Nurse Practitioners and The Use of Antipsychotic Medications in Long Term Care in Ontario, Canada

Introduction: Antipsychotic use in Long-Term Care (LTC) in Ontario, Canada continues to pose a challenge in the care of older adult patients living in these institutions. The dangers and patterns of inappropriate prescribing have been documented frequently. Most of the current literature focuses on dementia and behavioral and psychological symptoms of dementia, the role of prescribers, or on interprofessional interventions with person-centered care to address the behavior. Very little discussion has focused on the role of nurse practitioners and other frontline long-term care staff in the assessment and interactions with residents that may result in prescriptions of antipsychotics. Objectives: The purpose of this population based retrospective study of data from all LTC facilities in Ontario, Canada in 2019-2020 was to determine the extent to which antipsychotic medications were used in and the factors associated with this use. Reflections about the NP role are discussed. Results: The results demonstrate that over thirty percent of residents in LTC continue to receive antipsychotics and those with the responsive behaviours are significantly more likely to be prescribed antipsychotics. Conclusions: The findings identify a potential link between over-burdened front-line staff and increased antipsychotic prescriptions, as well as continued use of antipsychotics in attempts to prevent harm to residents and staff at long-term care homes. Recommendations are made that include changes to legislation that will ensure optimal front-line care and time for care, increased training for front line staff and, in particular, how the role of the nurse practitioner in LTC can be utilized to optimize the appropriate use of antipsychotics, and the support of discontinuing or decreasing the dose of antipsychotics when required.

Learning from incidents: applying the 3-P model of workplace learning

Purpose Learning from incidents (LFI) is an organisational process that high-risk industries use following an accident or near-miss to prevent similar events. Literature on the topic has presented a fragmented conceptualisation of learning in this context. This paper aims to present a holistic taxonomy of the different aspects of LFI from the perspective of front-line staff. Design/methodology/approach The 3-P model of workplace learning was used to guide a thematic analysis of interview data from 45 participants, exploring learner factors, learning context, learning processes and learning products. Findings The analysis was used to create a taxonomy of 21 aspects of learning, grouped into themes using the 3-P model of workplace learning. Many of the aspects of learning reflected previous literature, such as the importance of open communication. The analysis additionally demonstrated the interconnected nature of organisational and individual level learning, as well as how formal resources are needed to support informal learning in this context. Originality/value This study presents a holistic taxonomy of LFI from the perspective of front-line staff, addressing a known challenge of LFI literature being fragmented. Additionally, it provides examples of how aspects of organisational learning would influence individual-level learning and vice versa, adding to the relatively sparse number of studies that have explored this aspect. Finally, the paper highlights how informal learning in contexts where workers continually need to make sense of unseen hazards depends on formal learning activities and resources.

Challenges faced during the COVID-19 pandemic by family carers of people living with dementia towards the end of life

Background People living with dementia account for a large proportion of deaths due to COVID-19. Family carers are faced with making significant and emotive decisions during the pandemic, including decisions about end of life. We aimed to explore the challenges faced by family carers of people living with dementia during the first wave of the COVID-19 pandemic in England, as reported by charity telephone support line staff, who were able to objectively discuss a range of different experiences of many different carers who call the helpline. In particular, we focussed on key concerns and areas of decision making at the end of life. Methods We conducted a qualitative study using semi-structured interviews with eight telephone support line staff from two UK based charities who support carers of people living with dementia and those at the end of life. Interviews were conducted in the first wave of the pandemic in England in May–June 2020. Results An overarching theme of uncertainty and reactivity during a crisis was identified, and within this, five main themes were identified: concerns about care transitions, uncertainty in engaging support and help, pandemic-motivated care planning, maintaining the wellbeing of the person living with dementia, and trust, loss of agency and confusion. Conclusions Family carers may be reluctant to seek support because of fear of what may happen to their relative, which may include hospitalisation and becoming ill with COVID-19, care home placement, or not being able to be with a relative at the end of life. In some cases, a lack of trust has developed, and instead carers are seeking support from alternative services they trust such as nationally known charities.This study was used to inform the development of a decision aid to support family carers making decisions about care for their relative with dementia during the pandemic, who the lack the capacity to make their own decisions.

