August 30, 2022


Ontario’s new healthcare plan
Ontario Government Introduces A Plan to Stay Open: Health System Stability and Recovery

August 18, 2022
Plan hires up to 6,000 additional health care workers, frees up 2,500 more hospital beds and temporarily covers cost of examination, application and registration fees for retired and internationally trained nurses.

Strengthen Canada’s post-pandemic health care system by completing this survey
COVID-19 Recovery Survey from The Royal Society of Canada Working Group & Canadian Institutes of Heath Research

The Royal Society of Canada Working Group on Health Research System Recovery, in partnership with the Canadian Institutes of Health Research (CIHR), is conducting a research project to develop recommendations to strengthen Canada’s health research system post-pandemic. They are looking to hear from you on ways your organization has adapted to support COVID-19 pandemic recovery

New white paper on LTC architecture
Reimagining Long-Term Care Architecture in Post-Pandemic in Ontario–and Beyond

University of Toronto Centre for Design + Health Innovation, 2022
In 2021, the Provincial Government of Ontario committed an unprecedented $1.75 billion over five years to strengthen and modernize the Long-Term Care (LTC) network in Ontario. This policy decision was driven by the urgency to respond to the expanding COVID-19 pandemic. It is a governmental commitment with potentially major ramifications for LTC, which many Ontarians had long been advocating. In early 2021, Jacobs Canada hosted an interdisciplinary Roundtable event. It drew together leaders from the architectural, direct care provider, and home eldercare sectors to focus on how this planned investment can be most thoughtfully and successfully implemented. Recommendations were put forth: 1. Current insufficient freedom of choice exists among the general public in being able to self-select among various LTC facility locations; 2. Better system-wide planning is needed in anticipation of the growing number of aged individuals with cognitive impairments in need of viable LTC options; 3. Greater infrastructural connections, i.e. walkability, transit, are needed between a LTC facility and its neighborhood and broader urban context; and 4. New public policies are needed to foster the construction of genuinely therapeutic LTC residential care facilities.

New article by Matthias Hoben, Andrea Gruneir, and Stephanie Chamberlain
Prevalence and correlates of anxiety and depression in caregivers to assisted living residents during COVID-19: a cross-sectional study.
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Lane NE, Hoben M, Amuah JE, Hogan DB, Baumbusch J, Gruneir A, et al.
BMC geriatrics. 2022 Aug;22(1):662.
BACKGROUND: Family and friend caregivers play significant roles in advocating for and ensuring quality health and social care of residents in Assisted Living (AL) homes. However, little is known about how the COVID-19 pandemic and related visitor restrictions affected their health and mental well-being. We examined the prevalence and correlates of anxiety and depressive symptoms among caregivers of AL residents during the initial wave of COVID-19 in two Canadian provinces. METHODS: A cross-sectional web-based survey was conducted among family/friend caregivers of AL residents in Alberta and British Columbia (Oct 28, 2020-Mar 31, 2021) to collect data on their sociodemographic, health and caregiving characteristics, as well as concerns about residents’ health and social care before and during the first wave of the pandemic. A clinically significant anxiety disorder and depressive symptoms were assessed with the GAD-7 and CES-D10 instruments, respectively. Separate multivariable (modified) Poisson regression models identified caregiver correlates of each mental health condition. RESULTS: Among the 673 caregivers completing the survey (81% for Alberta residents), most were women (77%), white (90%) and aged ≥ 55 years (81%). Clinically significant anxiety and depression were present in 28.6% and 38.8% of caregivers respectively. Both personal stressors (comorbidity level, income reduction, low social support) and caregiving stressors exacerbated by the pandemic were independently associated with caregiver anxiety and depression. The latter included increased concern about the care recipients’ depression (adjusted risk ratio [adjRR] = 1.84, 95% confidence interval [CI] 1.19-2.85 for caregiver anxiety and adjRR = 1.75, 95% CI 1.26-2.44 for caregiver depressive symptoms) and reported intention to withdraw the resident from AL because of COVID-19 (adjRR = 1.24, 95%CI 0.95-1.63 for caregiver anxiety and adjRR = 1.37, 95%CI 1.13-1.67 for caregiver depressive symptoms). CONCLUSIONS: Caregivers of residents in AL homes reported significant personal and caregiving-related stressors during the initial wave of COVID-19 that were independently associated with an increased likelihood of experiencing clinically significant anxiety and depressive symptoms. Healthcare providers and AL staff should be aware of the prevalence and varied correlates of caregivers’ mental health during public health crises so that appropriate screening and support may identified and implemented.

