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Levy AM, Grigorovich A, McMurray J, Quirt H, Ranft K, Engell K, Stewart S, Astell A, Kokorelias K, Schon D, Rogrigues K, Tsokas M, Flint AJ, Iaboni A. Implementation of the Dementia Isolation Toolkit in long-term care improves awareness but does not reduce moral distress amongst healthcare providers. BMC Health Serv Res 2024; 24:481. [PMID: 38637814 PMCID: PMC11027277 DOI: 10.1186/s12913-024-10912-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 03/27/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Healthcare providers may experience moral distress when they are unable to take the ethically or morally appropriate action due to real or perceived constraints in delivering care, and this psychological stressor can negatively impact their mental health, leading to burnout and compassion fatigue. This study describes healthcare providers experiences of moral distress working in long-term care settings during the COVID-19 pandemic and measures self-reported levels of moral distress pre- and post-implementation of the Dementia Isolation Toolkit (DIT), a person-centred care intervention designed for use by healthcare providers to alleviate moral distress. METHODS Subjective levels of moral distress amongst providers (e.g., managerial, administrative, and front-line employees) working in three long-term care homes was measured pre- and post-implementation of the DIT using the Moral Distress in Dementia Care Survey and semi-structured interviews. Interviews explored participants' experiences of moral distress in the workplace and the perceived impact of the intervention on moral distress. RESULTS A total of 23 providers between the three long-term care homes participated. Following implementation of the DIT, subjective levels of moral distress measured by the survey did not change. When interviewed, participants reported frequent experiences of moral distress from implementing public health directives, staff shortages, and professional burnout that remained unchanged following implementation. However, in the post-implementation interviews, participants who used the DIT reported improved self-awareness of moral distress and reductions in the experience of moral distress. Participants related this to feeling that the quality of resident care was improved by integrating principals of person-centered care and information gathered from the DIT. CONCLUSIONS This study highlights the prevalence and exacerbation of moral distress amongst providers during the pandemic and the myriad of systemic factors that contribute to experiences of moral distress in long-term care settings. We report divergent findings with no quantitative improvement in moral distress post-intervention, but evidence from interviews that the DIT may ease some sources of moral distress and improve the perceived quality of care delivered. This study demonstrates that an intervention to support person-centred isolation care in this setting had limited impact on overall moral distress during the COVID-19 pandemic.
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Affiliation(s)
- Anne Marie Levy
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Lazaridis School of Business & Economics, Wilfrid Laurier University, Brantford, Ontario, Canada
| | - Alisa Grigorovich
- Recreation and Leisure Studies, Brock University, St. Catharines, Ontario, Canada
| | - Josephine McMurray
- Lazaridis School of Business & Economics, Wilfrid Laurier University, Brantford, Ontario, Canada
| | - Hannah Quirt
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Kaitlyn Ranft
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Katia Engell
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Steven Stewart
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Arlene Astell
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Department of Occupational Sciences & Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
- School of Psychology & Clinical Language Sciences, University of Reading, Berkshire, UK
| | - Kristina Kokorelias
- Department of Occupational Sciences & Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
- Department of Geriatrics, Sinai Health and University Health Network, Toronto, Ontario, Canada
| | - Denise Schon
- Chair of Family Council, Lakeside Long Term Care Centre, Toronto, Ontario, Canada
| | - Kevin Rogrigues
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Mario Tsokas
- Ontario Health Central, Toronto, Ontario, Canada
| | - Alastair J Flint
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Centre for Mental Health, University Health Network, Toronto, Ontario, Canada
| | - Andrea Iaboni
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada.
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
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Hapsari AP, Ho JW, Meaney C, Avery L, Hassen N, Jetha A, Lay AM, Rotondi M, Zuberi D, Pinto A. The working conditions for personal support workers in the Greater Toronto Area during the COVID-19 pandemic: a mixed-methods study. Can J Public Health 2022; 113:817-833. [PMID: 35616873 PMCID: PMC9134716 DOI: 10.17269/s41997-022-00643-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 04/06/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE During the height of the COVID-19 pandemic, personal support workers (PSWs) were heralded as healthcare 'heroes' as many of them cared for high-risk, vulnerable older populations, and worked in long-term care, which experienced a high number of COVID-19 outbreaks and deaths. While essential to the healthcare workforce, there is little understanding of PSW working conditions during the pandemic. The aim of our study was to examine the working conditions (including job security, work policies, and personal experiences) for PSWs in the Greater Toronto Area during the COVID-19 pandemic from the perspectives of PSWs. METHODS This study used a mixed-methods design. From June to December 2020, we conducted a survey of 634 PSWs to understand their working conditions during the COVID-19 pandemic. Semi-structured interviews with 31 survey respondents were conducted from February to May 2021 to understand in greater depth how working conditions were impacting the well-being of PSWs. RESULTS We found PSWs faced a range of challenges related to COVID-19, including anxiety about contracting COVID-19, reduced work hours, taking leaves of absences, concerns about job security, and losing childcare. While the COVID-19 pandemic highlighted the PSW workforce and their importance to the healthcare system (especially in the long-term care system), pre-existing poor work conditions of insecure jobs with no paid sick days and benefits exacerbated COVID-19-related challenges. Despite these hardships, PSWs were able to rely on their mental resilience and passion for their profession to cope with challenges. CONCLUSION Significant changes need to be made to improve PSW working conditions. Better compensation, increased job security, decreased workload burden, and mental health supports are needed.
