Building capacity in palliative care for personal support workers in long-term care through experiential learning

Background

Providing palliative care in long-term care (LTC) homes is an area of growing importance. As a result, attention is being given to exploring effective palliative care learning strategies for personal support workers (PSWs) who provide the most hands-on care to LTC residents.

The purpose of this intervention was to explore hospice visits as an experiential learning strategy to increase the capacity of PSWs in palliative care, specifically related to their new learning, and how they anticipated this experience changed their practices in LTC.

This study utilised a qualitative descriptive design.

Eleven PSWs from four Ontario LTC homes were sent to their local hospice to shadow staff for one to two days. After the visit, PSWs completed a questionnaire with open-ended questions based on critical reflection. Data were analysed using thematic content analysis.

PSWs commented on the extent of resident-focused care at the hospice and how palliative care interventions were tailored to meet the needs of residents. PSWs were surprised with the lack of routine at the hospice but felt that hospice staff prioritised their time effectively in order to meet family and client care needs. Some PSWs were pleased to see how well integrated the PSW role is on the community hospice team without any hierarchical relationships. Finally, PSWs felt that other LTC staff would benefit from palliative care education and becoming more comfortable with talking about death and dying with other staff, residents and family members.

This study highlighted the benefits of PSWs attending a hospice as an experiential learning strategy. Future work is needed to evaluate this strategy using more rigorous designs as a way to build capacity within PSWs to provide optimal palliative care for LTC residents and their family members.

PSWs need to be recognised as important members within the interdisciplinary team. PSWs who shadow staff at hospices view this experience as a positive strategy to meet their learning needs related to palliative care.

Ethical issues experienced by healthcare workers in nursing homes: Literature review

BACKGROUND: Ethical issues are increasingly being reported by care-providers; however, little is known about the nature of these issues within the nursing home. Ethical issues are unavoidable in healthcare and can result in opportunities for improving work and care conditions; however, they are also associated with detrimental outcomes including staff burnout and moral distress.

OBJECTIVES: The purpose of this review was to identify prior research which focuses on ethical issues in the nursing home and to explore staffs' experiences of ethical issues.

METHODS: Using a systematic approach based on Aveyard (2014), a literature review was conducted which focused on ethical and moral issues, nurses and nursing assistants, and the nursing home.

FINDINGS: The most salient themes identified in the review included clashing ethical principles, issues related to communication, lack of resources and quality of care provision. The review also identified solutions for overcoming the ethical issues that were identified and revealed the definitional challenges that permeate this area of work.

CONCLUSIONS: The review highlighted a need for improved ethics education for care-providers.

Training the public health workforce we need. Exploring perceptions for future public heath workers in Ecuador

Thesis (Master's)--University of Washington, 2015

Social chromosome variants differentially affect queen determination and the survival of workers in the fire ant Solenopsis invicta.

Intraspecific variation in social organization is common, yet the underlying causes are rarely known. An exception is the fire ant Solenopsis invicta in which the existence of two distinct forms of social colony organization is under the control of the two variants of a pair of social chromosomes, SB and Sb. Colonies containing exclusively SB/SB workers accept only one single queen and she must be SB/SB. By contrast, when colonies contain more than 10% of SB/Sb workers, they accept several queens but only SB/Sb queens. The variants of the social chromosome are associated with several additional important phenotypic differences, including the size, fecundity and dispersal strategies of queens, aggressiveness of workers, and sperm count in males. However, little is known about whether social chromosome variants affect fitness in other life stages. Here, we perform experiments to determine whether differential selection occurs during development and in adult workers. We find evidence that the Sb variant of the social chromosome increases the likelihood of female brood to develop into queens and that adult SB/Sb workers, the workers that cull SB/SB queens, are overrepresented in comparison to SB/SB workers. This demonstrates that supergenes such as the social chromosome can have complex effects on phenotypes at various stages of development.

A cross-sectional survey of attitudes to HIV risk and rapid HIV testing among clients of sex workers in Switzerland.

