Learnings From a Novel Virtual Care Planning Intervention Targeting Registered Practical Nurses in Long-Term Care Homes During COVID-19
Main Article Content
Abstract
Introduction: The PIECES approach has been utilized for over 25 years across various Canadian healthcare settings, including long-term care (LTC). PIECES fosters a team-based, person-centred approach to addressing responsive behaviors—such as yelling and restlessness—often linked to unmet personal needs.
Objective: This study aimed to explore, with implementation of the virtual version of PIECES: (a) the experiences of LTC staff, focusing on challenges, facilitators, and recommendations; and (b) resilience and interprofessional collaboration among LTC staff.
Methods: A convergent mixed method approach used focus groups with registered practical nurses (RPNs), managers, PIECES-trained RPN champions and PIECES mentors to gather their experiences. Surveys at baseline and post-intervention assessed individual and workplace resilience, and team collaboration.
Results: Themes identified through reflexive thematic analysis included increased team collaboration and efficacy to manage responsive behaviors through PIECES care planning. Formalized processes supported by leadership with input from family/care partners enhanced nurses’ ability to provide the needed care for responsive behaviors. Primary challenges to PIECES implementation were unfamiliarity with technology and staff shortage. Recommendations included embedding technology in usual care, ongoing support with referral process and continued virtual PIECES training. Standard outcome measures revealed reduced personal and workplace resilience, and team collaboration.
Discussion and Conclusion: The RPN-led referral algorithm for the virtual PIECES approach invested the LTC staff together during the difficult COVID period and challenged their existing skills and knowledge of technology.
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors hold the copyright on their papers without restrictions and retain it without restrictions after publication of the papers on the journal’s website.
References
Al Altintas, E., Boudoukha, A. H., Karaca, Y., Lizio, A., Luyat, M., Gallouj, K., & El Haj, M. (2022). Fear of COVID-19, emotional exhaustion, and care quality experience in nursing home staff during the COVID-19 pandemic. Archives of gerontology and geriatrics, 102, 104745. https://doi.org/10.1016/j.archger.2022.104745
Arain, M., Campbell, M. J., Cooper, C. L., & Lancaster, G. A. (2010). What is a pilot or feasibility study? A review of current practice and editorial policy. BMC medical research methodology, 10, 67. https://doi.org/10.1186/1471-2288-10-67
Campbell-Sills, L., & Stein, M. B. (2007). Psychometric analysis and refinement of the Connor-davidson Resilience Scale (CD-RISC): Validation of a 10-item measure of resilience. Journal of traumatic stress, 20(6), 1019–1028. https://doi.org/10.1002/jts.20271
Canadian Foundation for Healthcare Improvement. (2020, July). Reimagining Care for Older Adults: Next Steps in COVID-19 Response in Long-Term Care and Retirement Homes: What We Heard. https://www.healthcareexcellence.ca/media/pyeh54rn/2022_reimaginingcareforolderadults_whatweheard_en-final-ua.pdf
Connelly, D. M., Garnett, A., Snobelen, N., Guitar, N., Flores-Sandoval, C., Sinha, S., Calver, J., Pearson, D., & Smith-Carrier, T. (2022). Resilience amongst Ontario registered practical nurses in long-term care homes during COVID-19: A grounded theory study. Journal of advanced nursing, 78(12), 4221–4235. https://doi.org/10.1111/jan.15453
Connor, K. M., & Davidson, J. R. (2003). Development of a new resilience scale: the Connor-Davidson Resilience Scale (CD-RISC). Depression and anxiety, 18(2), 76–82. https://doi.org/10.1002/da.10113
Creswell, J. W., & Plano Clark, V. L. (2018). Designing and conducting mixed methods research (3rd ed.). SAGE.
Dijkstra A. (2007). Family participation in care plan meetings: promoting a collaborative organizational culture in nursing homes. Journal of gerontological nursing, 33(4), 22–31. https://doi.org/10.3928/00989134-20070401-04
Doll, W. J., & Torkzadeh, G. (1998). Developing a multidimensional measure of system-use in an organizational context. Information & Management, 33(4), 171–185.
