Measures to Improve Nurses' Pain Management

Pain is the most common medical issue that older people face in a long-term care facility. Nurses have a critical role in responding to pain. This research looked at nurses' responses to pain in long-term care facilities. The site for this research was a chosen long-term care facility in Ontario, Canada, a 160-bed nursing home for the elderly that provides various nursing and medical care services. Semi-structured focus group interviews lasting about an hour were done. This study's population consisted of 45 nurses. The researcher chose a sample of 25 nurses using a purposive sampling strategy. The data was reviewed using qualitative data analysis to detect recurring concerns. This research revealed the necessity of identifying nurses’ responses to pain to effectively manage pain in long-term care homes. This study demonstrated the importance of recognising nurses’ responses to pain practices in long-term care homes. Therefore, improved nurses’ response to pain practices are required to manage pain in a long-term care home effectively. The overall benefits of nurses’ responses to pain practices in long-term care homes expand nurses' clinical knowledge in the care of residents living in nursing homes.

Estimating the prevalence of renal insufficiency in seniors requiring long-term care

Long-term care (LTC) homes have been the epicentre of the coronavirus disease 2019 (COVID-19) pandemic in Canada to date. Previous research shows that for-profit LTC homes deliver inferior care across a variety of outcome and process measures, raising the question of whether for-profit homes have had worse COVID-19 outcomes than nonprofit homes. We conducted a retrospective cohort study of all LTC homes in Ontario, Canada, from Mar. 29 to May 20, 2020, using a COVID-19 outbreak database maintained by the Ontario Ministry of Long-Term Care. We used hierarchical logistic and count-based methods to model the associations between profit status of LTC homes (for-profit, nonprofit or municipal) and COVID-19 outbreaks in LTC homes, the extent of COVID-19 outbreaks (number of residents infected), and deaths of residents from COVID-19. The analysis included all 623 Ontario LTC homes, comprising 75 676 residents; 360 LTC homes (57.7%) were for profit, 162 (26.0%) were nonprofit, and 101 (16.2%) were municipal homes. There were 190 (30.5%) outbreaks of COVID-19 in LTC homes, involving 5218 residents and resulting in 1452 deaths, with an overall case fatality rate of 27.8%. The odds of a COVID-19 outbreak were associated with the incidence of COVID-19 in the public health unit region surrounding an LTC home (adjusted odds ratio [OR] 1.91, 95% confidence interval [CI] 1.19-3.05), the number of residents (adjusted OR 1.38, 95% CI 1.18-1.61), and older design standards of the home (adjusted OR 1.55, 95% CI 1.01-2.38), but not profit status. For-profit status was associated with both the extent of an outbreak in an LTC home (adjusted risk ratio [RR] 1.96, 95% CI 1.26-3.05) and the number of resident deaths (adjusted RR 1.78, 95% CI 1.03-3.07), compared with nonprofit homes. These associations were mediated by a higher prevalence of older design standards in for-profit LTC homes and chain ownership. For-profit status is associated with the extent of an outbreak of COVID-19 in LTC homes and the number of resident deaths, but not the likelihood of outbreaks. Differences between for-profit and nonprofit homes are largely explained by older design standards and chain ownership, which should be a focus of infection control efforts and future policy.

To obtain population-based estimates of emergency department (ED) visits by long-term care (LTC) residents. Retrospective cohort study using administrative data. All LTC facilities in Ontario, Canada. All LTC residents who visited an ED at least once during a 6-month period. All ED visits were described using the National Ambulatory Care Reporting System. Two distinct visit types were defined. Potentially preventable visits were defined as those for any ambulatory care sensitive condition; these are conditions for which exacerbations that result in hospital use suggest lack of access to adequate primary care. Low-acuity visits were defined as those triaged as non-urgent at ED registration and ended with return to the LTC facility without hospital admission. Nearly one-quarter of LTC residents visited the ED at least once in 6 months. Of all visits, 24.6% were for a potentially preventable reason, most commonly pneumonia, urinary tract infection, and congestive heart failure. These visits had a high frequency of ambulance transport (90.4%), emergent triage (35.3%), hospital admission (62.4%), and death within 30 days (23.6%). Of all visits, 11.0% were low acuity. Fall-related injury was the most common cause. Low-acuity visits were the shortest (mean length 4.5 +/- 4.0 hours) and had the lowest frequency of death within 30 days (4.3%). LTC residents made frequent visits to the ED. The visit types showed distinct patterns that suggest a need for better access to medical care for common conditions and a greater emphasis on fall prevention in LTC.

