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By the year 2024, one in four adults in Canada will be over the age of 65. In Ontario alone, 100,000 residents live in long-term care (LTC). Residents sometimes experience poor quality-of-life (QOL). Culture change has been proposed as an approach to improve residents’ QOL in LTC. One large LTC organization, Schlegel Villages, has developed and implemented an organizational culture change called Neighbourhood Team Development (NTD). This approach focuses on building cross-functional teams to enhance resident-centredness and promote QOL through optimizing residents’ autonomy and dignity. Implementation of NTD started in 2013 in six LTC homes. The aim of this secondary analysis was to evaluate if NTD has an impact on residents’ QOL in LTC. Using a quantitative repeated-measures design, residents from six LTC homes completed QOL assessments. Quantitative data were collected through the Resident Assessment Instrument-Minimum Data Set 2.0 (RAI-MDS) and the interRAI QOL Survey Short Form. QOL data were analyzed using a paired t-test to assess change scores between time point 1 (data collected between August 2011 and December 2012) and time point 2 (data collected between January 2014 and November 2015) for 232 residents. Study results demonstrate that NTD increased residents’ QOL (p = .003). Organizational culture change such as NTD can lead to innovative approaches to improve the QOL of residents in LTC. This study contributes to literature examining culture change in LTC, and helps inform LTC care models, and interventions to increase residents’ QOL in LTC. / Thesis / Master of Science (MSc)

This project, which used a qualitative, explanatory case-study design explored the transition to practice of new graduate Registered Nurses (RNs) and Registered Practical Nurses (RPNs) in long-term care (LTC). Specifically, this study focused on the self-described transition to practice experience of the new graduate nurse (NGN), the contextual factors present in LTC that influenced this transition to practice, and how the transition experience was similar and different for the new graduate RN and RPN. Both NGNs and LTC directors were included in the study. In total, 7 NGNs and 2 LTC directors participated in semi-structured interviews. The NGN participants were employed as a nurse in one of the two LTC sites and had been working as a nurse for less than one year. Data were collected through Key Informants (NGNs and LTC directors), and Key Documents (LTC policies and orientation material). Results of this study introduced six contextual factors present in LTC that influence the transition to practice of NGNs and five processes that, as a result of the contextual factors, accelerate the transition to practice experience. This described accelerated transition to practice refutes the previously universally applied transition to practice theory and contributes new knowledge and understanding to the transition to practice experience of the NGN in LTC and more specifically how the new graduate RPN experiences transitioning. The findings also described the many similarities and some differences between the transition to practice experience of the new graduate RN and RPN in LTC. With increasing demands on the long-term care sector, these findings will be of interest to a broad audience including policy makers, educators, LTC directors and administrators, as well as nursing students and NGNs. It is anticipated that these results will direct further research on this topic, and inform policy, practice, and educational programs. / Thesis / Master of Science (MSc)

Long-term care facility network in Ontario, and in Canada as a whole, encounters critical issues regarding balancing demand with capacity. Even worse, it is faced with rising demand in the coming years. Moreover, there is an urgent need to provide long-term care for patients in their own language (particularly French). This study proposes a dynamic Mixed-Integer Linear Programming model based on the current standing of the long-term care system in Ontario, which simultaneously optimizes the time and location of constructing new long-term care facilities, adjusting the capacity (namely, human resources and beds) of each facility dynamically, and the assignment of patients to the facilities based on their demand region, gender, language, and age group over a finite time horizon. We apply the diversity-support constraints, based on patients’ gender and language, to save patients from loneliness and to comply with the Canadian values of providing care. Finally, we validate the model by performing a case study in Hamilton, Ontario. An extensive set of numerical analyses are explored to provide deeper insights into the whole issue. One set of such analysis is an extensive simulation study to examine the effect of distributional uncertainty in some of the input parameters on the optimal results, hence providing a much more realistic understanding of the optimization model. / Thesis / Master of Science (MSc)

