加拿大长期护理院护士主导的碎片虚拟交付,以支持COVID-19期间出现反应性行为的老年人的护理:定性描述性研究

JMIR nursing Pub Date : 2022-12-13 DOI:10.2196/42731
Anna Garnett, Denise Connelly, Marie-Lee Yous, Lillian Hung, Nancy Snobelen, Melissa Hay, Cherie Furlan-Craievich, Shannon Snelgrove, Melissa Babcock, Jacqueline Ripley, Pam Hamilton, Cathy Sturdy-Smith, Maureen O'Connell
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引用次数: 1

摘要

背景:在世界范围内,2019冠状病毒病(COVID-19)大流行导致居住在长期护理院的老年人严重死亡。作为大流行的应对措施,长期护理中心实施了感染控制程序,包括将老年人隔离在他们的房间里,取消治疗计划,并限制家庭成员访问。社会孤立对LTC中的老年人产生负面影响,可能导致焦虑、抑郁、身体和认知能力下降、迷失方向、恐惧、冷漠和过早死亡的发生率增加。老年人的孤立也会导致反应性行为的增加(例如,大喊大叫,打人,大声喊叫),以表达沮丧,恐惧,限制行动和无聊。为了应对长期护理中心的挑战,并支持一线员工、老年人和家庭成员,在加拿大长期护理中心的家庭中实施了一种新型的注册实用护士(RPN)领导的PIECES方法,通过虚拟培训/指导来解决老年痴呆症患者的反应性行为。PIECES采用以个人和家庭/护理伙伴为中心的协作团队方法,为护士提供教育和能力建设;使家庭积极参与护理工作;并纳入循证实践,为有复杂需求的老年人提供以个人和家庭为中心的护理,包括痴呆症。目的:本研究的目的是描述LTC工作人员、家庭/护理合作伙伴和老年人研究合作伙伴在2019冠状病毒病大流行期间在加拿大两个LTC家庭实施一种新型rpn主导的PIECES护理计划方法的虚拟适应的经验。方法:采用定性描述设计,在安大略省的每个LTC家庭中由三到四名工作人员(例如,RPNs,经理)举行两个焦点小组。第三个焦点小组由三位PIECES导师组成。与RPN冠军、家庭/护理伙伴和老年人研究伙伴进行了个人半结构化访谈。研究小组会议记录提供了另一个数据来源。进行内容分析。结果:共有22名参与者参加了焦点小组(n=11)或深度个人访谈(n=11)。参与者的经验表明,实施rpn主导的虚拟PIECES促进了个性化护理,将家庭作为护理的合作伙伴,增加了跨学科合作,并改进了工作人员的做法。然而,虚拟碎片,作为交付,缺乏机会,家庭成员对老年人的结果反馈。实施促进者包括在各级实施和适当的技术基础设施上提供指导和领导。障碍与虚拟通信技术(家庭成员)的可用性和使用有关,老年人因在虚拟护理会议期间缺乏理解而感到不安。结论:这些发现为采用虚拟碎片提供了有希望的支持,虚拟碎片是一种团队方法,可以收集有价值的家庭投入和参与,以解决LTC中居民未满足的需求和反应性行为。未来的研究应探讨一种混合的沟通形式,以促进可持续的以个人和家庭为中心的护理计划实践,包括家庭在个性化护理计划中的积极合作。
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Nurse-Led Virtual Delivery of PIECES in Canadian Long-Term Care Homes to Support the Care of Older Adults Experiencing Responsive Behaviors During COVID-19: Qualitative Descriptive Study.

Background: Worldwide, the COVID-19 pandemic has resulted in profound loss of life among older adults living in long-term care (LTC) homes. As a pandemic response, LTC homes enforced infection control processes, including isolating older adults in their rooms, canceling therapeutic programs, and restricting family member visits. Social isolation negatively impacts older adults in LTC, which may result in increased rates of anxiety, depression, physical and cognitive decline, disorientation, fear, apathy, and premature death. Isolation of older adults can also cause an increase in responsive behaviors (eg, yelling, hitting, calling out) to express frustration, fear, restricted movement, and boredom. To respond to the challenges in LTC and support frontline staff, older adults, and family members, a novel registered practical nurse (RPN)-led delivery of the PIECES approach for addressing responsive behaviors among older adults with dementia using virtual training/mentoring was implemented in Canadian LTC homes. PIECES employs a person- and family/care partner-centered collaborative team-based approach to provide education and capacity-building for nurses; engages families as active participants in care; and embeds evidence-informed practices to provide person- and family-centered care to older adults with complex needs, including dementia.

Objective: The aim of this study was to describe the experiences of LTC staff, family/care partners, and older adult research partners with implementation of a novel RPN-led virtual adaptation of the PIECES care-planning approach for responsive behaviors in two Canadian LTC homes during the COVID-19 pandemic.

Methods: Using a qualitative descriptive design, two focus groups were held with three to four staff members (eg, RPNs, managers) per LTC home in Ontario. A third focus group was held with three PIECES mentors. Individual semistructured interviews were conducted with RPN champions, family/care partners, and older adult research partners. Research team meeting notes provided an additional source of data. Content analysis was performed.

Results: A total of 22 participants took part in a focus group (n=11) or an in-depth individual interview (n=11). Participant experiences suggest that implementation of RPN-led virtual PIECES fostered individualized care, included family as partners in care, increased interdisciplinary collaboration, and improved staff practices. However, virtual PIECES, as delivered, lacked opportunities for family member feedback on older adult outcomes. Implementation facilitators included the provision of mentorship and leadership at all levels of implementation and suitable technological infrastructure. Barriers were related to availability and use of virtual communication technology (family members) and older adults became upset due to lack of comprehension during virtual care conferences.

Conclusions: These findings offer promising support to adopting virtual PIECES, a team approach to gather valuable family input and engagement to address residents' unmet needs and responsive behaviors in LTC. Future research should investigate a hybridized communication format to foster sustainable person- and family-centered care-planning practices to include active collaboration of families in individualized care plans.

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16 weeks
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