Showing papers by "Souraya Sidani published in 2022"

Nurse Practitioners Navigating the Consequences of Directives, Policies, and Recommendations Related to the COVID-19 Pandemic in Long-Term Care Homes

Abstract: Objectives New models for the workforce are required in long-term care (LTC) homes, as was made evident during the Coronavirus Disease 2019 (COVID-19) pandemic. Nurse Practitioner (NP)-led models of care represent an effective solution. This study explored NPs’ roles in supporting LTC homes as changes in directives, policies, and recommendations related to COVID-19 were introduced. Design Qualitative exploratory study. Context Thirteen NPs working in LTC homes in Ontario, Canada. Methods Semi-structured interviews were conducted in March/April 2021. A five-step inductive thematic analysis was applied. Findings Analysis generated four themes: leading the COVID-19 vaccine rollout; promoting staff wellbeing related to COVID-19 fatigue; addressing complexities of new admissions; and negotiating evolving collaborative relationships. Conclusions Nurse practitioners were instrumental in supporting LTC homes through COVID-19 regulatory changes producing unintended consequences. The NPs’ leadership in transforming care is equally essential in LTC homes as in other established healthcare settings, such as primary and acute care.

Social isolation and loneliness in older immigrants during COVID-19: a scoping review

Abstract: Purpose The stay-at-home orders were necessary to contain the spread of COVID-19 but have worsened social isolation and loneliness among older persons. Strategies to maintain social connections have been proposed. It is unclear if the reported experiences of social isolation and loneliness are comparable for older immigrants and if the proposed strategies are relevant to this vulnerable population. This study aimed to address this knowledge gap. Design/methodology/approach This scoping review addressed two questions: What evidence exists on the experience of social isolation and loneliness in older immigrants? What strategies can be beneficial to keep older immigrants socially connected during the COVID-19 pandemic? The search for relevant articles was done in several databases covering the scientific and gray literature, using keywords that reflect the diversity of terminology referring to the main concepts (isolation and loneliness) and target population (older immigrants). Discussion papers and research studies were reviewed, and the main points or findings were documented on data abstraction forms and summarized in a table. The information in the table was compared and contrasted to identify common themes. Findings Only six articles (four discussion papers and two studies) met the scoping review’s eligibility criteria. Concerns about interruptions of older immigrants’ social connection during the pandemic were partially corroborated with the studies’ results. Most participants shifted the medium of their contacts from in-person to telephone or social media, and perceived no change in the experience of loneliness. Those with high levels of loneliness reported heightened anxiety and depression. The proposed strategies entailed the use of technology to connect with others and to deliver services, outdoor group activities within the constraints of containment measures and provision of culturally tailored social programs or services. Research limitations/implications The acceptability, feasibility and effectiveness of the proposed strategies should be examined to determine the best practices aimed to promote social connection among older immigrants within and outside the context of the pandemic. Originality/value The scoping review identified strategies that can be used to address social isolation and loneliness among older immigrants during the pandemic.

Family caregivers’ perspectives on the acceptability of four interventions proposed for rural transitional care: A multi-method study

Abstract: Background There is a critical need for hospital-to-home transitional care interventions to prepare family caregivers for patients’ post-discharge care in rural communities. Four evidence-based interventions (named discharge planning, treatments, warning signs, and physical activity) have the potential to meet this need but family caregivers’ perspectives on the acceptability of the interventions have not been examined. This gap is significant because unacceptable interventions are unlikely to be used or used as designed, thereby undermining outcome achievement. Accordingly, this study examined the perceived acceptability of the four interventions to rural family caregivers. Materials and methods A multi-method descriptive design was used. The quantitative method entailed the administration of an established scale to assess the interventions’ perceived acceptability to family caregivers. The qualitative method involved semi-structured interviews to explore family caregivers’ perceived acceptability of the interventions in greater depth, including acceptable and unacceptable aspects, in the context of their own transitional care experience. Participants were the family caregivers of a relative who had been discharged home in a rural community from an acute care hospital in Ontario, Canada. Results The purposive sample included 16 participants who were mostly middle-aged women (n = 14; 87.5%) caring for a parent (n = 9; 56.3%) at high risk for hospital readmission. The mean scores on the acceptability measure were 3 or higher for all interventions, indicating that, on average, the four interventions were perceived as acceptable. In terms of acceptable aspects, four themes were identified: the interventions: 1) involve family caregivers and proactively prepare them for discharge, 2) provide clear, written, and detailed guidance, 3) place the onus on healthcare providers to initiate communication, and 4) ensure post-discharge follow-up. In terms of unacceptable aspects, one theme was identified: the physical activity intervention would be challenging to implement. Discussion The findings support implementing the four interventions in practice throughout the hospital-to-home transition. Healthcare providers should assess family caregivers’ comfort in participating in the physical activity intervention and tailor their role accordingly.

