Charlene H. Chu

Turnover of regulated nurses in long‐term care facilities

AIMS To describe the relationship between nursing staff turnover in long-term care (LTC) homes and organisational factors consisting of leadership practices and behaviours, supervisory support, burnout, job satisfaction and work environment satisfaction. BACKGROUND The turnover of regulated nursing staff [Registered Nurses (RNs) and Registered Practical Nurses (RPNs)] in LTC facilities is a pervasive problem, but there is a scarcity of research examining this issue in Canada. METHODS The study was conceptualized using a Stress Process model. Distinct surveys were distributed to administrators to measure organisational factors and to regulated nurses to measure personal and job-related sources of stress and workplace support. In total, 324 surveys were used in the linear regression analysis to examine factors associated with high turnover rates. RESULTS Higher leadership practice scores were associated with lower nursing turnover; a one score increase in leadership correlated with a 49% decrease in nursing turnover. A significant inverse relationship between leadership turnover and nurse turnover was found: the higher the administrator turnover the lower the nurse turnover rate. CONCLUSION Leadership practices and administrator turnover are significant in influencing regulated nurse turnover in LTC. IMPLICATIONS FOR NURSING MANAGEMENT Long-term care facilities may want to focus on building good leadership and communication as an upstream method to minimize nurse turnover.

Factors Influencing Outcomes of Older Adults After Undergoing Rehabilitation for Hip Fracture

To determine the contribution of cognitive impairment, prefracture functional impairment, and treatment as predictors of functional status and mobility 6 months after discharge from rehabilitation for older adults with hip fracture.

Community-Based Rehabilitation Post Hospital Discharge Interventions for Older Adults With Cognitive Impairment Following a Hip Fracture: A Systematic Review Protocol

Background Hip fractures among older adults remain a public concern. Consequences of a hip fracture include the subsequent decline in function and mobility for the older adult, and an increased burden placed upon their caregivers and the health care system. The consequences may be more challenging if an older adult also has a compromised cognitive reserve. Although rehabilitation programs have proven effective, the best practices and resources required to maintain the gains in function and mobility, to negate diminution of effect, and to enable this patient population to continue living at home are currently unknown. Objective The objective of this study is to develop a systematic review protocol focused on identifying the evidence and evaluating the effectiveness of post discharge rehabilitation programs for older adults with a cognitive impairment following a hip fracture. Methods The search strategy will include a combination of text words and subject headings relating to the concepts of cognitive impairment, dementia, delirium, cognitive reserve, and hip fractures. Searching various databases will identify peer-reviewed journal articles. There will be two independent reviewers who will screen the titles and abstracts to determine which articles comprise a rehabilitation intervention within a community setting prior to being included for a full article review. A data extraction form and an evidence and quality checklist will be used during the full article data analysis and synthesis. It is expected that there will be a paucity of studies that focus on post discharge rehabilitation interventions for older adults with cognitive impairment following a hip fracture, and few studies that use the same or similar outcome measures. However, if possible, a meta-analysis will be conducted on studies that used similar outcome methods. Results This review will synthesize knowledge focusing on activities to maintain and restore function in older adult patients with cognitive impairment once they have completed their active rehabilitation program and return home. A synthesis of the findings will be conducted to determine which components of the interventions identified were the most advantageous to the patient population. The results will be used to develop a multi-faceted post discharge rehabilitation intervention aimed at enabling older adults to return and remain living at home after a hip fracture. Conclusions The aim of this systematic review is to generate results that can be used to create interventions that focus on the care necessary to enable older adults to remain living at home post discharge from acute or inpatient rehabilitation care for a hip fracture. With the support and contributions by our associated knowledge users, this systematic review will be used to help inform procedures and policies to facilitate the necessary care and resources required by our patient population.

The effects of an interprofessional patient-centered communication intervention for patients with communication disorders

PURPOSE OF THE STUDY This small scale study examined the influence of an interprofessional (IP) evidence based patient-centered communication intervention (PCCI), delivered by trained nurses in collaboration with Speech Language Pathologists, on patient outcomes in an active stroke rehabilitation setting. DESIGN AND METHODS The setting constraints imposed the use of a single-group pretest and post-test design to determine the influence of the intervention on patient outcomes. Validated tools measured patient quality of life (QOL), depressive symptoms and satisfaction with care. RESULTS Patients (n=34) showed improvement in all outcomes from pretest to post-test, including quality of life, geriatric depressive symptoms, and satisfaction with care. IMPLICATIONS The findings indicate that a comprehensive person-centered communication intervention has the potential to enhance patient outcomes at discharge. Challenges to implementing and evaluating evidence-based interventions in practice are highlighted.

