November 22, 2022


CIHI reports that RNs, LPNs, and NPs are less likely to work in LTC in 2021 compared to 2020
Fewer nurses willing to work in long-term care, new report says

Globe and Mail, 16 Nov 2022
Link to CIHI report
About 500 fewer registered nurses were employed in long-term care in 2021 than the previous year, a drop of 2.2 per cent, and about 100 fewer licensed practical nurses worked for community health agencies last year than in 2020, a decrease of 0.8 per cent.

New analysis in BMJ about how COVID-19 facilitated knowledge mobilization
Effective knowledge mobilisation: creating environments for quick generation, dissemination, and use of evidence.
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Ahmad R, Gordon AC, Aylin P, Redhead J, Holmes A, Evans DP.
BMJ. 2022 Nov 7;379:e070195.
Key messages
-Effective response to the pandemic required real time use of research knowledge
-Some existing infrastructures for generating and mobilising research findings accelerated collaborative working during the pandemic, and helped direct research appropriately
-Investment is needed in integration of data, particularly for social care
-Successful knowledge mobilisation needs to be sustained and expanded to support our recovery from the covid-19 pandemic and respond to further threats

New article about leadership in NHs
Longitudinal changes in nursing home leadership, direct care staff job strain and social support in Swedish nursing homes-findings from the U-AGE SWENIS study.
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Backman A, Lindkvist M, Lövheim H, Sjögren K, Edvardsson D.
Int J Older People Nurs. 2022 Nov 14;e12515.
BACKGROUND: Promoting healthy work environment as a manager in nursing homes is important to safeguard staff health and well-being as well as care quality when facing increasing demands. The impact of leadership on staff work environment needs further exploration. OBJECTIVES: To describe longitudinal changes in nursing home leadership, direct care staff characteristics, job strain and social support. METHODS: This study has a repeated cross-sectional design, a five-year follow-up study. Nursing home staff in 181 corresponding units (n = 1253 in 2014 and n = 1176 in 2019) completed surveys about leadership, staff job strain and social support in a five-year follow-up study. Descriptive and regression analyses were conducted. RESULTS: A higher degree of leadership defined by coaching and providing direct feedback to care staff, handling conflicts in a constructive way and having control of the clinical work, was significantly associated with a lower degree of job strain and a higher degree of social support among staff, with stronger associations at follow-up. The proportion of enrolled nurses increased significantly at follow-up. CONCLUSIONS: Leadership is increasingly important for staff work environment, especially in times of increased workload and decreasing collegiality and deteriorating work atmosphere at work. IMPLICATIONS FOR PRACTICE: Stakeholder and policy makers in nursing home care may reflect on how managers’ leadership is prioritised in these environments because such leadership is associated with staff job strain and social support. Managers striving to improve the work situation of staff may consider their own role and allow flexibility in how and when the work can be performed.

New article about the implementation of a health information system in a NH
A co-designed health information system implementation into residential aged care: A mixed-method evaluation.
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Bail K, Merrick E, Gibson D, Hind A, Strickland K, Redley B.
J Nurs Scholarsh. 2022 Nov 10.
INTRODUCTION: Internationally, the adoption of technology into residential aged care settings has been slow and fraught with multiple challenges for residents, staff and service providers. The aim of this study was to evaluate the acceptability, efficiency, and quality of health information system implementation into aged care. METHODS: Three-stage, mixed-methods participatory action research, concurrent with the natural experiment of a co-designed health information system implementation into a 169-bed aged care home in Australia. Data were collected pre-, during, and post implementation between 2019 and 2021. Qualitative data included focus groups, interviews, and observations. Quantitative data included work observations, pedometers, record audits, incident reports and staff and resident surveys. There were 162 participants composed of 65 aged care residents, 90 staff, and 7 managers/consultants. RESULTS: Improved work efficiency included reduced staff time searching for information (6%); reduced nurse time on documentation (20.4% to 6.4%), and 25% less steps. Documentation improvement included resident assessments (68% to 96%); resident-focused goals (56% to 88%) and evaluations (31% to 88%). The staff reported being better equipped to manage the ‘delicacies of dignity’. CONCLUSION: Implementation of a health information system into a residential aged care facility was associated with improved resident-focused care and staff efficiency. CLINICAL RELEVANCE: Technology can support nurses and care staff to spend more time with residents in residential aged care homes, improve the quality of resident care, and assist meeting regulatory reporting requirements. Flexible and tailored co-design strategies can enhance both effectiveness and success of technology implementation into residential aged care.

