December 15, 2020

The need for profound, systemic change in the nursing home sector has been clear for decades. The coronavirus disease 2019 pandemic has exacerbated existing deficiencies in the sector. Care aides (called certified nursing assistants in the US) provide up to 90% of direct care in Canadian nursing homes.4 They are both a neglected and socioeconomically disadvantaged workforce, as well as a critical source of emotional and social support for residents. Our objective is to describe care aides’ characteristics and quality of work life in Western Canadian nursing homes.

In this podcast Sube Banerjee considers the disproportionate burden of mortality and morbidity bourn by older people and people with dementia in care homes in the Covid-19 pandemic as an issue of discrimination. Framed by the words of Sam Cooke’s anthem “A change is gonna come”, he discusses how things can and must change for the better.

What is needed most at this time is leadership and true collaboration among all levels of government to deliver an agreement around national standards and targeted funding. Such an agreement has the potential to right a terrible wrong and ensure it does not happen, ever again.

A Perfect Storm: The COVID-19 Experience for Revera and the Long Term Care Sector was developed in the summer and fall of 2020 by a panel of external experts with national and international experience in a range of relevant fields. Revera asked the expert panel, using data the company collected from the first wave of COVID-19, to identify practical and actionable opportunities for improvement in the senior congregate living sector and develop implementable best practices to help the sector cope with subsequent waves of the pandemic and other future events.

Nursing leadership plays a vital role in shaping outcomes for healthcare organizations, personnel and patients. With much of the leadership workforce set to retire in the near future, identifying factors that positively contribute to the development of leadership in nurses is of utmost importance. Objectives To identify determining factors of nursing leadership, and the effectiveness of interventions to enhance leadership in nurses. Design We conducted a systematic review, including a total of nine electronic databases. Data Sources Databases included: Medline, Academic Search Premier, Embase, PsychInfo, Sociological Abstracts, ABI, CINAHL, ERIC, and Cochrane. Review Methods Studies were included if they quantitatively examined factors contributing to nursing leadership or educational interventions implemented with the intention of developing leadership practices in nurses. Two research team members independently reviewed each article to determine inclusion. All included studies underwent quality assessment, data extraction and content analysis. Results 49,502 titles/abstracts were screened resulting in 100 included manuscripts reporting on 93 studies (n=44 correlational studies and n=49 intervention studies). One hundred and five factors examined in correlational studies were categorized into 5 groups experience and education, individuals’ traits and characteristics, relationship with work, role in the practice setting, and organizational context. Correlational studies revealed mixed results with some studies finding positive correlations and other non-significant relationships with leadership. Participation in leadership interventions had a positive impact on the development of a variety of leadership styles in 44 of 49 intervention studies, with relational leadership styles being the most common target of interventions. Conclusions The findings of this review make it clear that targeted educational interventions are an effective method of leadership development in nurses. However, due to equivocal results reported in many included studies and heterogeneity of leadership measurement tools, few conclusions can be drawn regarding which specific nurse characteristics and organizational factors most effectively contribute to the development of nursing leadership. Contextual and confounding factors that may mediate the relationships between nursing characteristics, development of leadership and enhancement of leadership development programs also require further examination. Targeted development of nursing leadership will help ensure that nurses of the future are well equipped to tackle the challenges of a burdened health-care system.

Clinical leadership is fundamental in facilitating service improvements in healthcare. Few studies have attempted to understand or model the different approaches to leadership which are used when promoting the uptake and implementation of evidence-based interventions. This research aims to uncover and explain how distributed clinical leadership can be developed and improved to enhance the use of evidence in practice. In doing so, this study examines implementation leadership in orthopaedic surgery to explain leadership as a collective endeavour which cannot be separated from the organisational context. METHODS: A mixed-method study consisting of longitudinal and cross-sectional interviews and an embedded social network analysis will be performed in six NHS hospitals. A social network analysis will be undertaken in each hospital to uncover the organisational networks, the focal leadership actors and information flows in each organisation. This will be followed by a series of repeated semi-structured interviews, conducted over 4 years, with orthopaedic surgeons and their professional networks. These longitudinal interviews will be supplemented by cross-sectional interviews with the national established surgical leaders. All qualitative data will be analysed using a constructivist grounded theory approach and integrated with the quantitative data. The participant narratives will enrich the social network to uncover the leadership configurations which exist, and how different configurations of leadership are functioning in practice to influence implementation processes and outcomes. DISCUSSION: The study findings will facilitate understanding about how and why different configurations of leadership develop and under what organisational conditions and circumstances they are able to flourish. The study will guide the development of leadership interventions that are grounded in the data and aimed at advancing leadership for service improvement in orthopaedics. The strength of the study lies in the combination of multi-component, multi-site, multi-agent methods to examine leadership processes in surgery. The findings may be limited by the practical challenges of longitudinal qualitative data collection, such as ensuring participant retention, which need to be balanced against the theoretical and empirical insights generated through this comprehensive exploration of leadership across and within a range of healthcare organisations.

