and internal consistency of the TM-PCC were examined with a principal component analysis and Cronbach’s alpha coefficient. Findings revealed a three-component structure with factor 1, Supporting Social Relationships; factor 2, Familiarity with Residents’ Preferences; and factor 3, Meaningful Resident⁻Staff Relationships. The TM-PCC, as compared to the original survey, presented with less components (i.e., did not address Resident Autonomy, Personhood, Comfort, Work with Residents, Personal Environment, and Management Structure), yet included one new component (Meaningful...
The goal of this study was to examine current rates of resident deaths, Emergency Department (ED)... more The goal of this study was to examine current rates of resident deaths, Emergency Department (ED) use within the last year of life, and hospital deaths for long-term care (LTC) residents. Using a mixed-methods approach, we compared these rates across four LTC homes in Ontario, Canada, and explored potential explanations of variations across homes to stimulate staff reflections and improve performance based on a quality improvement approach. Chart audits revealed that 59% of residents across sites visited EDs during the last month of life and 26% of resident deaths occurred in hospital. Staff expressed surprise at the amount of hospital use during end of life (EOL). Reflections suggested that clinical expertise, comfort with EOL communication, clinical resources (i.e., equipment), and family availability for EOL decision making could all affect nondesirable hospital transfers at EOL. Staff appeared motivated to address these areas of practice following this reflective process.
Globally, as older adults are living longer and with more chronic conditions, there is a need to ... more Globally, as older adults are living longer and with more chronic conditions, there is a need to support their ability to age optimally in their homes and communities. Community-based interprofessional teams working closely with these older adults, their families, and informal caregivers will be instrumental in achieving this goal. Interprofessional education (IPE) is the means through which these teams can develop expertise in collaboratively working together with older adults. However, most IPE occurs in academic settings, and acute and long-term care sectors and little is known about IPE in the context of home and community care of older adults. The purpose of this study was to describe perceptions of academic and practice experts related to the current state of IPE in home and community care of older adults and the changes that are necessary to meet the future needs of practitioners and older adults. Using a qualitative descriptive design, interviews were conducted with 32 national and international key informants representing practitioners, educators, researchers, and health system decision-makers in the field of IPE. Thematic analysis of the data identified six themes: (a) client and family-centred care at the core of IPE, (b) the community as a unique learning setting across the learning continuum; (c) an aging-relevant IPE curriculum; (d) faculty commitment and resources for IPE; (e) technological innovation to support IPE; and (f) comprehensive IPE programme evaluation and research. These findings are explored through the lens of an interprofessional learning continuum model. The article concludes with a discussion of the study implications for IPE practice and research specifically in the care of community-living older adults.
Background: Patients with dementia have increased healthcare utilization and often have comorbid ... more Background: Patients with dementia have increased healthcare utilization and often have comorbid chronic conditions. It is not clear if the increase in utilization is driven by dementia, the comorbidities or both. The objective of this study was to describe the number and types of comorbid conditions in a population-based cohort of older adults with dementia and how the level of comorbidity impacts dementia-related and non-dementia-related health service utilization. Methods: This study is a retrospective cohort study using multiple linked administrative databases to examine health service utilization and costs of 100,630 community-living older adults living with pre-existing dementia in Ontario, Canada. Comorbid conditions and health service utilization were measured using administrative data (physician visits, emergency department visits, hospitalizations, and homecare contacts). Results: Nearly all, 96.3 %, had at least one comorbid condition, while 18.4 % had five or more comorbid conditions. The most common comorbid conditions were hypertension (77.8 %), and arthritis (66.2 %). All types of utilization increased consistently with the number of comorbid conditions. The average number of dementia-related services tended to be similar across all levels of comorbidity while the average number of non-dementia related visits tended to increase with the level of comorbidity. Conclusions: Comorbidities in community-living older adults with dementia are common and account for a substantial proportion of health service use and costs in this population. Our results suggest that comprehensive programs that take a holistic view to identify the needs of patients in the context of other comorbidities are required for persons with dementia living in the community.