Article on the importance of collaboration between HCAs and LPNs in LTC
It’s All about the Nurse Aides
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Beynon C, Supiano K, Siegel EO, Edelman LS, Hart SE, Madden C.
Journal of Long-Term Care. 2021.
Context: Collaboration between the certified nurse aide (CNA) and licensed nurse (LN) is crucial for the provision of safe, personalized, quality care in the nursing home. This study explored the lived work experience of collaboration in caregiving pairs that identified one another as successful care partners in the delivery of high-quality resident care. Objective: This research explored the CNA and LN experience of mutual support in four nursing homes in the Western United States with a particular focus on varied approaches of LN support for CNAs. Methods: Using a purposive sampling design, we surveyed 12 LN and 12 CNA participants individually and as part of an LN/CNA caregiving pair. Semi-structured interviews were recorded, transcribed verbatim, loaded into NVivo software, and coded for meaning Findings: LN participants described feeling most supported by CNAs who do their job well. LN and CNA participants described ways LNs in the sample provide holistic support to their CNA coworkers—a phenomenon we coinedundergirding: listen and respond, show respect, help with resident care and answer call lights, educate and explain, provide feedback and encouragement, adjust and divide workloads, protect the CNA, support physical needs, and provide emotional support. Undergirding promotes work success for the CNA and the LN. Most importantly, participants described how undergirding facilitates high-quality resident care.Limitations: This study was designed to identify and explore optimal collaboration as it is possible in the current nursing home setting. It was not intended to represent all LN/CNA caregiving pairs. Implications: These findings may be helpful for educators and administrators, but perhaps they are most important for policymakers. More effective support for CNAs is needed if we hope to decrease turnover, improve retention, and elevate nursing home residents’ quality of care.

New articles about LTC staff during the pandemic
English care home staff morale and preparedness during the Covid pandemic: A longitudinal analysis.
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Brainard DJ, Bunn DD, Watts ML, Killett DA, O’Brien PSJ, Lake PIR, et al.
Am J Infect Control. 2022 Nov 1;S0196-6553(22)00778-7.
BACKGROUND: Staff actions to prevent infection introduction and transmission in long-term care facilities (LTCFs) were key to reducing morbidity and mortality from COVID-19. Implementing infection control measures (ICMs) requires training, adherence and complex decision making while trying to deliver high quality care. We surveyed LTCF staff in England about their preparedness and morale at three timepoints during the COVID-19 epidemic. METHODS: Online structured survey targeted at LTCF workers (any role) administered at three timepoints (November 2020-January 2021; August-November 2021; March-May 2022). Narrative summary of answers, narrative and statistical summary (proportionality with Pearson’s chi-square or Fisher’s Exact Test) of possible differences in answers between waves. RESULTS: Across all three survey waves, 387 responses were received. Morale, attitudes towards working environment and perception about colleague collaboration were mostly positive at all survey points. Infection control training was perceived as adequate. Staff felt mostly positive emotions at work. The working environment remained challenging. Masks were the single form of PPE most consistently used; eye protection the least used. Mask-wearing was linked to poorer communication and resident discomfort as well as mild negative health impacts on many staff, such as dehydration and adverse skin reactions. Hand sanitiser caused skin irritation. CONCUSIONS: Staff morale and working practices were generally good even though the working environment provided many new challenges that did not exist pre-pandemic.

The psychological impact of the COVID emergency on Italian nursing homes staff and the effectiveness of eye movement desensitization and reprocessing.
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Faretta E, Maslovaric G, Garau MI, Marmondi G, Piras L, Rezzola S, et al.
Front Psychol. 2022;13:969028.
Residential nursing homes were particularly badly affected by the first wave of COVID-19, with large numbers of their frail person getting infected with COVID-19 and dying. The staff in these structures were catapulted into a reality very different from what they were used to. They had to adapt the way they used to take care of their patients in a very short space of time and in a scenario that was continually changing. In this manuscript we describe the subjective experience of staff in a number of Italian nursing homes during the first wave of the COVID-19 pandemic; and we report data showing the effectiveness of the Eye Movement Desensitization and Reprocessing (EMDR) treatment provided to support them during this Pandemic.