Nurse practitioner–led implementation of huddles to support staff in long-term care homes

Abstract: Abstract Staff working in long-term care (LTC) homes frequently report experiencing moral distress related to lack of autonomy and not being able to provide quality care. Huddles have been used as a communication tool for many years in acute care settings to improve collaboration and safety culture. In LTC homes, huddles are implemented less often, despite evidence of their benefits in improving support and teamwork. In this pre-test post-test implementation study, huddles led by a nurse practitioner (NP) were introduced in a privately-owned not-for-profit LTC home with < 150 beds, located in a medium urban centre in Ontario, Canada. Objectives of the study were to 1) examine fidelity of huddle implementation; 2) examine the extent to which the huddles improved staff’ outcomes of moral distress, job satisfaction, and support provided by the NP estimated with Bayesian proportional odds model. A total of 48 huddles were carried out by the NP over 15 weeks. Huddles were most commonly attended by personal support workers (98%) and registered practical nurses (96%), with an average of 7 individuals per huddle. Topics most often addressed at huddles were related to resident care (46%) and staff concerns (34%). Strong statistical evidence of a reduction in overall moral distress was evident for staff attending the huddles, when compared to staff who did not (posterior probability =.9933). No changes in job satisfaction and support provided by the NP were observed. Introducing huddles in LTC homes may be effective at reducing moral distress experienced by staff.

Development of a multi-component intervention to promote sleep in older persons with dementia transitioning from hospital to home.

Abstract: BACKGROUND Hospitalised older persons with dementia are commonly discharged with intensified sleep disturbances. These disturbances can impede the recovery process. Nurses are well-positioned to assist persons with dementia and their family caregivers in managing sleep disturbances during the transition from hospital to home. OBJECTIVES To describe the development of a multi-component intervention to promote sleep. METHODS We applied three stages of the intervention mapping method to develop a non-pharmacological, multi-component sleep intervention. The first stage involved a review of the literature to generate an understanding of the determinants of sleep disturbances experienced by persons with dementia in hospital and home settings. The second stage consisted of a literature review to identify therapies for managing commonly reported determinants of sleep disturbances. The third stage entailed delineation of the intervention components. RESULTS The most common determinants of sleep disturbances experienced by persons with dementia in hospital and home settings were: physiological changes associated with ageing, sleep environments non-conducive to sleep, limited exposure to light and engagement in physical activity, stress and sleep-related beliefs and behaviours. Therapies found effective included: light therapy, physical activity therapy, sleep hygiene, and stimulus control therapy. These therapies were integrated into a multi-component sleep intervention to be provided using the teach-back technique, during and following hospitalisation. DISCUSSION Consistent with the principles of patient engagement, the multi-component sleep intervention will be evaluated for its acceptability and feasibility. IMPLICATIONS FOR PRACTICE The intervention has potentials to improve sleep during the transition from hospital to home.