To characterize comorbid chronic conditions, describe health services use, and estimate health ca... more To characterize comorbid chronic conditions, describe health services use, and estimate health care costs among community-dwelling older adults with prior stroke. This is a retrospective cohort study using administrative data from Ontario, Canada. We identified all community-dwelling individuals aged 66 and over on April 1, 2008 (baseline), who had experienced a stroke at least 6 months prior. We estimated the prevalence of 14 comorbid conditions at baseline; we captured all physician visits, emergency department visits, hospital admissions, home care contacts, and associated costs over 5 years stratifying by number of comorbid conditions. Where possible, we distinguished between health services use for stroke- and non-stroke-related reasons. A total of 29,673 individuals met our criteria. Only 1% had no comorbid conditions, while 74.9% had 3 or more. The most common conditions were hypertension (89.8%) and arthritis (65.8%); 5 other conditions had a prevalence of 20% or more (ische...
Dependent older hospitalized patients rely on nurses to assist them with the removal of plaque fr... more Dependent older hospitalized patients rely on nurses to assist them with the removal of plaque from their teeth, dentures, and oral cavities. Oral care interventions by 25 nurses on post-acute units, where patients have longer hospital stays, were observed during evening care. In addition to efforts to engage patients in oral care, nurses provided the following interventions: (a) supporting the care of persons with dentures; (b) supporting the care of natural teeth; (c) cleansing the tongue and oral cavity; and (d) moisturizing lips and oral tissues. Patients' oral hygiene care was supported in just over one-third of encounters. Denture care was inconsistently performed, and was infrequently followed by care of the oral cavity. Nurses did not encourage adequate self-care of natural teeth by patients, and infrequently moisturized tissues. Evidence-based oral hygiene care standards are required to assist nurses to support patients in achieving optimal oral hygiene outcomes.
The majority of care for older adults with multiple chronic conditions (MCC) is provided by famil... more The majority of care for older adults with multiple chronic conditions (MCC) is provided by family (including friends) caregivers. Although caregivers have reported positive benefits to caregiving they also experience decreases in their physical and mental health. As there is a critical need for supportive interventions for this population, it is important to know what influences the health of family caregivers of persons with MCC. This research examined relationships among the changes from baseline to 6 months in health related quality of life (SF12v2) of family caregivers caring for older adults with multiple chronic conditions and the following factors: a) demographic variables, b) gender identity [Bem Sex Role Inventory (BSRI)] c) changes in general self-efficacy [General Self Efficacy Scale (GSES) (baseline to 6 months) and d)) changes in caregiver burden [Zarit Burden Inventory (ZBI)] baseline to 6 months. Specific hypothesis were based on a conceptual framework generated from...
Nursing faculty play an important role in facilitating nursing student learning and shaping stude... more Nursing faculty play an important role in facilitating nursing student learning and shaping student experience in the clinical setting. Emotional intelligence (EI) in clinical nursing faculty may be one avenue to develop teaching effectiveness. This study investigated the relationship between EI and clinical teaching effectiveness of nursing faculty in an undergraduate nursing program. Using a crosssectional correlation design, data were collected from a convenience sample of nursing faculty (N = 47) using the BarOn Emotional Quotient Inventory: Short (EQ-i:S), the Nursing Clinical Teacher Effectiveness Inventory (NCTEI) and a demographic data page. The results indicated a statistically significant positive relationship between the EQ-i:S and the NCTEI total scores (rs = .599, P b .01) and between many subscales of these tools. These findings contribute new knowledge to nursing education, including the following: (a) a significant relationship between EI and clinical teaching effectiveness exists, (b) faculty exhibit effective overall EI functioning with room to enhance competencies, and (c) faculty members see themselves as effective in their clinical teaching. Implications for clinical teaching practice include the need for faculty development and strengthening the faculty-student relationship. Possibilities for future research are discussed.
Worldwide, the literature reports that many residents in long-term care (LTC) homes are sedentary... more Worldwide, the literature reports that many residents in long-term care (LTC) homes are sedentary. In Canada, personal support workers (PSWs) provide most of the direct care in LTC homes and could play a key role in promoting activity for residents. The purpose of this institutional ethnographic study was to uncover the social organization of LTC work and to discover how this organization influenced the physical activity of residents. Data were collected in two LTC homes in Ontario, Canada through participant observations with PSWs and interviews with people within and external to the homes. Findings explicate the links between meals, lifts and transfers, and the LTC standards to reveal that physical activity is considered an add-on program in the purview of physiotherapists. Some of the LTC standards which are intended to product good outcomes for residents actually disrupt the work of PSWs making it difficult for them to respond to the physical activity needs of residents. This descriptive ethnographic account is an important first step in trying to find a solution to optimize real activities of daily living into life in LTC.