To identify and examine the structures and processes that support the director of nursing role in long-term care homes. The director of nursing in long-term care homes is central to overseeing and supporting the workforce and delivery of safe, quality resident care. With ongoing health human resource challenges and an aging population requiring care from long-term care homes, it is important to understand what individual and organizational factors support the director of nursing leadership in these settings. Evaluation. This review was guided by Cooper's five stages of the integrative review process. Donabedian's structure-process-outcome framework was applied to synthesize the literature. Key Issue(s). Five individual-level structures (years of experience, level of education, demonstrated leadership capabilities, completed certification and/or established linkages with a professional association, and completed continuing education); three organizational-level structures (physical presence of leadership across the organization, a clear job description, and salary); and four processes (nursing home administrators and the director of nursing relationship, availability of onsite continuing education opportunities targeting directors of nursing and support for continuing education, cultivating relationships and enhancing networks beyond the long-term care home, and orientation to the role) were identified across 11 articles to support the director of nursing role in long-term care homes. Conclusion(s). The findings indicate that there are individual characteristics that support the director of nursing in their role. Notably, there are organizational structures and processes that can be modified at the practice and policy level to better recruit, retain, and support the performance of directors of nursing. Implications for Nursing Management. There are actionable steps that leaders and decision-makers can take to support nursing leadership across long-term care homes and directly address health human resource challenges.

BackgroundGlobally, population‐wide sodium reduction strategies have been adopted and implemented to address the adverse health effects of excess dietary sodium. However, in Canada, minimal coordinated action by governments has occurred, including interventions aimed at food service operations in hospitals and long‐term care (LTC) centers. The objective of this study was to investigate actions, attitudes, barriers, and facilitators related to sodium reduction in these institutions.MethodologyA cross‐sectional survey was administered to food service administrators working in hospitals and LTC facilities in Ontario. Responses from key informants from 27 institutions, representing 9,823 patient/resident beds were included.ResultsOverall, 63.0% of institutions had an established sodium target (900–4,000 mg/day). The reported sodium level on “regular” menus was 2,845 ± 1,025 mg/day. Sixty‐three percent believed it was important to reduce sodium on inpatient/resident menus. Top facilitators reported for sodium reduction included group purchasing organizations identifying lower sodium foods (85.2%), increased availability of pre‐packaged lower sodium products (77.8%), government prioritizing and providing support and resources (74.1%), and improved taste of lower sodium foods (74.1%). Only 37.0% believed that patient/resident satisfaction would decrease with sodium reduction. Sodium reduction practices were variable among food service operations.ConclusionsThese data support the need for consistent and coordinated policies to facilitate sodium reduction in hospitals and long‐term care settings and for multi‐sectorial government, industry, and institutional support to ensure success.

The purpose of this article is to report the development and testing of the self-report Relational Care Scale (RCS). The RCS was specifically designed to evaluate the relational care that nursing staff provides to residents living in nursing homes. The scale's content validity was assessed with the assistance of experts and related research in the area of nurse-resident interactions, and then the scale was pilot tested with 30 residents of a long-term care (LTC) facility to determine its clarity and stability. The 6-item scale was then administered to a sample of 50 residents in an intervention study and then to 72 residents in a correlational study in two other LTC facilities in Ontario, Canada. Construct validity was demonstrated with positive correlations between RCS scores and a Relationship VAS measure (r = .63, p < .0001) and between RCS scores and an observational Relational Behavior Scale (r = .42, p < .001), which was also developed to assess relational care. Study results demonstrated that the RCS is a reliable and valid instrument that may be used to measure relational care to test interventions focusing on enhancing the relational care staff provides to residents.