OBJECTIVES: To assess attitudes to HIV risk and acceptability of rapid HIV testing among clients of street-based female sex workers (FSW) in Lausanne, Switzerland, where HIV prevalence in the general population is 0.4%. METHODS: The authors conducted a cross-sectional study in the red light district of Lausanne for five nights in September of 2008, 2009 and 2010. Clients of FSW were invited to complete a questionnaire in the street assessing demographic characteristics, attitudes to HIV risk and HIV testing history. All clients interviewed were then offered anonymous finger stick rapid HIV testing in a van parked on-site. RESULTS: The authors interviewed 112, 127 and 79 clients in 2008, 2009 and 2010, respectively. All were men, average age 32-37 years old; 40-60% were in a stable relationship. History of unprotected sex was higher with non-commercial partners (33-50%) than with FSW (6-11%); 29-46% of clients had never undergone an HIV test. Anonymous rapid HIV testing was accepted by 45-50% of clients. Out of 109 HIV tests conducted during the three study periods, none was reactive. CONCLUSIONS: On-site HIV counselling and testing is acceptable among clients of FSW in this urban setting. These individuals represent an unquantified population, a proportion of which has an incomplete understanding of HIV risk in the face of high-risk behaviour, with implications for potential onward transmission to non-commercial sexual partners.

Covariation between colony social structure and immune defences of workers in the ant Formica selysi

Several ant species vary in the number of queens per colony, yet the causes and consequences of this variation remain poorly understood. In previous experiments, we found that Formica selysi workers originating from multiple-queen (=polygyne) colonies had a lower resistance to a fungal pathogen than workers originating from single-queen (=monogyne) colonies. In contrast, group diversity improved disease resistance in experimental colonies. This discrepancy between field and experimental colonies suggested that variation in social structure in the field had antagonistic effects on worker resistance, possibly through a down-regulation of the immune system balancing the positive effect of genetic diversity. Here, we examined if workers originating from field colonies with alternative social structure differed in three major components of their immune system. We found that workers from polygyne colonies had a lower bacterial growth inhibitory activity than workers from monogyne colonies. In contrast, workers from the two types of colonies did not differ significantly in bacterial cell wall lytic activity and prophenoloxidase activity. Overall, the presence of multiple queens in a colony correlated with a slight reduction in one inducible component of the immune system of individual workers. This reduced level of immune defence might explain the lower resistance of workers originating from polygyne colonies despite the positive effect of genetic diversity. More generally, these results indicate that social changes at the group level can modulate individual immune defences.

Preliminary epidemiological study of latent tuberculosis in Mexican agricultural workers in the Niagara region, Canada

It is well documented that the majority of Tuberculosis (TB) cases diagnosed in Canada are related to foreign-bom persons from TB high-burden countries. The Canadian seasonal agricultural workers program (SAWP) operating with Mexico allows migrant workers to enter the country with a temporary work permit for up to 8 months. Preiimnigration screening of these workers by both clinical examination and chest X-ray (CXR) reduces the risk of introducing cases of active pulmonary TB to Canada, but screening for latent TB (LTBI) is not routinely done. Studies carried out in industrialized nations with high immigration from TBendemic countries provide data of lifetime LTBI reactivation of around 10% but little is known about reactivation rates within TB-endemic countries where new infections (or reinfections) may be impossible to distinguish from reactivation. Migrant populations like the SAWP workers who spend considerable amounts of time in both Canada and TBendemic rural areas in Mexico are a unique population in terms of TB epidemiology. However, to our knowledge no studies have been undertaken to explore either the existence of LTBI among Mexican workers, the probability of reactivation or the workers' exposure to TB cases while back in their communities before returning the following season. Being aware of their LTBI status may help workers to exercise healthy behaviours to avoid TB reactivation and therefore continue to access the SAWP. In order to assess the prevalence of LTBI and associated risk factors among Mexican migrant workers a preliminary cross sectional study was designed to involve a convenience sample of the Niagara Region's Mexican workers in 2007. Research ethics clearance was granted by Brock University. Individual questionnaires were administered to collect socio-demographic and TB-related epidemiological data as well as TB knowledge and awareness levels. Cellular immunity to M tuberculosis was assessed by both an Interferon-y release assay (lGRA), QuantiFERON -TB Gold In-Tube (QFf™) and by the tuberculin skin test (TSn using Mantoux. A total of 82 Mexican workers (out of 125 invited) completed the study. Most participants were male (80%) and their age ranged from 22 to 65 years (mean 38.5). The prevalence of LTBI was 34% using TST and 18% using QFTTM. As previously reported, TST (using ~lOmm cut-off) showed a sensitivity of 93.3% and a specificity of 79.1 %. These findings at the moment cannot predict the probability of progression to active TB; only longitudinal cohort studies of this population can ascertain this outcome. However, based on recent publications, lORA positive individuals may have up to 14% probability of reactivation within the next two years. Although according to the SA WP guidelines, all workers undergo TB screening before entering or re-entering Canada, CXR examination requirements showed to be inconsistent for this population: whereas 100% of the workers coming to Canada for the first time reported having the procedure done, only 31 % of returning participants reported having had a CXR in the past year. None of the participants reported ever having a CXR compatible with TB which was consistent with the fact that none had ever been diagnosed with active pulmonary TB and with only 3.6% reporting close contact with a person with active TB in their lifetime. Although Mexico reports that 99% of popUlation is fully immunized against TB within the first year of age, only 85.3% of participants reported receiving BOC vaccine in childhood. Conversely, even when TST is not part of the routine TB screening in endemic countries, a suqDrisingly high 25.6% reported receiving a TST in the past. In regards to TB knowledge and awareness, 74% of the studied population had previous knowledge about (active) TB, 42% correctly identified active TB symptomatology, 4.8% identified the correct route of transmission, 4.8% knew about the existence of LTBI, 3.6% knew that latent TB could reactivate and 48% recognized TB as treatable and curable. Of all variables explored as potential risk factors for LTBI, age was the only one which showed statistical significance. Significant associations could not be proven for other known variables (such as sex, TB contact, history of TB) probably because of the small sample size and the homogeneity of the sample. Screening for LTBI by TST (high sensitivity) followed by confirmation with QFT''"'^ (high specificity) suggests to be a good strategy especially for immigrants from TB high-burden countries. After educational sessions, workers positive for LTBI gained greater knowledge about the signs and symptoms of TB reactivation as well as the risk factors commonly associated with reactivation. Additionally, they were more likely to attend their annual health check up and request a CXR exam to monitor for TB reactivation.