Validation of the Therapeutic Self-Care Scale-European Portuguese Version in Primary Care Type 2 Diabetes Adults

Abstract: Self-care is an important nursing-sensitive outcome. Reliable and valid measures are needed for therapeutic self-care assessment that may inform the development and evaluation of individualized nursing interventions co-created with type 2 diabetes mellitus (T2DM) adults. The therapeutic self-care scale European Portuguese version (TSCS-EPV) is a validated generic measure that may be used to assess self-care in T2DM adults. Aim: To examine the psychometric properties of the TSCS-EP version in T2DM adults, in primary health care. Methods: A cross-sectional pilot study in a convenience sample of 80 adults with T2DM from two primary health care centers in Portugal was conducted. Individuals completed the Portuguese version of the TSC scale. Results: A three-factor solution emerged from the principal component analysis: “Recognizing and managing signs and symptoms”; “Managing changes in health condition” and “Managing medication”, explaining 75% of the total variance. Total scale Cronbach’s alpha was 0.884 and for the three factors ranged from 0.808 to 0.954. Conclusion: the therapeutic self-care scale European Portuguese version is a promising scale for assessing therapeutic self-care abilities in adults with T2DM in primary care settings. More consistent results on its validity and reliability are needed for it to be used in the country.

Family caregivers’ preparedness to support the physical activity of patients at risk for hospital readmission in rural communities: an interpretive descriptive study

Abstract: Physical activity in the post-discharge period is important to maximize patient recovery and prevent hospital readmission. Healthcare providers have identified family caregivers as potential facilitators of patients' engagement in physical activity. Yet, there is very little research on family caregivers' perspectives on their preparedness to support the physical activity of patients, particularly those at risk for hospital readmission in rural communities. Accordingly, this study explored the challenges related to family caregivers' preparedness to support the physical activity of a recently discharged, rural-dwelling relative at risk for hospital readmission.In this interpretive descriptive study, semi-structured interviews were conducted by telephone with 16 family caregivers. Interview transcripts were analyzed using thematic analysis.Participants were predominantly women (n = 14; 87.5%) with an average age of 49 years (range 26-67) who were the primary caregivers of a relative who had been hospitalized for a medical illness (n = 12; 75%) and was at high risk for hospital readmission. Four themes were identified: 1) family caregivers generally felt unprepared to support their relative's physical activity, 2) some family caregivers believed that rest was more important than physical activity to their relative's recovery, 3) insufficient physical activity preparation led to family caregiver-relative conflicts, and 4) to defuse these conflicts, some family caregivers wanted healthcare providers to be responsible for promoting physical activity.Despite assertions that family caregivers are a potential source of support for patient physical activity, our findings indicate that family caregivers are largely unprepared to assume that role and that more work needs to be done to ensure they can do so effectively. We suggest that healthcare providers be conscious of the potential for family caregiver-patient conflict surrounding physical activity, assess family caregivers' ability and willingness to support physical activity, educate them on the hazards of inactivity, and provide physical activity instructions to family caregivers and patients conjointly. Preparing family caregivers to support their relative's physical activity is particularly important given the current emphasis on early discharge in many jurisdictions, and the limited formal healthcare services available in rural communities.

Preference-based versus randomized controlled trial in prostate cancer survivors: Comparison of recruitment, adherence, attrition, and clinical outcomes

Abstract: Introduction Patients’ unwillingness to be randomized to a mode of exercise may partly explain their poor recruitment, adherence, and attrition in randomized controlled trials (RCTs) of exercise in oncology. It is unknown whether a preference-based trial can improve recruitment, adherence, retention, and clinical outcomes compared to a RCT of the same exercise interventions. Objective We assessed the effects of a 2-arm exercise preference trial on adherence and clinical outcomes compared to a similar 2-arm RCT in men with prostate cancer (PC). Methods This was a two-arm preference-based trial of group-based training (GROUP) or home-based training (HOME). PC survivors on androgen deprivation therapy (ADT) who declined randomization to the RCT but chose to participate in a preference trial were recruited in four Canadian centers. All study participants engaged in aerobic and resistance training, 4-5 days weekly for 6 months, aiming for 150 minutes/week of moderate-to-vigorous physical activity. The primary outcomes were changes from baseline to 6 months in fatigue and functional endurance. Secondary outcomes were quality of life, physical fitness, body composition, blood markers, and adherence. Linear mixed models were used to assess the effects of HOME versus GROUP on primary outcomes. In pooled preference and RCT data, the selection effect (i.e., difference between those who were and were not willing to be randomized) and treatment effect (i.e., difference between GROUP and HOME) were estimated using linear regression. Results and conclusion Fifty-four participants (mean [SD] age, 70.2 [8.6] years) were enrolled (GROUP n=17; HOME n=37). Comparable effects on primary and secondary outcomes were observed following GROUP or HOME in the preference-based trial. Adherence was similar between preference and RCT participants. However, attrition was higher in the RCT (50.0% vs. 27.8%, p= 0.04). Compared to GROUP, HOME was more effective in ameliorating fatigue (mean difference: +5.2, 95%CI=1.3 to 9.3 p=0.01) in pooled preference and RCT data. A preference-based trial results in comparable observed effects on clinical outcomes and adherence and lower attrition compared with a RCT of the same exercise interventions in PC survivors on ADT. Given the appeals of preference-based trials to study participants, additional studies are warranted. Clinical trial registration clinicaltrials.gov, identifier (NCT03335631).