Elo, S., & Kyngäs, H. (2008). The qualitative content analysis process. Journal of advanced nursing, 62(1), 107–115. https://doi.org/10.1111/j.1365-2648.2007.04569.x
Finlay, L., & Ballinger, C. (ed.). (2006). Qualitative research for allied health professionals : challenging choices. J. Wiley & Sons.
Gao, H., Yous, M. L., Connelly, D., Hung, L., Garnett, A., Hay, M., & Snobelen, N. (2023). Implementation and impacts of virtual team-based care planning for older persons in formal care settings: A scoping review. Digital health, 9, 20552076231151567. https://doi.org/10.1177/20552076231151567
Hamilton, P., LeClair, J., Collins, J., Sturdy-Smith, C., & O'Connell, M. (2020). PIECES™ Resource Guide: Guiding Collaborative Engagement, Shared Assessment, and Supportive Care. A Learning Resource for Health Care Practitioners Supporting Older Adults Living with Complexity (7th ed.). Pieces Canada.
Hsu, A. T., Lane, N., Sinha, S. K., Dunning, J., Dhuper, M., Kahiel, Z., Sveistrup, H. (2020, May 10). Impact of COVID-19 on residents of Canada’s long-term care homes – ongoing challenges and policy response. International Long-Term Care Policy Network. https://ltccovid.org/wp-content/uploads/2020/05/LTCcovid-country-reports_Canada_Hsu-et-al_May-10-2020-2.pdf
IBM. (2021). SPSS® Statistics (version 28.0.1) [Computer software]. https://www.ibm.com/support/pages/downloading-ibm-spss-statistics-28
Ickert, C., Rozak, H., Masek, J., Eigner, K., & Schaefer, S. (2020). Maintaining Resident Social Connections During COVID-19: Considerations for Long-Term Care. Gerontology & geriatric medicine, 6, 2333721420962669. https://doi.org/10.1177/2333721420962669
Iyamu, I., Plottel, L., Snow, M. E., Zhang, W., Havaei, F., Puyat, J., Sawatzky, R., & Salmon, A. (2023). Culture Change in Long-Term Care-Post COVID-19: Adapting to a New Reality Using Established Ideas and Systems. Canadian journal on aging = La revue canadienne du vieillissement, 42(2), 351–358. https://doi.org/10.1017/S0714980822000344
Kitzinger, J., & Barbour, R. S. (1999). Introduction: The Challenge and Promise of Focus Groups. In R. S. Barbour & J. Kitzinger (ed.), Developing Focus Group Research (pp. 1-20). SAGE Publications Ltd. https://doi.org/10.4135/9781849208857
LoGiudice, J. A., & Bartos, S. (2021). Experiences of Nurses During the COVID-19 Pandemic: A Mixed-Methods Study. AACN advanced critical care, 32(1), 14–26. https://doi.org/10.4037/aacnacc2021816
Lorente, L., Vera, M., & Peiró, T. (2021). Nurses´ stressors and psychological distress during the COVID-19 pandemic: The mediating role of coping and resilience. Journal of advanced nursing, 77(3), 1335–1344. https://doi.org/10.1111/jan.14695
McEwen, K. (2018). Resilience at Work: A Framework for Coaching and Interventions. https://catherinecarr.ca/wp-content/uploads/2018/09/R@WWhitePaper-May-2018.pdf
Oliveira, L. F., Camargos, E. F., Martini, L. L. L., Machado, F. V., & Novaes, M. R. C. G. (2021). Use of psychotropic agents to treat agitation and aggression in Brazilian patients with Alzheimer's disease: A naturalistic and multicenter study. Psychiatry research, 295, 113591. https://doi.org/10.1016/j.psychres.2020.113591
Orchard, C. A., King, G. A., Khalili, H., & Bezzina, M. B. (2012). Assessment of Interprofessional Team Collaboration Scale (AITCS): development and testing of the instrument. The Journal of continuing education in the health professions, 32(1), 58–67. https://doi.org/10.1002/chp.21123
Ou, X., Chen, Y., Liang, Z., Wen, S., Li, S., & Chen, Y. (2021). Resilience of nurses in isolation wards during the COVID⁃19 pandemic: a cross-sectional study. Psychology, health & medicine, 26(1), 98–106. https://doi.org/10.1080/13548506.2020.1861312
Public Health Ontario. (2022). COVID-19 in long-term care homes: focus on January 30, 2022 to February 12, 2022. https://www.publichealthontario.ca/-/media/Documents/nCoV/Archives/LTCH/2022/02/biweekly-ltch-report-2022-02-22.pdf?rev=87994f99b35b474bbd5c68c2cf3e8e18&la=fr
Qualtrics XM. (2024). Online survey tool. [computer software]. https://www.qualtrics.com/
Qudrat-Ullah, H., & Tsasis, P. (2017). Innovative Healthcare Systems for the 21st Century (1st ed.). Springer.
