JAMDA j o u r n a l h o m e p a g e : w w w . j a m d a . c o m

Background and Objectives There is an urgency to respond to the long-standing deficiencies in health human resources in the long-term care (LTC) home sector, which have been laid bare by the Coronavirus Disease 2019 (COVID-19) pandemic. Nurse Practitioners (NPs) represent an efficient solution to human resource challenges. During the current pandemic, many Medical Directors in LTC homes worked virtually to reduce the risk of transmission. In contrast, NPs were present for in-person care. This study aims to understand the NPs’ roles in optimizing resident care and supporting LTC staff during the pandemic. Research Design and Methods This exploratory qualitative study employed a phenomenological approach. A purposive sample of 14 NPs working in LTC homes in Ontario, Canada was recruited. Data was generated using semi-structured interviews and examined using thematic analysis. Results Four categories relating to the NPs’ practices and experiences during the pandemic were identified: a) containing the spread of COVID-19; b) stepping in where needed; c) supporting staff and families; and d) establishing links between fragmented systems of care by acting as a liaison. Discussion and Implications The findings suggest that innovative models of care that include NPs in LTC homes are required moving forward. NPs embraced a multitude of roles in LTC homes, but the need to mitigate the spread of COVID-19 was central to how they prioritized their days. The pandemic clearly accentuated that NPs have a unique scope of practice, which positions them well to act as leaders and build capacity in LTC home.

Due to the interplay of multiple complex and interrelated factors, long-term care (LTC) home residents are increasingly vulnerable to sustaining poor outcomes in crisis situations such as the COVID-19 pandemic. While death is considered an unavoidable end for LTC home residents, the importance of facilitating a good death is one of the primary goals of palliative and end-of-life care. Nurse practitioners (NPs) are well-situated to optimize the palliative and end-of-life care needs of LTC home residents. This study explores the role of NPs in facilitating a dignified death for LTC home residents while also facing increased pressures related to the COVID-19 pandemic. The current exploratory qualitative study employed a phenomenological approach. A purposive sample of 14 NPs working in LTC homes was recruited. Data were generated using semi-structured interviews and examined using thematic analysis. Three categories were derived: (a) advance care planning and goals of care discussions; (b) pain and symptom management at the end-of-life; and (c) care after death. The findings suggest that further implementation of the NP role in LTC homes in collaboration with LTC home team and external partners will promote a good death and optimize the experiences of residents and their care partners during the end-of-life journey.

BackgroundThe prevalence of vision and hearing loss is higher amongst older individuals with dementia, as well as higher in long-term care settings than in the wider community. However, the incidence of sensory impairment is underreported and often goes untreated. In this study, we aimed to understand nurses’ current experiences of screening and caring for long-term care residents who have dementia and sensory impairment.MethodsAs part of a larger study on the sensory screening of long-term care residents with dementia, an environmental scan was conducted with front-line healthcare providers. We report here on the findings from the content analysis of individual, semi-structured interviews with nurses working in two long-term care homes in Southern Ontario, Canada. Twenty regulated nurses, including designated resident assessment coordinators, working full- or part-time with individuals who have dementia, participated across the two sites. All interviews were transcribed, and their contents reviewed and coded for themes by means of inductive thematic analysis.ResultsFollowing a systematic and recursive approach, three analysts identified several themes relating to: 1) the sensory screening process, 2) communication strategies, and 3) quality of life, sensory loss, and dementia. Participants reported on the strengths and limitations of screening procedures, what improvements should be made, which informal strategies are effective, and the continued professional development that is needed.ConclusionsNurses demonstrated insight into the facilitators and barriers to effective screening and care of residents with dementia and sensory impairments, and expressed the need for further education, more suitable screening tools, and formalised accountability within the screening process for vision and hearing loss in these long-term care residents.Electronic supplementary materialThe online version of this article (10.1186/s12877-018-0917-x) contains supplementary material, which is available to authorized users.

Nurse managers who provide effective supervisory support can improve the quality of care provided to their residents.

Background and Objectives Despite emerging evidence that persons with cognitive impairment (CI) (including dementia and/or delirium) can be rehabilitated post-hip fracture surgery, there still remains a paucity of research on best practice rehabilitation strategies that help healthcare providers effectively rehabilitate persons with CI. Therefore, this qualitative study explores healthcare professionals’ (HCPs) perspectives who have been successfully providing rehabilitation for people with CI. Research Design and Methods Sixteen HCPs with a specialty in rehabilitating persons with CI from one inpatient rehabilitation facility with various professional backgrounds were purposively sampled using a maximum diversity sampling strategy. Three focus group discussions were conducted to explore their experiences of providing rehabilitation to persons with CI. A hybrid inductive–deductive approach was used to analyze the data. Findings HCPs acknowledged that older adults with CI deserved the opportunity for inpatient rehabilitation and that good outcomes were achievable; however, their knowledge, skills, and attitudes required reframing. The analysis identified three essential components to rehabilitation: (1) staff education and support, (2) tailored rehabilitation approaches, and (3) care partner involvement and support. Discussion and Implications Rehabilitation of persons with CI post-hip fracture surgery is achievable, and HCPs can learn to modify their practices to achieve positive patient outcomes. The attitudes of the healthcare team members had to be shifted to embrace the belief that persons with CI can be rehabilitated. However, it takes a steep learning curve, creativity, ingenuity, and tailored approaches to rehabilitate persons with CI successfully. This involves knowing the individual, maintaining routines, and learning the best ways to engage and motivate the person. As well, care partners’ knowledge and understanding of the individual improved the chances of a successful rehabilitation stay and discharge. Essential to the success of rehabilitation of persons with CI includes a supportive management team to help create the processes to enable their staff to succeed.

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Aim The charge nurse in long‐term care facilities (LTCFs) performs a multiplicity of tasks that range from oversight of the entire facility to directly assisting residents in activities of daily living. In order to refine resident‐centred care strategies and to increase the quality of care provided in LTCFs, this study aims at gaining a more nuanced understanding of the different dimensions of the charge nurse role as a central figure in these institutions. Methods Data were generated through semi‐structured interviews. A purposive sample of ten Registered Nurses in a charge nurse role, diverse in experience, age, gender and background, was recruited from five LTCFs in Ontario, Canada. The study used a combination of conventional and direct qualitative content analyses. Findings All tasks performed by the charge nurses were categorised in four dimensions: clinical, supervisory, team support and managerial. Administration was a cross‐cutting sub‐dimension which has gained presence over the years. Depending on the shift worked and the organisational structure of the facility, each dimension gained or lost weight as part of the overall role. Conclusion These findings suggest that the charge nurse role is in a state of flux and lacking standardisation within and across facilities. LTCFs would benefit from increasing recognition of the role according to the wide range of tasks performed and responsibilities assumed, and by recruiting their charge nurses accordingly. Implications for practice The proposed conceptual framework could be used to map and assess charge nurses’ workloads and responsibilities, in order to enhance staff satisfaction and resident‐centred care in LTCFs.