"The Whole is Greater than the Sum of the Parts" - Aristotle A happy new year to you all! I want to thank you all for your contributions. 2025 was another transformative year for Nurses Specialized in Wound, Ostomy and Continence Canada (NSWOCC®). It was a year in which we strengthened our core programs and the Wound, Ostomy and Continence Institute further, growing our organization by welcoming new members and rolling out important initiatives that will help to guarantee our continued success in the future. Working together, we made good progress toward our strategic goals and partnered to launch important educational programs such as the Indigenous ECHO Skin and Wound program. We also completed our first Ontario Ministry of Health and Long-Term Care contract for the education of 90 Skin Wellness Associate Nurses (SWAN (TM)) in Ontario Long-Term Care (LTC) facilities. We have now embarked on our second contract for 150 SWANs(TM) and 600 Personal Support Workers in Ontario LTC facilities. One of our largest initiatives is the upcoming World Council of Enterostomal Therapy (WCET®) joint Congress with NSWOCC® which will take place at the Vancouver Convention Center April 24-28, 2026. Together, our collective passion for making wound, ostomy and continence care the best that it can be, has been the center of our collaboration with WCET®. We truly appreciate this opportunity to bring nurses who have specialized in wound, ostomy and continence together from around the world to share best practice and learn from each other. I want to thank you for your continued commitment and effort. Every one of us has an important role to play in the work ahead and I’m confident that together we will achieve great things. I wish you and your loved ones a happy and successful 2026!

The objective of this review was to chart the literature on assistive technologies (excluding robots) that support social interaction of older adults in long-term care homes, and to advance a definition of socially assistive technologies. Loneliness and social isolation have adverse effects on the health and well-being of older adults. Many long-term care homes provide recreational programming intended to entertain or distract residents, yet the evidence of their effectiveness is limited. Absent from the literature are comprehensive reviews of assistive technologies (other than robots) that are used to support social interaction in long-term care homes. The review considered research studies as well as gray literature that included older adults (≥65 years) living in long-term care homes. The concept of interest was the use of assistive technologies (excluding robots) that support social interaction in long-term care homes. The databases were searched on June 26, 2019, and included CINAHL Full Text (EBSCO), MEDLINE (Ovid), PsycINFO (EBSCO), Sociological Abstracts (ProQuest), Embase (Elsevier), and Web of Science (Clarivate). The search for gray literature was conducted in ProQuest Dissertations and Theses Databases and across 11 websites during September and October 2019. The recommended JBI approach to study selection, data extraction, and data synthesis was used. Twenty-five articles were included in this review, with comparable numbers of quantitative (n = 6), qualitative (n = 9), and mixed methods (n = 7) studies, with the remaining articles employing non-empirical designs (n = 3). Technologies were categorized as low (easily recognizable to everyone), medium (more electronics), or high (involves internet). Two studies reported on low-assistive technologies, including videotapes and the telephone. Medium-assistive technologies were identified in nine studies and included videophones; Nintendo Wii; tablet-based games; picture- and video-viewing tools; and CRDL (pronounced "cradle"), a special instrument that translates touch into sound. More than half (n = 14) of the included articles utilized high-assistive technologies, such as computer labs/kiosks, tablet-based applications, social media (eg, Facebook), videoconferencing, and multi-functional systems. Five studies measured whether assistive technologies had an impact on the quantity of long-term care residents' social interaction levels. Qualitative themes were related to residents' social connections and experiences after using various technologies. Four studies systematically incorporated a framework/model, and Social Structuration Theory was considered the most comprehensive. In the absence of a definition of socially assistive technologies, the definition advanced from this review is as follows: Socially assistive technologies are user-appropriate devices and tools that enable real-time connectivity to enhance social interaction. Included literature reported the benefits of technology use, with considerable variability in engagement and no cost estimates. We recommend that future research continue to advance our definition of socially assistive technologies, make promising assistive technologies available in long-term care homes after studies are completed, report the costs of assistive technologies, and include participants with dementia and culturally and linguistically diverse backgrounds.