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Affiliation(s)
- Ayu Pinky Hapsari
- Upstream Lab, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, 30 Bond Street, Toronto, ON M5B 1W8 Canada
| | - Julia W. Ho
- Upstream Lab, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, 30 Bond Street, Toronto, ON M5B 1W8 Canada
| | - Christopher Meaney
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON Canada
| | - Lisa Avery
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada ,Department of Biostatistics, Princess Margaret Hospital, University Health Network, Toronto, ON Canada
| | - Nadha Hassen
- Faculty of Environmental and Urban Change, York University, Toronto, ON Canada
| | - Arif Jetha
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada ,Institute for Work and Health, Toronto, ON Canada
| | - A. Morgan Lay
- Institute of Population and Public Health, Canadian Institutes of Health Research, Toronto, ON Canada
| | - Michael Rotondi
- School of Kinesiology and Health Science, York University, Toronto, ON Canada
| | - Daniyal Zuberi
- Munk School of Global Affairs & Public Policy, University of Toronto, Toronto, ON Canada ,Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON Canada
| | - Andrew Pinto
- Upstream Lab, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, 30 Bond Street, Toronto, ON M5B 1W8 Canada ,Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON Canada ,Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada ,Department of Family and Community Medicine, St. Michael’s Hospital, Toronto, ON Canada
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Lin L, Liu X, McGilton KS, Yuan Y, Li H, Dong B, Xie C, Wang H, Li H, Tian L. Level of nurse supportive supervision and its influencing factors in long-term care facilities. Geriatr Nurs 2021; 42:1316-1322. [PMID: 34560526 DOI: 10.1016/j.gerinurse.2021.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 08/28/2021] [Accepted: 08/31/2021] [Indexed: 11/17/2022]
Abstract
Quality of care provided by personal support workers (PSWs) in long-term care facilities (LTCFs) is associated with the supportive supervisory performance of registered nurses (RNs). To determine the level of supportive supervision of RNs and its influencing factors in LTCFs in East China, a cross-sectional survey was conducted in 12 LTCFs using self-designed sociodemographic questionnaires and the Chinese version of the Supportive Supervisory Scale. A total of 643 PSWs supervised by 260 RNs were surveyed. The average supportive supervision score was 59.60 ± 7.53, representing a moderate level of supervisory support. Supportive supervision was found to be positively correlated with the PSW's years of working, the RN's education, position, number of years in nursing, having access to managerial training as well as the RN/PSW ratio in the unit (p < 0.05). These factors can be modified to potentially influence the supportive capacity of nurse supervisors in LTCFs.
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Affiliation(s)
- Lu Lin
- The First Affiliated Hospital of Soochow University, No. 188 Shizi Road, Suzhou 215006, People's Republic of China; School of Nursing, Medical College of Soochow University, No. 188 Shizi Street, Suzhou 215006, People's Republic of China
| | - Xiaoming Liu
- The First Affiliated Hospital of Soochow University, No. 188 Shizi Road, Suzhou 215006, People's Republic of China
| | - Katherine S McGilton
- Toronto Rehabilitation Institute-UHN, Toronto, ON, Canada; University of Toronto, ON, Canada
| | - Yang Yuan
- School of Nursing, Medical College of Soochow University, No. 188 Shizi Street, Suzhou 215006, People's Republic of China
| | - Haixia Li
- Suzhou Kowloon Hospital, Shanghai Jiao Tong University School of Medicine, Suzhou 215006, People's Republic of China
| | - Bei Dong
- School of Nursing, Medical College of Soochow University, No. 188 Shizi Street, Suzhou 215006, People's Republic of China
| | - Congyan Xie
- School of Nursing, Medical College of Soochow University, No. 188 Shizi Street, Suzhou 215006, People's Republic of China
| | - Hong Wang
- Suzhou Kowloon Hospital, Shanghai Jiao Tong University School of Medicine, Suzhou 215006, People's Republic of China
| | - Huiling Li
- School of Nursing, Medical College of Soochow University, No. 188 Shizi Street, Suzhou 215006, People's Republic of China.
| | - Li Tian
- The First Affiliated Hospital of Soochow University, No. 188 Shizi Road, Suzhou 215006, People's Republic of China; School of Nursing, Medical College of Soochow University, No. 188 Shizi Street, Suzhou 215006, People's Republic of China.
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