Engaging Direct Care Providers in the Implementation of Montessori Programming for Dementia

There is a need to engage direct care providers such as certified nursing assistants (CNAs) explicitly in efforts to implement innovative programming in long-term care environments. This presentation will outline engagement strategies that supported the implementation of Montessori programming in a community of 20 individuals living with severe dementia. Examples about positioning the CNA at the center of decision making, negotiating and building trust, cultivating opportunities for mutual consultation, creating spaces for new ideas to emerge, and synthesizing diverse perspectives will be highlighted. Although the program achieved positive outcomes on a number of measures including decreased responsive behaviors from people living with dementia, decreased negative qualities of relationships between CNAs and persons with dementia, and increased positive qualities of relationships between CNAs and persons with dementia, this presentation will focus on the “how” of engagement between the project team and the CNAs by highlighting qualitative data.

Is Long-Term Care Person Centred? A Case Study

In Ontario long-term care (LTC) settings, person-centred care (PCC) is promoted by government legislation, accreditation organizations and professional practice guidelines aiming to integrate this approach. However, there is currently no standardized approach to providing PCC in LTC. The purpose of this study was to examine public policies on PCC in Ontario and explore how they are interpreted and translated into practice in LTC. A qualitative case study approach was used to examine the perspectives of key stakeholders at one LTC facility in Ontario. Focus groups were conducted with residents, family members, direct care providers and managers. Through content analysis, findings were organized into four categories showcasing both overlapping and differential understandings of PCC in practice: 1) conceptualization, 2) barriers, 3) facilitators, and 4) evaluation. Identified tensions between policy and the delivery of PCC highlight systemic issues that must be addressed to enable equitable person-centred LTC rooted in resident-identified priorities.

Is Long-Term Care Person Centred? A Case Study

In Ontario long-term care (LTC) settings, person-centred care (PCC) is promoted by government legislation, accreditation organizations and professional practice guidelines aiming to integrate this approach. However, there is currently no standardized approach to providing PCC in LTC. The purpose of this study was to examine public policies on PCC in Ontario and explore how they are interpreted and translated into practice in LTC. A qualitative case study approach was used to examine the perspectives of key stakeholders at one LTC facility in Ontario. Focus groups were conducted with residents, family members, direct care providers and managers. Through content analysis, findings were organized into four categories showcasing both overlapping and differential understandings of PCC in practice: 1) conceptualization, 2) barriers, 3) facilitators, and 4) evaluation. Identified tensions between policy and the delivery of PCC highlight systemic issues that must be addressed to enable equitable person-centred LTC rooted in resident-identified priorities.

582 A Survey of Burn Care Providers Regarding the Utility of Telehealth to Provide Outpatient Burn Care

Introduction Telehealth is purported to be the wave of the future, offering improved access to care by overcoming geographical and other logistical challenges while simultaneously improving efficiencies within the healthcare system. As the global COVID-19 pandemic swept through our state, we were abruptly forced to take our burn clinic to a telehealth platform for most patients. The purpose of this study was to evaluate our experience with telehealth in managing burn wounds and other complex skin defects. Methods A 16-item survey was developed using the framework outlined by the National Quality Forum for the development of telehealth measures. The survey was distributed to direct care providers and focused on the domains of experience and effectiveness and the subdomains of efficiency and satisfaction. Results There were a total of 14 respondents, including physicians, allied healthcare professionals, therapists and nurses. Seventy-seven percent of participants felt that overall, the system was efficient in the 4 categories of time required for scheduling, check-in, visit conduct and care coordination. Telehealth was deemed moderately to very effective by 80% in providing the patient access to care and the provider’s ability to educate the patient. However, providers, therapists and nurses uniformly found telehealth to be either not at all effective or slightly effective in assessing wounds, musculoskeletal function and developing a plan of care. When rating satisfaction with connectivity and overall quality of the clinic visit 70% of respondents were either dissatisfied/neither satisfied nor dissatisfied with the platform. Conclusions The operational aspects of our burn clinic telehealth program implemented during the COVID-19 pandemic were found to be largely satisfactory, with the exception of connectivity issues. However, the clinical aspects of the program were found to be largely unsatisfactory and, notably, were judged to be inferior to in-person visits.

