Health> Vol.4 No.9A, September 2012

Understanding organizational context and heart failure management in long term care homes in Ontario, Canada

DownloadDownload as PDF (Size:96KB)  HTML    PP. 725-734  

ABSTRACT

Objective: To assess current heart failure (HF) care processes and organizational context in long-term care (LTC) homes as a prelude to adapting the Canadian Cardiovascular Society (CCS) HF guidelines for use in these settings. Methods: This research reports on the results of thirteen focus groups (N = 83 participants; average of 60 minutes duration) conducted in three Ontario LTC homes to better understand how HF was managed and how organizational context impacted care. Participants included physicians, nurse practitioners, registered nurses, registered practical nurses, and personal support workers. Results: Focus group findings revealed that the complexity of the LTC environment presents challenges for managing HF. Most residents have multiple advanced chronic conditions that must be managed simultaneously. Culturally, LTC is first and foremost a resident’s home where residents may choose not to comply with care recommendations. Staff routines, scopes of practice, professional hierarchies, available resources and government regulations limit flexibility in providing care. Staff lacked knowledge, skills and resources for managing HF. Nevertheless, all staff viewed LTC as the preferred place for managing HF, avoiding residents’ hospitalizations wherever possible. These data suggest that strategies for improving LTC staff communication and education, strengthening existing relationships between staff, family, residents and community resources, and acquiring additional resources in LTC homes have the potential to improve HF management in this setting. Conclusion: LTC is a complex and dynamic environment that presents many challenges for providing care for residents. This research provides the foundation for subsequent work to develop and test implementation strategies to manage HF in LTC, which are consistent with the CCS HF guidelines and are feasible within LTC staff’s work routines, capacities and resources.

Cite this paper

Marcella, J. , Nadarajah, J. , Kelley, M. , Heckman, G. , Kaasalainen, S. , Strachan, P. , McKelvie, R. , Newhouse, I. , Stolee, P. , McAiney, C. and Demers, C. (2012) Understanding organizational context and heart failure management in long term care homes in Ontario, Canada. Health, 4, 725-734. doi: 10.4236/health.2012.429113.

