Supporting relationships between family and staff in continuing care settings

In this Canadian study, a participatory action research approach was used to examine the relationships between families of residents of traditional continuing care facilities and the health care team. The objectives were to (a) explore the formation and maintenance of family-staff relationships, with attention paid to the relational elements of engagement and mutual respect; (b) explore family and staff perspectives of environmental supports and constraints; and (c) identify practical ways to support and enhance these relationships. Results indicate that the resource-constrained context of continuing care has directly impacted family and staff relationships. The nature of these relationships are discussed using the themes of "Everybody Knows Your Name," "Loss and Laundry," "It's the Little Things That Count," and "The Chasm of Us Versus Them." Families' and staff's ideas of behaviors that support or undermine relationships are identified, as are concrete suggestions for improving family- staff relationships in traditional continuing care settings in Canada.

Effectiveness of a preoperative teaching programme for cataract patients

Shortened hospital stays have necessitated examination of alternative approaches for pre and postoperative teaching. An investigation of one alternative became a study in which a home care preoperative teaching programme for older adults undergoing cataract extractions with lens implants was implemented and evaluated. The findings indicated that the teaching programme was effective and resulted in positive benefits.

Decision-making and nurse case management: a philosophical perspective

Decision-making related to resource allocation in home care case management practice is addressed from the unique perspective of nursing. The case management process stipulates the adherence to both client-centered and system-centered goals. Issues that emerge from this process include the ethical dilemma of deciding the equitable and fair distribution of resources related to the provision of appropriate levels of service; economic factors as they relate to limited financial resources; and the variance among case managers in their decision-making. Moderate realism, as compared to critical and feminist theory, provides a philosophical perspective that allows a practical interpretation of these issues.

Sensitive period for lesion-induced reorganization of intracortical projections within the vibrissae representation of rat's primary somatosensory cortex

Previous experiments from this laboratory demonstrated that intracortical connections in lamina IV of the rat primary somatosensory cortex (SI) are most dense outside the patches of cytochrome oxidase (CO) staining that correspond to the mystacial vibrissae. This pattern of intracortical connections becomes apparent on postnatal day 4 (P-4), at least 2 days after the appearance of the vibrissae-related pattern of thalamocortical afferents. Transection of the infraorbital nerve (ION) on the day of birth (P-0) disrupts both the CO and intracortical projection patterns. This series of experiments was undertaken to determine whether the patterning of either thalamocortical afferents or intracortical projections defines the end of the period over which peripheral damage can alter intracortical projections in lamina IV of SI. The infraorbital nerve (ION) was transected in different cohorts of rats on P-1 through P-5, and animals were allowed to survive > or =45 days, at which time biotinylated dextran amine (BDA) injections were made into the SI. After 7 days, animals were killed, and alternate cortical sections were processed for the demonstration of BDA or CO. Transection of the ION on P-1 or P-2 altered the patterning of both CO and intracortical connections in the SI. In contrast, cutting the ION on P-3 left the pattern of CO densities in the SI intact, but significantly altered the patterning of intracortical connections. Transection of the nerve on P-5 resulted in qualitatively and quantitatively normal patterns of both CO densities and BDA-labelled intracortical projections. These results indicate that the establishment of a stable barrel pattern in layer IV of the SI is not sufficient for normal adult patterning of intracortical projections in this lamina. However, once the mature pattern of intracortical projections in layer IV is established, ION lesions can no longer alter it.

Knowledge and lifestyle behaviors of healthy older adults related to modifying the onset of vascular dementia

The purpose of this study was to examine the relationship between knowledge and practice of lifestyle behaviors in healthy older adults related to the prevention of vascular dementia. Data were derived from a convenience sample of 281 Canadian participants 55 years of age and older. Lifestyle was measured using the health-promoting lifestyle profile (HPLP). Seven knowledge sub-scales were developed consistent to the HPLP. Multivariate analysis found that four independent variables accounted for 26% of the variance of a healthy lifestyle score and included those who reported a lower level of stress, indicated a higher knowledge of interpersonal relations, had a better general health self-assessment and higher medical knowledge. These Canadian results were compared with those from a study conducted in Australia and found to be similar. The study argues that health professionals and health education programs can better promote and increase awareness of healthy lifestyle behaviors by assisting older adults to apply this knowledge in their daily lives. Specifically, the study discusses policy and practice implications with regards to lifestyle issues relating to health responsibility, physical activity, spirituality, stress management, interpersonal relationships and nutrition.

Factors that influence case managers' resource allocation decisions in pediatric home care: an ethnographic study

BACKGROUND

Case managers make decisions that directly affect the amount and type of services home care clients receive and subsequently affect the overall available health care resources of home care programs. A recent systematic review of the literature identified significant knowledge gaps with respect to resource allocation decision-making in home care.

METHODS

Using Spradley's methodology, we designed an ethnographic study of a children's home care program in Western Canada. The sample included 11 case managers and program leaders. Data sources included interviews, card sorts, and participant observation over a 5-month period. Data analyses included open coding, domain, taxonomic, and componential analysis.

