Home Care

This article reports on the development and psychometric testing of a learning needs assessment questionnaire related to the Canadian community health nursing Standards of practice.

Professional competencies have been widely used as a basis for the development of learning needs assessment. The Canadian Community Health Nursing Standards of Practices (CCHN Standards) were released in 2003. However, it is not known whether community health nurses (CHNs) have the educational background to enable them to meet these standards. This article reports on the development of a learning needs assessment questionnaire for CHNs. Exploratory and confirmatory factor analyses were conducted to examine the consistency of factors underpinning the CCHN Standards. Also, validity and reliability of the questionnaire were evaluated using appropriate techniques. This process resulted in a valid and reliable CHN learning needs assessment questionnaire to measure learning needs of large groups of practitioners, where other forms of measurement cannot be feasibly conducted.

Co-author:

Akhtar-Danesh, N., Valaitis, R., Schofield, R., Underwood, J., Martin-Misener, R., Baumann, A., Kolotylo, C.

Research Funding:

• A Pan-Canadian Survey of Community Health Nurses’ Learning Needs

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This article reports on a usability study of remote noninvasive cardiac testing in homes. We studied the Vitaphone 3100BT (Bluetooth®) event loop recorder (Vitaphone GmbH, Mannheim, Germany) and paired BlackBerry® Curve™ 8520 smartphone (Research In Motion, Ltd., Waterloo, ON, Canada).

This application requires independent device set-up by patients in their own homes following receipt by mail out of the kit (instructions plus the event loop recorder and smartphone). The case studies of five participants, each with varying experience with technology, were documented as they interacted with the devices. Participants were videotaped following written instructions as they performed a "think aloud" procedure while completing 20 device set-up tasks. Interviews provided insight into how the independent device set-up and processes could be improved. This study concluded that gender, age, and familiarity with technology seemed to influence the participants' abilities to successfully set up these devices and that sending the kit by mail appeared to be an acceptable strategy to provide remote noninvasive cardiacdiagnostic services. This study provides a foundation for future research assessing usability of mobile healthcare technology.

Co-author:

Sparkes, J., Valaitis, R., McKibbon, A.

Students:

1. Jane Sparkes

Research Funding:

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The research objective was to collaborate with frontline homecare workers (e.g. care coordinators, nurses, physiotherapists, occupational therapists, and personal support workers) and key stakeholders (e.g. Registered Nurses’ Association of Ontario, Heart and Stroke Foundation) to inform, design and build an innovative mobile health application to support communication and collaboration. A Webinar was given for the Ontario Home Care Association, January 27, 2016.

The end goals of the application are to promote evidence-informed care for older adults who have experienced a stroke and have multiple chronic conditions (MCC), and to provide a communication tool for all members of the homecare team, including healthcare providers, clients, and their family caregivers.

Co-researcher:

Matthew-Maich, N., Bender, D., Taberner, C., Markle-Reid, M., Ploeg, J., Gafni, A., Valaitis, R.

Research Funding:

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• News Story

Systems navigation services provided by a designated provider or team have the potential to address health and social disparities. We conducted an environmental scan of navigation activities in a large urban Canadian community to identify and describe: service providers who engage in systems navigation; the clients who require systems navigation support and the issues they face; activities involved; and barriers and facilitators in providing systems navigation support to clients.

 Using an online survey and convenience sampling, we recruited individuals who self-identified as community navigators or practiced systems navigation activities as part of their role. The majority of respondents (n¼145) were social workers, social services workers, or nurses. Clients of navigators struggled with mental health or addictions issues, disabilities, chronic diseases, and history of trauma or abuse. The most frequently reported activities of navigators were building professional relationships, managing paperwork, and communicating with relevant agencies or organizations. Barriers and facilitators are reported. 

Co-author:

Nancy Carter, Ruta Valaitis, Janice Feather, Laura Cleghorn, and Annie Lam

Students:

1. Janice Feather

Research Funding:

• Evaluation of a Community Nurse Navigator in a Priority Hamilton Neighbourhood

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• Link to paper

Canadian Community health nurses (CHNs) work in diverse urban, rural, and remote settings such as: public health units/departments, home health, community health facilities, family practices, and other community-based settings.

