To ensure older people living in care homes receive optimal care, care home workers (CHWs) require access to specialist support and education. Extension for Community Healthcare Outcomes (ECHO) uses existing videoconferencing to connect CHWs to specialists using case-based learning. There is evidence in other settings to suggest that ECHO can improve practitioner knowledge and patient outcomes. There is a dearth of evidence regarding strategies for effective implementation of ECHO with CHWs.
To establish the experiences of ECHO, and the barriers and enablers to implementation, from the perspective of CHWs in Scotland.
Qualitative online focus groups (n = 4) with CHWs (n = 13) who had participated in at least one care home ECHO session and with facilitators/presenters (n = 6). Transcripts were thematically analysed.
Findings were grouped into three areas: perceived impact, inhibitors and enablers. CHWs reported the positive impact of ECHO including key benefits to enhance residents' care, satisfaction with the sessions and feeling valued. Inhibitors included limited digital skills, workforce challenges and the pitch and duration of ECHO sessions. Enablers included administrative and technical support, scheduling and the structure of the ECHO approach.
ECHO allows CHWs to access specialist support, enabling learning and development, with the potential to improve residents' care. Benefits to residents' care included CHWs' enhanced understanding of choices around death and dying, and insights and understanding of causation of challenging behaviours in older people and how to manage these. Adaptations to ECHO to suit a care home context are recommended.
CHWs require technical support to build competence and confidence in IT skills. This study highlights the potential for ECHO to support CHWs to access specialist support and learning for older adults in a care home context.
Much of the literature examining the experiences of advance care planning (ACP) in long-term care (LTC) has been from the perspectives of residents and their families. Largely absent from the literature are the perspectives of LTC nurses, who are key members of the healthcare team most involved with LTC residents/families and well positioned to facilitate the ACP process. The purpose of this study was to develop an inductively derived empirical model to address this gap in empirical knowledge.
A constructivist grounded theory (CGT) methodology was used in this study of 25 nurses working in 18 different LTC facilities in central Canada. Data were collected using a demographic questionnaire; in-depth, semi-structured, audio-recorded and face-to-face/telephone interviews; field notes; and memos. Descriptive statistics and specific CGT coding procedures were used to analyse the data.
The basic social process that emerged from the data was that of nurses trying to identify an ACP level and craft a corresponding care plan that they believed would optimise residents' comfort in LTC during both acute medical events and at the end-of-life (EOL). The empirically derived theoretical model that captured the experiences, processes and strategies of nurses to address the identified social process was orchestrating comfort: getting everyone on the same page. This model encompassed two main processes, downgrading and upgrading ACP levels, and two preconditions, piecing together the big picture and selling the big picture.
Ensuring comfort for LTC residents at the end-of-life or during acute events by getting everyone on the same page is a complex process. The ability of nurses to downgrade or upgrade the ACP level to orchestrate comfort for LTC residents involves many factors related to the resident, family, healthcare providers and the context in which the ACP discussions take place.
Providing ACP/dementia information in LTC admission packages and through informational sessions can raise family awareness of these topics and dementia's complications. Clinical rotations in LTC facilities for medical, nursing, and paramedic students could also improve their understanding of the sector's complexities.
In long-term care (LTC) facilities, nurses play a key role in detecting changes in residents' health conditions and preventing avoidable emergency transfers and hospitalisations through multidisciplinary collaboration. This study aimed to explore how nurses detect changes that indicate the deterioration in LTC residents' conditions.
Semi-structured interviews were conducted with 23 nurses from 14 LTC facilities. Data from these interviews were qualitatively analysed using coding and constant comparison methods.
The three main categories were ‘preparing’, ‘assessing’ and ‘judging’. Nurses worked closely with care workers who spent a considerable amount of time with the residents, and by sharing information, the nurses could rapidly respond to changes in the residents' conditions. They also evaluated the risk of residents experiencing changes by leveraging their clinical experience.
This study found that LTC nurses should collaborate with care workers to enhance their health assessment skills, enabling them to detect changes in residents' conditions. Findings from this study can be used to promote collaboration between nurses and care workers and to develop effective educational interventions to improve nursing practice in LTC facilities.
This study underscores the necessity of nurses' ability to identify early deterioration in LTC residents. The findings reveal key symptoms and warning signs that nurses should prioritize in their assessments. By leveraging clinical experience and close observation, nurses can make timely and effective decisions to address residents' health changes, preventing further deterioration and enhancing their quality of life.
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