Analysis of Recruitment System and Effective Selection for Front-Line Staff Outsource at Pt Garuda Indonesia (Persero) TBK

PT Garuda Indonesia (Persero) TBK is a state-owned company whose business focus is transportation services pax and cargo. In carrying out its business processes, the Garuda Indonesia Company has a cooperation with PT Perdana Perkasa Elastindo (Persaels) in providing outsourced labor for front-line staff. The performance evaluation data of the front-line outsource staff stationed at Garuda Indonesia Medan Branch for the last 3 years (2015, 2016 and 2017), it was found that around 40% of the total front-line staff did not show good performance according to the company's needs. The purpose of this research is to identify the factors exist in the dimensions of the recruitment and selection system that are constraints, and formulate an effective recruitment process design and selection for outsourced front-line staff by outsourced service providers. The requirements of front-line staff met with the company needs as outsourced service users. The data analysis used descriptive qualitative technique. The results of the research on several factors from the existing recruitment and selection dimensions indicate that the factors of Job description, Job Requirements, Sources of recruitment, interview process and consistency in the implementation of the selection test are factors that become obstacles in producing competent outsourced front-line staff according to the needs of the company PT Garuda Indonesia ( Persero) TBK. Keywords: Recruitment system, front-line staff outsource, PT Garuda Indonesia (Persero) TBK.

System wide learning from first wave Covid 19: A realist synthesis of what works?

Background This paper presents a thematic analysis of 176 interview transcripts from front line staff working during the first wave of COVID-19 in the East of England. Methods Presented as a descriptive case study it reflects the complexity and numerous variables that influenced staff experiences of delivering care and support across the health and social care system between April and August 2020. Drawing upon the methodology of realist synthesis, it addresses the question “What works for whom and in what contexts and why?” to help illuminate real-world issues that people have faced. Results Thirty-one themes were distilled highlighting lessons learned from things that went well compared with those that did not; challenges compared with the celebrations and outcomes; learning and insights gained; impact on role; and system headlines. Four tentative theories of system transformation are presented to highlight support mechanisms that are needed to enable front line teams to be effective in further waves of the pandemic, capitalising on system wide learning, patient, resident and staff wellbeing. Conclusions This paper presents a unique insight into front line staff experiences of working during the first wave of the Covid-19 pandemic using realist synthesis methods to distil key themes and tentative theories about what strategies work to enable and empower front line teams to be effective and to support system wide learning and transformation.

Perceptions and experiences of healthcare workers during the COVID-19 pandemic in the UK

ObjectiveThe COVID-19 pandemic has set unprecedented demand on the healthcare workforce around the world. The UK has been one of the most affected countries in Europe. The aim of this study was to explore the perceptions and experiences of healthcare workers (HCWs) in relation to COVID-19 and care delivery models implemented to deal with the pandemic in the UK.MethodsThe study was designed as a rapid appraisal combining: (1) a review of UK healthcare policies (n=35 policies), (2) mass media and social media analysis of front-line staff experiences and perceptions (n=101 newspaper articles, n=1 46 000 posts) and (3) in-depth (telephone) interviews with front-line staff (n=30 interviews). The findings from all streams were analysed using framework analysis.ResultsLimited personal protective equipment (PPE) and lack of routine testing created anxiety and distress and had a tangible impact on the workforce. When PPE was available, incorrect size and overheating complicated routine work. Lack of training for redeployed staff and the failure to consider the skills of redeployed staff for new areas were identified as problems. Positive aspects of daily work reported by HCWs included solidarity between colleagues, the establishment of well-being support structures and feeling valued by society.ConclusionOur study highlighted the importance of taking into consideration the experiences and concerns of front-line staff during a pandemic. Staff working in the UK during the COVID-19 pandemic advocated clear and consistent guidelines, streamlined testing of HCWs, administration of PPE and acknowledgement of the effects of PPE on routine practice.