scholarly journals Implementing Caregiver Support Programs in a Regional Stroke System

Stroke ◽  
2019 ◽  
Vol 50 (12) ◽  
pp. 3585-3591 ◽  
Author(s):  
Victrine Tseung ◽  
Susan B. Jaglal ◽  
Nancy M. Salbach ◽  
Jill I. Cameron
Keyword(s):  
Focus Groups ◽  
Program Implementation ◽  
Best Practice ◽  
Well Being ◽  
Healthcare Systems ◽  
System Level ◽  
Structured Interviews ◽  
Term Care ◽  
Caregiver Support ◽  
Regional Variations

Background and Purpose— Family caregivers play a central role in the recovery of people with stroke. They need support to optimize the care they provide and their own health and well-being. Despite support from the literature and best practice recommendations, healthcare systems are not formally adopting caregiver programs. This study aimed to describe system-level facilitators and barriers to caregiver support program implementation in a regional stroke system. Methods— Using a qualitative descriptive study design, focus groups were conducted with regional rehabilitation specialists, education coordinators, community and long-term care specialists, and regional/district program directors. Semi-structured interviews were conducted with regional medical directors, health professionals providing stroke care in acute care, rehabilitation and community settings, regional health executives, and primary care leaders. Data were analyzed using inductive thematic analysis. Results— Four focus groups (n=43) and 29 interviews were conducted. We identified 4 themes related to caregiver program implementation: (1) establishing the need for caregiver education and support in an integrated healthcare system; (2) incorporating caregiver programs into the system of care across the care continuum; (3) uncertainty regarding ownership and responsibility for implementation; and (4) addressing regional variations related to access, availability, and culture. Conclusions— This study provides a comprehensive understanding of organization and system-level considerations for implementing caregiver programs in a regional stroke system. Program implementation requires evidence to establish the need for caregiver programs, practical strategies, and establishing ownership to incorporate programs into existing healthcare systems, and consideration of regional variations across healthcare systems. Ultimately, adopting programs to support caregivers will improve recovery in people with stroke and caregiver well-being.

scholarly journals PET VISITATION AS NARRATIVE CARE FOR OLDER ADULTS IN THERAPEUTIC SETTINGS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S867-S867
Author(s):  
Jill Yamasaki ◽  
Kelley Murfin
Keyword(s):  
Older Adults ◽  
Los Angeles ◽  
Participant Observation ◽  
Ways Of Knowing ◽  
Well Being ◽  
Structured Interviews ◽  
Term Care ◽  
Personalized Care ◽  
Healing Relationships ◽  
Therapeutic Settings

Abstract A growing body of research highlights the physiological and psychosocial benefits of pet visitation programs in therapeutic settings. These programs utilize the profound connection between humans and animals to promote holistic healing, foster greater quality of life, and influence meaningful communication between patients and providers. For older adults in hospitals or long-term care, these benefits are often correlated with moments of pleasure, comfort, relaxation, and entertainment. The current study builds on this prior knowledge by examining pet visitation programs as a novel form of narrative care that can also help preserve biographical continuity and promote the sharing of lived stories. We worked with two volunteer pet visitation programs in Houston and one in Los Angeles. Our research included a variety of ethnographic methods, including participant observation; informal interviews with providers, patients (or residents, depending on the context), and their families; semi-structured interviews with volunteers; and discourse review of organizational materials. We employed a method of constant comparison to identify and thematically analyze recurrent patterns of behavior and overarching meanings across the data. Three primary themes emerged from the data: (a) compassion, (b) connection, and (c) response. Collectively, the presence of pets prompted stories and behaviors that foster healing relationships characterized by empathy and mutual understanding between patients (or residents), family members, and providers. Pet visitation programs facilitate storied conversations, increased autonomy, and alternative ways of knowing that promote greater understandings of the patient’s (or resident’s) psychosocial context and biographical history, leading to more personalized care and improved well-being.