New articles on LTC workers during the pandemic
Care home workers experiences of stress and coping during COVID‐19 pandemic: A mixed methods study
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Beattie M, Carolan C, Macaden L, Maciver A, Dingwall L, Macgilleeathain R, et al.
Nursing Open. 2022 Aug.
AIM: The aim of the study was to explore the stress and coping experiences of healthcare workers (HCWs) in care home settings in Scotland during the COVID-19 pandemic. DESIGN: A cross-sectional mixed methods study was conducted using an online survey and interviews. METHODS: Mean scores were calculated for both stress and coping and t-tests used to explore possible links to demographics. Qualitative data were analysed thematically using Braun and Clarke’s method. RESULTS: For 52 survey participants, the mean score for the PSS was M = 39.75 and CSE-M = 150.6 indicating high stress and medium coping skills. From the t-test, only absence of health issues was associated with higher levels of coping. Thirteen HCWs participated in one-to-one interviews. Qualitative data analysis generated four themes contributing to stress: 1. personal factors, 2. changed care environment, 3. amplified scrutiny and 4. psychological responses. Coping was represented as three main themes: 1. personal factors, 2. organizational culture and 3. safety and security. There is a critical need for a strategic approach to provide psychological support to care home staff both during and beyond the context of the pandemic.

How much are we worth? Experiences of nursing assistants in Swedish nursing homes during the first wave of COVID-19.
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Bergqvist M, Bastholm-Rahmner P, Gustafsson LL, Holmgren K, Veg A, Wachtler C, et al.
International journal of older people nursing. 2022 Aug;e12498.
BACKGROUND: NHs have been severely exposed during the COVID-19 pandemic. Little is known about how staff who provide practical daily care of older residents experienced work during the pandemic. The aim of this study was to understand how nursing assistants (NAs) experienced their work at nursing homes (NHs) for older people during the first wave of the COVID-19 pandemic. METHODS: We conducted a qualitative study of focus group discussions with in total 20 participants from four NHs in Stockholm, Sweden. Discussions were held in November 2020. Transcripts were analyzed using inductive thematic analysis. RESULTS: We identified three major themes: 1) We felt abandoned, scared and disrespected, 2) We made sure we made it through, and 3) We can do good work with appropriate resources. NAs felt disregarded as they were often left alone without adequate support from managers, registered nurses and the municipalities. NAs felt distressed and guilty and developed their own strategies to cope and manage their work. CONCLUSION AND IMPLICATION FOR PRACTICE: During the first wave of the COVID-19 pandemic NAs felt abandoned and burdened due to lack of leadership. Organizational improvements are required to protect the wellbeing of NAs and to ensure sustainability of patient safety. NAs are crucial in the care for vulnerable older people and their experiences should constitute a keystone for development of future policy and practice in NHs.

