[John-paul]

Welcome to the end of week 6. Here you will post your 2-completed learning activities and respond to 1-other learners’ post. Remember your response to your peers should be reflective. Avoid brief acknowledgements and agreements.

Activity 1: Draft an email communication to your manager/supervisor/director with recommendations to address your research topic selected in week 1 using SBAR format. In your email, support your position and recommendations with references to the prime articles resulting from your literature search. Include recommendations for one of the three knowledge mobilization frameworks from this week’s readings. (Maximum of 500 words, excluding references)
Once this is completed, you move to the next discussion board to complete activity 2.

[Rachel]

To [Supervisor Name],

I was assisting a client with a diagnosis of dementia with their personal care on November 1 and the client demonstrated responsive behaviours. Staff have stated that this client has been demonstrating these behaviours consistently for longer than one month, putting the patient at risk for developing infection due to inadequate personal hygiene. The staff have expressed that they are struggling to help this client and they don’t feel safe when they provide the client with personal care. The patient and the staff are experiencing increased stress due to this situation.

I’ve conducted some research that may help inform the current process of providing personal care to patients with dementia. According to Sibley and Mercer (2023), creating and updating a client’s care plan to include individualized strategies to manage responsive behaviours can help caregivers to predict and better manage the responsive behaviours. Roberton and Daffern (2022) insist that developing a standardized protocol for interaction with clients with dementia may help staff feel more confident and safe when providing personal care to patients with dementia.

Improving staff training and providing more training opportunities may help staff feel more confident in more complex situations (Roberton and Daffern, 2022). Perhaps training that improves the problem-solving skills of staff could be even more effective (Baker Sheikh et al., 2022).

My research helped me ask an important question: can we do more for our patients by doing less? Patients may benefit more when they have better function and independence. If we can implement evidence-informed reablement interventions for patients living with dementia, we may be able to enhance function and independence for people with dementia (O’Connor et al, 2020). Interventions such as social programs, exercise programs, and cognitive stimulation therapy may help patients with dementia with reablement (O’Connor et al., 2020).

My recommendation as a result of this research is to review our current training opportunities for staff and review the current procedures for interacting with patients with dementia. Patients and staff may benefit from more training opportunities and clearer procedures for engaging with patients. These changes can be implemented effectively by using the seven phases of the Knowledge-to-Action Framework because it focuses on the knowledge creation process as well as taking action (Graham et al., 2006).

I would be happy to discuss more with you at our next meeting.

Kindly,
Rachel

[Maame]

Hello Rachel.

I wanted add that DOS monitoring is another tool we use in long term care for responsive behaviors. DOS stands for Dementia Observational Sheet in which it assess’ person’s behaviour over a 24 hour cycle for up to 7 days to determine the occurrence, frequency, and duration of behaviours of concern. This tool is very helpful to determine when the peak of the behavior starts and then settles down if so. Wasn’t sure if you were aware of this tool but thought I would share. Thanks for sharing.

Regards,

Maame

[Oghenefegor]

Hello Rachel,
Greetings. It was nice reading your post. Individualized strategies to manage responsive behaviors is of utmost importance. In my five years of practice as a bedside nurse, I have never had two patients alike. All patients are unique. Recently, in response to a sincere question posed to me about how many patients I was assigned that day, my heartfelt response was, ‘I never count’. With the inquirer taken aback, I added, ‘these are people. Not numbers.’ My response was to kindly communicate that all patients are distinct. Likewise, should the approach to their care be. With certainty, this applies to older adults living with dementia.

[Maame]

Good day Nurse Manager,

I wanted to discuss with you a research project I am conducting, I believe with the research I’m conducting it can be beneficial to our unit. I have evidence based recommendations to address what interventions nurses can implement in promoting reduction of episodes amongst older adults living in long-term care homes. I have observed in our unit some residents’ not having a toileting schedule in place which I feel is causing issues like responsive behaviors and more frequent incontinence episodes. Educational interventions for example: pelvic muscle exercise,toilet training and lifestyle modifications will reduce episodes of stress incontinence.(Mohammed et al., 2021). According Borglin et al. the importance of teamwork; the need for nurses to embrace leadership at the point of care and be more visible in terms of the provision of direct care.Substantiation that evidence-based interventions, such as scheduled toileting and prompted voiding, should constitute the norm in continence care within the context of home care (2019).
I would recommend that we have extra training for registered staff in regards to leadership and care planning so they are able to gain extra knowledge in which they are able to translate it to the unit and lead their colleagues . The framework that I believe resonates with my research is Health Quality Ontario’s QI Framework RE-AIM. Each of the phases is iterative and designed to build on knowledge gained in the previous phase . 1. Getting Started 2. Defining the problem 3. Understanding Your System 4. Designing Testing Solutions 5. Implementing and Sustaining Changes 6. Spreading Improvement (Health Quality Ontario , April 2013). I believe by following this framework we can address this problem collectively as a team. Thanks for your time, I am looking forward to hearing from you.