Perceptions of family and staff on the role of the environment in long-term care homes for people with dementia

2012 ◽  
Vol 24 (5) ◽  
pp. 753-765 ◽  
Author(s):  
Linda J. Garcia ◽  
Michèle Hébert ◽  
Jean Kozak ◽  
Isabelle Sénécal ◽  
Susan E. Slaughter ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Focus Groups ◽  
Long Term Care ◽  
Disruptive Behaviors ◽  
Well Being ◽  
Care Homes ◽  
Term Care ◽  
Staff Members

ABSTRACTBackground: Disruptive behaviors are frequent and often the first predictor of institutionalization. The goal of this multi-center study was to explore the perceptions of family and staff members on the potential contribution of environmental factors that influence disruptive behaviors and quality of life of residents with dementia living in long-term care homes.Methods: Data were collected using 15 nominal focus groups with 45 family and 59 staff members from eight care units. Groups discussed and created lists of factors that could either reduce disruptive behaviors and facilitate quality of life or encourage disruptive behaviors and impede the quality of life of residents. Then each participant individually selected the nine most important facilitators and obstacles. Themes were identified from the lists of data and operational categories and definitions were developed for independent coding by four researchers.Results: Participants from both family and staff nominal focus groups highlighted facility, staffing, and resident factors to consider when creating optimal environments. Human environments were perceived to be more important than physical environments and flexibility was judged to be essential. Noise was identified as one of the most important factors influencing behavior and quality of life of residents.Conclusion: Specialized physical design features can be useful for maintaining quality of life and reducing disruptive behaviors, but they are not sufficient. Although they can ease some of the anxieties and set the stage for social interactions, individuals who make up the human environment are just as important in promoting well-being among residents.

Faculty wellness in academic medicine: Addressing stressors in the workplace

Work ◽  
2021 ◽  
pp. 1-7
Author(s):  
Claudia Finkelstein ◽  
Anne Ordway ◽  
Kurt L. Johnson
Keyword(s):  
Health Care ◽  
Organizational Context ◽  
Well Being ◽  
Professional Autonomy ◽  
Individual Responsibility ◽  
System Level ◽  
Physician Burnout ◽  
Structured Interviews ◽  
Physician Wellness ◽  
Promotion System

BACKGROUND: Burnout is widely regarded as a syndrome resulting from chronic occupational stress. While physician burnout has been the subject of extensive research, physician wellness has been proposed as an alternative framework for understanding physician distress. OBJECTIVE: The purpose of this qualitative study was to understand the organizational context of faculty wellness within an academic health care system. METHODS: Semi-structured interviews were conducted with 24 chairs of clinical and non-clinical departments in a US university school of medicine. RESULTS: Chairs described several system-level factors perceived to interfere with faculty wellness such as a stricter regulatory environment, the loss of professional autonomy, the up or out promotion system, limitless hours, and the rise of shadow work. While all chairs articulated some degree of responsibility for the wellness of their faculty, some said they lacked the skills or knowledge of resources to fully engage in this role. CONCLUSIONS: Findings from this study are consistent with recent research on physician burnout, which has pivoted from describing burnout as an individual responsibility to including the professional, organizational, and societal factors which likely contribute to physician job satisfaction and well-being. As health care organizations, including academic medical centers, move toward systems-based solutions for physician occupational health, it will be incumbent upon organizational leaders to make administrative decisions favoring physician wellness.

scholarly journals Vocational rehabilitation via social firms: a qualitative investigation of the views and experiences of employees with mental health problems, social firm managers and clinicians

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Nicola Morant ◽  
Alyssa Milton ◽  
Eleanor Gilbert ◽  
Sonia Johnson ◽  
Nicholas Parsons ◽  
...  
Keyword(s):  
Mental Health ◽  
Focus Groups ◽  
Vocational Rehabilitation ◽  
Mental Health Problems ◽  
Well Being ◽  
Health Problems ◽  
Management Support ◽  
Mental Health Clinicians ◽  
Structured Interviews ◽  
The Uk