Ambulation of hospitalized patients: Knowledge, values, and barriers of direct care providers

The desire to ambulate hospitalized patients is tempered by their risk of falling. Research articulates the health-related benefits of ambulation, yet routinely providing this intervention is challenging. This descriptive survey-design study obtained data from consented licensed and unlicensed direct-care providers, which assessed their knowledge, values, and perceived barriers associated with routine ambulation of patients receiving care in a hospital setting. Analyses of these data conclude that the subjects were knowledgeable about and value ambulating patients. The most frequently cited barrier to routine ambulation was an inadequate staff number, followed closely by an unexpected rise in volume and patient acuity. Interventions aimed at improving the ambulation of patients should include the results of this study.

ASSESSING PREFERENCES FOR COMMUNICATING WITH TECHNOLOGY: COMMUNITY-BASED PROVIDER PERSPECTIVES

Miscommunication during older adults’ care transitions from hospital to community-based settings (e.g. home health) can lead to adverse events. Effective use of technology assisted communication (TAC) may help to remedy miscommunication surrounding care transitions. Care providers in community-based settings are well-positioned to provide insight on the feasibility and current use of TAC. The purpose of this research was to determine contextual factors (i.e., intrapersonal, interpersonal, environmental) that influence the use of TAC in the home health setting from the perspective of community-based direct care providers and administrators. Focus groups were conducted with direct care providers and c administrators from two different settings – rural and urban/suburban. Content analysis was used to determine themes. Participants indicated that there are many barriers for older adults’ use of TAC such as low interest, fear of technology, knowledge gaps, and lack of access to technology. However, others embraced the use of TAC and technology in the community-based care. Additionally, certain forms of TAC, such as text and email, may be better for communicating with informal caregivers. Some direct care providers indicated they were not allowed or encouraged to use certain TAC with patients due to potential security concerns. The community-based care administrators highlighted the importance of TAC but did indicate that use can be limited due to liability and HIPAA concerns. These findings provide important insight for both determining how to best implement TAC for older adults in community-based care settings and aiding in the development of a tool for measuring preferences.

REDUCING ANTIPSYCHOTIC USE IN LONG-TERM CARE: CONSIDERING THE ROLE OF CULTURE OF CARE AND INFORMAL COMMUNICATION

Persons living with dementia-related disorders (PwD) can experience challenging behavioural and psychological symptoms (BPSD) as their illness progresses. There is a continued reliance on antipsychotic drugs (APD) in long-term care to manage this issue despite the well-documented risks of adverse events and increased morbidity and mortality. This study examines the role of culture of care in relation to efforts at reducing inappropriate APD use in managing BPSD within long-term care. Culture of care consists of shared norms, beliefs, and cognitive frames which guide clinical practice and inform the development and implementation of care strategies. Findings were obtained from three Canadian long-term care facilities working on reducing inappropriate use of APD. Data came from interviews with 6 nurses, 18 licenced practical nurses, 14 health care assistants, 4 activity leaders, 4 directors of care, 1 chaplain, and 10 physicians. We found that direct care providers initially varied in their perceived ability to develop and use alternate care strategies with health care assistants being most concerned about safety and exposure to violence. Change involved detective work and innovative thinking in assessing possible causes of BPSD beyond psychosis, including pain and feelings of confusion. Informal reciprocal patterns of communication emerged among health care assistants to identify effective non-pharmaceutical strategies to manage BPSD. Overall, the study shows how shared beliefs in the need for and value of alternate care practices among direct care providers along with the existence of effective informal communication can contribute to successful reduction in APD use when managing BPSD in PwD.

The effectiveness of cares dementia training modules on delivery of person centered care inside a memory care unit : utilizing the cares observational tool

This study compared the efficacy of using online dementia training modules on both direct and non-direct care providers in long-term care settings and how this impacted their delivery of Person Centered Care (PCC), as well as their knowledge of caring for residents with a diagnosis of Alzheimer Disease (AD), dementia. Traditional educational opportunities for staff working specifically with demented residents inside Memory Care Units (MCU) were investigated, along with an alternative approach of training all staff (to include direct and non-direct care providers). The option of utilizing online dementia training modules for all staff was then evaluated by using an observational Person Centered Care tool, to see if education had made an impact on interactions between staff and the demented residents that they care for. This study utilized a single-group, repeated measures design to test a 10-week, standardized and computerized set of 10 interactive training modules in a 60-bed MCU . Fifty-one observations were made between MCU residents and staff and included in this study, employing a single-group pre-post-posttest design. The findings suggest that online dementia training modules may be beneficial for both knowledge and delivery of PCC to staff in MCUs who care for residents with a diagnosis of AD.