Top Ten Tips Palliative Care Clinicians Should Know About Navigating the Needs of Adults with Intellectual Disabilities

As many people with intellectual disabilities (ID) live longer, the need for access to quality palliative care (PC) rises. People with ID realize significant barriers and inequities in accessing health care and PC. The need for integrated disability and PC services with extensive collaboration is great. The following tips are for PC clinicians caring for people with ID, their families, caregivers, and the community. While patient-centered care is difficult to distill into "tips," this article, written by an interdisciplinary team of PC and ID specialists, offers resources and references to improve the care provided to people with ID and serious illnesses.

LGBTQ Older Adults in Long-Term Care Settings: An Integrative Review to Inform Best Practices

OBJECTIVES

To synthesize literature about lesbian, gay, bisexual, transgender, and queer (LGBTQ) older adults in long-term care (LTC) facilities and provide recommendations for best practice guideline development to inform practice, research, and policy.

METHODS

Four electronic databases were searched in June 2019 for studies conducted between 2000- 2019 related to caring for LGBTQ older adults in LTC settings. An integrative literature review was conducted on the twenty eligible studies.

RESULTS

LGBTQ participants fear discrimination in LTC settings leading to the invisibility of their identities. They recognize a need for increased staff training and the importance of community networks and facility preferences. LTC staff have mixed experiences with inclusive practices and complex views of LGBTQ older adults. LTC staff experience training deficits and require more expansive modalities.

CONCLUSIONS

LGBTQ participants and LTC staff both advise that LTC facilities revise forms and policies to ensure all sexual orientations and gender identities are affirmed and protected in addition to providing widespread training.

CLINICAL IMPLICATIONS

This review calls to attention the need for LTC settings to uniformly follow best-practices. Clinical recommendations to promote equitable healthcare include: staff training at all levels and communication that does not assume heterosexuality or cisgender identity.

Supporting the needs of people with intellectual and developmental disabilities 1 year into the COVID ‐19 pandemic: An international, mixed methods study of nurses' perspectives

As the largest public health crisis within a century, the COVID‐19 pandemic has caused long‐term disruption in the support systems of people with intellectual and developmental disabilities (IDD) across the globe. The purpose of this study was to investigate challenges and ameliorative strategies to supporting the basic care needs of people with IDD 1 year into the pandemic, as experienced by nurses who specialize in IDD nursing. We surveyed a convenience sample of 369 nurses from across North America, Europe, and Australasia using a 52‐item online questionnaire. Descriptive statistics were used to rank the greatest challenges and the degree of support available to nurses, and manifest content analysis was used to analyze open‐ended responses related to ongoing challenges and ameliorative strategies. Results of descriptive analyses revealed consistent findings across global regions in terms of the challenges faced by nurses; the greatest challenges related to supporting or enabling socialization with family/friends, ensuring adequate day programming or educational services, identifying/planning alternative entertainment activities, ensuring adequate staffing of familiar support workers and caregivers, and managing challenging behaviors related to change in daily routine and activities. Nurses described a considerable degree of support offered by their organizations in terms of flexibility in scheduling related to family obligations and paid time off for COVID‐19‐related isolation and quarantine. Content analysis of open‐ended survey responses revealed numerous challenges related to: (1) client socialization, meaningful activity, and mental/behavioral health; (2) interpreting, keeping up with, and helping others to understand COVID‐19 guidelines; (3) access to, quality of, and continuity of care; and (4) COVID‐19 fatigue and the influence of time. Overall, our study highlights ongoing issues with access to care and support, exacerbated by the pandemic, and the importance of having meaningful activity and socialization for overall well‐being of people with IDD during a long‐term public health crisis.