Abstract Background Employment within social firms in the UK is under-developed and under-researched, but a potentially beneficial route to vocational rehabilitation for people with mental health problems. This study explores the views and experiences of employees with mental ill-health, managers of social firms and mental health clinicians, in order to understand the potential value of social firms for the vocational rehabilitation, employment and well-being of people with mental health problems. Methods Semi-structured interviews were conducted with 23 employees with mental health problems in 11 social firms in England. A focus group and individual interviews were conducted with 12 managers of social firms. Two focus groups were held with 16 mental health clinicians. Data were analysed using thematic analysis. Results Most employees expressed very positive views about working in a social firm. In responses from both employees and social firm managers, an overarching theme regarding the supportive ethos of social firms encompassed several related features: openness about mental health issues; peer, team and management support; flexibility; and support to progress and develop skills over time. Managers identified benefits of employing people with mental health problems who were sufficiently recovered. Knowledge of social firms within clinician focus groups was very limited, although clinicians thought they could be a welcome additional vocational resource. Conclusions High levels of job satisfaction among social firm employees may be explained by the supportive ethos of these working environments. Social firms have potential to be a helpful addition to the range of vocational pathways available for people with mental ill-health. Further mixed methods investigations of experiences and outcomes in order to understand who engages with and benefits from this form of vocational rehabilitation would be valuable in informing decisions about scaling up the model.

Clinicians’ perceptions of opioid error–contributing factors in inpatient palliative care services: A qualitative study

2019 ◽  
Vol 33 (4) ◽  
pp. 430-444 ◽  
Author(s):  
Nicole Heneka ◽  
Priyanka Bhattarai ◽  
Tim Shaw ◽  
Debra Rowett ◽  
Samuel Lapkin ◽  
...  
Keyword(s):  
Palliative Care ◽  
Qualitative Study ◽  
Focus Groups ◽  
System Level ◽  
Quality And Safety ◽  
Specialist Palliative Care ◽  
Structured Interviews ◽  
Contributing Factors ◽  
Care Services ◽  
Palliative Care Services

Background: Opioid errors are a leading cause of patient harm and adversely impact palliative care inpatients’ pain and symptom management. Yet, the factors contributing to opioid errors in palliative care are poorly understood. Identifying and better understanding the individual and system factors contributing to these errors is required to inform targeted strategies. Objectives: To explore palliative care clinicians’ perceptions of the factors contributing to opioid errors in Australian inpatient palliative care services. Design: A qualitative study using focus groups or semi-structured interviews. Settings: Three specialist palliative care inpatient services in New South Wales, Australia. Participants: Inpatient palliative care clinicians who are involved with, and/or have oversight of, the services’ opioid delivery or quality and safety processes. Methods: Deductive thematic content analysis of the qualitative data. The Yorkshire Contributory Factors Framework was applied to identify error-contributing factors. Findings: A total of 58 clinicians participated in eight focus groups and 20 semi-structured interviews. Nine key error contributory factor domains were identified, including: active failures; task characteristics of opioid preparation; clinician inexperience; sub-optimal skill mix; gaps in support from central functions; the drug preparation environment; and sub-optimal clinical communication. Conclusion: This study identified multiple system-level factors contributing to opioid errors in inpatient palliative care services. Any quality and safety initiatives targeting safe opioid delivery in specialist palliative care services needs to consider the full range of contributing factors, from individual to systems/latent factors, which promote error-causing conditions.

Couple-based mind-body intervention for patients with metastatic lung cancer and their spouses.

2017 ◽  
Vol 35 (31_suppl) ◽  
pp. 179-179
Author(s):  
Kathrin Milbury ◽  
Rosalinda Engle ◽  
Zhongxing X. Liao ◽  
Anne S. Tsao ◽  
April Owens ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Depressive Symptoms ◽  
Focus Groups ◽  
Sleep Disturbances ◽  
Controlled Trial ◽  
Well Being ◽  
Preliminary Evidence ◽  
Metastatic Lung Cancer ◽  
Structured Interviews ◽  
Metastatic Lung