Exploring the Perceptions of Cultural Competence Among Personal Support Workers in an Ontario Long-Term Care Home: A Case Study

Personal Support Workers (PSWs) spend a large amount of time with long-term care (LTC) home residents providing assistance with their activities of daily living. The s limited research on their perceptions of cultural competence presents the need to bridge this knowledge gap. The researcher conducted a qualitative case study at a LTC home in Ontario. Data were collected by conducting a policy document analysis, a key informant interview with the Director of Care (DOC), and two focus groups with PSWs. The five major overarching themes were: The Culture of the LTC Home, Provision of a Supportive Environment, Collaborative Team Approach to Care, Building a Relationship with the Residents, and Maintenance of Staff Morale. The findings illuminated the broad nature of culture, connections to person centered care, and the factors that facilitate or hinder PSWs’ culturally competent care. The ambiguous perception of cultural competence among PSWs suggests further research and education on cultural competence in LTC home settings.

Integrating Children with Emotional and Behavioural Disabilities into Community Recreation Programs: A Handbook for Staff

This study examined the process of integrating children with Emotional Behavioural Disorders (EBDs) with their peers into recreation programs. The purpose was to develop a set of recommendations for the development of a handbook to help workers in recreation with the integration process. To this end, a needs assessment was conducted with experienced recreation workers in the form of semistructured interviews. Participants were recruited from two community centers in a large southern Ontario city. Themes were drawn from the analysis of the interview transcripts and combined with findings from the research literature. The results were a set of recommendations on the content and format of a handbook for integrating children with EBDs into recreation programs.

Diversification In Employment Structure And Status Of Rural Women Workers In Ernakulam District

The basic objective of the present study has been to observe the process and pattern of employment diversification among the rural women workers in Ernakulam district. The evidences are that the women workers in the rural areas of the state are being increasingly diversified into the tertiary sector. The clear cut evidence for the fact that in Kerala non-agricultural employment of rural women is increasing with more and more of them getting diversified into the tertiary sector. The women get more self esteem and recognition in terms of the work being done by them. In the urban areas of the state as a poverty eradicating measure the Kerala government has already introduced a new scheme under the banner of Kudumbasree. Another fact noticed in the study that the sectoral shift of women workers has posed a grave problem to the agricultural sector. The reluctance of workers to do manual jobs on land and the prevalence of high wages among the agricultural labours has left many a cultivable area fallow or has induced farmers to shift to less labour –intensive crops. The situation is expected to worsen in future as even the high wages fail to attract the young generation to this sector. To conclude the study has fulfilled all its objectives, viz; highlighting the rural employment structure in Kerala, examining the process, pattern, determinants and consequences of diversification among rural women workers in the sample villages. Being the first of its kind at the micro level in the state it contributes to the available literature in the area enriching the database that is crucially lacking for devising projects at the village and block-level. There exists ample scope for future research of similar nature in an urban background where the secondary data-sources are hinding towards a reversal of trends from non-agriculture to agriculture.