Evidence-based Recommendations to Inform Best Practices for LGBTQ Older Adults in Long-term Care Settings

Lesbian, gay, bisexual, transgender, and queer (LGBTQ) older adults are more likely to live alone and have less familial support, which disproportionately contributes to a reliance on long-term care facilities as they age. Best-practice guidelines supported by scholarly literature to care for LGBTQ older adults in long-term care settings do not exist. This review synthesizes literature about LGBTQ older adults in long-term care facilities and provides recommendations for best practice guideline development. Four electronic databases were searched in June 2019 for studies conducted between 2000 – 2019 related to caring for LGBTQ older adults in long-term care settings. An integrative literature review was completed on the twenty eligible studies. Findings showed that LGBTQ participants fear discrimination in long-term care leading to the invisibility of their identities. They recognize a need for increased staff training and the importance of community networks and facility preferences. Long-term care staff have mixed experiences with inclusive practices and complex views of LGBTQ older adults. They experience training deficits and have a need for more expansive training modalities. The recommendations offered by both LGBTQ participants and long-term care staff are to revise policies and forms as well as provide widespread training and education. LGBTQ participants recommend that their unique identities be recognized within long-term care while long-term care staff recommend leadership involvement to change culture and practice. This review provides evidence-based recommendations to promote equitable healthcare to the LGBTQ older adult population and calls to attention the need for long-term care settings to uniformly follow best-practices.

"We Were Absolutely in the Dark": Latent Analysis of Developmental Disability Nurses' Experiences During the COVID-19 Pandemic

People with developmental disabilities (DD) are devastatingly impacted by COVID-19, yet no studies have explored the experiences of developmental disability nurses during the pandemic. In April 2020, as part of a multiple method study, we used manifest content analysis to evaluate nurses' 287 open-ended responses to our online survey question: "What is the experience of being a developmental disability nurse while encountering challenges to meeting basic care needs during the early COVID-19 pandemic?" We identified four themes: living with fear and stress, helping others to understand and cope, navigating a changing landscape, and being left out. Findings reinforce the need for accessible health information for people with developmental disability, guidelines relevant to developmental disability nursing settings, emotional support for developmental disability nurses, and education of health care professionals about the contribution of the developmental disability nurse in supporting the holistic well-being of people with DD.

Impact of COVID-19: Nursing challenges to meeting the care needs of people with developmental disabilities

Background

People with developmental disabilities (DD) are a population at high-risk for poor outcomes related to COVID-19. COVID-19-specific risks, including greater comorbidities and congregate living situations in persons with DD compound existing health disparities. With their expertise in care of persons with DD and understanding of basic principles of infection control, DD nurses are well-prepared to advocate for the needs of people with DD during the COVID-19 pandemic.

Objective

To assess the challenges faced by nurses caring for persons with DD during the COVID-19 pandemic and how the challenges impact people with DD.

Methods

We surveyed 556 DD nurses, from April 6–20, 2020. The 35-item mixed-method survey asked nurses to rate the degree of challenges faced in meeting the care needs of people with DD. We analyzed responses based on presence of COVID-19 in the care setting and geographically. One open-ended question elicited challenges not included in the survey, which we analyzed using manifest content analysis.

Results

Startlingly, nurses reported being excluded from COVID-19 planning, and an absence of public health guidelines specific to persons with DD, despite their high-risk status. Obtaining PPE and sanitizers and meeting social-behavioral care needs were the most highly ranked challenges. COVID-19 impacted nurses’ ability to maintain adequate staffing and perform essential aspects of care. No significant geographic differences were noted.

Conclusions

DD nurses must be involved in public health planning and policy development to ensure that basic care needs of persons with DD are met, and the disproportionate burden of COVID-19 in this vulnerable population is reduced.

Development and Evaluation of a Mexican Immigrant Family Support Program

A report to Congress in the fall of 1998 warned that immigrant children are in a state of emergency regarding access to health care. This article presents the three phases involved in developing, implementing, and evaluating a Mexican American Problem Solving (MAPS) program designed to promote the mental health of families. Methods were Phase 1 focus groups to identify concerns and desired approaches for intervention; Phase 2 instrument assessment and prevalence assessment of mental health; and Phase 3 intervention testing. In Phases 1 and 2, 67% of mothers and 59% of children had mental health scores that required referral for evaluation. Participating mothers and children reported positive views of the intervention and showed significant improvements in mental health scores.

Specific standards of care for adults with intellectual disabilities

Individuals with intellectual and developmental disabilities (ID) represent a small but important group of patients who have high levels of hospitalisation, and who are likelier to have more complications and spend more days in intensive care than those without ID admitted to hospital for similar problems. However, nursing and medical staff lack training in the care of people with ID. To address the needs of this patient group, an academic medical centre in the mid-western United States has developed specific standards of nursing care. This article describes the standards, which cover nursing interventions to enhance communication, the provision of safe and accessible environments, and collaboration with and support for caregivers; it also outlines the online educational programme that was developed for nurses to support their implementation and use of the standards.

