An interprofessional nurse-led mental health promotion intervention for older home care clients with depressive symptoms

Abstract

BackgroundDepressive symptoms in older home care clients are common but poorly recognized and treated, resulting in adverse health outcomes, premature institutionalization, and costly use of health services. The objectives of this study were to examine the feasibility and acceptability of a new six-month interprofessional (IP) nurse-led mental health promotion intervention, and to explore its effects on reducing depressive symptoms in older home care clients (≥ 70 years) using personal support services.MethodsA prospective one-group pre-test/post-test study design was used. The intervention was a six-month evidence-based depression care management strategy led by a registered nurse that used an IP approach. Of 142 eligible consenting participants, 98 (69%) completed the six-month and 87 (61%) completed the one-year follow-up. Outcomes included depressive symptoms, anxiety, health-related quality of life (HRQoL), and the costs of use of all types of health services at baseline and six-month and one-year follow-up. An interpretive descriptive design was used to explore clients’, nurses’, and personal support workers’ perceptions about the intervention’s appropriateness, benefits, and barriers and facilitators to implementation.ResultsOf the 142 participants, 56% had clinically significant depressive symptoms, with 38% having moderate to severe symptoms. The intervention was feasible and acceptable to older home care clients with depressive symptoms. It was effective in reducing depressive symptoms and improving HRQoL at six-month follow-up, with small additional improvements six months after the intervention. The intervention also reduced anxiety at one year follow-up. Significant reductions were observed in the use of hospitalization, ambulance services, and emergency room visits over the study period.ConclusionsOur findings provide initial evidence for the feasibility, acceptability, and sustained effects of the nurse-led mental health promotion intervention in improving client outcomes, reducing use of expensive health services, and improving clinical practice behaviours of home care providers. Future research should evaluate its efficacy using a randomized clinical trial design, in different settings, with an adequate sample of older home care recipients with depressive symptoms.Trial registrationClinicaltrials.gov identifier: NCT01407926.

Therapist differences in a randomised trial of the outcome of cognitive behaviour therapy for health anxiety in medical patients

“…It has been well demonstrated that naïve nurses, including both those who are generally and mental health trained, are competent at delivering behavioural and cognitive behaviour therapies in a range of medical settings, mostly for depressive symptoms (Ekers et al, 2013a,b;Feng et al, 2012;Gega et al, 2007;Hendriks et al, 2014;Markle-Reid et al, 2014) but this study is the first to suggest superiority of nurses over other professional disciplines, including psychologists. The main limitation of the study is that the patients were not randomised to the therapists and so there could be confounding factors.…”

Optimization of home care nurses in Canada: A scoping review

“…Multiple papers identified manageable workloads influenced nursing optimisation. Insufficient time to provide quality care was an optimisation barrier (Armstrong‐Stassen & Cameron, ; Cockerill et al, ; Denton, Zeytinoglu, Davies, & Hunter, ; Doran et al, ; Kaasalainen, Brazil, et al, ; Markle‐Reid et al, ; VON Canada, ; Williams, ). Specifically, healthcare restructuring (shifting acute care delivery from hospital to community) resulted in heavier workloads and increasingly complex patients receiving home care (Denton, Zeytinoglu, & Davies, ; Denton et al, ; Williams, ).…”

“…Since education typically produces generalists (Canadian Nurses Association, ), there is a need for orientation and access to standardised, ongoing training to fulfill HCN roles such as: case management, outcomes management, research, specialised technologies, program development and mental health promotion (Canadian Nurses Association, ; Dash, ; Home Care Sector Study Corporation, ; Kaasalainen et al, ; AETMIS, ; Lorimer, ; Markle‐Reid et al, ). Insufficient specialised orientation to manage increasingly complex work led to inappropriate assignments (VON Canada, ), workplace stress, absenteeism and burnout (Home Care Sector Study Corporation, ; Zeytinoglu & Denton, ).…”

“…Many papers report benefits of ongoing professional development through in‐services or agency‐sponsored sessions to enhance skills (Canadian Nurses Association, ; Harris & Shannon, ; Harrison et al, ; Morin, Saint‐Laurent, Bresse, Dallaire, & Fillion, ; Pesut et al, ; Tourangeau et al, ). HCNs have identified gaps in knowledge and skills in: mental health, addictions, harm reduction, and stigma; chronic disease management; palliative care; and; caring for clients with increased acuity (Andrews, Morgan, & Stewart, ; Arnaert et al, ; Kaasalainen, Strachan, et al, ; Kushner et al, ; Macleod et al, ; Marchessault, Legault, & Martinez, ; Markle‐Reid et al, ; Schofield et al, ).…”

A Hybrid Process Fidelity Assessment in a Home-Based Randomized Clinical Trial

“…Prior research has demonstrated that multiple barriers exist to intervention delivery in HHC interventions due to the complexity of the home environmental as well as the changing social milieu (Liebel, Friedman, Watson, & Powers, 2009;Markle-Reid et al, 2014). For example, one study (Nicolaides-Bouman et al, 2007) found that patients were less likely to engage in collaborative self-care management with nurses when there were contextual challenges such as unsafe home environments or cognitive decline.…”