Browsing by Author "McCleary, Lynn"

Now showing 1 - 5 of 5
  • Thumbnail Image
    ItemOpen Access
    A pilot evaluation of the Strengthening a Palliative Approach in Long-Term Care (SPA-LTC) program
    (2020-07-13) Kaasalainen, Sharon; Sussman, Tamara; Thompson, Genevieve; McCleary, Lynn; Hunter, Paulette V; Venturato, Lorraine; Wickson-Griffiths, Abigail; Ploeg, Jenny; Parker, Deborah; Sinclair, Shane; Dal Bello-Haas, Vanina; Earl, Marie; You, John J.
    Abstract Background Despite increased annual mortality in long-term care (LTC) homes, research has shown that care of dying residents and their families is currently suboptimal in these settings. The purpose of this study was to evaluate resident and family outcomes associated with the Strengthening a Palliative Approach in LTC (SPA-LTC) program, developed to help encourage meaningful end of life discussions and planning. Methods The study employs a mixed method design in four LTC homes across Southern Ontario. Data were collected from residents and families of the LTC homes through chart reviews, interviews, and focus groups. Interviews with family who attended a Palliative Care Conference included both closed-ended and open-ended questions. Results In total, 39 residents/families agreed to participate in the study. Positive intervention outcomes included a reduction in the proportion of emergency department use at end of life and hospital deaths for those participating in SPA-LTC, improved support for families, and increased family involvement in the care of residents. For families who attended a Palliative Care Conference, both quantitative and qualitative findings revealed that families benefited from attending them. Residents stated that they appreciated learning about a palliative approach to care and being informed about their current status. Conclusions The benefits of SPA-LTC for residents and families justify its continued use within LTC. Study results also suggest that certain enhancements of the program could further promote future integration of best practices within a palliative approach to care within the LTC context. However, the generalizability of these results across LTC homes in different regions and countries is limited given the small sample size.
  • Thumbnail Image
    ItemOpen Access
    Awakening Canadians to ageism: a study protocol
    (2021-10-09) Dahlke, Sherry; Hunter, Kathleen F.; Fox, Mary T.; Davidson, Sandra; Perry, Nicole; Watts, Laura T.; Martin, Lori S.; Butler, Jeffrey I.; Raymond, Christy; Chasteen, Alison L.; McCleary, Lynn; Boscart, Veronique; Moody, Elaine
    Abstract Background Making fun of growing older is considered socially acceptable, yet ageist humour reinforces negative stereotypes that growing old is linked with physical and mental deterioration, dependence, and less social value. Such stereotypes and discrimination affect the wellbeing of older people, the largest demographic of Canadians. While ageism extends throughout professions and social institutions, we expect nurses—the largest and most trusted group of healthcare professionals—to provide non-ageist care to older people. Unfortunately, nurses working with older people often embrace ageist beliefs and nursing education programs do not address sufficient anti-ageism content despite gerontological nursing standards and competencies. Methods To raise awareness of ageism in Canada, this quasi-experimental study will be supported by partnerships between older Canadians, advocacy organizations, and academic gerontological experts which will serve as an advisory group. The study, guided by social learning theory, will unfold in two parts. In Phase 1, we will use student nurses as a test case to determine if negative stereotypes and ageist perceptions can be addressed through three innovative e-learning activities. The activities employ gamification, videos, and simulations to: (1) provide accurate general information about older people, (2) model management of responsive behaviours in older people with cognitive impairment, and (3) dispel negative stereotypes about older people as dependent and incontinent. In Phase 2, the test case findings will be shared with the advisory group to develop a range of knowledge mobilization strategies to dispel ageism among healthcare professionals and the public. We will implement key short term strategies. Discussion Findings will generate knowledge on the effectiveness of the e-learning activities in improving student nurses’ perceptions about older people. The e-learning learning activities will help student nurses acquire much-needed gerontological knowledge and skills. The strength of this project is in its plan to engage a wide array of stakeholders who will mobilize the phase I findings and advocate for positive perspectives and accurate knowledge about aging—older Canadians, partner organizations (Canadian Gerontological Nurses Association, CanAge, AgeWell), and gerontological experts.