The Impact of Walking Programs on Reduction of Menopausal Symptoms: A Scoping Review

Abstract: Abstract Keywords: Menopause, Walking, Pedometer-based Walking Aim: To conduct a scoping review of the existing literature on walking programs for menopausal women and explore the impact of various walking interventions on the reduction of menopausal symptoms. Background: Menopause is natural occurring phenomenon for women and can present with several physical and mental symptoms that are more severely experienced by some individuals. These experiences can be very distressing for women to deal with, especially in light of their personal, social, and work lives. The substantial impact of menopausal symptoms direly calls for effective coping strategies and treatment methods. Specific to menopause, physical activity is a form of treatment that can decrease occurrences and severity of menopausal symptoms. Previous studies have reported the benefits of walking in reducing symptoms, yet it is unclear which specific programs are most effective in reducing menopausal symptoms, especially in light of the time and efficacy barriers reported by menopausal women. Methods: A scoping review was conducted in nine databases for articles published up to September 2011, to identify studies exploring the topic of interest. Two investigators independently screened articles and two investigators independently extracted data based on specific themes. Mean differences and effect sizes were calculated to determine the effectiveness of walking interventions. Risk of bias assessments were also conducted for all reviewed studies. Findings: Seven studies, including five RCTs, met all inclusion criteria. All studies presented improvements in post-intervention menopausal symptoms of depression, sleep quality and physiological markers. Amongst all interventions (Pedometer-based programs, Nordic walking, walking training and SaBang Dolgi), pedometer-based walking presented the greatest improvement from baseline frequencies. Amongst all symptoms, depression saw the greatest reduction post interventions. Conclusion: Pedometer-based walking programs seem to be the most effective intervention for reduction of menopausal symptoms. Findings are comparable to those of other studies.

Arabic-speaking older immigrants’ perceived acceptability of interventions for preventing elder abuse

Abstract: Objective: Although research has identified interventions to address risk factors for elder abuse, it is unclear which interventions are relevant to specific immigrant communities. This study examined how Arabic-speaking immigrants in the Greater Toronto Area perceived the acceptability of interventions for elder abuse and explored gender differences in these perceptions. Methods: Older women and men (N = 37) who self-identify as Arabic-speaking immigrants residing in the Greater Toronto Area rated the acceptability of 14 interventions. The literature describes these interventions as addressing the risk factors for elder abuse as reported at the levels of older adults, the family, their relationship, and the social environment. Four items, adapted from a validated measure, were used to assess the interventions’ acceptability. The data were analyzed using descriptive statistics (objective 1) and independent sample t-test (objective 2). Results: Arabic-speaking older immigrants perceived five interventions to prevent elder abuse in their community as highly acceptable: case management, community outreach, advocacy, community-outreach programs, and peer-support programs. Gender differences were found for four interventions: two interventions (case management and community outreach) targeted older adults, one intervention (education) targeted the family, and one (advocacy) focused on the social environment. Conclusion: Findings can inform service providers, managers, and policymakers about which interventions must be prioritized to address elder abuse in the Arabic-speaking immigrant community.