New article on the organizational factors that should inform NH innovations.
A theory of change of an innovation for therapeutic care and meaningful living in a German nursing home.
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Desch A, Förstner B, Artmann J, Häusler A, Hauptmann M, Altin S, et al.
BMC Geriatr. 2022 Nov 11;22(1):849.
BACKGROUND: Demographic changes are leading to growing care needs of older people and creating a challenge for healthcare systems worldwide. Nursing homes (NHs) need to provide care for growing numbers of residents while ensuring a high-quality care. We aimed to examine an innovative NH in Germany and apply a theory of change (ToC) approach to develop a best practice model (BPM) for therapeutic care in NHs. METHODS: A multimethod qualitative study conducted from February to July 2021 in Germany involved interviews with 14 staff members of an innovative NH and 10 directors and care managers of other NHs. The interview guidelines included questions on nursing practices, infrastructure, resources, interprofessional collaboration, and working culture. Additional material on the participating NH (website, promotion videos, newsletters, care documentation) were collected. Contextual literature on NH culture and therapeutic care in Germany, ToC methodology, and NH culture change were reviewed. Following a question-focused analysis of all material, we generated a ToC model towards a BPM of therapeutic care and meaningful living in NHs. Results were verified in interdisciplinary team meetings, with study participants and other stakeholders to establish consensus. RESULTS: The participating NH’s care concept aims to improve residents’ functional abilities and wellbeing as well as staff members’ job satisfaction. Central components of their approach include therapeutic elements such as music and movement in all nursing activities, multidisciplinary collaboration, a broad therapy and social activity offer, the continuation of therapy in everyday activities, a focus on individual life history, values, needs, and skills, social integration into the regional community, and the creation of a meaningful living environment for residents and staff. CONCLUSION: The BPM we developed shows how a meaningful living environment can be created through therapeutic care and integrative activities. The ToC sheds light onto the contextual factors and cultural values which should be considered in the development of NH interventions. Research on not only biomedical aspects, but also psychosocial dynamics and narrative co-constructions in nursing practice should inform NH innovations. The ToC also highlights the importance of developing adequate political frameworks and infrastructures for implementing such innovative practices on a larger scale.

New Canadian article on LTC cultural change
Culture Change in Long-Term Care-Post COVID-19: Adapting to a New Reality Using Established Ideas and Systems.
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Iyamu I, Plottel L, Snow ME, Zhang W, Havaei F, Puyat J, et al.
Can J Aging. 2022 Nov 9;1–8.
The response to the COVID-19 pandemic in long-term care (LTC) has threatened to undo efforts to transform the culture of care from institutionalized to de-institutionalized models characterized by an orientation towards person- and relationship-centred care. Given the pandemic’s persistence, the sustainability of culture-change efforts has come under scrutiny. Drawing on seven culture-change models implemented in Canada, we identify organizational prerequisites, facilitatory mechanisms, and frontline changes relevant to culture change that can strengthen the COVID-19 pandemic response in LTC homes. We contend that a reversal to institutionalized care models to achieve public health goals of limiting COVID-19 and other infectious disease outbreaks is detrimental to LTC residents, their families, and staff. Culture change and infection control need not be antithetical. Both strategies share common goals and approaches that can be integrated as LTC practitioners consider ongoing interventions to improve residents’ quality of life, while ensuring the well-being of staff and residents’ families.

New article on RN views of the organizational factors that lead to quality decline
Registered Nurses’ perspective of systemic factors affecting nursing home care quality decline: A qualitative descriptive study.
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Park Y, Min D.
Nurs Open. 2022 Nov 14.
AIM: A growing number of older people are living in nursing homes worldwide, but their safety and quality of care are not guaranteed. This study explores registered nurses’ (RNs) perspectives on systemic factors affecting the quality of care and safety decline of nursing home. DESIGN: Qualitative descriptive study. METHODS: In this study, semi-structured interviews were conducted with 10 RNs working in six nursing homes, who were chosen through purposive sampling. Data were collected from 1 August-19 September 2019, and analysed using thematic analysis. RESULTS: The following five themes were derived: lack of sufficient number of RNs, poor work conditions, unclear job descriptions for RNs, no official position of nursing director and absence of transition care system. PATIENT OR PUBLIC CONTRIBUTION: All reports of RNs affecting resident safety and quality of care decline were related to systemic factors. Therefore, improving quality of care in nursing homes should be supported by changes in systemic factors, such as maintaining an appropriate number of RNs and improving their working conditions.