Research into specific learning needs of practicing CHNs is sparsely reported. This paper examines Canadian CHNs learning needs in relation to the 2008 Canadian Community Health Nursing Standards of Practice (CCHN Standards). It answers: What are the learning needs of CHNs in Canada in relation to the CCHN Standards? What are differences in CHNs’ learning needs by: province and territory in Canada, work setting (home health, public health and other community health settings) and years of nursing practice? CHN educators and practice leaders need to consider these results in determining where to strengthen content in graduate and undergraduate nursing programs, as well as professional development programs. For practicing CHNs educational content should be tailored based on learner’s years of experience in the community and their employment sector.

First Author:

Valaitis, R.K., Schofield, R., Akhtar-Danesh, N., Baumann, A., Martin-Misener, R., Underwood, J., Isaacs, S.

Research Funding:

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• Community Health Nurses of Canada (CHNC)

The purpose of this study was to conduct a scoping review of current practices and recommendations for designing, implementing, and evaluating mHealth technologies to support the management of chronic conditions in community-dwelling older adults.

There is limited yet increasing use of mHealth technologies in home health care for older adults. A user-centered, collaborative, interdisciplinary approach to enhance feasibility, acceptability, and usability of mHealth innovations is imperative. Creating teams with the required pools of expertise and insight regarding needs is critical. The cyclical, iterative process of developing mHealth innovations needs to be viewed as a whole with supportive theoretical frameworks. Many barriers to implementation and sustainability have limited the number of successful, evidence-based mHealth solutions beyond the pilot or feasibility stage. The science of implementation of mHealth technologies in home-based care for older adults and self-management of chronic conditions are important areas for further research. Additionally, changing needs as cohorts and technologies advance are important considerations. Lessons learned from the data and important implications for practice, policy, and research are discussed to inform the future development of innovations.

Co-author:

Matthew-Maich, N., Harris, L., Ploeg, J., Markle-Reid, M., Valaitis, R., Ibrahim, S., Gafni, A., & Isaacs, S.

Students:

1. Sandra Isaacs

Research Funding:

• Centre for Research in Community Interventions to Promote Optimal Aging at Home

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• Ontario Ministry of Health and Long-Term Care, Health System Research Fund ($445,194)

This scoping review was conducted in advance of our design and build of a mobile health app to support an interprofessional nurse-led team approach in the delivery of community-based stroke rehabilitation in home care.

We systematically mapped the breadth of research related to three topic areas: mobile and electronic devices, technology based healthcare delivery, and aging populations and/or chronic conditions. From the research question “What are the current practices and recommendations for designing, implementing and evaluating mHealth solutions to support older adults living in their homes?” we identified 42 studies. Report to the Ministry of Health and Long-Term Care, February 2016. To ensure success, a user-centered, collaborative, interdisciplinary and iterative approach is imperative to enhance feasibility, acceptability and usability of mHealth innovations. Implementation within systems or organizations requires a thorough understanding of culture, values and context readiness from researchers.

First Author:

Valaitis, R., Markle-Reid, M., Kelly Stradiotto, C., Archer, N., Bender, D., Brown, P., Chambers, T., Chang, K., Hillmer, M., Karimi, R., Kennedy, L., Magwood-Tye, R., Matthew-Maich, N., Murray, N., Ploeg, J., Taberner, C.

Students:

1. Kristina Chang
2. Rojin Karimi

Research Funding:

• Centre for Research in Community Interventions to Promote Optimal Aging at Home

Final report submitted to the Ontario Ministry of Health and Long-Term Care, pp. 1-53, July 2017.

First Author:

Valaitis. R., Markle-Reid, M., Ploeg, J., Butt, M., Ganann, R., *Bookey-Bassett, S., Kennedy, L., Murray, N., & Yousif, C.

