Supporting our Long Term Care Resident Teams
Addressing Interprofessional Team Challenges Caring for Long Term Care Residents Throughout the Dying Process:
Toward Ethical and Effective Support
As the Canadian population ages, more people will die in long term care (LTC), with estimates as high as 39% of residents dying in their LTC home (each year) by 2020 (Marcella & Kelley, 2015). While this trend puts increasing stress on residents and their families, it also affects the stress of interprofessional health care providers (HCPs) in LTC, who are dealing with increasingly complex resident and family needs throughout the dying process (Marcella & Kelley, 2015) in an era of constrained resources across Canadian health care delivery sectors. Thus, there are important intersecting vulnerabilities for LTC residents, their families, and LTC HCPs. These vulnerabilities reflect the ethical tensions arising from the obligation to provide ethical and effective end of life care for residents and their families and also support the moral agency and well being of HCPs.
At Providence Health Care (PHC) in British Columbia we are facing the Canadian challenges noted above. PHC LTC facilities are increasingly providing end of life care, with approximately 35% of residents dying each year and 8% of residents within the first 3 months after ‘moving-in’ or admission. This has generated an increase in related stress across all sites and all levels of staff (care aides, nurses, rehabilitation staff, and other allied staff) caring for dying residents. While this trend is echoed nationally and internationally, we are committed to taking action at PHC to improve the health and well being of all LTC HCPs in relation to their care of dying residents and those residents' families.
Our team of researchers has embarked on a program of research to alleviate and prevent workplace stress and moral distress related to LTC resident deaths for HCPs from all backgrounds, across all kinds of practice, and across all PHC LTC sites. Our overall goal is to foster ethical and effective end of life care for residents and their families while simultaneously supporting the moral agency and well being of HCPs.
RESEARCHERS: Kit Chan (PHC dietitian), Patricia Rodney (UBC nursing faculty), Anne Leclerc (PHC physiotherapist), Chris Bernard (PHC spiritual health practitioner), Karen Pott (PHC occupational therapist), Annes Song (PHC registered nurse), Joseph Puyat (Health Researcher, CHEOS at PHC).
RESEARCH ASSISTANTS: Nora Abdoh (nursing undergraduate student, UBC), Nassim Adhami (nursing doctoral candidate, UBC), Laura Gall (nursing undergraduate student, UBC), Anica Villamayor (occupational therapy masters student, UBC), Jeff Yu (nursing undergraduate student, UBC), Brenda Sawatzky-Girling (population and public health doctoral candidate, UBC).
Study # 1: Caring for Long Term Care Residents throughout the Dying Process: An Exploratory Study to Understand Related Interdisciplinary Care Team Stress
The purpose of this study was to describe and measure care team members’ stress related to caring for dying residents. The results from this study can be used to provide evidence-based knowledge on how to improve on the current processes and supports that exist for interdisciplinary care team members in Long Term Care.
The Research Questions were:
- How are interdisciplinary care team members in PHC residential care facilities affected by the death of the residents they are looking after?
- What do interdisciplinary care team members in PHC residential care facilities find helpful in supporting them to cope with resident deaths?
Study # 2: Supporting Long Term Care Residents Throughout the Dying Process: Understanding and Addressing Related Health Care Provider Stress
The interdisciplinary research team members for this one-year PHC WorkSafe BC study (commencing in April, 2017) will use participatory action research to better understand and address:
- How residential care facility team members are affected by the increasing number of deaths of the residents they are looking after;
- What strategies team members would find helpful in supporting them to cope with resident deaths; and
- How these strategies can be incorporated into the ongoing work of PHC’s five residential care facilities and beyond.
Qualitative individual interviews and qualitative focus groups with diverse health care providers across all 5 PHC LTC sites were used to generate data and consolidate planning for goals 1) and 2). A capstone knowledge translation event (conference) as well as ongoing HCP and administrative meetings are being used to address goal 3).
Feedback from staff and PHC management is being used to evaluate the effectiveness of the study.
We have been awarded the Health Employers Association of BC (HEABC) 2019 Workplace Health Innovation Gold Apple Award for our innovative knowledge-to-action research and current implementation of our recommendations.
Research team members in attendance: Dr. Joseph Puyat, Annes Song, Anne Leclerc and Kit Chan, then Betsy Gibbons (HEABC Board Chair) and Michael McMillan (HEABC President; CEO). Team members missing at presentation: Karen Pott, Chris Bernard and Dr. Paddy Rodney.
The PHC Foundress Mission Team Award for 2017 is awarded at the AGM to the PHC Residential Care Interdisciplinary Research Challenge Team.
In the photo - from left to right: Diane Doyle (PHC CEO), team members Kit Chan, Karen Pott, Annes Song, Anne Leclerc, Chris Bernard, Geoff Plant (PHC Board Chair) & Paddy Rodney, mentor.