Background 50% of antibiotic courses in long-term care facilities (LTCFs) are unnecessary, leading to increased risk of harm such as Clostridiodes difficile infection and antibiotic-resistant organisms. Antimicrobial Stewardship (AS) interventions plays an important role in optimizing antibiotic use. Most studies to improve antibiotic prescribing in LTCFs showed modest and unsustained results. We aimed to identify facilitators, barriers and strategies in implementing a urinary tract infection (UTI)-focused AS intervention at a LTCF with the secondary objective of exploring the pharmacist’s potential role(s) in this intervention. Methods A qualitative approach using conventional content analysis was used. Through purposeful sampling, we recruited different healthcare providers and administrators at Kensington Gardens. Interviewees attended focus groups or one-on-one interviews. Data were collected using a semi-structured interview guide. Data were analyzed inductively using a codebook modified in an iterative analytic process. Barrier and facilitator themes were identified from the transcripts and mapped using the COM-B (capability, opportunity, motivation and behaviour) model (Michie et al). Similarly, themes were identified from the transcripts regarding the pharmacist’s roles in this intervention. Results Sixteen participants were interviewed. Most barriers and facilitators mapped to the opportunities domain of the COM-B model. The main barrier themes were lack of access, lack of knowledge, ineffective communication, lack of resources and external factors while the main facilitator themes were education, effective collaboration, good communication, sufficient resources and access. For the pharmacist’s role, the barrier themes were ineffective collaboration and communication. Furthermore, the pharmacist can play a role in education and antibiotic selection. Conclusions A UTI-focused antimicrobial stewardship intervention in LTCF should consider strategies to improve access, knowledge, communication and collaboration in its design, having sufficient resources and addressing external factors in order to optimize the intervention’s success. Pharmacists can play a role in education and antibiotic selection. / Thesis / Master of Science (MSc) / Half of antibiotics prescribed in long-term care are not needed, leading to increased harm. It is unclear which strategies should be used to improve antibiotic prescribing. This project aims to identify facilitators, barriers and strategies in identifying and managing urinary tract infection in a long-term care facility as well as exploring the role of the pharmacist in this setting. We conducted focus groups and interviews to gather information and analyzed the transcripts to determine barrier and facilitator themes relating to urinary tract infection management and the role of the pharmacist. The main barrier themes were lack of access, lack of knowledge, ineffective communication, lack of resources and external factors while the main facilitator themes were education, effective collaboration, good communication, sufficient resources and access. For the pharmacist’s role, the barrier themes were ineffective collaboration and communication. In addition, the pharmacist can play a role in education and antibiotic selection.

No / Within care organizations, “people with dementia” are often labeled as a homogenous group with little differentiating them from each other. This can mark them out as separate from and less capable than those without dementia. When individuals with dementia are described, understood, and related to in terms of their diagnosis, individuality may get lost. In this article, we seek to unsettle the socially constructed boundary between “people with dementia” and people without dementia. This is explored in the context of fieldwork we undertook as part of a Participatory Video project where we worked alongside people with a dementia diagnosis to co-create short films about their interests and concerns. In the process of this work, we found that alternative unities emerged between ourselves and people with dementia, as the dementia label faded into the and the person, with all his or her diverse interests and life experiences, came to the fore. We found ourselves building rapport and making connections with our research participants, a diverse group of individuals whose life experiences, outlooks, and experiences were simultaneously unique to them but also shared in many ways between themselves, and with us. As we spent time with participants in the communal lounge, in the adjoining day center, walking the hallways, out in the garden, or in individual apartments when invited, we found that people shared a wealth of information with us: about how they were feeling, things they liked, things they had done, instances of trauma, as well as some of their happiest times.

Yes / Film-making is an effective way of engaging people with dementia and improving their well-being. Andrea Capstick and colleagues explain how ‘participatory video’ gave one group an opportunity to tell their own story in film.

Yes / The aim of the study is to identify the degree of association between mood, activity engagement, activity location, and social interaction during everyday life of people with dementia (PwD) living in long-term care facilities. Method: An observational study using momentary assessments was conducted. For all 115 participants, 84 momentary assessments of mood, engagement in activity, location during activity, and social interaction were carried out by a researcher using the tablet-based Maastricht Electronic Daily Life Observation-tool. Results: A total of 9660 momentary assessments were completed. The mean age of the 115 participants was 84 and most (75%) were women. A negative, neutral, or positive mood was recorded during 2%, 25%, and 73% of the observations, respectively. Positive mood was associated with engagement in activities, doing activities outside, and social interaction. The type of activity was less important for mood than the fact that PwD were engaged in an activity. Low mood was evident when PwD attempted to have social interaction but received no response.

Thesis (M.G.S.)--Miami University, Dept. of Sociology and Gerontology, 2007. / Title from first page of PDF document. Includes bibliographical references (p. 48-50).