.The aim of this research was to examine the prevalence of olfactory impairment in a sample of individuals living in long term care (LTC) homes and to examine associations between olfactory scores and food and fluid intake. Data were collected as part of a cross-sectional study conducted in 32 LTC homes across 4 provinces in Canada. Olfactory capabilities of 300 individuals were estimated using Burghart Sniffin’ Sticks. Food and fluid intake and self-reported olfactory capabilities were also collected. Based on Sniffin’ Stick scores, participants were classified into groups (anosmic vs not anosmic) with the majority (n=273) classified as anosmic. Differences in dietary and body weight data between the two groups were examined using pooled t-tests. No differences existed between olfactory group and body weight, caloric intake, nutrient intake or overall diet quality. Results indicate that older adults in LTC homes have significant olfactory impairments that do not show an association with food and fluid intake.

AIM: To identify barriers to/enablers of attendance at eye screening among three groups of immigrantsto Canada from cultural/linguistic minority groups living with diabetes. METHODS: Using a patient-oriented research approach leveraging Diabetes Action Canada’s patient engagement platform, we interviewed a purposeful sample of people with type 2 diabetes who had immigrated to Canada from: Pakistan (interviews in Urdu), China (interviews in Mandarin) and French-speaking African and Caribbean nations (interviews in French). We collected and analysed data based on the Theoretical Domains Framework covering key modifiable factors that may operate as barriers to or enablers of attending eye screening. We used directed content analysis to code barrier/enabler domains. Barriers/enablers were mapped to behaviour change techniques to inform future intervention development. RESULTS: We interviewed 39 people (13 per group). Many barriers/enablers were consistent across groups, including views about harms caused by screening itself, practical appointment issues including forgetting, screening costs, wait times and making/getting to an appointment, lack of awareness about retinopathy screening, language barriers, and family and clinical support. Group-specific barriers/enablers included a preference to return to one’s country of birth for screening, the impact of winter, and preferences for alternative medicine. CONCLUSION: Our results can inform linguistic and culturally competent interventions to support immigrants living with diabetes in attending eye screening to prevent avoidable blindness.

The COVID-19 pandemic has impacted on all aspects of life and society for people across the world. Evidence has emerged of the higher risk of developing severe illness with coronavirus being greater in people who are older and those who have pre-existing health conditions. There is also evidence, worldwide, of the rapid transmission possible within closed settings. Of particular concern are settings where older people, those with weak immune systems and those with long-term health conditions live in environments of multiple occupancy with shared facilities, hence the adverse impact on those who live in long term care facilities worldwide. Many of Scotland’s care homes have already experienced outbreaks of COVID-19, particularly in March / April 2020 at the previous peak of the pandemic in the UK, and around 10% of care homes in Scotland have one or more cases of suspected COVID-19 1 , mirroring the current rise in community cases. The Cabinet Secretary for Health and Sport commissioned a rapid review of recent COVID-19 outbreaks in care homes; the primary aim of the review was to ensure that areas for improvement are identified, focussing on systems analysis and opportunities to enhance the support available for the delivery of care in the care home sector.2 ‘The aim was to collate and evaluate local level experiences and responses to the resurgence of COVID-19 outbreaks within care homes and to support learning and practice across the sector through the sharing of learning identified and approaches to improvement.’ This review focussed on four care homes currently identified with outbreaks involving a high number of positive cases of COVID-19. These care homes may not be representative of the experience of other homes in similar circumstances, those homes who had outbreaks with fewer cases, or those with no outbreaks at all. In order to check if these findings were representative of other care homes and NHS Board experiences at this time, we reviewed safety huddle data and other intelligence in the system beyond these homes, and spoke with national organisations. This triangulation indicated these findings were in line with wider system issues. We also checked the findings with the review reference group, who were drawn from NHS Boards and sector partners beyond those four care homes included in the review, they confirmed these were issues in the wider system being experienced. Due to the fast-paced environment within which constant evaluation of relevant factors is being undertaken, within a multi-factorial approach involving many agencies, the review team recognise it is possible that work may already be underway to address elements of some of the recommendations we have made. In these circumstances, will serve to reinforce the need for development and progression of these existing work-streams