179 Background: Given the incurable nature of metastatic lung cancer, patients and their spouses are at risk of experiencing psychological and spiritual distress. To address these concerns, we developed a couple-based mind-body (CBMB) intervention. This formative research aimed to examine intervention acceptability and initially efficacy in patients with metastatic lung cancer undergoing treatment and their spouses. Methods: We first conducted focus groups followed by a single-arm trial. Focus group participants completed program exercises and then semi-structured interviews and written evaluations including Likert-scale and open-ended questions. In the single-arm trial, the four intervention session were delivered over a 2-week period focusing on cultivating mindfulness, interpersonal connection, gratitude and purpose. Couples completed measures of depressive symptoms (CES-D), cancer distress (IES), spiritual well-being (FACT-Sp) and sleep disturbances (PSQI) before and after the program. Results: Focus groups (n = 7 dyads) revealed high acceptability ratings of the CBMB intervention (e.g., all participants would recommend the intervention). Consent and adherence rates (54% and 67%, respectively) were acceptable for the single arm trial (n = 7 dyads). All patients (67% male; µ age = 55 years) and partners (33% male; µ age = 59 years) rated the intervention as useful. Paired t-test analyses revealed large effects for sleep disturbances ( d= 1.83) and medium effects for cancer distress ( d= .61) for patients and large effects for depressive symptoms for spouses ( d= .90). Conclusions: Based on this two part study, the CBMB intervention appears to be acceptable and subjectively useful. There was also preliminary evidence regarding treatment gains for both patients and partners. A randomized controlled trial is warranted to further examine this supportive care strategy.

scholarly journals Seniors’ Campus Continuums: Local Solutions for Broad Spectrum Seniors Care

2020 ◽  
Author(s):  
Frances Margaret Morton-Chang ◽  
Shilpi Majumder ◽  
Whitney Berta
Keyword(s):  
Older Adults ◽  
Social Care ◽  
Well Being ◽  
System Level ◽  
Integrative Model ◽  
Term Care ◽  
Integration Of Care ◽  
Health And Social Care ◽  
Community Supports ◽  
Housing Options

Abstract Background: As demand and desire to “age-in-place” grows within an aging population, challenges exist to realizing this wish. Changing demographics and new areas of need have governments nationally and internationally calling for more focused attention on integrative approaches to health and well-being. Seniors’ Campus Continuums are models of care that seek to broaden access to an array of services and housing options to meet the growing health and social needs of aging populations in their communities . The objective of this study is to increase understanding of this integrative model through the exploration of factors that influence Campus development, functioning, and scope and extent of integration of care for older adults wishing to remain in their own home and community.Methods: This research uses a comparative case study approach across six bounded cases offering four physically co-located components – mixed independent housing options, internal community supports to residents, external community supports to the broader community, and a long-term care home – to explore how Seniors’ Campus Continuums operating in various contexts across Ontario, Canada integrate health, housing and social care for older adults.Results: Seniors’ Campus Continuums come in different shapes, sizes, and geographies however, they share many influencing factors in their evolution, design, function, and ability to integrate a broad range of supports and services for older adults with different and progressive needs. Enabling factors include i. rich historical legacies of helping people in need; ii. organizational vision and readiness to capitalize on key windows of opportunity; iii. leveraging organizational structure and capacity; iv. intentional physical and social design; v. broad services mix, amenities and innovative partnerships. Impeding factors include vi. policy hurdles and rigidities; vii. human resources shortages and inequities; and viii. funding limitations. A number of benefits afforded by campuses at an individual, organizational and system level were observed. Conclusion: Findings from this research provide detailed descriptions of campus continuums from inception to expansion and highlight opportunities to optimize their potential on many levels. At an individual level, campuses increase local access to a coordinated range of care services, supports and housing options that can be tailored to benefit their health and social care needs. At an organizational level, campuses offer enhanced collaboration opportunities across providers and partners to improve consistency and coordination of care, access to shared resources, expertise and infrastructure, improved economies of scale, and rich environments for training/research, education and volunteering. At a system level, they offer potential to address a diversity of health, social, financial, and housing needs to help seniors avoid premature or inappropriate use of higher intensity care settings. This study fills a gap in evidence-based research on this integrative model and offers lessons to consider for future “age-friendly” policy development.