New Canadian article on LTC residents’ loneliness during the pandemic
Exploring experiences of loneliness among Canadian long-term care residents during the COVID-19 pandemic: A qualitative study.
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Smith CB, Wong KLY, To-Miles F, Dunn S, Gregorio M, Wong L, et al.
Int J Older People Nurs. 2022 Nov 8;e12509.
BACKGROUND: The COVID-19 pandemic has significant impact on long-term care (LTC) residents’ health and well-being. OBJECTIVES: This study investigated resident experiences of loneliness during the COVID-19 pandemic in Canadian LTC homes to offer lessons learned and implications. METHODS: 15 residents and 16 staff members were recruited from two large urban Canadian LTC homes with large outbreaks and fatalities. We used a telepresence robot to conduct one-on-one semi-structured interviews with participants remotely. We applied the Collaborative Action Research (CAR) methodology and report the early phase of CAR focused on collecting data and reporting findings to inform actions for change. Thematic analysis was performed to identify themes. RESULTS: Four themes were identified. The first two themes characterise what commonly generated feelings of loneliness amongst residents, including (1) social isolation and missing their family and friends and (2) feeling hopeless and grieving for lives lost. The second two themes describe what helped residents alleviate loneliness, including (3) social support and (4) creating opportunities for recreation and promoting positivity. CONCLUSIONS: Residents living in LTC experienced significant social isolation and grief during the pandemic that resulted in loneliness and other negative health consequences. IMPLICATIONS FOR PRACTICE: Promoting meaningful connection, safe recreational activities and a positive atmosphere in LTC homes during the pandemic may help mitigate residents’ experiences of loneliness due to social isolation and/or grief and enhance their quality of life.

New review on the efficacy of reminiscence therapy
Effectiveness of reminiscence therapy interventions for older people: Evidence mapping and qualitative evaluation.
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Yan Z, Dong M, Lin L, Wu D.
J Psychiatr Ment Health Nurs. 2022 Nov 12.
WHAT IS KNOWN ON THE SUBJECT? Reminiscence therapy is a common psychosocial intervention in mental health nursing. Numerous secondary studies have explored the effects of reminiscence therapy interventions in older adults, and while the effects are significant, conflicting results remain. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE? To date, research on reminiscence therapy has examined different disorders in isolation from one another. By illustrating the evidence gaps between studies, this paper highlights the need for a new evidence-based summary overview of reminiscence therapy research. The results suggest that reminiscence therapy can be beneficial to the improvement of mental health and quality of life for older people. However, we found that the secondary studies were not of high quality and that further high-quality literature supporting the evidence is still needed. INTRODUCTION: Reminiscence therapy is an alternative to pharmaceutical intervention provided during long-term care, especially for older people with mental and psychological problems. However, the effects of reminiscence therapy remain inconclusive. AIM: The present study aimed to systematically identify, synthesise, and describe the research evidence and quality of systematic reviews (SRs) related to reminiscence interventions for older people through an evidence-mapping approach. METHODS: Commonly used English and Chinese databases, including PubMed, EMBASE, The Cochrane Library, Web of Science, CNKI, WANFANG, VIP, and SinoMed, were searched from inception till 31 Mar 2022. The study type was restricted to SRs with or without meta-analysis. The methodological quality of the included SRs was assessed by A Measurement Tool to Assess Systematic Reviews (AMSTAR-2). The Microsoft Excel 2019 tool was used for data extraction and coding, and bubble charts were used to synthesise information on the study population, intervention category, original study sample size, and classification of findings. RESULTS: A total of 28 SRs were enrolled, including 514 original studies, 91.4% of which were randomised controlled trials. The main participants of the study were depressed older people (7 publications), older people with dementia (10 publications), and ordinary older people (8 publications). The findings of 26 (92.8%) publications were categorised as either ‘beneficial’ or ‘potentially beneficial’. The primary outcome indicators of the effectiveness of the reminiscence intervention for older people are mental and psychological problems (especially depressive symptoms and cognitive functioning), quality of life, and categories of positive psychology (e.g., life satisfaction, happiness, and self-esteem). The main factors influencing the intervention effect were the intervention period, residential setting, intervention format (group/individual), and intervention intensity. The intervention settings/contexts were mainly community and long-term care facilities. However, the methodological quality of 27 (96.4%) of the SRs was scored as either ‘Low’ or ‘Critically Low’. DISCUSSION: Reminiscence therapy has been used to study the mental health and quality of life of older people in various conditions, with significant results. However, due to the limited evidence included in the studies and the low methodological quality, there is still a need to focus on the issue of effectiveness and evidence gaps for different interventions in the field of recall in the future, in addition to efforts to improve the methodological quality and standardise the reporting process for the evaluation of reminiscence intervention systems. IMPLICATIONS FOR PRACTICE: Reminiscence therapy may be considered a useful non-pharmacological intervention for older people with mental and psychological problems. A standard protocol for reminiscence therapy may be necessary for future studies.