References

[1] Sharkey, S. (2008) People caring for people: Impacting the quality of life and care of residents of long-term care homes. A report of the independent review of staffing and care standards for long-term care homes in Ontario. Saint Elizabeth Health Care.
[2] Daamen, M.A., Schols, J.M., Jaarsma, T. and Hamers, J.P. (2010) Prevalence of heart failure in nursing homes: A systematic literature review. Scandinavian Journal of Caring Sciences, 24, 202-208. doi:10.1111/j.1471-6712.2009.00708.x
[3] Heckman, G.A., Demers, C., McKelvie, R.S. and Hogan, D.B. (2007) Heart failure in older persons. Canadian Journal of General Internal Medicine, 2, 24-26.
[4] Wang, R., Mouliswar, M., Denman, S. and Kleban, M. (1998) Mortality of the institutionalized old-old hospitalized with congestive heart failure. Archives of Internal Medicine, 158, 2464-2468. doi:10.1001/archinte.158.22.2464
[5] Heckman, G.A., Misiaszek, B., Merali, F., Turpie, I.D., Patterson, C.J., Flett, N. and McKelvie, R.S. (2004) The management of heart failure in Canadian long-term care facilities. Canadian Journal of Cardiology, 20, 963-969.
[6] Canadian Institute for Health Information (2009) Patient pathways: Transfers from continuing care to acute care. http://secure.cihi.ca/cihiweb/products/Patient_Transfers_EN.pdf
[7] Inouye, S.K. (2006) Delirium in older persons. The New England Journal of Medicine, 354, 1157-1165. doi:10.1056/NEJMra052321
[8] Finucane, P., Wundke, R., Whitehead, C., Williamson, L. and Baggoley, C. (2000) Use of in-patient hospital beds by people living in residential care. Gerontology, 46, 133-138. doi:10.1159/000022148
[9] Bowman, C.E., Elford, J., Dovey, J., Campbell, S. and Barrowclough, H. (2001) Acute hospital admissions from nursing homes: Some may be avoidable. Postgraduate Medical Journal, 77, 40-42. doi:10.1136/pmj.77.903.40
[10] Coburn, A.F., Keith, R.G. and Bolda, E.J. (2002) The impact of rural residence on multiple hospitalizations in nursing facility residents. Gerontologist, 42, 661-666. doi:10.1093/geront/42.5.661
[11] Finn, J.C., Flicker, L., Mackenzie, E., Jacobs, I.G., Fatovich, D.M., Drummond, S., Harris, M., Holman, D.C. and Sprivulis, P. (2006) Interface between residential aged care facilities and a teaching hospital emergency department in western Australia. Medical Journal of Australia, 184, 432-435.
[12] Rizza, P., Bianco, A., Pavia, M. and Angelillo, I.F. (2007) Preventable hospitalization and access to primary health care in an area of southern Italy. BMC Health Services Research, 7, 134. doi:10.1186/1472-6963-7-134
[13] Colón-Emeric, C.S., Lekan, D., Utley-Smith, Q., Ammarell, N., Bailey, D., Corazzini, K., Piven, M.L. and Anderson, R.A. (2007) Barriers to and facilitators of clinical practice guideline use in nursing homes. Journal of the American Geriatrics Society, 55, 1404-1409. doi:10.1111/j.1532-5415.2007.01297.x
[14] Valle, R., Chinellato, M., Milani, L. and di Piave, S.D. (2001) Impact of a guideline-based management on outcomes of very old persons with heart failure living in nursing homes. Archives of Internal Medicine, 161, 2264-2265. doi:10.1001/archinte.161.18.2264-a
[15] American Medical Directors Association (2002) Heart failure: Clinical practice guideline.
[16] Martinen, M. and Freundl, M. (2004) Managing congestive heart failure in long-term care. Journal of Gerontological Nursing, 30, 5-12.
[17] Jacobs, B. (2011) Reducing heart failure hospital readmissions from skilled nursing facilities. Professional Case Management, 16, 18-24.
[18] Boxer, R.S., Dolansky, M.A., Frantz, M.A., Prosser, R., Hitch, J.A. and Pi?a, I.L. (2012) The Bridge Project: Improving heart failure care in skilled nursing facilities. Journal of the American Medical Directors Association, 13, e1-e7.
[19] Tjam, E.Y., Pletz, D.E., Hirdes, J.P., Smith, S.J., Costigan, J., Wilwerth, B. and Poss, J. (2006) Prevention of avoidable acute care use by retirement and long term care resi dents: Management of chronic heart failure through the use of an innovative interdisciplinary education program for care providers (EPOCH study). Presented at the Canadian Cardiovascular Society, Vancouver.
[20] Newhouse, I.J., Heckman, G., Harrison, D., D’Elia, T., Kaasalainen, S., Strachan, P.H. and Demers, C. (2012) Barriers to the management of heart failure in Ontario long-term care homes: An Interprofessional Care perspective. Journal of Research in Interprofessional Practice and Education, in Press.
[21] Arnold, J.M.O., Liu, P., Demers, C., Dorian, P., Giannetti, N., Haddad, H., Heckman, G.A., Howlett, J.G., Ignaszewski, A., Johnstone, D.E., Jong, P., McKelvie, R.S., Moe, G.W., Parker, J.D., Rao, V., Ross, H.J., Sequeria, E.J., Svendsen, A.M., Teo, K., Tsuyuki, R.T. and White, M. (2006) Canadian cardiovascular society consensus conference recommendations on heart failure 2006: Diagnosis and management. Canadian Journal of Cardio-logy, 22, 23-45. doi:10.1016/S0828-282X(06)70237-9