The Canadian long-term care (LTC) workforce cares for increasingly complex residents. With greater care needs come greater demands. Despite this, LTC staffing and resources are largely unchanged and underresearched over the last decade. The Atlantic provinces are home to the oldest population in Canada, indicating a high need for LTC. The health and well-being of the LTC workforce are critical components of care quality, yet only in Western Canada are such data routinely and systematically collected. Translating Research in Elder Care is a 2-decade research program studying the LTC work environment and has found strong links between the working conditions of LTC staff and resident outcomes. We draw upon their success to generate the evidence needed to understand, support, and manage the LTC workforce in Canada's four Atlantic provinces. This study aims (1) to assess the quality of work life among staff in LTC homes in Atlantic Canada; (2) to examine the effects of the work environment on the quality of work life; and (3) to build capacity for research in the LTC sector in Atlantic Canada among knowledge users, researchers, and trainees. The objective of this paper is to describe the approach needed to examine the quality of work life and health of care staff in LTC homes. Stratified random sampling will be used to recruit homes in Atlantic Canada. The sampling frame was designed to recruit 25% of the LTC homes in each of the 4 provinces with proportional representation by size; ownership model; and, if applicable, region or language. Key outcome variables include measures of mental health and well-being, quality of work life, intention to leave, workplace context, and missed or rushed care. Primary data will be obtained through structured interviews with care aides and web-based surveys from registered nurses, licensed practical nurses, managers, and allied health providers. Eligible participants were from an LTC home with at least 25 residents, 90% of whom were aged 65 years or older, and had worked in the home for at least 3 months. Multivariate analyses include regression analysis for explaining predictors of quality of work-life outcomes and multilevel modeling for more complex relationships of staff outcomes by provinces and LTC home characteristics. Data collection and cleaning are complete as of October 2024 (N=2305). Care aides (n=1338), nurses (n=724), allied health providers (n=154), and managers (n=89) from 53 homes make up the sample. Data analysis is ongoing. Initially, individual reports will present descriptive data for each participating LTC home. Concurrent analysis is planned for publication in peer-reviewed journals. This peer-reviewed research protocol lays the foundation for a comprehensive analysis of the effects of the work environment on the quality of work life of LTC staff in Atlantic Canada. DERR1-10.2196/66338.

OPTIMIZING PRESCRIBING OF ANTIPSYCHOTICS IN LONG-TERM CARE (OPAL)

The use of data for process and quality improvement in long term care and home care: a systematic review of the literature.

Background: During the COVID-19 pandemic, new processes and policies were implemented to limit the spread of COVID-19 in long-term care homes (LTCH).Technology use within LTCH changed significantly. Research Aim:The purpose of this literature review was to examine the breath of evidence in the use of technology in LTCHs in North America during the COVID-19 pandemic.Methods: Guided by Arksey and O'Malley's scoping review framework, five databases were searched to identify peer-reviewed articles using key words and subject headings related to Long Term Care, COVID-19, and Technology.Results: Research articles that described the investigation of, or the analysis of reported data on, the use of any kind of technology in LTCHs in North America during the COVID-19 pandemic were included for analysis.There were 121 articles retrieved, of which 32 articles met the inclusion and exclusion criteria and were included for analysis.Technology was deployed in support of the quality of life of LTCH residents in the context of social isolation, telehealth, virtual services, multidisciplinary collaborations, continuing education and training, infection prevention and control services, and activities, computer-based modelling for the LTCH setting.Technologies described included robots, web-based websites and games, and computer-based models that predict COVID-19 transmission in LTCHs, though most described the use of information and communication technologies to connect people within the LTCH to those outside the LTCH.Researchers also noted technology challenges in LTCH such as poor technological infrastructure, unstable Wi-Fi connectivity and inadequate number of devices to support virtual visits, other online recreation activities in LTCH, as well as the provision of telehealth services.Conclusion: Findings emphasize the need to examine the impacts of technology use in LTCH in rural and remote areas, to inform actionable insights to the promote accessible, inclusive, and sustainable adoption of new technologies across all LTCH settings.