New article by Anne-Marie Boström
Factors Associated with Health-Related Quality of Life in Older Persons Residing in Nursing Homes.
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Boström AM, Cederholm T, Faxén-Irving G, Franzén E, Grönstedt H, Seiger Å, et al.
J Multidiscip Healthc. 2022;15:2615–22.
PURPOSE: Health-related quality of life (HRQoL) is an important patient-related outcome for the assessment of interventions and treatments in older people. Understanding underlying mechanisms for HRQoL is crucial for improving care, rehabilitation and symptom relief. This study examined the associations between HRQoL and frailty, sarcopenia, dependence of ADL, physical function and nutritional status in older nursing home (NH) residents. PATIENTS AND METHODS: This is a cross-sectional study employing baseline data from the Older Person’s Exercise and Nutrition (OPEN) study. Residents ≥75 years and able to stand up from seated position, residing in eight nursing homes in Sweden, were recruited. The EuroQoL 5-dimension Questionnaire (EQ-5D-5L, 0-1) was used to assess HRQoL. For exposure, the FRAIL and SARC-F questionnaires, Bergs Balance Scale, Functional Independence Measure (FIM), and Mini Nutritional Assessment-Short Form (MNA-SF) were used, including chair-stand test, walking speed and some biochemical markers. Descriptive and inferential statistics including linear regression models were applied. RESULTS: Data from 113 residents (59% women, mean age 85 years) revealed a mean EQ-5D index of 0.76. After relevant adjustments, factors associated with low HRQoL were sarcopenia (p<0.001), cognitive function (p<0.001), dependence in ADL (p=0.002), low plasma-albumin (p=0.002) and impaired nutritional status (p=0.038). CONCLUSION: This study displays evidence that modifiable conditions like sarcopenia and malnutrition are related to HRQoL in older NH residents. Such findings indicate a potential for physical exercise, including muscle training, and improved nutritional routines, including protein supplementation, to enhance nursing home care. Future studies, in larger NH populations, on exercise and nutrition for effects on HRQoL are needed.

New article by Janice Keefe
Do Residential Long-Term Care Policies Support Family Involvement in Residents’ Quality of Life in Four Canadian Provinces?
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Keefe JM, Taylor D, Irwin P, Hande MJ, Hubley E.
J Aging Soc Policy. 2022 Nov 11;1–25.
Family members are essential contributors to the quality of life (QoL) of persons living in residential long-term care (RLTC). This paper analyzes how the system enables or inhibits family involvement with residents in RLTC. Our analysis of 21 policies that regulate long-term care in four Canadian Provinces reveal differences in their portrayal of residents’ families. Family roles are characterized procedurally (task-oriented) or relationally (interactive). Operational standards linked to licensing of RLTC homes employ more formal terminology, while RLTC program guidelines, use facilitative language to engage families and build relationships. Examples of orientation procedures, care protocols, living at risk, and end-of-life care reveal inter-provincial variations. We argue that there are opportunities to further engage families within the current regulatory framework and improve their continued contributions in the post-pandemic era.

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