Research Funding:

Expert advisory committee member of Ontario’s Ministry of Health and Long-term Care’s “Optimization of the Nursing Workforce Working Group” for the Nursing Secretariat reporting to the Joint Provincial Nursing Council (JPNC).

The Optimization of the Nursing Workforce Working Group, which is a working group of the Joint Provincial Nursing Committee (JPNC).  This group systematically explored opportunities to optimize the home health-care nursing workforce and presented a report to JPNC. 

Committee member :

Ministry of Health and Long-term Care: Joint Provincial Nursing Council Sub-committee

Students:

1. Dr. Rebecca Ganann

Research Funding:

Nurses are among the largest providers of home care services thus optimisation of this workforce can positively influence client outcomes. This scoping review maps existing Canadian literature on factors influencing the optimisation of home care nurses (HCNs).

Arskey and O'Malley's five stages for scoping literature reviews were followed. Populations of interest included Registered Nurses, Registered/Licensed Practical Nurses, Registered Nursing Assistants, Advanced Practice Nurses, Nurse Practitioners and Clinical Nurse Specialists. Interventions included any nurse(s), organisational and system interventions focused on optimising home care nursing. Papers were included if published between January 1, 2002 up to May 15, 2015. The review included 127 papers, including 94 studies, 16 descriptive papers, 6 position papers, 4 discussion papers, 3 policy papers, 2 literature reviews and 2 other. Optimisation factors were categorised under seven domains: Continuity of Care/Care; Staffing Mix and Staffing Levels; Professional Development; Quality Practice Environments; Intra‐professional and Inter‐professional and Inter‐sectoral Collaboration; Enhancing Scope of Practice: and, Appropriate Use of Technology. Fragmentation and underfunding of the home care sector and resultant service cuts negatively impact optimisation. Given the fiscal climate, optimising the existing workforce is essential to support effective and efficient care delivery models. Many factors are inter‐related and have synergistic impacts (e.g., recruitment and retention, compensation and benefits, professional development supports, staffing mix and levels, workload management and the use of technology). Quality practice environments facilitate optimal practice by maximixing human resources and supporting workforce stability. Role clarity and leadership supports foster more effective interprofessional team functioning that leverages expertise and enhances patient outcomes. Results inform employers, policy makers and relevant associations regarding barriers and enablers that influence the optimisation of home care nursing in nursing, intra‐ and inter‐professional and inter‐organisational contexts.

Senior Author:

Rebecca Ganann, Annette Weeres, Annie Lam, Harjit Chung, Ruta Valaitis

Research Funding:

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Report to the WHO, Series Number 16, March 2009. Primary health care (PHC) is a philosophy and an educational practice approach. Nursing is one of the key services for the delivery of PHC. The purpose of this background paper is to examine PHC education for nurses in the globalized world.

A case study approach is used to provide information about PHC education. The paper will define and describe PHC, nursing education in Canada and curriculum development. Challenges will be discussed and a policy framework will be provided. In addition, recommendations specific to PHC nursing education will be made.

Co-author:

Baumann, A., Valaitis, R., Kaba, A.

Research Funding:

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• Report

Final report submitted to Veterans Affairs Canada, pp. 1-27, March 2017.

Co-author:

Markle-Reid, M., Ganann, R., Whitmore, C., Valaitis, R., & Ploeg, J.

Research Funding:

We conducted a mixed-methods case study to explore the perceptions of family caregivers and palliative cancer patients of home telehealth, and their experience with it.

Overall the patients, family caregivers and tele-nurses felt that home telehealth enabled family caregiving, citing increased access to care, and patient and family caregiver reassurance. Pain management was the most common reason for initiating contact with the nurse, followed by emotional support. Concerns included lack of integration of services, inappropriate timing of the intervention and technical problems. The case study confirmed the importance of timely and accessible care for a group of clinically vulnerable, dying cancer patients and their family caregivers.

Co-author:

Stern, A., Valaitis, R., Weir, R., Jadad, A.

Students:

1. Anita Stern

Research Funding:

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