Thesis (M.Sc.)--Memorial University of Newfoundland, Faculty of Medicine, 2001. / Typescript. Bibliography: leaves 127-132.

Dying is a normal life process. Palliative care is the means in which health care professionals care for individuals with either life limiting or terminal illness at or near the end of life. It is important to deliver palliative care across all health care contexts - from acute care to residential care. Nurses within the specialty of palliative care or who have had palliative care education consider all aspects of caring for individuals - physical, psychological, social, and spiritual. Quality of life (QoL) is important at all stages of life. Older persons with life limiting illness residing in long term care homes may have different factors that influence their QoL than younger persons in good health. The purpose of this study was to describe factors affecting quality of life for older persons with life limiting illness who reside in long term care (LTC) homes. It was also of interest to discover what nursing strategies are used to promote quality of life for this population. A literature review of sixteen articles was carried out. Articles which were relevant to the literature review’s aim were retrieved from CINAHL and PubMed databases. Twelve articles were retrieved from the databases and four articles were found using a manual search. A systematic process of reviewing each article, reading and re-reading them to analyze the method and results was undertaken. Deductive reasoning was used to develop themes with inspiration from the World Health Organization’s domains of quality of life. Results were categorized into categories of sociodemographic characteristics, psychological/spiritual, physical health/independence, environment, and nursing strategies. It was found that being female and married positively affected one’s quality of life. Visits from family and friends positively affected QoL. Of interest was that having a higher education negatively affected one’s quality of life. Having a lower cognitive function and more comorbidities negatively affected one’s quality of life. Living in a smaller long term care home and also long term care homes with more leisure activities positively affected one’s quality of life. Nursing strategies to positively affect quality of life in long term care homes included education of staff in palliative care by a palliative care consult team, and assessment and treatment of older persons’ pain. In conclusion, QoL must be emphasized in LTC homes since the world’s population is aging and more complex symptoms within an increase in co-morbidities require expert nursing. QoL is affected by social factors such as visits from family and friends. It is affected by nurses’ attention to pain management and their caring nature in supporting residents’ dignity. QoL is also affected by demographic characteristics which staff and managers must be aware of in order to support the resident in optimizing QoL in a LTC home. Nurses, nurse specialists and managers at LTC homes need to prioritize their work in order to positively affect QoL for older persons with life limiting illness.

<p><strong>Background:</strong> Despite strong evidence, strategies for improving bone health are underutilized. Knowledge translation (KT) interventions aim to improve uptake of evidence-based practices, however the feasibility and effectiveness of such strategies require further evaluation within Long-term Care (LTC). In this thesis, we examined the impacts of a province-wide osteoporosis strategy and a more intensive multifaceted KT strategy including expert-led educational meetings, audit/feed-back, and action planning for quality improvement. Both studies targeted interdisciplinary LTC teams (physicians, nurses, pharmacists, dietician, and other staff).</p> <p><strong>Methods: </strong>In the first thesis study, we examined the impact of the <em>Ontario Osteoporosis Strategy for LTC</em> by investigating changes in facility-level prescribing rates (vitamin D, calcium, osteoporosis medications) before and after its implementation (2007 versus 2012). The second study was a pilot cluster randomized trial evaluating the feasibility and effectiveness of a 12-month, multifaceted, interdisciplinary KT intervention [Vitamin D and Osteoporosis Study (ViDOS)]. Prescribing outcomes included: vitamin D ≥800 IU (primary), calcium ≥500 mg/day, and osteoporosis medications (high-risk residents only). Feasibility outcomes included recruitment, retention, data collection, intervention fidelity, and process changes. We analyzed resident level data using the generalized estimating equations (GEE) technique, adjusting for clustering.</p> <p><strong>Results:</strong></p> <p>In both studies, significant improvements were observed for vitamin D and calcium prescribing. In the first study, prescribing increased by 38% and 4%, respectively, between 2007 and 2012. In the ViDOS trial, the 12-month intervention resulted in an absolute improvement of 15% and 7%, respectively (intention to treat cohort). There was no significant effect for prescribing of osteoporosis medications in either study. In the ViDOS study, recruitment and retention rates were 22% and 63%, respectively; good intervention fidelity was achieved and intervention homes reported several process changes.</p> <p><strong>Conclusion:</strong></p> <p>This thesis study demonstrated that KT interventions targeting evidence-based osteoporosis and fracture prevention strategies were feasibly and effectively applied with interdisciplinary LTC teams.</p> / Doctor of Philosophy (PhD)

<p><strong>Objectives</strong>: Research shows that Montessori-based activities can help address responsive behaviours experienced by persons with dementia by increasing their participation in and enjoyment of daily life. The purpose of this study was to investigate staff perceptions of factors that affect the implementation of Montessori Methods for Dementia™ (MMD) in Ontario long-term care (LTC) homes.</p> <p><strong>Methods</strong>: Qualitative data was obtained during semi-structured telephone interviews with 17 participants who were putting MMD into practice in Ontario LTC homes. The study was guided by a political economy of aging perspective using thematic analysis to elucidate the various factors that affected the implementation of MMD.</p> <p><strong>Results</strong>: Several themes emerged from the data: Regulating and Funding Medical Practices; Shifting Practice Amidst Resistance to Change; Educating and Understanding; Seeing Results is Believing; Being Supported; (Re-)Connecting People and Passions; and Improving Residents’ Quality of Life. Barriers such as insufficient funding and negative attitudes toward activities and MMD reinforced a task-oriented biomedical model of care, whereas various forms of support and understanding helped put MMD into practice as a person-centred program, which improved the quality of life of residents with dementia, staff and family members.</p> <p><strong>Conclusions</strong>:<strong> </strong>The results from this research can help ensure that MMD are as practical and easy to implement as possible despite perceived barriers so that persons with dementia in LTC and their partners in care can have a good quality of life. The findings include suggestions for future research, reducing staff hierarchies and ensuring there is sufficient organizational, financial, educational, and personal support. <strong><br /> </strong></p> / Master of Arts (MA)