The implications of COVID-19 on health and social care personnel in long-term care facilities for older people: An international scoping review.
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Jones K, Schnitzler K, Borgstrom E.
Health & social care in the community. 2022 Aug.
This scoping review mapped out the existing literature pertaining to health and social care personnel experiences during the coronavirus disease-2019 (COVID-19) pandemic and their work in a long-term care setting for older people. This review identified the gaps in the implications of health and social care personnel’s own health and well-being during the pandemic as well as the ethical dilemmas inherent in providing care during the COVID-19 pandemic. The authors utilised the PRISMA checklist for undertaking scoping reviews. The Databases Medline, PsychINFO, CINAHL, SCOPUS, Web of Science and Google Scholar were searched for relevant articles in English that were published between March 28, 2020 and June 1, 2022. This time period was selected to focus specifically on the COVID-19 pandemic. In the context of this review, long-term care facilities were defined to include institutions such as nursing homes, skilled nursing facilities, retirement homes and residential care homes. The gaps identified were a paucity of research on the experiences of health and social care personnel in long-term care facilities, the impact on their mental health, and the wider challenges experienced during the COVID-19 pandemic is discussed. The findings of this scoping review indicate a need for adequate preparedness during a pandemic within the health and social care sector to protect health and social care personnel and the individuals they care for.

Prevalence, Predictors, and Experience of Moral Suffering in Nursing and Care Home Staff during the COVID-19 Pandemic: A Mixed-Methods Systematic Review.
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Laher Z, Robertson N, Harrad-Hyde F, Jones CR.
International journal of environmental research and public health. 2022 Aug;19(15).
(1) Background: Nursing and care home staff experienced high death rates of older residents and increased occupational and psychosocial pressures during the COVID-19 pandemic. The literature has previously found this group to be at risk of developing mental health conditions, moral injury (MI), and moral distress (MD). The latter two terms refer to the perceived ethical wrongdoing which contravenes an individual’s moral beliefs and elicits adverse emotional responses. (2) Method: A systematic review was conducted to explore the prevalence, predictors, and psychological experience of MI and MD in the aforementioned population during the COVID-19 pandemic. The databases CINAHL, APA PsychINFO, APA PsychArticles, Web of Science, Medline, and Scopus were systematically searched for original research studies of all designs, published in English, with no geographical restrictions, and dating from when COVID-19 was declared a public health emergency on the 30 January 2020 to the 3 January 2022. Out of 531 studies screened for eligibility, 8 studies were selected for review. A thematic analysis was undertaken to examine the major underpinning themes. (3) Results: MI, MD, and related constructs (notably secondary traumatic stress) were evidenced to be present in staff, although most studies did not explore the prevalence or predictors. The elicited major themes were resource deficits, role challenges, communication and leadership, and emotional and psychosocial consequences. (4) Conclusions: Our findings suggest that moral injury and moral distress were likely to be present prior to COVID-19 but have been exacerbated by the pandemic. Whilst studies were generally of high quality, the dearth of quantitative studies assessing prevalence and predictors suggests a research need, enabling the exploration of causal relationships between variables. However, the implied presence of MI and MD warrants intervention developments and workplace support for nursing and care home staff.

You Killed the Hospital, They Have No Place Left”: The Experience of Nursing Home Multidisciplinary Staff in Israel during the COVID-19 Pandemic.
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Lev S, Dolberg P.
Journal of aging & social policy. 2022 Aug;1–21.
The purpose of the present study is to examine how multidisciplinary staffs experienced and coped with the COVID-19 pandemic crisis in nursing homes. The research included six in-depth online focus groups consisting of 21 multidisciplinary staff members from 14 Israeli nursing homes. The qualitative analysis was encoded in stages with repeated comparisons between individual participants and within groups and led to four main themes: (a) Multidisciplinary staff perceptions of nursing home management’s performance in relation to them, which was experienced as insufficient appreciation and feelings of abandonment among the non-medical staff; (b) Multidisciplinary staff perceptions of the Ministry of Health’s performance, which was experienced as chaotic and disconnected albeit supportive on the personal level; (c)The nursing home multidisciplinary staff experience during the COVID-19 pandemic, in terms of perceived stress and burnout, as well as development of a routine; (d) The multidisciplinary staff’s coping strategies, which included commitment to work despite risk, redefinition of their role, and staff insights about the need to take responsibility for their role and not rely on outside help. The findings indicate the importance of relationships that promote support and mutual communication between multidisciplinary staff, and both nursing home management and Ministry of Health.KEY POINTS Nursing home multidisciplinary staff experienced disconnection from and abandonment by nursing home management and Ministry of Health during the Covid-19 pandemic.Nursing home multidisciplinary staff experienced stress and burnout but also developed a routine.Despite intensified negative emotional feelings, multidisciplinary staff also underwent processes of redefining their role and gaining greater independence.Findings indicate the importance of creating a climate that facilitates mutual sharing, listening and learning.