[22] Morgan, D. (1997) Focus groups as qualitative research. 2nd Edition, Sage Publications, London.
[23] Sandelowski, M. (2000) Whatever happened to qualita-tive description? Research in Nursing & Health, 23, 334-340. doi:10.1002/1098-240X(200008)23:4<334::AID-NUR9>3.0.CO;2-G
[24] DiCenso, A., Hutchison, B., Grimshaw, J., Edwards, N. and Guyatt, G. (2005) Health services interventions. In: DiCenso, A., Guyatt, G. and Ciliska, D., Eds., Evidence-Based Nursing: A Guide to Practice, Elsevier Mosby, St. Louis.
[25] Coburn, A.F., Keith, R.G. and Bolda, E.J. (2002) The impact of rural residence on multiple hospitalizations in nursing facility residents. The Gerontologist, 42, 661-666. doi:10.1093/geront/42.5.661
[26] Hutt, E., Frederickson, E., Ecord, M. and Kramer, A.M. (2003) Associations among processes and outcomes of care for medicare nursing home residents with acute heart failure. Journal of the American Medical Directors Association, 4, 195-199. doi:10.1016/S1525-8610(04)70345-X
[27] McGrail, K.M., McGregor, M.J., Cohen, M., Tate, R.B. and Ronald, L.A. (2007) For-profit versus not-for-profit delivery of long-term care. Canadian Medical Association Journal, 176, 57-58. doi:10.1503/cmaj.060591
[28] Jogerst, G.J., Daly, J.M., Dawson, J.D., Peek-Asa, C. and Schmuch, G. (2006) Iowa nursing home characteristics associated with reported abuse. Journal of the American Medical Directors Association, 7, 203-207. doi:10.1016/j.jamda.2005.12.006
[29] Weech-Maldonado, R., Meret-Hanke, L., Neff, M.C. and Mor, V. (2004) Nurse staffing patterns and quality of care in nursing homes. Health Care Management Review, 29, 107-116. doi:10.1097/00004010-200404000-00004
[30] Huberman, A.M. and Miles, M.B. (1994) Data management and analysis methods. In: Miles, M.B. and Huberman, A.M., Eds., Qualitative data analysis: An expanded sourcebook, 2nd Edition, Sage, Thousand Oaks, 428-444.
[31] Charmaz, K. (2006) Constructing grounded theory. Sage Publications, Thousand Oaks.
[32] Creswell, J. (2009) Research design: Qualitative, quantitative and mixed method approaches. 3rd Edition, Sage Publications, Thousand Oaks.
[33] Peshkin, A. (2000) The nature of interpretation in qualitative research. Educational Researcher, 29, 5-9. doi:10.3102/0013189X029009005
[34] Kaasalainen, S., Brazil, K., Coker, E., Ploeg, J., Martin-Misener, R., Donald, F., DiCenso, A., Hadjistavropoulos, T., Dolovich, L., Papaioannou, A., Emili, A. and Burns, T. (2010) An action-based approach to improving pain management in long-term care. Canadian Journal on Aging, 29, 503-517. doi:10.1017/S0714980810000528
[35] Kortes-Miller, K., Habjan, S., Kelley, M.L. and Fortier, M. (2007) Development of a palliative care education program in rural long-term care facilities. Journal of palliative care, 23, 154-162.
[36] Ontario Ministry of Health and Long-Term Care (2005) Laying the foundation for change: A progress report on Ontario’s health human resources initiatives. http://www.health.gov.on.ca/english/public/pub/ministry_reports/hhr_05/hhr_05.html
[37] Lee, P.G., Cigolle, C. and Blaum, C. (2009) The co-occurrence of chronic diseases and geriatric syndromes: The health and retirement study. Journal of the American Geriatrics Society, 57, 511-516. doi:10.1111/j.1532-5415.2008.02150.x
[38] Canadian Nurses Association (2010) Patient safety: Developing the right staff mix. http://www.cna-iic.ca/CNA/documents/pdf/publications/PatientSafety_ThinkTank_e.pdf
[39] Canadian Nurses Association (2010) Evaluation frame-work to determine the impact of nursing staff mix decisions.
[40] Kaasalainen, S., Agarwal, G., Dolovich, L., Papaioannou, A., Brazil, K. and Akhtar-Danesh, N. (2010) Nurses’ perception of their medication management system in long- term care. Canadian Journal of Nursing Research, 42, 58-79.
[41] McGillis-Hall, L. (2003) Nursing staff mix models and outcomes. Journal of Advanced Nursing, 44, 217-226. doi:10.1046/j.1365-2648.2003.02786.x
[42] Mentes, J.C., Teer, J. and Cadogan, M.P. (2004) The pain experience of cognitively impaired nursing home residents: Perceptions of family members and certified nursing assistants. Pain Management Nursing, 5, 118-125. doi:10.1016/j.pmn.2004.01.001
[43] Stolee, P., Esbaugh, J., Aylward, S., Cathers, T., Harvey, D.P., Hillier, L.M., Keat, N. and Feightner, J.W. (2005) Factors associated with the effectiveness of continuing education in long-term care. Gerontologist, 45, 399-405. doi:10.1093/geront/45.3.399
[44] Parsons, H.M. (1974) What happened at Hawthorne? Science, 183, 922-932. doi:10.1126/science.183.4128.922

comments powered by Disqus

Copyright © 2014 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.