Dying and death within the culture of long‐term care facilities in Canada

Cable-Williams, Beryl; Wilson, Donna M.

doi:10.1111/opn.12125

Cited by 25 publications

(13 citation statements)

References 33 publications

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“…Long-Term-Care (LTC) homes are a major site of death for older adults globally [ 1 , 2 ]. Yet, many LTC facilities still lack formalized palliative care programs, resulting in sub-optimal end of life care [ 3 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

Exploration of the acceptability and usability of advance care planning tools in long term care homes

et al. 2020

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Objectives Despite known benefits, advance care planning (ACP) is rarely a component of usual practice in long-term care (LTC). A series of tools and workbooks have been developed to support ACP uptake amongst the generable population. Yet, their potential for improving ACP uptake in LTC has yet to be examined. This study explored if available ACP tools are acceptable for use in LTC by (a) eliciting staff views on the content and format that would support ACP tool usability in LTC (b) examining if publicly available ACP tools include content identified as relevant by LTC home staff. Ultimately this study aimed to identify the potential for existing ACP tools to improve ACP engagement in LTC. Methods A combination of focus group deliberations with LTC home staff (N = 32) and content analysis of publicly available ACP tools (N = 32) were used to meet the study aims. Results Focus group deliberations suggested that publicly available ACP tools may be acceptable for use in LTC if the tools include psychosocial elements and paper-based versions exist. Content analysis of available paper-based tools revealed that only a handful of ACP tools (32/611, 5%) include psychosocial content, with most encouraging psychosocially-oriented reflections (30/32, 84%), and far fewer providing direction around other elements of ACP such as communicating psychosocial preferences (14/32, 44%) or transforming preferences into a documented plan (7/32, 22%). Conclusions ACP tools that include psychosocial content may improve ACP uptake in LTC because they elicit future care issues considered pertinent and can be supported by a range of clinical and non-clinical staff. To increase usability and engagement ACP tools may require infusion of scenarios pertinent to frail older persons, and a better balance between psychosocial content that elicits reflections and psychosocial content that supports communication.

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Section: Introductionmentioning

confidence: 99%

Exploration of the acceptability and usability of advance care planning tools in long term care homes

et al. 2020

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“…Adequate training in advance care planning is also found lacking [ 5 ]. Qualitative data from Canadian nursing homes suggests that enhanced staff training in the palliative care topics could help avoid consequences, such as the late initiation of palliative care [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Hospital transfer rates and advance care planning following a nursing home-targeted video-conference education series (Project ECHO): a prospective cohort study

et al. 2022

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Key Summary Points Aim What effect does a novel education programme have on emergency hospital transfers of, and advance care planning decisions among, nursing home residents? Findings This education programme did not affect overall rates of emergency hospital transfer. It did increase advance care planning discussions, increase compliance with the results of these discussions and increase “DNR” orders among nursing home residents. Message Novel tele-education programmes have the potential to improve advance care planning discussions in nursing homes.

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“…Consequently, little or no PC is provided at earlier stages in the disease trajectory (Cable-Williams & Wilson, 2017). There is also evidence that LTCF staff may lack critical knowledge of PC and, therefore, are unprepared for their role (Cable-Williams & Wilson, 2017;Collingridge Moore et al, 2020;Frey et al, 2016Frey et al, , 2017Lida et al, 2020;Trotta et al, 2018;Unroe et al, 2015), while there remains a lack of standardisation of such care (Lida et al, 2020;Smets et al, 2018;Trotta et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

Living, loving and letting go‐navigating the relational within palliative care of older people in long‐term care facilities: An action research study

Molloy

Phelan

2021

Int J Older People Nursing

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Background: Long term care facilities are important environments for the delivery of palliative care, which includes end of life care. Despite this, staff may feel this care focus is separate to their roles. Consequently, this study explores and makes visible how palliative care is understood in long term residential care facilities for older people. It focuses on how relationships with residents and families are experienced by nurses and health care assistants and how this influences the introduction and provision of palliative care to older people in long term care facilities. Objectives:To develop an understanding of what palliative care means to staff caring for older people in residential care.Methods: A co-operative inquiry action research approach was used. A total of 18 healthcare assistants and 16 registered nurses in two older person long term care facilities participated in co-operative inquiry groups. Co-inquirers reflected on deaths that occurred over a 6-month period and generated narratives on their relationships in the context of palliative care.Results: Three themes were identified to describe relationships which were immersed in an ethos of person-centred care. These were living, loving and letting go. Living rather than dying was the predominant focus of care. Loving described deep engagement with older people and families while letting go navigated the dying process. Conclusions:Staff in nursing homes experience deep attachments to residents when delivering palliative care and end of life care. There is a need to understand these relationships and how they impact on the understanding and integration of palliative care in older person residential care as well as acknowledging and addressing staff's grief processes to enhance resilience. K E Y W O R D Saction research, end of life care, long-term care facilities, older people, palliative care, personcentred careThis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

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Dying and death within the culture of long‐term care facilities in Canada

Cited by 25 publications

References 33 publications

Exploration of the acceptability and usability of advance care planning tools in long term care homes

Exploration of the acceptability and usability of advance care planning tools in long term care homes

Hospital transfer rates and advance care planning following a nursing home-targeted video-conference education series (Project ECHO): a prospective cohort study

Living, loving and letting go‐navigating the relational within palliative care of older people in long‐term care facilities: An action research study

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