Resilience Among Direct Care Staff in Nursing Homes. Validation of the CD-RISC2.
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Pérez-Rojo G, López J, Noriega C, Velasco C.
Clinical gerontologist. 2022 Aug;1–11.
OBJECTIVES: Caring for older adults is a demanding task. Some professionals may find themselves in complex situations for which they may not be prepared. However, the repercussions of these difficult experiences will depend on personal factors. Resilience acts as a buffer against difficulties and experiences. However, its study with first-line caregivers in nursing homes is limited. This study aimed to validate the Connor-Davidson Resilience Scale-2 (CD-RISC2), examine its psychometric properties, and analyze the variables associated with resilience (sociodemographic and professionals´ variables). METHODS: 312 nursing home professionals participated in the study. Besides the Connor-Davidson Resilience Scale-2, they answered questionnaires about good care, burnout, quality of life, person-centered care, and well-being. RESULTS: The CD-RISC2 showed adequate reliability and test-retest reliability. Good support was found for convergent validity with perceived health, person-directed care, personal growth, life purpose, quality of life and good care, and for discriminant validity with burnout. Conclusions: To our knowledge, this is the first study that validates the CD-RISC2 Spanish version with front-line workers in nursing homes showing adequate psychometric properties. CLINICAL IMPLICATIONS: An abbreviated, simpler, self-assessed version may be more useful than longer versions, especially with professionals with a heavy workload, such as direct care staff in nursing homes.

New articles on the state of implementation science
Promises and pitfalls in implementation science from the perspective of US-based researchers: learning from a pre-mortem.
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Beidas RS, Dorsey S, Lewis CC, Lyon AR, Powell BJ, Purtle J, et al.
Implementation science : IS. 2022 Aug;17(1):55.
BACKGROUND: Implementation science is at a sufficiently advanced stage that it is appropriate for the field to reflect on progress thus far in achieving its vision, with a goal of charting a path forward. In this debate, we offer such reflections and report on potential threats that might stymie progress, as well as opportunities to enhance the success and impact of the field, from the perspective of a group of US-based researchers. MAIN BODY: Ten mid-career extramurally funded US-based researchers completed a “pre-mortem” or a group brainstorming exercise that leverages prospective hindsight to imagine that an event has already occurred and to generate an explanation for it – to reduce the likelihood of a poor outcome. We came to consensus on six key themes related to threats and opportunities for the field: (1) insufficient impact, (2) too much emphasis on being a “legitimate science,” (3) re-creation of the evidence-to-practice gap, (4) difficulty balancing accessibility and field coherence, (5) inability to align timelines and priorities with partners, and (6) overly complex implementation strategies and approaches. CONCLUSION: We submit this debate piece to generate further discussion with other implementation partners as our field continues to develop and evolve. We hope the key opportunities identified will enhance the future of implementation research in the USA and spark discussion across international groups. We will continue to learn with humility about how best to implement with the goal of achieving equitable population health impact at scale.