"Profile of Industrial workers in Kerala - A Comparative Study of the Socioeconomic Profile of Workers in Traditional and Modern Industries

The objective of this study is to assess the changes that have been taking place in the socio-economic profile of organized industrial workers of Kerala in the context of the changes that have been taking place in the state's industrial structure. with this object in view, the study seeks to find out the similarities and differences in the profile of workers belonging to two Segments of factory sector industries in Kerala viz., modern and traditional segments. It also seeks to examine the factors leading to the differences in profile, if any, and their consequences. As noted earlier, the profile of workers may be influenced both by external societal factors and by internal factors like the difference in industrial structure and the technologies used. It is proposed to assess the relative importance of these two groups of factors. In drawing up the profile, we seek to find out whether the workers belonging to the organised sector of industry in Kerala particularly the more modern sector have begun to form a ‘select group‘ in the Kerala society and the total work force. Wherever possible, it is proposed to compare the profile of the Kerala workers with those of workers in other states of India. As an incidental objective, it is also proposed to find out to the extent possible, whether trends towards labour embourgeoisement and class shifting have begun to set in among the industrial workers of Kerala, particularly among the workers in the modern industries as a result of their relative affluence and their middle class socioeconomic background. besides, the study seeks to find out whether there is any difference in the class consciousness of workers belonging to these two segments of organized industry, arising from the differences in their economic status and social background.

Implication of Trade, Livelihood and Employment Exclusion among Workers in Plantation Sector in Kerala

The first part of the study has focused on the trends in area, production and productivity comparing the state’s performance with of national level performance. Also an attempt was made to understand the trends in commodity price over the years especially in the post liberalization period from the early 1990s. Plantation commodities occupy an important share in the country’s export basket and thereby earning foreign exchange to the national exchequer. Taking into consideration the competitive dimension of natural rubber, cardamom and pepper in the export market was analyzed to see penetration of these commodities in the world market.The second part of the study has tried to understand the plantation workers livelihood by understand the employment generation in the sector. Livelihood assets of plantation workers were analyzed to understand the nature of ownership of various assets. Understanding the poor quality and ownership of various livelihood assets and their relative deprivation the study also tried to understand the income-expenditure patterns and the nature of indebtedness among workers and the factors responsible for deprivation and thereby social exclusion.Area, Production and productivity trends of rubber, pepper and cardamom show a mixed picture. Area, Production trends are impacted greatly by the commodity price of the plantation crops.High correlation exists between commodity price and area and production trends of plantation crops in the state.In terms of Natural Rubber, Kerala experienced a steady growth over the years in terms of area production and productivity as the price of rubber has increasedIn terms of black pepper, the state witnessed a deceleration in growth.In the case of cardamom the area of cultivation declined whereas production increasedProductivity of natural rubber, pepper and cardamom has increased substantially over the yearsEmployment pattern in rubber and spices sub-sector has been analyzed by looking in to the commodity prices so as to see the changes in employment pattern over the years. The study has helped to understand that commodity price and employment generation in plantations are interconnected to such an extent that a fall in the commodity price have greater reverberations on the employment pattern in plantations.Livelihood analysis both in the small and large holdings show that workers belonging to rubber (large and small rubber) plantations have shown better possession of livelihood assets when compared to spices plantation workers as 16.2 percent of the spices sub-sector workers claimed about ownership of house which is considered to be an important and primary livelihood asset.In the case of natural assets like accessibility, availability and duration of water for drinking and other household purposes, the situation of workers in spices plantation still remain poor as around 80 percent of workers depending on public well public taps and canals as source of drinking water.Evaluating financial assets also give clear indication that the road to secure financial assets still remains a distant dream for the workers in plantation sectorEvaluating income and expenditure trends pinpoints to the fact that disparity in terms of income exist among the plantation workersWhile observing the employment though wage levels have improved because of improvement in commodity price of plantation crops, significant improvements are not visible in their livelihood and they remain excluded compared to other sections of the society.