Educating nursing students in clinical leadership

One of the goals of nursing education is to develop caring and responsible nurses with clinical reasoning skills who are capable of improving outcomes in complex healthcare systems. Using the Model of Situated Learning in Nursing Leadership, generalist entry graduate nursing students at Rush University in Chicago, part of a large academic medical centre with Magnet recognition for excellence in nursing practice, are educated using a curriculum based on the clinical nurse leader (CNL) competencies. This article presents a case study that demonstrates how the model is used to provide experiences for learning the CNL role. The students learn leadership in practice through their involvement in ongoing efforts at the medical centre to improve the care of patients with intellectual and developmental disabilities. The case study provides lessons in teaching CNL leadership competencies through efforts to improve the quality of care for an at-risk group of patients.

Clinical Trail Outcomes of the Mexican American Problem Solving Program (MAPS)

Depression among Mexican immigrant women and children exceeds national prevalence rates. Given the influence of maternal depression on children, a clinical trial testing the effects of the Mexican American Problem Solving (MAPS) program was designed to address depression symptoms of Mexican immigrant women and their fourth and fifth grade children (302 dyads) through a linked home visiting and after school program compared to peers in a control group. Schools were randomized to intervention and control groups. There were statistically significant improvements in the children's health conceptions and family problem solving communication, factors predictive of mental health. Improvements in children's depression symptoms in the intervention group approached statistical significance. These promising results suggest that refined school based nursing interventions be included in community strategies to address the serious mental health problems that Mexican immigrants face.

Matching a Graduate Curriculum in Public/Community Health Nursing to Practice Competencies: The Rush University Experience

An evidence-based approach to Public/Community Health Nursing (P/CHN) requires that P/CHN educators prepare practitioners with the relevant skills, attitudes, and knowledge. Such education should be competency-based and have measurable outcomes to demonstrate student preparation. In 2003, the Quad Council competencies were developed to be applied at two levels of public health nursing practice: the staff nurse/generalist role and the manager/specialist/consultant role. This paper describes a process for evaluation and revision of a graduate curriculum to prepare Advanced Practice Clinical Nurse Specialists (CNS) in P/CHN, to ensure that the educational program addresses and develops knowledge and proficiency in all relevant competencies. This paper documents the process of integrating the competencies throughout the P/CHN graduate curriculum at varying levels, guiding students to achieve proficiency in each competency by the end of the program. Measurement of achievement in these competencies will be discussed, and examples provided. Advanced Practice Public Health Nurses educated via this competency-based approach will be prepared to sit for national certification as a CNS in Public/Community Health, and to assume leadership roles in public health nursing.

Depression and suicidal ideation among Mexican American school-aged children

The purpose of this study was to describe depression and suicidal ideation rates in a community sample of 182 urban fourth and fifth grade Mexican American children using the Children's Depression Inventory (CDI). We used a descriptive secondary data analysis design. The mean CDI score was 9.55 (SD = 5.8). Thirty-one percent fell in the depressed range using a clinical cut point of 12 and 7% fell into the depressed range using the non-clinical cut point of 19. Thirty-eight percent (n = 69) reported suicidal ideation. The depression rate was consistent with national rates. A non-clinical cut point of 19 showed that 87% of children reporting suicidal ideation were not identified as depressed. Many of these children do not report the most typical symptoms of depression. The results of this study provide school nurses with vital information to support efforts addressing the mental health needs of Mexican American children.

Development and evaluation of a Mexican immigrant family support program

A report to Congress in the fall of 1998 warned that immigrant children are in a state of emergency regarding access to health care. This article presents the three phases involved in developing, implementing, and evaluating a Mexican American Problem Solving (MAPS) program designed to promote the mental health of families. Methods were Phase 1 focus groups to identify concerns and desired approaches for intervention; Phase 2 instrument assessment and prevalence assessment of mental health; and Phase 3 intervention testing. In Phases 1 and 2, 67% of mothers and 59% of children had mental health scores that required referral for evaluation. Participating mothers and children reported positive views of the intervention and showed significant improvements in mental health scores.