  • Thumbnail Image
    ItemOpen Access
    Meaningful connections in dementia end of life care in long term care homes
    (2018-09-24) McCleary, Lynn; Thompson, Genevieve N; Venturato, Lorraine; Wickson-Griffiths, Abigail; Hunter, Paulette; Sussman, Tamara; Kaasalainen, Sharon
    Abstract Background Most persons with dementia die in long term care (LTC) homes, where palliative approaches are appropriate. However, palliative approaches have not been widely implemented and there is limited understanding of staff and family experiences of dying and bereavement in this context. Method This descriptive qualitative study explored family and staff experiences of end of life and end of life care for persons with dementia in LTC homes. Eighteen focus groups were conducted with 77 staff members and 19 relatives of persons with dementia at four LTC homes in four Canadian provinces. Results Three themes emerged: knowing the resident, the understanding that they are all human beings, and the long slow decline and death of residents with dementia. Discussion Intimate knowledge of the person with dementia, obtained through longstanding relationships, was foundational for person-centred end of life care. Health care aides need to be included in end of life care planning to take advantage of their knowledge of residents with dementia. There were unmet bereavement support needs among staff, particularly health care aides. Persons with dementia were affected by death around them and existing rituals for marking deaths in LTC homes may not fit their needs. Staff were uncomfortable answering relatives’ questions about end of life. Conclusions Longstanding intimate relationships enhanced end of life care but left health care aides with unmet bereavement support needs. Staff in LTC homes should be supported to answer questions about the trajectory of decline of dementia and death. Further research about residents’ experiences of deaths of other residents is needed.
  • Thumbnail Image
    ItemOpen Access
    Perspectives and experiences of compassion in long-term care facilities within Canada: a qualitative study of patients, family members and health care providers
    (2019-05-06) Smith-MacDonald, Lorraine; Venturato, Lorraine; Hunter, Paulette; Kaasalainen, Sharon; Sussman, Tamara; McCleary, Lynn; Thompson, Genevieve; Wickson-Griffiths, Abigail; Sinclair, Shane
    Abstract Introduction This paper details a subset of the findings from a participatory action research project exploring a palliative intervention in long-term care sites across Canada. The findings presented in this paper relate to understanding compassion within the context of a palliative approach to long-term care. Methods Findings presented are drawn from qualitative interviews and focus groups with residents, family members, healthcare providers, and managers from 4 long-term care sites across 4 provinces in Canada. In total, there were 117 individuals (20 residents, 16 family members, 72 healthcare providers, and 9 managers) who participated in one of 19 focus groups. Data was analyzed by multiple members of the research team in accordance with thematic analysis. Individual concepts were organized into themes across the different focus groups and the results were used to build a conceptual understanding of compassion within Long Term Care . Findings Two themes, each comprised of 5 sub-themes, emerged from the data. The first theme 'Conceptualizing Compassion in Long-Term Care generated a multidimensional understanding of compassion that was congruent with previous theoretical models. 'Organizational Compassion: resources and staffing', the second major theme, focused on the operationalization of compassion within the practice setting and organizational culture. Organizational Compassion subthemes focused on how compassion could support staff to enact care for the residents, the families, one another, and at times, recognizing their pain and supporting it through grief and mourning. Conclusions Results suggest that compassion is an essential part of care and relationships within long-term care, though it is shaped by personal and professional relational aspects of care and bound by organizational and systemic issues. Findings suggest that compassion may be an under-recognised, but essential element in meeting the promise of person-centred care within long-term care environments.
  • Thumbnail Image
    ItemOpen Access
    Recognition and Assessment of Geriatric Depression in Residential Care Facilities in Alberta: A Mixed Methods Study of Perspectives and Practices of Regulated Nursing Staff
    (2016) Azulai, Anna; Hall, Barry; Walsh, Christine; Hirst, Sandra; Konnert, Candace; Seneviratne, Cydnee; McCleary, Lynn
    Geriatric depression is under-detected in residential care facilities. There is a paucity of Canadian and Alberta-specific research on how this mental health condition is recognized and assessed in residential care settings. The purpose of this exploratory study was to learn about the perspectives and practices of regulated nurse professionals on the recognition of geriatric depression in long-term care (LTC) and designated supportive living (DSL) facilities in Alberta. The research questions focused on: 1) relevant knowledge, beliefs, and education of participants; 2) the relationship between the level of knowledge and types of facilities; 3) depression assessment process and methods; 4) barriers to the recognition and assessment; and 5) perceived strategies for the effective detection of depression. The study employed a convergent parallel mixed methods design, including a survey (N = 635) and qualitative interviews (N = 14). Findings suggested a risk for social exclusion of residents with geriatric depression from mental health services in Alberta. While considering the assessment of depression important, participants reported multiple challenges to its identification in facilities. One of the main challenges included specific socio-cultural beliefs about geriatric depression among staff, residents, and public, such as ageism, the normalization and the stigmatization of geriatric depression. Other challenges related to a less than optimal clinical knowledge of participants about geriatric depression, scarcity of resources, complicated and unclear assessment protocols, inconsistent use of assessment methods, poor communication between all stakeholders, and marginalized priority of the mental health care in facilities. These inter-connected structural and agential barriers on micro, mezzo, and macro levels served as constraining conditions in the depression assessment process. The perceived improvement strategies targeted addressing this complex constellation of barriers to enable successful detection. Recommendations included actions to alter views about geriatric depression, such as public awareness campaigns and enhancing depression-specific education, as well as increasing resources, elevating the priority of mental health in facilities, and advocating for the legislative changes to support effective regulations and policies for mental health provision in these care settings.