Older people’s long-term care experiences during the COVID-19 pandemic in Ghana: a qualitative descriptive study

2021 ◽  
Author(s):  
Kofi Awuviry-Newton ◽  
Jacob Oppong Nkansah ◽  
Abraham Newton ◽  
Kwamina Abekah-Carter
Keyword(s):  
Long Term Care ◽  
Well Being ◽  
Descriptive Study ◽  
Structured Interviews ◽  
Term Care ◽  
Care Policies ◽  
Qualitative Descriptive ◽  
Descriptive Approach ◽  
Southern Ghana

This study explores older people’s long-term care experiences during the COVID-19 pandemic in Ghana. A qualitative descriptive approach employing semi-structured interviews was used to collect data from 15 older people from Southern Ghana. Analysis of interview data resulted in five interrelated themes: (1) sources and type of long-term care; (2) older people’s satisfaction with the long-term care received; (3) changes in their long-term care; (4) feelings of neglect regarding long-term care; and (5) older people’s resilience in long-term care. The sustainability of long-term care depends on the state’s ability to devise innovative long-term care policies and programmes to promote older people’s and their carers’ well-being.

scholarly journals Implementing Non-Pharmacologic Interventions for People Living with Dementia in Long-Term Care Settings

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 691-692
Author(s):  
Emily Ihara
Keyword(s):  
Best Practice ◽  
Long Term Care ◽  
Psychological Symptoms ◽  
Low Cost ◽  
Neuropsychiatric Symptoms ◽  
Well Being ◽  
Social Model ◽  
Term Care ◽  
Wide Range

Abstract Person-centered dementia care is a best practice recommendation by the Alzheimer’s Association, and non-pharmacologic interventions that emphasize well-being and quality of life as defined by the individual are important to preserve personhood. Non-pharmacologic, person-centered interventions have been shown to effectively address various neuropsychiatric symptoms, commonly known as behavioral and psychological symptoms in dementia (BPSD), which include a wide range of behaviors such as verbal or physical aggression, agitation, wandering, and pacing. Interventions that are focused on an individual’s holistic needs and preferences can stimulate positive emotions and behavior regardless of the stage of dementia. Person-centered care emphasizes a social model of care, rather than a medical model, by focusing on an individual’s emotional needs and care preferences that are consistent with their previous lifestyle. This symposium explores four different non-pharmacologic interventions for individuals living with dementia and discusses challenges and best practices for implementation in long-term care settings. For example, a best practice includes “buy-in” from facility staff who ultimately are responsible for implementing interventions that follow a social care model. A challenge found includes creating consistency and adherence to non-pharmacologic interventions so they are sustained over time, potentially replacing additional doses of medication. Symposium presenters will discuss the Mason Music & Memory Initiative (M3I), the Alzheimer’s Poetry Project, Birdsong, and TimeSlips, which are all interventions that are relatively low-cost and easy to implement by non-specialists. Strategies for intergenerational programming and adaptability of these programs to different contexts will also be discussed.

scholarly journals Communication in Home Care: The Experiences of Formal Caregivers in Communicating with Persons Living with Dementia

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 899-899
Author(s):  
Pabiththa Kamalraj ◽  
Marie Savundranayagam ◽  
J B Orange ◽  
Marita Kloseck
Keyword(s):  
Home Care ◽  
Care Home ◽  
Personal Space ◽  
Phenomenological Approach ◽  
Structured Interviews ◽  
Term Care ◽  
Caregiver Support ◽  
Formal Caregivers ◽  
Personal Support ◽  
Hermeneutic Phenomenological

Abstract There is limited literature on formal caregivers’ communication with persons living with dementia (PLWD) in home settings. Most research comes from studies of long-term care home settings or informal home care contexts. Yet, there are expected needs and rising demands for formal caregiver support within home care. The aim of this study was to understand better the lived experiences of personal support workers (PSWs) regarding their communication with PLWD in home settings. A hermeneutic phenomenological approach guided this research. Semi-structured interviews were conducted with 15 PSW participants. Three major themes were identified through thematic analysis: (1) challenged by dementia-related impairments; (2) valuing communication in care; and (3) home is a personal space. PSWs experienced difficulties in their communication with PLWD despite recognizing the importance of communication in providing optimal home care. This suggests that while PSWs possess good intentions, they do not possess the skills necessary to ensure effective interactions. Dementia-specific education and training are recommended to improve PSWs’ communication skills and to enhance quality of care. Findings highlight further the uniqueness of the personal home space itself on PSWs experiences with communication. Aspects of the home care environment can enable, but also complicate, successful communication between PSWs and PLWD. Consequently, findings also have implications for family members of PLWD and home care employers regarding optimizing practice and improving care.

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