An Interprofessional Communication Training Program to Improve Nurses’ Ability to Communicate With Stroke Patients With Communication Disorders

Purpose The aim of the study was to evaluate change in nurses’ knowledge, attitudes, and behaviors after an Interprofessional (IP) Communication Training Program designed to improve nurses’ ability to communicate with stroke rehabilitation inpatients with communication disorders. Design/Methods A quasi-experimental longitudinal study was conducted to evaluate an IP Communication Training Program consisting of a full-day and booster workshop and speech language pathologist support for nurses. The Communication Impairment Questionnaire and the Providers Interactional Comfort Survey were collected prior to and 3 months and 1 year postintervention. Focus groups assessing program acceptability were conducted. Results Forty-six nurses participated. The Communication Impairment Questionnaire significantly improved postintervention (p = .001), but not at 1 year follow-up (3.76, p = .123). The Providers Interactional Comfort Survey significantly improved postintervention (p = .001) and remained significant 1 year later (8.84, p = .03). Focus groups indicated high acceptability and reported that the education increased their confidence and reduced their frustration. Conclusion Nurses’ attitudes toward and knowledge about communication strategies improved, which enhances their ability to care for stroke patients with communication disorders. Clinical Relevance Interdisciplinary workshops and speech language pathologist support appear beneficial to nurses working with patients with communication disorders.

A Feasibility Study of a Multifaceted Walking Intervention to Maintain the Functional Mobility, Activities of Daily Living, and Quality of Life of Nursing Home Residents With Dementia

PURPOSE The aim of the study was to evaluate the feasibility, acceptability, and efficacy of a multifaceted walking intervention (MWI) aimed to maintain the functional mobility, activities of daily living function, and quality of life of long-term care home residents with dementia. DESIGN/METHODS A quasiexperimental time-series design was used. The 4-month intervention provided one-on-one walking 2-4 days a week, guided by an individualized communication care plan and interviews with collaterals and staff. RESULTS The MWI was feasible based on high recruitment and adherence rates (86% and 94%, respectively) and highly acceptable to stakeholders. Residents (n = 25) showed significant improvements after the intervention: Timed Up-and-Go (-8.85 seconds, p = .00), Two-Minute Walk Test (27.47 m, p = .00), Functional Independence Measure (0.72, p = .00), and Alzheimers Disease-Related Quality of Life (2.44, p = .05). CONCLUSION The MWI was feasible and improved functional mobility compared to usual care. CLINICAL RELEVANCE Physical activity delivered with a person-centered care was feasible and may be beneficial to mitigate decline in long-term care home residents with dementia.

Supportive Supervision and Staff Intent to Turn Over in Long-Term Care Homes

Background and Objectives To examine the association between supervisory support and intent to turn over among personal support workers (PSWs) employed in long-term care (LTC) homes in Ontario, Canada, by assessing whether the association is mediated by job satisfaction and the potential confounding effect of happiness. Research Design and Methods Cross-sectional survey data of 5,645 PSWs working within 398 LTC homes in Ontario, Canada, were obtained and analysed through a series of multilevel regression models. Results Overall, analyses support the assertion that the effect of supervisory support on intent to turn over is partially mediated by job satisfaction. However, happiness may act as an effect modifier rather than as a confounder. Discussion and Implications These results reinforce the importance of supportive supervision for PSWs working in LTC homes and highlight the multifaceted role of nurses in LTC, who traditionally provide the majority of PSW supervision. Nurses must be equipped with competencies and skills that reflect the complex organisational environments in which they work. However, these results must also be interpreted in context with the limitations of cross-sectional data; future research should incorporate prospective data collection and clarify the potential role of happiness.

Pilot of a Tailored Dance Intervention to Support Function in People With Cognitive Impairment Residing in Long-Term Care: A Brief Report:

Older adults who live in long-term care settings are at risk for functional decline, which may be mitigated by regular exercise. Using a single-group repeated measures design, this pilot study explored the feasibility, acceptability, and preliminary effects of a Waltz-based dance intervention delivered to 13 Canadian, English-speaking, long-term care residents with mild to moderate cognitive impairment. The findings supported intervention feasibility, based on a high completion rate (93%), level of attendance (M = 7.15 of 10 sessions) and level of engagement during dance sessions (M = 1.75 to 1.97 out of 2.00). On average, residents perceived dance sessions positively, and staff and family participants (N = 26) rated them as somewhat acceptable overall (M = 2.37, 0 to 4 scale). Additional research is needed to assess intervention efficacy in a larger sample.

NEWLY ADMITTED NURSING HOME RESIDENTS WITH DEMENTIA EXPERIENCE FUNCTIONAL MOBILITY DECLINE WITHIN THE FIRST 60 DAYS

ysis: The raw and IRT-derived HBC scores were analyzed with and without the MCI Screen using logistic regression to predict FAST stage. Results: The HBC and MCI Screen measures correlated weakly. Combining their information optimized classification of functionally normal (FAST 1, 2) vs. functionally impaired subjects (FAST 3, 4). The item difficulty and discrimination measures showed that 15 of the 16 HBC items had good psychometric validity. The raw HBC scores and IRT-derived, theta scores gave similar classification accuracies. Conclusions: The weak correlation between subjective and objective cognitive measures, and the improved classification when they are combined, indicates the subjective and objective information measure different aspects of cognitive performance. 15 of 16 HBC items have good psychometric validity. It would be helpful to understand the different aspects of cognition captured by subjective and objective assessment so that they can be more gainfully exploited.