A systematic literature review of diabetes self-management education features to improve diabetes education in women of Black African/Caribbean and Hispanic/Latin American ethnicity, Patient Education and Counseling

Abstract: Abstract: Objective This systematic literature review aims to identify diabetes self-management education (DSME) features to improve diabetes education for Black African/Caribbean and Hispanic/Latin American women with Type 2 diabetes mellitus. Methods We conducted a literature search in six health databases for randomized controlled trials and comparative studies. Success rates of intervention features were calculated based on effectiveness in improving glycosolated hemoglobin (HbA1c), anthropometrics, physical activity, or diet outcomes. Calculations of rate differences assessed whether an intervention feature positively or negatively affected an outcome. Results From 13 studies included in our analysis, we identified 38 intervention features in relation to their success with an outcome. Five intervention features had positive rate differences across at least three outcomes: hospital-based interventions, group interventions, the use of situational problem-solving, frequent sessions, and incorporating dietitians as interventionists. Six intervention features had high positive rate differences (i.e. ≥50%) on specific outcomes. Conclusion Different DSME intervention features may influence broad and specific self-management outcomes for women of African/Caribbean and Hispanic/Latin ethnicity. Practical implications With the emphasis on patient-centered care, patients and care providers can consider options based on DSME intervention features for its broad and specific impact on outcomes to potentially make programming more effective.

The effects of a preference-based exercise trial on outcomes in men on androgen deprivation therapy (ADT) for prostate cancer compared to an exercise randomized controlled trial of the same interventions.

Abstract: 75 Background: Recruitment for most exercise trials is challenging and often hindered by participants’ inability to travel to the study centre and/or unwillingness to be randomized. Thus, patients in exercise randomized controlled trials (RCTs) are highly selected and may not reflect real-world experiences. Our objectives were to compare baseline characteristics and outcomes of men who agreed to participate in a preference-based trial (PREF) compared to a RCT of the same exercise interventions. Methods: A 2-arm multicentre PREF trial was conducted concurrently with a 2-arm RCT. Participants were men on ADT who were treated at 2 academic and 2 community hospitals in Canada and selected to engage in a group-based in-centre exercise intervention (GROUP) or a home-based exercise program (HOME). All participants underwent aerobic and resistance training 4-5 days per week for 6 months. Co-primary outcomes included fatigue (FACT-F) and the 6-minute walk test (6MWT). Differences at baseline between the two trials were compared using ANOVA. Analysis of covariance with adjustment for baseline value was used to assess differences in the study outcomes between the two trials and between exercise arms. Results: 56 participants (mean age 70 y) consented and selected to participate in GROUP (n = 18) or HOME (n = 38). Recruitment rate was 21.5%. Retention at 6 months in the PREF and RCT was 72.7% and 50%, respectively. No significant differences were observed in baseline characteristics between participants of the two trials. Adherence was met by 60% of participants in PREF. Participants in PREF exhibited a 28.7-metre increase (better) in the 6MWT at 6 months compared to RCT participants ( p = 0.20). Additionally, participants in PREF demonstrated less time (better) to complete 5 chair stands (mean change: -1.24s) at 6 months relative to participants in the RCT irrespective of exercise mode ( p = 0.06). HOME participants in the PREF completed the 5 chair stands faster (mean change: -2.19s) compared to HOME participants in the RCT (p = 0.01). Similarly, GROUP participants in the RCT required less time (mean change: -2.11s) for 5 chair stands compared to GROUP participants in the PREF (p = 0.04). Hip circumference was higher (worse) at 6 months in PREF participants (mean change: +2.95cm) compared to their RCT counterparts (p = 0.02). Although fatigue was not significantly different between participants in the two studies at 6 months, GROUP participants in the RCT experienced worse fatigue (mean change: -6.93) compared to those who selected GROUP (p = 0.03). Conclusions: Allowing participants to select the exercise intervention of their preference may improve retention and ameliorate functional declines as a result of ADT. Further studies that assess the effects of preference-based trials on clinical outcomes are warranted. Clinical trial information: NCT03335631.