This qualitative study describes health care assistants' (HCA) perceptions and experiences related to bathing people with dementia in residential care settings. Data were collected from three focus groups with 18 HCA participants from 12 different residential care facilities. HCAs constructed two definitions of a successful bath, which informed their choice of bathing strategies. Three themes emerged from the data analysis in regard to their bathing strategies: I Know You, I Am All Alone, and I Am Not Prepared. These data informed the development of a framework to guide gerontological nurses in creating and supporting the opportunity for successful bathing.

Dementia is a progressive, life-limiting illness. People with the condition who move into a care home deserve palliative care. This article discusses an interprofessional pilot workshop for direct care providers held in a care home in British Columbia, Canada. The workshop aimed to incorporate a palliative approach into dementia care for residents. Workshop development, teaching strategies, evaluation and outcomes are shared. The four-hour workshop was structured to promote critical reflection and challenge participants to consider that people with dementia and their families need palliative care much earlier than during the last days of life. Commitment to change statements gathered as part of the workshop indicated that participation increased knowledge, skill and confidence to incorporate a palliative approach into care for people with advanced dementia and their families.

Many Indigenous people who live on their traditional territory die in hospital when their preference is to enter the spirit world from their home. Indigenous people in Canada describe experiencing many barriers that prevent them from making this final choice in life. The First Nations Health Authority in British Columbia (BC), Canada, in collaboration with Douglas College, offered end-of- life doula training classes to Indigenous people in BC in 2019. The goal was to build on the strengths of community members already supporting people and their families during their final journey into the spirit world. There were 86 participants (72% identified as Indigenous) from the five health regions in BC, representing 47 Indigenous communities. Participants were overwhelmingly satisfied with the five-day course and planned to take their new learnings back to their community. It was noted, however, that this course would benefit from adaptations, including a greater emphasis on traditional Indigenous practices, facilitation tips, and strategies to support people through loss and bereavement. Furthermore, the term “end-of-life doula” is sometimes associated with a for-profit business, which is counterintuitive to traditional Indigenous practices, highlighting the necessity for a name change. Further evaluation over the next year is necessary to confirm that the course makes a positive difference in the final journey for Indigenous people.

The Serious Illness Conversation Guide (SICG) has been shown to be an effective communication tool used by health care professionals when interacting with patients facing a life-limiting illness. However, Ariadne Labs, the originators of the tool, have not tested it with First Nations and Indigenous Peoples. In this project, the British Columbia Centre for Palliative Care and the First Nations Health Authority in British Columbia (BC), Canada collaborated to adapt the SICG to be more culturally safe for First Nations and Indigenous Peoples. Multiple feedback strategies were employed. Feedback was received from 35 older adults, Elders, and community members from two First Nations communities plus approximately 80 nurses serving in First Nations communities across BC. Key areas of focus for feedback on the clinical tool included setting up the conversation, involving family, closing the conversation, and using principles of health literacy to reduce power differences. Three questions were added in response to feedback received. By creating a safe space for dialogue, it is hoped that health care providers and family members will develop a deeper understanding of what is important to the person with a life-limiting illness. These conversations promote patient-centred health care that aligns with patient values and wishes. Findings from this project directly informed modification of the tool to support a more culturally safe conversation. Further research will inform whether this tool is culturally safe for all seriously ill people.

Residential, long-term care serves vulnerable older adults in a facility-based environment. A new care delivery model (CDM) designed to promote more equitable care for residents was implemented in a health region in Western Canada. Leaders and managers faced challenges in implementing this model alongside other concurrent changes. This paper explores the question: How did leadership style influence team functioning with the implementation of the CDM? Qualitative data from interviews with leadership personnel (directors and managers, residential care coordinators and clinical nurse educators), and direct care staff (registered nurses, licensed practical nurses, health care aides, and allied health therapists), working in two different facilities comprise the main sources of data for this study. The findings reveal that leaders with a servant leadership style were better able to create and sustain the conditions to support successful model implementation and higher team functioning, compared to a facility in which the leadership style was less inclusive and proactive, and more resistant to the change. Consequently, staff at the second facility experienced a greater sense of overload with the implementation of the CDM. This study concludes that strong leadership is key to facilitating team work and job satisfaction in a context of change.