Sincerely,
Maame

[Jennifer]

Great work !! Thank you for sharing your emails and responses. The Re-Aim and Knowledge to Action Frameworks can be helpful to use as a guide in many different situations and scenarios.

[Oghenefegor]

To the nursing Manager,
Purple Springs Long-Term Care Home,
Bantille, Canzon,

Recommendations to Address a Research Topic

Greetings. Hope this email finds you well. First, I would like to thank you for all your work and contributions towards quality care for residents, nurses and PSWs at Purple Springs Long Term Care Home. Your exemplary leadership in words, deed and action is worth commending.

The purpose of this email is to communicate recommendations to address a research topic. The research topic is: Is there a Relationship between Short Periods of Compassion-based Responsive Behaviors by Non-Family Member Caregivers and Mental Wellness in Older Adults Residing in LTC? This research topic has its roots in the research question: How can short periods of compassion-based responsive behaviors by non-family member caregivers help support mental wellness in older adults residing in LTC?

Short periods of interaction have a profound impact on the mental wellness of the residents, especially those living with dementia and depression. However, since after the COVID-19 pandemic, there has been decreased interactions with residents, nurses and PSWs. This could be attributed to the very busy and fast-paced nature of activities in the Long-Term Care home resulting in an overarching task-based approach to care. Nurses and PSWs express that high workloads and short staffing allow for little or no time to interact with residents. The culminating effect of the issues laid out is that nurses and PSWs have not been able to support the mental wellness of older adults in their care, in the way they so desire.

I did an extensive review of existing literature. The findings from the literature reveal that a different approach to patient care could empower nurses and PSWs to support the mental wellness of the residents at Purple Springs Long-Term Care home. This different approach entails incorporating short periods of compassion-based responsive behaviors or activities in the care of the residents. These behaviors and activities would be patient-centered and patient-appropriate, within the range of tolerability of nurses and PSWs (Hesse & Rauscher, 2018). Some of these behaviors and activities include active listening, therapeutic silence, positive affirmations, engaging on short bursts of lively conversations in a shared topic of interest and many more (Kahana et al., 2021). Studies show that these behaviors and activities have a positive impact on the mental well-being of older adults, in turn making care delivery easier and more seamless (Ngamwongwiwat et al., 2023). With care being better managed, nurses and PSWs are empowered to provide heartfelt person-centered care.

As a caveat, it is important to note that nurses and PSWs will only be able to support the mental health and wellness of residents at Purple Springs Long-Term Care home. If they are well-equipped to do so physically, mentally and emotionally (Perez et al., 2022). For this reason, I suggest that the wellness programs for nurses and PSWs be ramped up as well to reflect a more personal approach for staff.

With regards to knowledge mobilization, I suggest the Stetler Model of Research Utilization to facilitate evidence-based practice. This model presents with five phases including preparation, validation, comparison evaluation, decision making, translation/application and evaluation (Stetler, 2001). Please, kindly see the email attachment for your reference to this model.

Please, do feel free to reach out to me via my unit extension at ext 5206, via email, or even in-person if you would like to discuss further.

Hope to hear from you soon.

Best Regards,
Oghenefegor Uwejeya
Registered Practical Nurse (RPN)

References

Hesse, C., & Rauscher, E. (2018). The relationships between doctor-patient affectionate communication and patient perceptions and outcomes. Health communication, 34 (8), 881-891.

Kahana, E., Bhatta, T. R., Kahana, B., & Lekhak, N. (2021). Loving others: The Impact of Compassionate love on later-life psychological well-being. The Journals of Gerontology Series B, 76(2), 391–402.

Ngamwongwiwat, B., Kongsuwan, V., & Songwathana, P. (2023). Interventions for Improving Mental Health and Quality of Life of Older Adults with Mental Illness in Long-term Care: A Systematic Review and Meta-analysis. Pacific Rim International Journal of Nursing Research, 27(4), 671–693.

Pérez, V., Menéndez-Crispín, E. J., Sarabia-Cobo, C., de Lorena, P., Fernández-Rodríguez, A., & González-Vaca, J. (2022). Mindfulness-Based Intervention for the Reduction of Compassion Fatigue and Burnout in Nurse Caregivers of Institutionalized Older Persons with Dementia: A Randomized Controlled Trial. International journal of environmental research and public health, 19(18), 11441.

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