Immigrants represent 28%of the Canadian population over 65,and older immigrants–more of them are ... more Immigrants represent 28%of the Canadian population over 65,and older immigrants–more of them are women –now comprise the majority of the aging population in Canada’s large metropolitan cities. Despite ample research about abuse of older adults in general, few Canadian studies have focused on abuse of older immigrant women. This paper reports policy-relevant findings from a project that aimed to develop a shared program of research to prevent abuse of older immigrant women in Canada. The project involved a review of the literature on elder abuse and immigrant women, local meetings with key stakeholders in seven provinces, a public event in Toronto, and a two-day interdisciplinary symposium with provincial stakeholders. Two significant themes emerged from these activities: the value of bringing together professionals representing multiple disciplines and service sectors as well as older immigrant women and the need for changes in social policies to reduce older immigrant women’s vulne...
Community support services (CSSs) enable persons coping with health or social problems to maintai... more Community support services (CSSs) enable persons coping with health or social problems to maintain the highest possible level of social functioning and quality of life. Access to these services is challenging because of the multiplicity of small agencies providing these services and the lack of a central access point. A review of the literature revealed that most service awareness studies are marred by acquiescence bias. To address this issue, service providers developed a series of 12 vignettes to describe common situations faced by older adults for which CSSs might be appropriate. In a telephone interview, 1152 older adults were presented with a series of vignettes and asked what they would do in that situation. They were also asked about their most important sources of information about CSSs. Findings show awareness of CSSs varied by the situation described and ranged from a low of 1% to 41%. The most important sources of information about CSSs included informational and referral...
The purpose of this systematic overview was to summarize evidence about the effectiveness of adol... more The purpose of this systematic overview was to summarize evidence about the effectiveness of adolescent suicide prevention curricula programs. A comprehensive search of published and unpublished literature resulted in retrieval of 11 relevant studies. The findings, of this overview indicate that there is currently insufficient evidence to support curriculum-based suicide prevention programs. The evidence suggests that there may be both beneficial and harmful effects of the programs on students. In most studies, knowledge related to suicide improved as a result of the programs. However, studies found both beneficial and harmful effects on attitudes related to suicide. One study found in increase in hopelessness and maladaptive coping for males following the intervention. The literature suggests that more broadly based comprehensive school health programs should be evaluated for their effectiveness in addressing the determinants of adolescent risk behaviour.
Canadian family physician Médecin de famille canadien, 2014
takeholder engagement is critical in the development of a new program intervention. 1-3 Focus gro... more takeholder engagement is critical in the development of a new program intervention. 1-3 Focus groups 2 or interviews 4 are traditional data collection strategies typically used for this process. The persona-scenario exercise, an alternative to traditional strategies, originated from the feld of human computer interface design. 4-6 This article describes how personascenario exercises were applied in the codesign of the complex primary care intervention TAPESTRY (Teams Advancing Patient Experiences: Strengthening Quality). (For more information on TAPESTRY, visit www. healthtapestry.ca). The goal of the TAPESTRY program is to determine how health care teams can be more responsive to the needs of our aging population. The program involves trained community volunteers reaching out to older adults in their homes to assess their health needs. Volunteers will be linked to patients' health care teams using technology, which will improve communication with providers and will also maximize engagement with community service providers. The persona-scenario exercise is a structured approach that asks participants to create a fictitious, authentic "persona" based on guiding questions (eg, What is your name, age, and sex? What is your experience with intervention components?). Personas should characterize the stakeholder group that participants represent (eg, primary care provider, patient). Participants use their personas to create the potential intervention (the scenario) using another set of guiding questions (eg, How does the person get involved in the program? What are the volunteers, patients, and providers doing in the scenario? How are they interacting?). Scenarios allow for "multiple views of an interaction" and "diverse kinds and amounts of detailing." 5 This does not happen by using focus groups, in which participants take turns responding to guided questions based on past experiences and their context. The persona-scenario exercise has several potential advantages. It allows participants to use their own experiences and perceptions to help guide the development of complex interventions through the personas and scenarios that they create. In program development, in which some intervention elements are not known and incorporation of stakeholder opinion is vital, this method helps introduce the program components and identify potential interactions between them.
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Papers by Jenny Ploeg