Developing and testing a nursing home end -of -life care chart audit tool.

BACKGROUND: Nursing home (NH) administrators need tools to measure the effectiveness of care delivered at the end of life so that they have objective data on which to evaluate current practices, and identify areas of resident care in need of improvement. METHODS: A three-phase mixed methods study was used to develop and test an empirically derived chart audit tool aimed at assessing the care delivered along the entire dying trajectory. RESULTS: The Auditing Care at the End of Life (ACE) instrument contains 27 questions captured across 6 domains, which are indicative of quality end-of-life care for nursing home residents. CONCLUSIONS: By developing a brief chart audit tool that captures best practices derived from expert consensus and the research literature, NH facilities will be equipped with one means for monitoring and assessing the care delivered to dying residents.

Every team needs a coach: Training for interprofessional clinical placements.

Despite growing awareness of the benefits of interprofessional education and interprofessional collaboration (IPC), understanding how teams successfully transition to IPC is limited. Student exposure to interprofessional teams fosters the learners' integration and application of classroom-based interprofessional theory to practice. A further benefit might be reinforcing the value of IPC to members of the mentoring team and strengthening their IPC. The research question for this study was: Does training in IPC and clinical team facilitation and mentorship of pre-licensure learners during interprofessional clinical placements improve the mentoring teams' collaborative working relationships compared to control teams? Statistical analyses included repeated time analysis multivariate analysis of variance (MANOVA). Teams on four clinical units participated in the project. Impact on intervention teams pre- versus post-interprofessional clinical placement was modest with only the Cost of Team score of the Attitudes Towards Healthcare Team Scale improving relative to controls (p = 0.059) although reflective evaluations by intervention team members noted many perceived benefits of interprofessional clinical placements. The significantly higher group scores for control teams (geriatric and palliative care) on three of four subscales of the Assessment of Interprofessional Team Collaboration Scale underscore our need to better understand the unique features within geriatric and palliative care settings that foster superior IPC and to recognise that the transition to IPC likely requires a more diverse intervention than the interprofessional clinical placement experience implemented in this study. More recently, it is encouraging to see the development of innovative tools that use an evidence-based, multi-dimensional approach to support teams in their transition to IPC.

Advancing Interprofessional Collaborative Teams in the Winnipeg Health Region.

This project developed an evaluation platform aimed at diagnosing team functioning using evidence-informed, measurable indicators to provide an actionable roadmap to guide teams in improving their interprofessional collaborative team performance. A scoping literature review, stakeholder consultation, survey and focus groups were conducted to inform both the final selection of eight indicators of effective, high-performing teams and the process to assess and evaluate teams against these indicators. The program was piloted with two interprofessional teams in the Winnipeg Health Region. Focus groups and questionnaires were used to evaluate the program.

From primary nurse to collaborative nursing care team: Early feedback on a new model.

This article discusses key findings from a preliminary review of a nursing care delivery model implemented in Winnipeg, Manitoba, by the Winnipeg Regional Health Authority Home Care Program in 2014. Results suggest that the model is generally seen positively by staff but challenging to implement, given established administrative practices. To meet future demands on the healthcare system, home care programs need policies and procedures that empower nurses to perform as true community health nurses.

Setting a new standard of care in nursing homes.

The Winnipeg Regional Health Authority's introduction of a full-time nurse practitioner in a 116-bed non-profit nursing home provided an opportunity to explore a collaborative relationship between an NP acting as the primary care provider and a single physician serving as the consultant for complex care and after-hours care. The outcomes were measured in terms of resident and family satisfaction, quality of care indicators and cost effectiveness. Data were collected from pre-existing quality indicators, including a resident/family satisfaction survey, transfers to acute care, and medication use statistics. Unstructured interviews were also conducted with nursing staff and members of the interdisciplinary team. Dramatic improvements in medication use were observed, including a 17 per cent reduction in overall drug costs, a 55 per cent decrease in polypharmacy rates and a 63 per cent reduction in antipsychotic drug use. Transfers to emergency decreased by 20 per cent. Family satisfaction with the quality of health care provided to residents increased by 24 per cent. The collaborative practice of an NP with physician consultation is an effective way of delivering quality care to nursing home residents.

"Caring as if it were my family": health care aides' perspectives about expert care of the dying resident in a personal care home.

OBJECTIVE: A qualitative pilot study was conducted to identify and describe expert behaviors in care of the dying resident in a personal care home setting from the perspective of health care aides (N = 5) nominated by their peers as demonstrating excellence in end-of-life care. METHODS: Data was collected through audio-taped semi-structured interview, and transcribed verbatim using constant-comparative analysis procedures. RESULTS: The over-arching theme emerging from the data was "caring as if it were my family." Subsumed within this main theme included the sub-themes of: (1) care of the resident; (2) tending to the environment; (3) care of the family; (4) going to bat; and (5) processing loss. SIGNIFICANCE OF RESULTS: The findings from this pilot study provide preliminary empirical evidence that could inform educational programs for and performance evaluation of, health care aides providing end-of-life care in personal care home environments.