Is implementation research out of step with implementation practice? Pathways to effective implementation support over the last decade
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Metz A, Jensen T, Farley A, Boaz A.
Implementation Research and Practice. 2022 Jan;3:26334895221105584.
Background: There is growing interest in the lived experience of professionals who provide implementation support (i.e., implementation support practitioners). However, there remains limited knowledge about their experiences and how those experiences can contribute to the knowledge base on what constitutes successful and sustainable implementation support models. This study aimed to examine pathways of implementation support practice, as described by experienced professionals actively supporting systems? uptake and sustainment of evidence to benefit children and families. Methods: Seventeen individuals with extensive experience providing implementation support in various settings participated in semi-structured interviews. Data were analyzed using qualitative content analysis and episode profile analysis approaches. Iterative diagramming was used to visualize the various pathways of implementation support practitioners? role reflection and transformation evidenced by the interview data. Results: Findings highlighted rich pathways of implementation support practitioners? role reflection and transformation. Participants described their roots in providing implementation support as it relates to implementing and expanding the use of evidence-based programs and practices in child and family services. Almost all participants reflected on the early stages of their careers providing implementation support and described a trajectory starting with the use of ?push models,? which evolved into ?pull models? and eventually ?co-creation or exchange models? of implementation support involving both technical and relational skills. Conclusions: Developing an implementation support workforce will require a deeper understanding of this lived experience to prevent repeated use of strategies observed to be unsuccessful by those most proximal to the work. The pathways for implementation practice in this study highlight impressive leaps forward in the field of implementation over the last 15 years and speaks to the importance of the professionals leading change efforts in this growth. Plain Language SummaryOver the past few years, professionals in the field of implementation science have identified a growing gap between implementation research and implementation practice. While this issue has been highlighted informally, the field is lacking a shared understanding and clear way forward to reconcile this gap. In this paper, the authors describe how professionals providing implementation support have shifted their implementation practice over time through systematic observations of what works (and what does not work) for supporting and sustaining evidence use in service systems to improve population outcomes. The authors share the impressive leaps forward made in the field of implementation practice ? from didactic training to responsive and tailored implementation strategies to co-created and relationship-based implementation solutions. The paper concludes with a call to action to the field for the creation of a virtuous learning cycle between professionals conducting implementation research and professionals providing implementation support to change practice as a way to produce a more robust and relevant science of implementation.

New article on intersectionality and implementation science research
Selecting implementation models, theories, and frameworks in which to integrate intersectional approaches.
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Presseau J, Kasperavicius D, Rodrigues IB, Braimoh J, Chambers A, Etherington C, et al.
BMC medical research methodology. 2022 Aug;22(1):212.
BACKGROUND: Models, theories, and frameworks (MTFs) provide the foundation for a cumulative science of implementation, reflecting a shared, evolving understanding of various facets of implementation. One under-represented aspect in implementation MTFs is how intersecting social factors and systems of power and oppression can shape implementation. There is value in enhancing how MTFs in implementation research and practice account for these intersecting factors. Given the large number of MTFs, we sought to identify exemplar MTFs that represent key implementation phases within which to embed an intersectional perspective. METHODS: We used a five-step process to prioritize MTFs for enhancement with an intersectional lens. We mapped 160 MTFs to three previously prioritized phases of the Knowledge-to-Action (KTA) framework. Next, 17 implementation researchers/practitioners, MTF experts, and intersectionality experts agreed on criteria for prioritizing MTFs within each KTA phase. The experts used a modified Delphi process to agree on an exemplar MTF for each of the three prioritized KTA framework phases. Finally, we reached consensus on the final MTFs and contacted the original MTF developers to confirm MTF versions and explore additional insights. RESULTS: We agreed on three criteria when prioritizing MTFs: acceptability (mean = 3.20, SD = 0.75), applicability (mean = 3.82, SD = 0.72), and usability (median = 4.00, mean = 3.89, SD = 0.31) of the MTF. The top-rated MTFs were the Iowa Model of Evidence-Based Practice to Promote Quality Care for the ‘Identify the problem’ phase (mean = 4.57, SD = 2.31), the Consolidated Framework for Implementation Research for the ‘Assess barriers/facilitators to knowledge use’ phase (mean = 5.79, SD = 1.12), and the Behaviour Change Wheel for the ‘Select, tailor, implement interventions’ phase (mean = 6.36, SD = 1.08). CONCLUSIONS: Our interdisciplinary team engaged in a rigorous process to reach consensus on MTFs reflecting specific phases of the implementation process and prioritized each to serve as an exemplar in which to embed intersectional approaches. The resulting MTFs correspond with specific phases of the KTA framework, which itself may be useful for those seeking particular MTFs for particular KTA phases. This approach also provides a template for how other implementation MTFs could be similarly considered in the future. TRIAL REGISTRATION: Open Science Framework Registration:

New article that defines assisted care in Canada
Defining the Assisted Living Sector in Canada: An Environmental Scan.
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Manis DR, Bronskill SE, Rochon PA, Sinha SK, Boscart V, Tanuseputro P, et al.
Journal of the American Medical Directors Association. 2022 Aug.
OBJECTIVES: In this study, we (1) identify the terms used to describe the assisted living sector and the legislation governing operation in all Canadian provinces and territories; (2) identify the cost estimates associated with residency in these homes; and (3) quantify the growth of the sector. DESIGN: Environmental scan. SETTING AND PARTICIPANTS: Internet searches of Canadian provincial and territorial government websites and professional associations were conducted in 2021 to retrieve publicly accessible sources related to the assisted living sector. METHODS: We synthesized data that identified the terms used to describe the sector in all provinces and territories, the legislation governing operation, financing, median fees per month for care, and growth of the sector from 2012 to 2020. Counts and proportions were calculated for some extracted variables. All data were narratively synthesized. RESULTS: The terms used to describe the assisted living sector varied across Canada. The terms “assisted living,” “retirement homes,” and “supportive living” were prevalent. Ontario was the only province to regulate the sector through an independent, not-for-profit organization. Ontario, British Columbia, and Alberta had some of the highest median fees for room, board, and care per month (range: $1873 to $6726). The licensed assisted living sector in Ontario doubled in size (768 in 2020 vs 383 in 2012), and there was a threefold increase in the number of corporate-owned chain assisted living facilities (465 in 2020 vs 142 in 2012). CONCLUSIONS AND IMPLICATIONS: The rapid growth of the assisted living sector that is primarily financed through out-of-pocket payments may indicate a rise in a two-tier system of housing and health care for older adults. Policymakers need better mechanisms, such as standardized reporting systems and assessments, to understand the needs of older adults who reside in assisted living facilities and inform the need for sector regulation and oversight.

New article by Susan Slaughter
Successful Recruitment to Qualitative Research: A Critical Reflection
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Negrin KA, Slaughter SE, Dahlke S, Olson J. S.
International Journal of Qualitative Methods. 2022 Jan;21:16094069221119576.
Recruitment to qualitative research is an important methodological consideration. However, the process of recruitment is under-communicated in qualitative research articles and methods textbooks. A robust recruitment plan enhances trustworthiness and overall research success. Although recruitment has recently received increased attention in the qualitative methodology literature, a more nuanced understanding is required. We realized successful recruitment to our focused ethnographic inquiry. Numerous nurse educators, researchers, and administrators volunteered within three months of study initiation. Using Gibbs? Reflective Cycle, we conducted a critical reflection on the recruitment log and participant interview data to surface factors contributing to our success. This article offers our insights into the facilitators of successful recruitment. Our reflection revealed four themes contributing to successful enrollment: (a) laying the groundwork, (b) recruitment plan, (c) building rapport, and (d) participant motivations. Two new recruitment strategies accounted for over 60% of our sample. Reporting on successful strategies for recruiting participants to qualitative research and specifying participants? motivations to volunteer, from their perspective, make important contributions to the recruitment literature. Our article offers guidance to qualitative researchers pursuing successful recruitment. Additional research is required to evaluate the relative influence of various recruitment strategies.

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