RESULTS

One of the key findings was a taxonomy of factors that influence case manager resource allocation decisions. The factors were grouped into one of four main categories: system-related, home care program-related, family related, or client-related. Family related factors have not been previously reported as influencing case manager resource allocation decision-making and nor has the team's role been reported as an influencing factor.

CONCLUSION

The findings of this study are examined in light of Daniels and Sabin's Accountability for Reasonableness framework, which may be useful for future knowledge development about micro-level resource allocation theory.

The relational nature of case manager resource allocation decision making: an illustrated case

We used ethnographic methods in the tradition of Spradley (1979) and constant comparative analysis to explore case manager resource allocation decision making. We interviewed; observed and shadowed 11 case managers within a children's home care program in a regional health authority in western Canada as they went about their daily work over a 5-month period. Our findings provide knowledge about the little-understood set of processes at the micro level of resource allocation. Although the case manager considers many factors, reported elsewhere (Fraser, Estabrooks, Allen, & Strang, 2009), they balance and weigh these factors within a relational context. The purpose of this article is to use Jenna's story as a case example to illustrate how the case manager balances and weighs the factors that influence their resource allocation decisions within this context. Jenna's story demonstrates the complex and multidimensional processes that are embedded in the relational nature of resource allocation decisions. We discuss home care case manager resource allocation decisions as viewed through the lens of relational ethics.

Adult day care programs: a source for respite

Respite care can be considered an illness prevention and health promotion intervention for both caregivers and the older people dependent on them. By maintaining clients' level of functioning, the process of deterioration is delayed and a degree of health promotion is achieved. Similarly, the relief of caregivers' burden, although minimal, sustains them in their role. A community-based mode of providing adult day care is supported in the literature. It seems logical to combine the services of a community-based organization and a long-term care institutional setting whenever possible.

Value and vulnerability: reflections on joint appointments

For more than 20 years, joint appointments between nursing education and nursing service have been recommended as a strategy to foster excellence in nursing education and nursing practice, bridge the theory-practice gap, and promote clinically relevant research. This article discusses the termination of a joint-appointment initiative after research that had demonstrated its success in terms of benefits to both agencies and satisfaction for the incumbents in the positions. It presents the value and vulnerability of joint academic-clinical agency joint appointments based on critical analysis of the academic literature juxtaposed with our research and subsequent experience with four joint appointments between a faculty of nursing and a home-care agency. Top-level administrative support and understanding of the potential of such positions are crucial for the nurses involved, and the positions themselves become vulnerable in times of change and fiscal restraint.

Issues in the evaluation of small-scale adult day care programs

Evaluation of health care programs is a complex process which presents many challenges. A case study of a small-scale adult day care program evaluation is presented to illustrate these issues. The rationale for developing the program and the findings from the evaluation study are discussed. Several evaluation issues including the use of multiple methods, levels of analysis, characteristics of the sponsoring agency, political influences, methodological issues and influences on utilization of findings are addressed.

Enhancing the quality of home health care

A strong partnership between clinical practice and nursing education is essential to innovative home health care services. Nevertheless, these two components have not always worked in close association for mutual benefit--bringing the two together has been a continuing challenge. Recently, such an alliance was achieved in Edmonton, Alberta, brought on by necessity and triggered by rapid and substantial changes in both home health care and nursing educational environments.

Predictors of bereavement outcomes in families of patients with cancer: a literature review

The purpose of this paper is to review the literature on predictors of bereavement outcomes in family caregivers of persons who have died of cancer. The literature has been divided into common themes of predictors: characteristics of the deceased person, characteristics of the bereaved person, comparisons of bereaved and non-bereaved persons, well-being of the bereaved person prior to the death, prior interpersonal relationships, characteristics of the illness, characteristics of the caregiving experience, and characteristics of terminal care. A number of recurring patterns point the way to identifying persons who may be at increased risk for poor adjustment during bereavement. It is apparent that men and women express their grief somewhat differently. Whether men or women are at greater risk for poor adjustment, however, remains to be determined. There is some empirical evidence to suggest that lower socioeconomic status and linguistic barriers interfere with adjustment during bereavement. There is a dearth of culturally relevant services to help palliative-care patients and their family members make the required adjustments. The literature makes apparent the need for open awareness of the impending death and for careful and thoughtful planning for where and how the death ought to occur. The regular and frequent presence of professional caregivers contributes to family caregivers' satisfaction with care. Discrepant findings point to the need to explore the issues that underline them. Older bereaved caregivers appear to have some advantages over younger ones, but this finding is not universally found in the results of these studies. Methodological problems include small sample sizes and large variations in the particular bereavement outcomes studied.

Prospective and retrospective research: considerations and questions

We have outlined some of the reasons why retrospective research is generally considered inferior to prospective research and have explained some of the rationale for this view. Despite the problems, there are ethical and practical reasons for conducting retrospective research. Indeed, we have argued that there are times when retrospective research may produce more valid data. We hope that these ideas will contribute to ongoing discussions about oncology research designs.