The Involvement of Caregivers in the End-of-life Care of an Older Adult Living in a Long-term Care Home: A Qualitative Case Study with Nurses and Relatives

BACKGROUND

A key role of nurses working in long-term care homes (LTCHs) is to promote the involvement of care partners in end-of-life (EOL) care. However, studies on the involvement of care partners in EOL care in LTCHs have focused on care planning and decision-making. While care partners can participate in other ways, it's unclear how they are currently involved in EOL care by staff.

PURPOSE

We aimed to explore the involvement of care partners in the EOL care of an older adult living in a LTCH.

METHODS

A qualitative case study was conducted. Data was collected from a sample of four nurses and three care partners, using sociodemographic questionnaires, individual semi-structured interviews, documents pertaining to the LTCH's philosophy for EOL care, and a field diary.

RESULTS

The results of a thematic analysis showed the broad scope of care partners' possible involvement, including contributing to care, obtaining information, and being present. As there was some variation in care partners' desire to be involved, nurses seemed to rely on them to convey their wishes. To promote this involvement, some strategies aimed at health professionals and managers were suggested.

CONCLUSIONS

These results can guide improvement in clinical practices and raise awareness on the EOL care experiences of care partners.

Leading well and staying psychologically healthy: the role of resources and constraints for managers in the healthcare sector

PURPOSE

Maintaining a healthy and productive workforce is a challenge for most organizations. This is even truer for health organization, facing staff shortages and work overload. The aim of this study is to identify the resources and constraints that influence managers' mental health and better understand how they are affected by them.

DESIGN/METHODOLOGY/APPROACH

A qualitative approach was chosen to document the resources, the constraints as well as their consequences on managers in their day-to-day realities. The sample included executive-, intermediate- and first-level managers from a Canadian healthcare facility. A total of 62 semi-structured interviews were conducted. The coding process was based on the IGLOO model of Nielsen et al. (2018) to which an employee-related level was added (IGELOO).

FINDINGS

Results highlight the importance of considering both resources as well as constraints in examining managers' mental health. Overarching context, organizational constraints and the management of difficult employees played important roles in the stress experienced by managers.

PRACTICAL IMPLICATIONS

The results offer a better understanding of the importance of intervening at different levels to promote better organizational health. Results also highlight the importance of setting up organizational resources and act on the various constraints to reduce them. Different individual strategies used by managers to deal with the various constraints and maintain their mental health also emerge from those results.

ORIGINALITY/VALUE

In addition to addressing the reality of healthcare managers, this study supplements a theoretical model and suggests avenues for interventions promoting more sustainable organizational health.

Inclusion of informal caregivers in the palliative and end-of-life care of older adults: a scoping review protocol

INTRODUCTION

Palliative and end-of-life (EOL) care will increasingly be required in years to come as a result of an ageing population. An important component of this type of care is the inclusion of informal caregivers, who are family members or friends offering unpaid assistance to older adults with a terminal illness. Although systematic reviews were conducted on topics related to the inclusion of informal caregivers in the palliative and EOL care of older adults, several gaps remain as they were specific to a health condition and/or setting. The purpose of our scoping review is to map the extent of knowledge on this subject.

METHODS AND ANALYSIS

We will conduct our scoping review following Levac's methodology. We will gather publications of various types through nine databases, manual searches in journals and search engines and reference lists. The selection process will be conducted by two independent reviewers and consist of screening by title and abstract, followed by reading the full text to confirm eligibility. An independent reviewer will then extract data and assess quality from included publications. Data extracted from different publication types will be synthesised together in the Excel software using a content analysis method, with quantitative data transformed into a qualitative description. Results will be presented through descriptive statistics and themes. During different steps of the review, we will also consult informal caregivers and health professionals for feedback as stakeholders.

ETHICS AND DISSEMINATION

The conduction of this scoping review requires no ethical approval. Results will provide an overview of the state of knowledge on the inclusion of informal caregivers in palliative and EOL of older adults, which could help guide clinical practice, the development of interventions and policy and further research. We will disseminate these results by publishing an article, presenting in conferences, and discussing findings with stakeholders.

Les comportements des personnes âgées vivant avec un trouble neurocognitif : l’approche centrée sur les relations pour améliorer l’expérience de tous

Older people living with a major neurocognitive disorder often have difficulty communicating. They may exhibit reactive behaviors, such as vocal or aggressive behaviors, which are manifestations of malaise. These behaviors have consequences for these older people, as well as for their relatives and formal caregivers. This article discusses the relationship-centered approach to improving the experience of each of these persons by stimulating a reflection on what unites us. Then, the principles of this relationship-centered approach are outlined, based on the unique needs of each person, the reciprocity of their relationship, and their common aspirations. The application of these principles to older people living with a neurocognitive disorder who exhibit reactive behaviors is reflected through the adoption of consistent language, the identification of the meanings of behaviors and personalized actions, and the establishment of a care partnership. An example of a process integrating this approach is presented, as well as its possible effects. The adoption of this approach may present several challenges in care settings. To meet these challenges, implementation strategies are described promoting the adoption of this approach and contributing to everyone’s well-being.

Organizational constraints as root causes of role conflict

PURPOSE

The purpose of this paper is to gain a better understanding of the difficulties encountered in the hybrid roles of physician-managers (P-Ms), examine the impact of organizational constraints on the role conflicts experienced by P-Ms and explore the different ways their two roles are integrated.

DESIGN/METHODOLOGY/APPROACH

A qualitative approach was adopted, using six focus groups made up of clinical co-managers, medical directors and P-Ms. In all, 43 different people were interviewed to obtain their perceptions of the day-to-day realities of the role of the P-M. The data collected were subsequently validated.

FINDINGS

Although the expectations of the different groups involved regarding the role of P-Ms are well understood and shared, there are significant organizational constraints affecting what P-Ms are able to do in their day-to-day activities, and these constraints can result in role conflicts for the people involved. Such constraints also affect the ways P-Ms integrate the two roles. The authors identify three role hybridization profiles.

PRACTICAL IMPLICATIONS

The results afford a better understanding of how organizational constraints might be used as levers of organizational change to achieve a better hybridization of the dual roles of P-Ms.

ORIGINALITY/VALUE

This paper seeks to reach beyond a simple identification of constraints affecting the dual roles of P-Ms by analyzing how such constraints impact on these professionals' day-to-day activities. Results also enable us to further refine Katz and Kahn's (1966) role model, in addition to identifying hybridization profiles.