Sacco, G., Lléonart, S., Simon, R., Noublanche, F., Annweiler, C., & TOVID Study Group (2020). Communication Technology Preferences of Hospitalized and Institutionalized Frail Older Adults During COVID-19 Confinement: Cross-Sectional Survey Study. JMIR mHealth and uHealth, 8(9), e21845. https://doi.org/10.2196/21845
Sandelowski M. (2000). Whatever happened to qualitative description?. Research in nursing & health, 23(4), 334–340. https://doi.org/10.1002/1098-240x(200008)23:4<334::aid-nur9>3.0.co;2-g
Simard, J., & Volicer, L. (2020). Loneliness and Isolation in Long-term Care and the COVID-19 Pandemic. Journal of the American Medical Directors Association, 21(7), 966–967. https://doi.org/10.1016/j.jamda.2020.05.006
Song, Y., Hoben, M., Weeks, L., Boström, A. M., Goodarzi, Z. S., Squires, J., Doan, H., Wagg, A., Reid, R. C., & Estabrooks, C. (2019). Factors associated with the responsive behaviours of older adults living in long-term care homes towards staff: a systematic review protocol. BMJ open, 9(5), e028416. https://doi.org/10.1136/bmjopen-2018-028416
Stall, N. M., Brown, K. A., Maltsev, A., Jones, A., Costa, A.P., Allen, V., Brown, A.D., Evans, G.A., Fisman, D.N., Johnstone, J., Juni, P., Malikov, K., McGeer, A., Rochon, P.A., Sander, B., Schwartz, B., Sinha, S.K., Smith, K.,…Hillmer, M.P. (2021). COVID-19 and Ontario’s long-term care homes. Journal of Elder Policy, 1(3), 65–110. https://www.journalofelderpolicy.org/uploads/1/3/6/5/136597491/covid-19_and_ontario’s_long-term_care_homes.pdf
Stein, K. V., Goodwin, N., & Miller, R. (2020). From Crisis to Coordination: Challenges and Opportunities for Integrated Care posed by the COVID-19 Pandemic. International journal of integrated care, 20(3), 7. https://doi.org/10.5334/ijic.5595
Tupper, S. M., Ward, H., & Parmar, J. (2020). Family Presence in Long-Term Care During the COVID-19 Pandemic: Call to Action for Policy, Practice, and Research. Canadian geriatrics journal : CGJ, 23(4), 335–339. https://doi.org/10.5770/cgj.23.476
Vázquez-Calatayud, M., Regaira-Martínez, E., Rumeu-Casares, C., Paloma-Mora, B., Esain, A., & Oroviogoicoechea, C. (2022). Experiences of frontline nurse managers during the COVID-19: A qualitative study. Journal of nursing management, 30(1), 79–89. https://doi.org/10.1111/jonm.13488
Winwood, P. C., Colon, R., & McEwen, K. (2013). A practical measure of workplace resilience: developing the resilience at work scale. Journal of occupational and environmental medicine, 55(10), 1205–1212. https://doi.org/10.1097/JOM.0b013e3182a2a60a
Working with resilience. (2020). Resilience at Work® Toolkit. https://www.workingwithresilience.com.au/measure-resilience