Background Long-Term Care (LTC) homes are highly regulated and task oriented, with demanding work and insufficient resources. Chronic underfunding of the sector, coupled with increased complexity of care, has deteriorated working conditions, resulting in precarious employment, intensified and stressful work, and decreased job satisfaction. These work conditions have contributed to severe staffing shortages of healthcare workers globally. To meet increased labour demands, OECD countries on average will need to increase the proportion of overall employment dedicated to LTC by 32% over the next decade. While reviews of literature have examined the association between staffing and care outcomes for residents in LTC, they have not examined how staffing structures affect the healthcare staff themselves. This scoping review asks: How does staffing impact the health of staff and working conditions in LTC? Methods A scoping review of empirical peer reviewed and grey literature was conducted to examine the association between LTC staffing practices and how they impact working conditions and the health and well-being of staff. PubMed, CINHAL, and Scopus databases were searched for relevant articles published within the past 10 years. Results Searches yielded 3994 unique articles, which were independently screened by pairs of reviewers. Preliminary results highlight that staffing levels are not optimized for healthy, sustainable work conditions. The level of staff, their skill mix, and ratios all impact the ability to provide care. In circumstances where there is inadequate staffing, care workers are more likely to experience stress, burnout, job dissatisfaction, and increased injury and illness. Conclusions Staffing practices shape working conditions which impact healthcare workers own health outcomes. To facilitate a strong LTC workforce, working conditions and occupational health need to be a priority in improvement initiatives. Key messages • With extreme staffing shortages challenging the healthcare sector, this review highlights the need for heightened attention to the impact of staffing practices on the healthcare workforce. • Improving working conditions and attuning to the needs of the workforce, ultimately improves quality of care.

BackgroundAs the aging population continues to grow, the number of adults living with dementia or other cognitive disabilities in residential long-term care homes is expected to increase. Technologies such as real-time locating systems (RTLS) are being investigated for their potential to improve the health and safety of residents and the quality of care and efficiency of long-term care facilities.ObjectiveThe aim of this study is to identify factors that affect the implementation, adoption, and use of RTLS for use with persons living with dementia or other cognitive disabilities in long-term care homes.MethodsWe conducted a systematic review of the peer-reviewed English language literature indexed in MEDLINE, Embase, PsycINFO, and CINAHL from inception up to and including May 5, 2020. Search strategies included keywords and subject headings related to cognitive disability, residential long-term care settings, and RTLS. Study characteristics, methodologies, and data were extracted and analyzed using constant comparative techniques.ResultsA total of 12 publications were included in the review. Most studies were conducted in the Netherlands (7/12, 58%) and used a descriptive qualitative study design. We identified 3 themes from our analysis of the studies: barriers to implementation, enablers of implementation, and agency and context. Barriers to implementation included lack of motivation for engagement; technology ecosystem and infrastructure challenges; and myths, stories, and shared understanding. Enablers of implementation included understanding local workflows, policies, and technologies; usability and user-centered design; communication with providers; and establishing policies, frameworks, governance, and evaluation. Agency and context were examined from the perspective of residents, family members, care providers, and the long-term care organizations.ConclusionsThere is a striking lack of evidence to justify the use of RTLS to improve the lives of residents and care providers in long-term care settings. More research related to RTLS use with cognitively impaired residents is required; this research should include longitudinal evaluation of end-to-end implementations that are developed using scientific theory and rigorous analysis of the functionality, efficiency, and effectiveness of these systems. Future research is required on the ethics of monitoring residents using RTLS and its impact on the privacy of residents and health care workers.